ObjectivesOur objectives were to characterise the nature and extent of delay times to essential surgical care in a developing nation by measuring the actual stages of delay for patients receiving Bellwether procedures.SettingThe study was conducted at Timor Leste’s national referral hospital in Dili, the country’s capital.ParticipantsAll patients requiring a Bellwether procedure over a 2-month period were included in the study. Participants whose procedure was undertaken more than 24 hours from initial hospital presentation were excluded.Primary and secondary outcome measuresData pertaining to the patient journey from onset of symptoms to emergency procedure was collected by interview of patients, their treating surgeons or anaesthetists and the medical records. Timelines were then calculated against the Three Delays Framework.ResultsFifty-six patients were entered into the study. Their mean delay from symptom onset to entering the anaesthesia bay for a procedure was 32.3 hours (+/-11.6). The second delay (4.1+/-2.5 hours) was significantly less than the first (20.9+/-11.5 hours; p<0.005) and third delays (7.2+/-1.2 hours; p<0.05). Additionally, patients with acute abdominal pain (of which 18/20 ultimately had open appendicectomy and two emergency laparotomies) had a delay time of 53.3 hours (+/-21.3), significantly more than that for emergency caesarean (22.9+/-18.6 hours; p<0.05) or management of an open long-bone fracture (15.5+/-5.56 hours; p<0.05).ConclusionsSubstantial delays were observed for all three stages and each Bellwether procedure. This study methodology could be used to measure access and the three delays to emergency surgical care in low/middle-income countries, although the actual reasons for delay may vary between regions and countries and would require a qualitative study.

Background: Surgically treatable conditions are well documented in high-income countries. There is a gap in epidemiological understanding of breast pathology in many developing countries, Timor-Leste among them. This study was conducted to determine the burden of breast disease and to inform public health measures to address early detection, diagnosis and management. Methods: A retrospective quantitative case-control study was conducted at Guido Valadares National Hospital in Dili. Patients were included if they attended surgical outpatients or had a pathology specimen recorded between 1 September 2016 and 1 September 2017. Results: There were 444 female patients with a clinical diagnosis of breast disease over the 12-month period. The average age was 33.7 years. There were 188 (42.3% of total sample) cases of fibroadenoma and 122 (27.4% of total sample) diagnoses consistent with nonspecific lumps. Of the 116 female patients presenting to Guido Valadares National Hospital who had a biopsy, 62.6% were malignant or hyperplastic in nature, and 86% of those with a malignant biopsy had clinically locally advanced disease. Conclusion: Breast conditions including cancer in Timor-Leste are relatively common and occur in young women in the prime of their lives (37 years of age). Developing a national cancer registry and funding directed towards improving early presentation and good clinical care of breast cancer patients will be critical for reducing early morbidity and mortality and improving other patient outcomes including income loss, gender health inequality and the intergenerational effects of early parental death.

No abstract

The purpose of this study was to describe the epidemiology of patients presenting with acute burns and undergoing admission at Hospital Nacional Guido Valadares (HNGV) in Dili, Timor-Leste in the period 2013 to 2019. HNGV is the only tertiary referral hospital in Timor-Leste. This was a retrospective study involving all acute burn patients admitted to the surgical wards of HNGV from 2013 to 2019. The data was collected from patient charts and hospital medical archives. Data were reviewed and analyzed statistically in terms of age, gender, residence, cause, total body surface area (TBSA), burns depth, length of stay (LOS), and mortality. The outcomes were analyzed using logistic regression. Over the 7-year period, there were 288 acute burn patients admitted to the surgical wards of HNGV. Most patients were children (55%), male (65%) and from the capital city of Dili or surrounding areas (59%). The most common cause of burns in children was scalds and the most common cause among adults was flames. Of the admitted patients 59% had burns affecting >10% of the TBSA and 41% had full thickness burns. The median LOS was 17 days (1–143) and the average mortality for admitted burn patients in HNGV was 5.6% (annual mortality 0–17%). The odds ratio for extended LOS was 1.9 (95% confidence interval 1.1–3.2) in female compared with male patients. The odds ratio for mortality was 14.6 (95% confidence interval 2.7–80.6) in the older adults when compared with younger adults. Higher TBSA, full thickness burns, and flame burns were also significantly associated with longer LOS and higher mortality. Children and male patients were disproportionately overrepresented among patients admitted to HNGV, while female patients had longer LOS and older adults had more severe injury and a higher risk of mortality. Establishment of a national program for the prevention of burns is essential.