Health for All: The volunteers serving Timor-Leste’s remote communities

A trip into the mountains touches on some of the fundamental challenges still facing rural communities in Timor-Leste.

Words and photos by Alex Ray

When doctor Andre Belo told me how he spends most weekends I was impressed and wanted to know more.

Nearly every Friday he leaves his workplace, the United Nations clinic in Dili, the capital of Timor-Leste, to lead volunteer medical missions to some of the country’s most remote villages.

Some are more than half a day’s walk from the nearest town – let alone a hospital – and are rarely visited by government health professionals.

To get there and back by Sunday afternoon, the teams regularly walk through Friday night, allowing them all day Saturday to provide treatment.

Dr Belo’s volunteer organisation known as SABEH – Saude ba Ema Hotu (Health for Everyone) – was established in 2018 with the support of Dr Rui Araujo, a former prime minister and health minister.

The volunteer team assembles.
The volunteer team assembles.

It was the wet season – when Timor-Leste’s mountain roads turn to thick mud and are frequently blocked by landslides – when I set out with the SABEH team in mid-February 2021.

We were headed to Fatucalo, a village of fewer than 200 people in the mountains bordering Ainaro and Manufahi municipalities.

As Dili workers left their offices for the week, ten of us piled into a sturdy pick up and began the three-hour drive towards the mountain town of Turiscai. Our final destination was a further five hours walk from there.

Fatucalo is so remote that it was largely hidden during the Indonesian occupation of Timor-Leste between 1975 and 1999.

Children from the town now leave home at age 12 to attend school in Turiscai, where the Fatucalo community have built a boarding house for their young people to live in while studying.

Dr Belo and the volunteers eat and rest at the Fatucalo boarding house.

We arrived at the house around 9.30 pm and were greeted with hot sweet coffee and a generous dinner to prepare for the walk ahead.

Fatucalo’s Xefe Suco (village chief) Floriano Carlos Almeida was waiting to accompany us to the village.

After studying agriculture in Dili, Almeida became one of hundreds of Timorese to be granted scholarships by the Israeli government to study dry-land agriculture at the Arava Institute in the southern Negev Desert.

Almeida was friendly, full of energy and inquisitive, and we quickly got to chatting in English about everything from Fatucalo customs to Middle East politics.

Belo and Almeida told us the story of SABEH’s first visit to Fatucalo in 2015.

Taking advantage of better dry season road conditions, Belo managed to take a small generator to the village, marking the first time the village had electricity. “The children didn’t want to go home all night,” Belo said.

Volunteers eat and rest at the Fatucalo boarding house.
Dr Belo has visited all of the 452 sucos in Timor-Leste.

SABEH has visited over 100 of Timor-Leste’s 452 sucos (villages) in Timor-Leste. Within each suco there can be up to several sub-villages (aldeias). In rural areas these can be several hours walk from the suco centre. 

“We have had 379 volunteers work with us over the years,” said Belo. “They are graduates who are not yet employed full time. So far 179 have gained work.”

SABEH’s volunteers include doctors, nurses, midwives, public health workers, pharmacists and even nutritionists – all complementing each other’s specialisations.

After dinner we continue the drive to the walking track.

Just as under occupation, domestic and international solidarity is important in the current health battle.

Youths commemorate lives lost under Indonesian occupation.

Under the half-moon light in the back of the pick-up, Belo  recounted stories of life growing up under Indonesian occupation.

“Every day before school we had to collect water for the Indonesian soldiers and deliver it to them.”

Belo was born in a rural village between Timor-Leste’s second city Baucau and the resistance-fighter stronghold of Foho Matebian (All Souls’ Mountain).

The mountain is named for tens of thousands of Timorese who hid and suffered under heavy ground and aerial bombardment by the Indonesian military in the late ‘70s.

Nuns from the Salesian Sisters cared for Belo growing up. Pictured: A nun lights candles on the 12th of November massacre commemoration at Santa Cruz cemetery.

At eight years old, Belo was practically orphaned when his father – an undercover agent in the resistance – was kneecapped by the Indonesian military.

Belo was taken in and educated by the Salesian Sisters orphanage in Baucau – who he volunteers for to this day.

In 1999 he was adopted by visiting Australian counselor Susan Kendall, who went on to establish PRADET, one of Timor-Leste’s primary domestic violence shelter services.

Kendall sponsored Belo to study medicine in Indonesia. “I have never been to Australia but it is my dream to visit Susan one day,” he says.

