Speech Pathology in Timor-Leste

“Recovering from years of militia occupation—providing medical care to the developing nation of Timor-Leste.”

Celina Lai, Speech Pathologist

After 400 years of occupation and 25 years of civil war, Timor-Leste (East Timor) officially became an independent nation in May 2002. This small country lies 640 kms northwest of Darwin (Australia)—less than an hour’s flight away—but the difference in health status, education opportunities, and economic success compared with Australia’s could not be more different.

This developing nation is still recovering from years of militia occupation and the decimation of lives, culture, and infrastructure—the price paid for independence. But the Timorese are nothing if not resilient, and over the past 17 years, with the help of the international community, they are slowly rebuilding.

Providing Medical Care

Mark Moore is a cleft surgeon who is part of the Royal Darwin Hospital Cleft Lip and Palate Team. He has been travelling to East Timor and other Asian countries for more than 15 years, providing plastic surgery with the support from the Overseas Specialist Surgical Association of Australia, an NGO dedicated to providing surgical services around Asia. In East Timor, Mark has conducted and supervised more than 800 cleft surgeries and trained local surgeons in cleft surgery and management.

Mark invited me to go to East Timor in 2013 on one of his surgical missions and I have since participated in 2 more missions. The team (plastic surgeon, theatre nurse, and anaesthetist) works from the Hospital Nacional Guido Valadares, located in the capital, Dili. Timorese travel from all parts of the country for their consult with the visiting cleft team. Many children and the occasional adult, present with a variety of unrepaired clefts. Those that can have surgery are offered an appointment and I am in awe of the hope these teams give to the patient and their families.

Alotu is the first and only practising speech pathologist (graduated in 2012 from Akademi Terapi Wicara-YBW Jarkarta, Indonesia) in Timor. With the assistance of Rotary, Alotu has visited Australia to observe speech pathologists in a number of clinical settings, including Darwin.

Challenges

Alongside Alotu, I have conducted feeding and speech assessments for children pre- and post-surgery. Breastfeeding is the norm in Timor and trying to explain the mechanics of sucking/suctioning and the impact of clefting can be a hurdle. The availability of appropriate feeding equipment is also problematic—I have seen teats with tops chewed off to increase flow and mothers expressing into spoons to feed the baby.

Another challenge is convincing families to return after cleft repair for speech follow-up. One of the major barriers is distance, as Alotu is located in Dili and the travel from districts to the capital can be tough.

Helping families understand the purpose of therapy is yet another challenge—many do not comprehend that 1 session with the therapist (and no home practice) is not going to change a speech problem.

How to Help

There is much work to be done to raise the awareness of communication problems and the impact upon the individual and their families in East Timor. Alotu is very keen to build up the speech pathology services. If anyone has an interest in East Timor or is heading there, please let me know and I can put you in touch with Alotu.