First aid in the world’s youngest country

تم النشر: 25 فبراير 2004 0:00 CET

Prabha Chandran

May 20, 2002 was a day like no other in the history of East Timor as the nation awoke to freedom. Few had slept the previous night. Every man, woman and child was caught in the huge outpouring of joy that accompanied the birth of the world's youngest nation.

But the scenes of jubilation were tempered with concerns for crowd management, medical emergencies and lingering militia violence even as world leaders descended on the over-crowded capital. For the group of 100 newly trained Red Cross first aid volunteers it was to be a baptism by fire.

Some 100,000 Timorese, including the elderly and babies, had gathered in the vast encampment of Tasi Tolu, many travelling for days on foot to witness the moment of independence. Now they were exhausted, hungry, cramped and tense at the possibility of last minute attacks by Pro-Indonesian militia.

"It turned out to be a most difficult time for the volunteers,” Francisco Ximenes, secretary general of the East Timor Red Cross (CVTL) recalls. “We worked round the clock for two days and nights as more and more people started collapsing from exhaustion and sickness.”

“The crowd was so large we had to deploy our volunteers in groups of four; one would carry a flag and position himself with a stretcher while the other three would comb the crowds nearby for those needing emergency medical aid. For 48 hours we ferried the sick and injured to field hospitals run by the Portuguese, Russian and Australian peacekeeping forces. And all the time we were afraid there might be attacks by militias," he says.

Things have changed significantly since that Herculean effort by volunteers fresh from the first CVTL training programme, organized by the Indonesian Red Cross (PMI) in April 2002.

The first aid programme today includes 300 volunteers in 10 of the 13 districts, trained not just in traditional emergency-based first aid but community-based first aid (CBFA) which focuses on basic health education and fighting disease. But why did the fledgling Timorese Red Cross choose first aid as its cornerstone?

"We were getting requests from the Ministry of Health and several international organizations, like the World Health Organization, Oxfam and World Vision to provide trained first aid volunteers," says Ximenes, "and given the positive response of students who wanted to be trained, we also saw this as an important way of building up the CVTL nationwide."

With support from the New Zealand and South Korean Red Cross Societies, CVTL's first aid programme is now close to the stage where its own trainees will have acquired enough expertise to train others. It's a small but significant step on the road to self-sufficiency.

It is also beginning to make an impact in remote districts where people have little knowledge of basic hygiene and less access to health care. In such a scenario simple things like washing hands and food before eating can make the difference between life and death. If that sounds unlikely, consider this: fully 60 per cent of deaths in this country where life expectancy is a mere 47 years are caused by simple respiratory tract infections and diarrhoea.

In the mountain hamlet of Tibar, an hour's drive from Dili, Maklooba Baboo is giving her three-year-old a thorough scrubbing under the community tap provided by CVTL. The gurgling baby splashes happily for the camera as we review the water project, developed by CVTL with Australian government support. Before, washing babies was difficult due to the trek through the forest and water had to be carried over long distances.

"I am very happy, because the volunteers taught us many things after bringing the water," says Maklooba. Typical of the integrated community first aid approach, the villagers were taught how to wash properly, how to keep the water safe from contamination and "we now boil it before drinking so the babies get less sick."

Sometimes even simple instructions can be hard to follow in the poorest hamlets where toiletries are a luxury says Narciso Fernandez, CVTL's Health Coordinator in Dili.

"We have an experienced first aid volunteer in Maliana, Armandina Lopes, a gym teacher at the Senior and Junior School. She organized special classes to teach children basic hygiene. But the children said, 'how can we do what you say? Give us soap, give us toothbrushes, give us mosquito nets. We don't even have water at home to wash so we have to use the rivers’."

Not surprisingly, CBFA is vital in a country where knowledge of health is scarce - the majority of children like Maklooba's seven-year-old daughter Adelina don't go to school - and tertiary health care remains underdeveloped.

Apart from preventable chest and alimentary tract infections, malaria and typhus are endemic in all districts, with children particularly vulnerable. There has been a threefold increase in malaria, while leprosy and tuberculosis are also common. Add to that a maternal mortality rate of 860 per 100,000 births, amongst the worlds' highest, and a grim picture emerges.

As if that were not enough, a new concern is HIV/AIDS, which has become an integral part of CBFA's health awareness campaign. "The government wants us to run a big campaign," says Ximenes, recalling that the first cases came to light when the International Committee of the Red Cross began running the blood banks after the Indonesian troops came here.

"Women were raped but nobody was able to find out about the infections till much later,” he says.

Supported by the New Zealand Red Cross, the AIDS awareness campaign seeks to counter the spread of the disease through information about healthy practices, for although the numbers are very small right now, social displacement, poverty and ignorance provide the conditions to allow a rapid spread.

Meanwhile, the enthusiastic response to national celebrations like Armed Forces Day and Independence Day keep first aid workers on their toes, as do the national football championships when injuries are not uncommon.

"I think the main beneficiaries of first aid have been athletes and those injured from jumping fences etc at public celebrations," says Ximenes, "but we need an ambulance, more often than not volunteers take the injured by taxi to hospital paying from their own pocket."

Such teething troubles do not deter volunteers like Meliana Cardoso, 20, who teaches basic first aid to new recruits.

"During the troubles the PMI was here helping people and I want to do the same," she says. Her chance came during the Falintil Day celebrations when a large, emotional crowd gathered to honour the heroes of the freedom struggle.

"After the ceremony people went into the mountains to look for the bones of the martyrs, many people are still trying to find the remains of loved ones. During the search lots of people were injured, some badly scratched by thorns and others fainted. It was a big challenge giving them first aid out there,” Meliana says.

A mountain rescue service may one day be a necessity in this hilly island but for now volunteers are busy learning the ropes, preparing for the challenges ahead.