Crossing the first river late into the night.

By 11pm we were out of the car and knee-deep in the cool river, carefully helping one another with bags of clothes, books, medical supplies.

There were even six carbon water filter systems being donated to Fatucalo and neighbouring Lesuwata by social enterprise Abundant Water.

After climbing 25 metres up a steep gravel river bank the group found it’s form. A string of flashlights and excited voices kept check of everyone on the muddy path slowly inclining toward Fatucalo.

Almeida, the Xefe Suco, guided us on his motorbike, helping to carry some of the bulkier items on the back with impressive muddy mountain road riding skills.

There are few places Timorese cannot go on a motorbike, and they are an essential –– yet still expensive – form of transport for remote communities.

Largely funded by individual donations collected in Dili, SABEH has received little government support, despite the crucial role it plays for rural communities.

Recognising SABEH’s commitment, local supermarkets and the luxury Hotel Timor provide food and snacks to support volunteers and their host communities.

In October 2020, SABEH was able to sign a Memorandum of Understanding (MoU) with the Ministry of Health formally recognising the organisation’s work.

The MoU will make it easier for SABEH to submit proposals to MoH and international institutions. Despite conducting vital Covid-19 awareness training in rural communities, the pandemic fallout has limited available funding.

By 2am the group’s energy was dipping, with at least three hours still to go. Reaching the sub-village of Lesuwata, we agreed to stop and sleep for a few hours on the floor of a host family’s home.

After a hearty breakfast, four volunteers split off to provide medical consultations for Lesuwata while the rest of us kept walking.

We passed curious children and their welcoming parents. Meriana Freitas ­– an immunisation specialist – stopped briefly to review vaccination records and fine motor skills of new-borns.

Her first patient was a 26-year-old woman with six children. “She has had nearly one child every year since she married,” said Freitas.

Further down the path, we passed an elderly woman walking down the steep slope toward the river with four empty 10-litre plastic jugs.

She was collecting water for the day by herself. Water access is an ongoing challenge to health and development in rural villages, and is often the responsibility of women and girls.

“Even though simple filter systems like ours can make spring and river water safe to drink, the equipment is still hard to access and expensive for many communities,” said Australian Tom O’Malley, who had joined the group on behalf of Abundant Water.

Almeida told me that even with his specialist education in water-efficient agriculture, little of it can be implemented in Fatucalo.

“We learnt many amazing things of course, but in Israel they have the money and equipment to implement it. Here we can’t even get the pipes to do drip irrigation.”

Wedged between several jagged mountain ridges, and two rivers, Fatucalo is relatively well endowed with water compared to other parts of Timor-Leste, where climate change is causing longer and less predictable dry seasons.

With the morning heating up rapidly, we passed traditional sacred houses bearing columns of corn hanging to dry from frames. It will be stored for the months to come.

By 10 am we crossed the final river before a steep slippery climb to Fatucalo. Almeida and his brother loaded up their motorbikes with our heaviest bags for the final slog. 

Chests heaving and dripping with sweat, we stumbled onto the plateau where Fatucalo sits, surrounded by fields of corn and 300-degree views into the mountains.

In a reminder of the ever-present environmental dangers, the village is split in half by an old landslide 25 metres wide in the path of a former stream.

The real difficult work begins

We regrouped and rested briefly with Almeida in the shade of a concrete-floored, timber-slat building, similar to most in the tidy town.

A commotion awaited us at the nearby Sede Suco (village hall) – a large square concrete building with windows enclosed by chicken wire and a tall zinc-sheet roof.

The building was encircled by Fatucalo residents, old and young, peering in and lining up for their consultations.

We were greeted with smiles and welcomes all-round as Freitas began a public briefing to the community about Covid-19 and available prevention measures.  

The rest of the team set to work alongside six other volunteers who arrived the previous day.

Two young doctors, Jonio Fernandes and Juvencia Menezes, sat behind a makeshift pharmacy – a tabled splayed with generic medicines – explaining their uses and dosages to patients.

“The most common ailments we treat are respiratory infections, skin infections, urinary tract infections, diarrhoea and hypertension,” Freitas told me. “Malnutrition is also common among children, mainly due to a lack of protein and vitamins.”

Up to 50% of Timorese children still suffer from malnutrition, caused by a lack of fresh fruit and vegetables and protein, in a diet dominated by rice, corn and instant noodles.

