Bringing Health Skills to the Villages: Barefoot Nurses

When Timor Leste became an independent nation, community health provision in Baucau remained minimal, especially for people in villages and hamlets outside the nation's second-largest city. The Barefoot Nurses program began in 2012 with the aim of further developing the skills of local health workers, an initiative building on the work of the San Antonio Clinic established in 2007 through the efforts of Helen Peters RN and supporters from St Joseph's College, Sydney to promote healthy communities in the Baucau area. The San Antonio Clinic is adjacent to the San Damian clinic operated by the Sisters of the Company of the Imitation of Jesus, based in Indonesia.

By making personal contact with the Timorese people, being sensitive to their needs and culture, educating them in effective ways of improving their own health, and co-operating with local health initiatives, two health professionals in the San Antonio Clinic have made the clinic the first point of contact for people in the local villages and hamlets.

Anastasia da Costa, a local nurse at the clinic who trained under Indonesian rule, was joined in 2012 by Benilda Sanches, a Timorese nurse trained and registered in Australia. Recruited by IACE, Benilda has significantly enhanced Anastasia's understanding of patient care and provided her with the expertise to diagnose, treat and refer patients. Benilda's research has also resulted in a proposal to the Ministry of Health, Timor Leste to provide education services to health workers in Baucau and surrounding districts.

Among the first patients of the clinic have been staff and students of the Teachers' College at Baucau (ICFP), but contact with Anastasia and Benilda has also engaged the people of the local community. Anastasia records and assesses observations of patients and distributes medications and assesses their effectiveness. Benilda runs professional development programs for local health workers on topics such as training for wound management, hypertension, urinary tract infections, hepatitis B, basic life support, physical assessment and management of patient acuity. With greater knowledge and understanding, patients are taking greater responsibility for their own health management. Although palliative care is minimal, and often the only possible treatment for patients with a terminal illness, they can gain a sense of peace and self-worth from the understanding and support of members of their immediate community.

Barefoot Nurses co-operates with other agencies such as Australian Catholic University, the eMerge Foundation, the Catholic Alliance for International Development (CAID), the Salesians, Marist Brothers and Red Cross of Timor Leste, the Order of Malta and the Company of the Imitation of Jesus, to further the well-being of the Baucau community.

Their support for SISCa, the Integrated Community Health Care organization of the Ministry of Health in Timor-Leste, is helping to develop mobile clinics and to promote awareness of health needs and supply of medications in remote areas and to ensure that limited resources are used effectively.

In early November 2012 CAID, an umbrella organization comprising representatives of ACU, Caritas Australia and Catholic Religious Australia, held a meeting at Dare bringing together a range of Catholic health providers in Timor Leste.

The services offered by these providers are wide ranging: from organizational programs and roles in government, health services and dioceses to small village-based clinics. All representatives hoped to expand services, obtain resources, improve capacity and ultimately make the Timorese people independent, and recognized the value of the synergy between health and education, using schools as sites for programs regarding nutrition, clean water and health education.

Representatives agreed that success stems from stability of presence, learning the local language, building relationships, listening to need, responding to the wishes of the community and developing capacity among the Timorese. They also undertook to invite other health providers to the next meeting in 2013.