Surgical capacity building in Timor‐Leste: a review of the first 15 years of the Royal Australasian College of Surgeons‐led Australian Aid programme

Abstract

Background Timor‐Leste suffered a destructive withdrawal by the Indonesian military in 1999, leaving only 20 Timorese‐based doctors and no practising specialists for a population of 700 000 that has now grown to 1.2 million. Methods This article assesses the outcomes and impact of Royal Australasian College of Surgeons (RACS) specialist medical support from 2001 to 2015. Three programmes were designed collaboratively with the Timor‐Leste Ministry of Health and Australian Aid. The RACS team began to provide 24/7 resident surgical and anaesthesia services in the capital, Dili, from July 2001. The arrival of the Chinese and Cuban Medical Teams provided a medical workforce, and the Cubans initiated undergraduate medical training for about 1000 nationals both in Cuba and in Timor‐Leste, whilst RACS focused on specialist medical training. Results Australian Aid provided AUD$20 million through three continuous programmes over 15 years. In the first 10 years over 10 000 operations were performed. Initially only 10% of operations were done by trainees but this reached 77% by 2010. Twenty‐one nurse anaesthetists were trained in‐country, sufficient to cover the needs of each hospital. Seven Timorese doctors gained specialist qualifications (five surgery, one ophthalmology and one anaesthesia) from regional medical schools in Papua New Guinea, Fiji, Indonesia and Malaysia. They introduced local specialist and family medicine diploma programmes for the Cuban graduates. Conclusions Timor‐Leste has developed increasing levels of surgical and anaesthetic self‐sufficiency through multi‐level collaboration between the Ministry of Health, Universidade Nacional de Timor Lorosa'e, and sustained, consistent support from external donors including Australian Aid, Cuba and RACS.

Capacity building in Timor Leste: a work in progress

“…The hospital system in which the described surgical institute is located is a tertiary referral centre with a number of preexisting resources and an academic culture that has allowed for this concept to be developed and implementedin other words, it could be argued that it is coming from a position of strength. 2 The trouble is that in most places the challenge is not so much to 'utilize strong surgical departments with strong academic output and leadership to support and mentor' as it is to find any such departments. Therefore, a critical test for this approach will be to successfully establish a surgical institute in a centre without a previous strong academic background.…”

“…The retreating forces destroyed most of the infrastructure but fortunately the hospitals and churches were left intact. There were only 20 Timorese doctors left to care for a population of 700 000 people . Many will recall that the UN forces who took initial control of East Timor were led by our current Australian Governor General, Sir Peter Cosgrove.…”

“…As a nation and a College, we can be truly proud of the RACS programme in East Timor. An account of the first 10 years is published in this issue . It reflects the significant contribution made by a number of Fellows to a strategic programme under the direction of David Scott and Glen Guest and managed by Daliah Moss.…”

“…An account of the first 10 years is published in this issue. 2 It reflects the significant contribution made by a number of Fellows to a strategic programme under the direction of David Scott and Glen Guest and managed by Daliah Moss. It is a story of capacity building but it has not been straight forward or easy.…”

Surgical training programmes in the South Pacific, Papua New Guinea and Timor Leste

“…Wherever access to SAOs is limited, one option, albeit a short‐term solution, is to increase the number of trained providers through task‐sharing or task delegation: training other health workers to provide essential services, as in some parts of sub‐Saharan Africa. For example, in PNG and Timor Leste, anaesthesia is often provided by anaesthesia scientific officers or nurse anaesthetists, although also by doctors and specialists.…”