“Some children eat only corn all year,” said Frietas, who travels the country working on health awareness with the WHO. “That’s why last year we introduced the fishponds and home gardens,” Frietas added.

SABEH’s approach is to help the community to counter malnutrition through self-reliance measures, such as establishing one fishpond per family, one chicken per person, and a kitchen garden for each household.

Fatucalo is so remote that they are already largely self-reliant in food and cannot easily buy ingredients or supplies.

“We grow cassava, rice, corn, coconuts, bananas, papayas, taro, many green vegetables, but we can’t sell any of it at market because the access is so hard,” Almeida said.

As the consultations continued, O’Malley and I were asked to take a moment to attend a ceremony in our honour. It’s because, as Belo told us, “You are the first foreigners to visit Fatucalo.”

Almeida and the village elders gathered a crowd outside the Sede Suco where we were presented with slim woven tais ­scarves – one of Timor’s most recognisable cultural practices ­– in the colours of the national flag.

Blushing, we thanked the community for their hospitality and wished them good health.

Across from the Sede Suco, smoke billowed from a low-roofed timber slat building surrounded by banana palms. Inside, women of the town were preparing lunch for the volunteers. Cooking on wood fires with pots propped up on stones, they told me about the meal of pumpkin leaves, banana flowers and green papaya.

Their explanations were suddenly drowned out by heavy rain pelting onto the metal roof. Old men, children, and dogs all crowded into the smoky room for shelter, smiling at the welcome relief from the accumulating heat.

The consultation waiting bench ­– a row of cinder blocks stacked four-high ­along the wall – was now occupied by breastfeeding mothers.

Seemingly playing with the new-borns, Freitas checked their fine motor skills and advised the mothers about vaccinations they will need to travel to Turiscai for.

By 3pm the buzz of activity and excited children settled as we sat down for a typical rural lunch ­– lots of simple vegetables, rice, boiled corn and some of Asia’s hottest chili paste (ai-manas).

Taking advantage of the calm after lunch ­– O’Malley and his Timorese colleague Simi, ­presented their donated water filters to the town, explaining the simplicity of the carbon-filter process.

As light faded, people living far from the centre of Fatucalo arrived for walk-in consultations.

In addition to English, Portuguese and Tetum I discovered nearly all of the volunteers speak Spanish – they were trained by Cuban medical professors who have been working in Timor-Leste since 2004.

Renowned for its generous health support services to developing nations, Cuba trained over 1000 Timorese doctors prior to 2012 and now maintains a long-term teaching and advisory mission.

The volunteers recounted stories of learning Spanish as well as the spirit of Cuban ‘South-South’ solidarity.

After dark, under dim lights, card games and a ukulele were produced and children gathered to sing Timorese folk songs of community solidarity and connection to the land.

Casually reinforcing the reality of Timorese resilience, empty plastic bottles and pill-containers were immediately re-purposed into percussion instruments for the joyful youth choir. 

We packed it in early – sleeping on wooden slat beds or the concrete floor – for a 4am start on the walk back. The risk of walking on the slippery dark paths in half-moon light is worth it to avoid the heat of the day.

On the road again

Our Sunday morning departure coincided with many community members making the walk to Turiscai to sell odd items at market.

In the dark, we were overtaken by women and men in their 50s and 60s. Some carried chickens under their arms while others guided dwarf ponies laden with sacks of crops.

By sunrise we found ourselves taking a “shortcut” along a high ridgeline above the river we crossed on the first night. Stopping to drink water, we took in the view of the clouds ringing the mountain peaks.

Descending the steep riverbank to the crossing, my now-compañeros picked fresh tamarind as a snack to get them through the last hour ­­­– though they were still riding high on volunteer spirit, solidarity and the gift of giving.

The fast cool river water provided welcome refreshment as we collapsed on the final riverbank before piling into the car for the ride back to Turiscai.

Sunday best

At the community boarding house, we were greeted with cheers and a gourmet cooked breakfast. Muddy shoes and smelly clothes were peeled off to dry in the sun, and some of us visited the Turiscai markets.

We arrived as families wearing their Sunday best exited mass and flowed toward the colourful stalls. 

The two-street town has two prominent landmarks – the ruined Portuguese colonial ‘Posada’ administration building and the modern church.

The latter looms far larger and fancier than any other building in town, including the health clinic. 

Sore and exhausted, the volunteers collapsed into the back of the pick up for our ride back to Dili. No sooner than having left Turiscai, they were already excitedly asking “are you going to join us next week?

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