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At the time of Indonesian withdrawal in 1999, there were only twenty general doctors for a population of seven hundred thousand (2). By comparison, in Australia at the same time there were 1,787 doctors per seven hundred thousand people (3). In Timor-Leste today, the density of skilled health professionals -1.3 per 1000 population -remains well below the World Health Organisation's recommended lower threshold of 2.3 per 1000 population, and far below Australia's current density of 16.2 health-workers per 1000 population (4, 5). The majority of specialist medical care over the last two decades in East Timor has been provided by outreach medical services from Australian physicians and surgeons (6).The East Timor Hearts Fund (ETHF) commenced work in Timor-Leste from 2002, and was formally created as a charitable foundation in 2010. Specialist cardiologists volunteer in Timor-Leste and perform clinical and echocardiographic assessment . Patients identified as suitable candidates are referred for cardiac intervention (surgical or percutaneous) in Australia, with costs paid for by charitable donations (7). Through ETHF's efforts, Timor-Leste has been identified to have one of the highest rates of rheumatic heart disease in the world; approximately 2% prevalence identified on aThis article is protected by copyright. All rights reserved. screening study of school children in 2016 (8). Two key goals of the ETHF are to provide high-quality specialist cardiac care to Timor-Leste's citizens and to develop in-country resources and training in cardiology, with the ultimate goal that Timor-Leste does not require the services of Australian physicians for the provision of cardiac care. We undertook a review of one decade of clinical activity in order to assess demographics and patterns of cardiac disease presenting in Timor-Leste, quantify our clinical coverage, and assess evolving trends.This study is intended to 'take the pulse' of Timor-Leste's cardiac needs by highlighting areas of evolution to facilitate healthcare planning for the future decade. We anticipate that our experience will be of interest to physicians working in a range of developing countries with limited healthcare resources. Methods:Australian cardiologists travel to East Timor with the ETHF three times per year during the non-rainy season (7). The medical team comprises up to four adult cardiologists and ideally at least one paediatric cardiologist and echocardiographer . Additional medical volunteers may include a general practitioner or cardiac nurses, who assess vital signs and perform six-minute walk tests. Two Timorese interpreters are present at all clinics: one at the reception desk and one moving between clinical rooms. Clinics are primarily based at the national hospital in Dili (the Hospital Nacional Guido Valadares (HNGV) with one outreach day to a different rural area each trip.

S53 cobalt, nickel, copper, arsenic, cadmium, selenium, mercury and lead was undertake on a subset of samples. The United States Pharmacopoeia and Federal Drug Administration recommendation for heavy metals content for injectable drugs was used as reference standards. Samples were subjected to particle size assessment and optical light microscopy to assess crystal structure. Results: A total of 35 batches of BPG were obtained from 16 countries, including areas with known adverse reactions to BPG. None of the tested samples demonstrated issues with low potency. The median particle size was 65 m (IQR 48.59-90.4 m). Eleven samples tested had normal water content and heavy metal analysis. Conclusion: Preliminary analysis of active ingredients indicate adherence to United States pharmacopoeia standards. No identifiable contamination was detected. Significant differences in physical characteristics possibly contribute to needle blockages. We suggest review the drug monograph to minimize inter-brand discrepancies.

Background The East Timor Hearts Fund (ETHF) has provided cardiac services in Timor‐Leste since 2010, conducting three clinics yearly. With international border closures due to the COVID‐19 pandemic, development of collaborative telehealth services was required. Methods Scoping discussions identified major challenges (structural, patient‐related and medical system‐related). At two pilot clinics, patient history, investigation and management were collated. Clinic metrics were compared to an index face‐to‐face clinic in February 2019. Post‐clinic discussions identified areas of success and shortfall in the conduct of the telehealth clinics. Results 23 patients were reviewed at the online telehealth clinics held onsite at Timorese medical facilities. Compared to an index 2019 clinic,there were markedly lower numbers of new referrals (2 vs 190 patients, 8.7% vs 59.4%). Patients seen at the online clinic were predominantly female (17/23, 73.9%) and Dili‐based (18/23, 78.3%) with a mean age of 25.9 ± 7.2 years old. The majority (12/23, 52.2%) had isolated rheumatic mitral valve disease. Investigations including electrocardiography, pathology, echocardiography and 6‐minute walk tests were conducted in select patients. Medication advice was provided for 10 (43.5%) patients. 11 patients (47.8%) were deemed to require urgent intervention. Post‐clinic discussions indicated general satisfaction with telehealth clinics, although frustration at current inability to provide interventional services was highlighted. Conclusion Our pilot telehealth clinics indicate that capacity‐building telemedicine can be rapidly implemented in an emergency setting internationally. Clinic design benefits from careful identification and resolution of challenges to optimise flow. Cardiac patients in Timor‐Leste have a significant burden of disease amenable to intervention. This article is protected by copyright. All rights reserved.

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