Mark Wilson gives you some tips on how to arrange an elective in East Timor

After the atrocities with Indonesia, the Democratic Republic of Timor-Leste (or East Timor or Timor-Lorosae) became fully independent in May 2002. The violence resulted in 60% of doctors fleeing the country and the theft of much medical equipment. For a country that already had horrific health problems, the war made things even worse. The situation is improving though. Obviously, with the formation of a new government, changes are rapid. Up to date information can be found on the government of East Timor's website (www.gov.east-timor.org).

You must discuss the possibility of doing an elective in East Timor with your occupational health department and seek the latest advice from the foreign office. The country is becoming a common destination for Australian students, but details for other students are sketchy. An elective here would, however, be a fascinating experience. In addition to the medicine, local attractions include Atauro Island (an ecotourism destination run by Oxfam) and trips to Suai and Mount Ramelau.

Medicine

Tuberculosis is still the main cause of death. Malaria, dengue fever, Japanese encephalitis, diarrhoea, pneumonia, and skin infections are some of the other common pathologies. Chikungunya (Swahili for "contorts" or "bends up") is another viral infection transmitted by mosquitos. Average life expectancy is 46 years for men and 48 for women. Malnutrition is a serious problem, especially in children.

Hospitals

The East Timor Interim Health Authority (www.gov.east-timor.org/old/social/health/ iha.php) currently coordinates all non- governmental organisations and would be a good starting point for finding out about current projects.

Before independence, East Timor had 10 government run hospitals and around 20 Catholic run clinics. There were also 67 puskesmas (health dispensaries). The National Hospital (formely run by the Red Cross) is situated in Dili (tel +670 311 022). Other civilian hospitals can be found in Baucau, Maliama, Viqueque, Ainaro, Oecussi, and Los Palos.

The United Nations Military Hospital is near the Obrigado barracks and has a continuing education programme every Tuesday evening which students can attend, but electives cannot currently be arranged here. Another hospital run by the United Nations is in Suai.

Details on Bairo Pite Clinic (PO Box 259, Dili Tinor Loro-sae) featured in this month's elective, can be found at http://bairopiteclinic.tripod.com Accommodation for students working here has previously been provided by the local car rental franchise. A nun in Parunas (Sister Lourdes) can also provide accommodation a little closer. Local families may also offer.

Safety

Currently the UK foreign office (www.fco. gov.uk) advises against all holiday and non-essential travel to East Timor. Occasionally anti-governmental violence still erupts. In addition, Westerners in South East Asia are under a general threat from terrorism (some extremist Muslims have condemned the separation of East Timor from Indonesia). In June this year severe flooding was also a problem. If you decide to go on an elective to East Timor, then register with the British Embassy as soon as you arrive. If you have a second passport take it with you because replacements are not possible. Make sure you have proper insurance, medical cover (including evacuation), and secure accommodation provided. Do not go out of town after dark and drive slowly as the streets are the main gathering place for children and livestock (insurance is not available and crashes can result in nasty arguments). The mobile phone network is good; take your mobile and buy a SIM card there.

Flights to Dili are usually either via Bali or Darwin. Check with the Foreign Office before booking your route.

Visas

So far, most electives to East Timor have been by Australian students. Since Australia was so heavily involved in the conflict, they have much closer arrangements. A charge of $25 (£15; a22) is payable for a 30 day visit. Thirty day extensions cost $30. There is an exit fee of $50 and a $10 departure tax. Please contact the embassy in Dili or your destination clinic for fully up to date information on visas as this is constantly changing.

The British Embassy in East Timor at Avenida de Portugal, Dili (postal address PO Box 194, The Post Office, Dili, East Timor; tel 390 723 1606; fax 390 312 652; email dili.fco@gtnet.gov.uk) does not offer consular and visa services (such as replacing passports) and has only limited facilities to help in an emergency. For such problems contact the British Embassy in Jakarta, Indonesia.

Health

Malaria, dengue fever, and Japanese encephalitis are common throughout the island. Tuberculosis, cholera, and rabies are also present. Malaria is chloroquine resistant so take doxycycline or mefloquine. East Timor has limited optical and dental services so take anything you may need (contact lens solutions, filling kits) with you. Remember sunscreen, especially if you are taking doxycycline for malaria to minimise photosensitivity. Severe acute respiratory syndrome is not a big problem at present, but all travellers to South East Asia need to be aware of symptoms and keep an eye out for them.

You must discuss the possibility of doing an elective in East Timor with your occupational health department and seek the latest advice from the foreign office. The country is becoming a common destination for Australian students, but details for other students are sketchy. An elective here would, however, be a fascinating experience. In addition to the medicine, local attractions include Atauro Island (an ecotourism destination run by Oxfam) and trips to Suai and Mount Ramelau.

Mark Wilson author of The Medic's Guide to Work and Electives around the World, University College Hospital, London
Email: mark@medicstravel.com

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