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Issue #1692      July 8, 2015

Timor Leste

Tomorrow’s doctors

Dr Merita (Metha) Monteiro is head of the Department Infectious Diseases at Timor Leste’s Ministry of Health. She was one of the first group of Timorese students to study medicine in Cuba, graduating in 2011. Almost 1,000 doctors have been trained on scholarships in Cuba or by Cuban doctors in Timor Leste. Metha was a special guest at the recent national Consultation of Australia-Cuba Friendship Societies. Around 120 people took part in the annual Consultation which was held in Sydney this year from June 6-8. Metha spoke to the Guardian about her experiences as a student in Cuba and her work in Timor Leste since graduation.

Cuban ambassador Jose Manuel Galego, Dr Metha and Kenia Serrano – ACFS National consultation, Sydney.

Metha: I was born in Dili in Timor-Leste in 1983. I come from a very simple family. I have 10 brothers and I have lived with my parents up to now. In 2004, I got a scholarship to Cuba. This is an offer from the government of Timor-Leste in collaboration with the Cuban government because, if I’m not wrong, in 2003 our President Xanana Gusmao had a meeting in Malaysia with all the leaders from outside of the country. He met with Fidel Castro there, so they were negotiating how to carry out cooperation in the health sector.

At that time it was decided to send some Cuban doctors to help with the country’s health system and also to send some students from Timor-Leste to study medicine in Cuba. So I’m one of those students who went to Cuba then to study medicine. I was in Cuba for around five to six years.

When we arrived there we had to do a Spanish course that took nine months. After we graduated from the Spanish course, we started medicine. I started to study medicine in one province in Cuba, Ciego de Avila. I stayed in Morón.

So, in Cuba I’ve learned a lot and made many friends. I had a Cuban family. Cubans are very friendly, they don’t treat you like a foreigner, they treat you as their family. So I have Cuban mothers and fathers and family. Now I miss them so much and I don’t know when will I have a chance to meet them again.

One of the things I learned from Cuba is not only how you can treat your patients with medicines, but how you can feel what people feel using your spirit of humanity and spirit of solidarity to do your job to help the people who need it.

The health system in Cuba is very different, it’s very good and education is really good. Everyone receives free health care and education is also free.

Everything is different. You can walk around at night. For example, in other countries you might be scared when you walk in the street at night, but in Cuba nothing will happen to you. Sometimes at the weekend, we go out with friends at night and we always returned safely. This is one of the things that made us feel really comfortable in Cuba, as if we are really at home.

Guardian: And which school did you attend in Cuba?

Metha: I attended Cuba Faculdade de Medicina in Ciego de Avila.

Under the Cuban system we just did theory in the first and second years, but in the third to sixth years we started working with patients in the hospital.

In 2010, we had to come back to Timor-Leste because we’d already completed our course and we had to complete our internship year before graduation.

Guardian: Did the Timor-Leste government recognise your Cuban qualification?

Metha: Yes. After our internship year, when we graduated we got the certificate from the Cuban school and also we got one from our National University in Dili. And our country recognised the certificates.

After graduation the Ministry of Health sends the graduates to different municipalities. This is in the contract, to work in the villages after graduation. Before there were no doctors there, only in the Referral hospitals in each region and the National Hospital.

After I graduated they sent me to work as a general practitioner in the Viqueque district. I practised medicine there as a doctor for more or less one year attending to patients. I was working closely with the Cuban medical brigades who were working there. After that I was appointed to join the Ministry of Health to participate in the administrative side. I was working for the infectious diseases department in the Ministry of Health. It’s called CDC – Centres for Disease Control and Prevention.

And now I’m working in the Ministry of Health for two years and in my department we are looking for infectious diseases like malaria, tuberculosis, HIV, sexually-transmitted infections, hepatitis, dengue and also neglected tropical diseases like soil transmitted helminths, like lymphatic filariasis, yaws, and others.

Up to now there are about 1,000 of us who have graduated, and this is a big group. Some of us graduated in Cuba, some from Dili because of the collaboration between the Ministry of Health and the Ministry of Education with the Cuban health and educational systems. Now we have a Faculty of Medicine in Timor-Leste.

Guardian: So the Cuban doctors set up this Faculty?

Metha: Cuban doctors with our people set up the Faculty of Medicine.

Guardian: So it is also possible to study medicine in Dili?

Metha: Yes.

Guardian: Are the doctors who were there before the Cuban program private?

Metha: There are some doctors who did not study in Cuba. Some of them studied in Indonesia, in the Philippines, Papua New Guinea, Fiji, etc. Most of them work with the government, in the public health system, but only two or three of them have their own private clinic.

Guardian: And the public system is free?

Metha: Yes. In Timor-Leste, in our system, up to now, everything is free. Our government health facilities are free.

So, we’ve got a facility at the village level, we call it suco level, we have facilities at the sub-district level called Community Health Centres (CHC), regional hospitals and one National Hospital.

We have a referral system. So, for example, if the doctor sees a patient at the suco level and diagnoses some illness that needs to be followed up by the upper levels then the doctor will refer the patient to the Community Health Centre.

At the CHC a doctor will evaluate the patient. If they can solve the problem, they will keep the patient there. If they think that the patient needs a consultation with a specialist, they will send that patient to the Referral Hospital for care.

If in the Referral Hospital they think they need to send the patient to Dili for some tests because all the equipment is in the National Hospital, then they will send the patient there to be diagnosed and then treated. Also, if they feel they cannot solve the problem, then they refer the patient to countries like Indonesia or Singapore to do some more studies.

In Portuguese they call it junto ao medico. It is the meeting of the specialists who study the medical conditions of the patient and evaluate whether the patient really needs to be transferred outside of the country or not. And all this is free.

Guardian: And what about medications?

Metha: They are also free. For example, if I go to the CHC not feeling well, maybe I have dengue or malaria, they will do the tests and after the results will write a prescription. Then I go to the pharmacy in the Health Centre and get the medication.

Guardian: Would you like to comment on the results you have had with your programs to combat non-communicable diseases?

Metha: Yes. For example, the malaria program in Timor-Leste has been very successful because we have a very good national strategy to control it and also a vector control program. That’s why the number of our malaria incidence is going down. Before we had more than 200 cases per 1,000 of the population but now we have less than one per 1,000 of the population.

Guardian: Is there any health education in schools?

Metha: Sure, we have our department, it’s called Health Promotion. They have a unit for the health education, so they are working closely with the Ministry of Education. They’ve got a plan to go to every school and tell everything about health to the students. They have a program to give out vitamin A and to give regular albendazol [used to control a variety of parasitic worm infestations]. They are also teaching students to wash their hands properly and giving them information on oral health.

Guardian: What importance is placed on preventative and primary care?

Metha: We are doing both. We are preventing and also correcting.

One of the things we’ve learned from Cuba is more prevention rather than corrective because if we prevent illnesses, we won’t have to treat them later.

I’m telling you about communicable diseases. But we also have a number of non-communicable diseases that are increasing now like hypertension, diabetes mellitus and other problems with heart attacks, etc.

It’s very interesting because, for example, we’ve got lots of problems with diabetes, which is something the system could prevent. It is one of the non-communicable diseases.

Next article – As mayors meet, ending racist violence a theme

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