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Report on Nutrition in Hera, East Timor Report by Des Buchhorn February 2000
DESCRIPTION Sucu Hera is a collection of six villages (aldeia) 15 kilometres east of Dili on the northern coastline of East Timor. A map of the area is given in Figure 1 The elected chief of the Sucu is Simão Pedro Ribeiro, who was our main informant and contact in the area. The main organisation is the CNRT (Conselho Nacional da Resistencia Timorense). Other groups are a women’s group (OMT, Organizacão Mulher Timor), a youth group OJT (Organizacão Juventude Timorense) and a workers group OTT (Organizacão Trabalhadores Timorense). Attacks by militia occurred from July 1999, earlier than in most other areas of East Timor. Most people left Hera during July and August 1999. The market and boatyard were closed on August 6th. Most of the population left and hid in the hills, or went to West Timor. About 30% of Hera was destroyed. Many people were killed by the militia. The local people are unwilling to go back to some of the areas where killings occurred. After the arrival of Interfet forces, many people returned to the area. Table 1 Population estimates at January 2000
In February 2000, most of the returnees assembled at a location known as Central, near to the church and school. As these people were not included in the figures above, the total population is different in the table below Table 2. Age Distribution:
The population before the referendum was 6,069. The Indonesian police, TNI and Public Servants have left, some Timorese have been killed and others have not returned. In Acanunu, 95 people have not returned. Most people were in West Timor. The most recent returnees were 11 people who came back in the middle of January 2000. Water supply is provided by two springs, but the pipe from one of these is broken. There are wells with hand pumps also. Metinaro is another settlement another 10 kilometres to the east. It is said that the chief of Metinaro was a leader of the Militia. Most people left Metinaro during July and August, much earlier than other parts of East Timor. Metinaro was about 70% destroyed and its population was about 3,000, now about 2,000 as many people are in Dili. INDUSTRY Prior to the destruction, the following industries were in the area:
At the time of writing, only three fishing boats (not all working) employing 52 families and part of the agricultural production remain. As there are few fishing boats, it is believed that fish have been caught recently using explosives. Small amounts of fish are for sale beside the roads. Previously people had jobs with the government, in fishing and in agriculture. Income was derived from the sale of animals and corn, also beans and onions. The main problem since the referendum is the lack of employment, and hence insufficient money to buy food. Pedro Ribeiro requested machetes to enable the clearing of land, and to reduce mosquitos. No machetes were available in Dili. He had meetings with Rumiana Decheva and Alice Prisco from UNTAET, with CIVPOL and with Timor Aid with a view to revival of the fishing industry. These people met with the village on February 1st. Meetings with Interfet led to the selection of Hera as a place for the cleaning of Australian Army vehicles. This work will provide 50-100 jobs for six months and provide improvements in infrastructure. There was a yard in Hera manufacturing fibreglass fishing boats. All of the equipment, except for some large moulds, were removed. The yard is now used as an office by the CNRT. AGRICULTURE People buried their seed before departure, and therefore had enough to plant a corn crop on return. Pedro Ribeiro asked for mung bean seeds, which we obtained from CARE, and peanut seed, for planting as a cash crop. Peanut seed was not available in Dili. Also needed are vegetable seeds such as eggplant and snake beans. Replacement of chickens would be very desirable. Hera has been the site of a project conducted by a Permaculture group under the name of Sustainable East Timor. A Hera man named Eugenio F Lemos, trained in agriculture at the Hera Polyteknik, is enthusiastic about the Permaculture project and speaks English. MEDICAL SERVICES Previously three clinics were in operation, with doctors in attendance less than once a month, one has been burned down. Timor Aid provided a medical clinic in Hera central from late December to 22nd January. A separate report for Timor Aid was prepared by Mark and Tanya Foreman. Pedro Ribeiro is concerned that the Timor aid clinic closed at the end of January and left no medications. The clinic is in need of repairs, as described in the medical report. The nurses have requested drugs, a microscope, posters and stationery. HEALTH WORKERS The nurses are Domingos da Costa, who lives near the clinic and Moses Amorade, who lives at the back of the clinic. Domingos has been a nurse since 1983 and Moses since 1993. Domingos has training in mosquito control and microscopic detection of malaria. He prescribed medications to treat malaria. He used a backpack spray known as Bedik and a chlorine water treatment known as kapor. Moses had training in nutrition, with six months training in Denpasar, Bali. He had a number of records of patients including MUAC measurements, but these have been lost. Medications which they had previously dispensed were:
The nurses used to prescribe medications, give injections and carry out minor procedures under local anaesthetic. They were trained at the Lahane school in Dili for three years, after three years of secondary education. We gave nurses a brief knowledge test in which they scored well. Indonesians administered vaccinations as follows – the most recent May 1999:
Previously there were four nurses, all males. One of them, Samuel Ribeiro, now lives in Dili, who has nine years experience. He speaks some English. Two health workers at the remaining clinic in Hera have been in attendance much of the time and have expressed willingness to work in the clinic or in public health activities. The chief of Hera has requested that these men be fully utilised. It would make good sense if they could be engaged in activities they are competent with. We have supplied the nurses with 2 bicycles to help with this work, but they will need ongoing support.
PUBLIC HEALTH Pedro Ribeiro identifies the main public health problem as malaria. He reported ten deaths from malaria between 1st and 24th January, mainly in Sakaer Laran and Motaquia. All except one were children under 5 years of age. Clinical reports show that 394 persons were treated for malaria on a clinical diagnosis from 8th to 22nd January. This is 54 percent of the 727 presentations in that period. Local residents identify contributing factors as darkness due to the lack of electric light, and the amount of greenery near homes harbouring mosquitos. A number of large pools of water are apparent. Timor Aid distributed enough mosquito nets for the whole population of Hera. Oxfam has visited Hera, commencing on February 1st, and has commenced a program to control mosquitos. Pedro Ribeiro is very interested in health education for the people, and supports the use of the two nurses in education. Written information is of limited use as about 50 percent of the people are literate. Radio broadcasts would be a useful means of education, but as yet radios are not working due to lack of batteries or mains electricity. NUTRITIONAL STATUS Pedro Ribeiro reported that in January the need for food was urgent. We approached CARE which provided 600kg of rice and 50kg of mung bean seed. Further approaches led to the delivery of more rice on January 31st. Prior to the referendum a wide range of food supplies were provided in the area or purchased with earnings. Now the incomes are next to nothing, and local production greatly reduced. Farm animals have been killed by Militia.
Chief of the Sucu Hera, Simão Pedro Ribeiro, believes that they will be independent for food supply when the corn crop matures at the end of February. The market has reopened on a small scale and operates on Tuesday and Saturday. During a period of 2 weeks when good statistics are available, 727 patients were seen at the clinic. Clinical signs of malnutrition were apparent, particularly in small children not breast fed, and in the elderly. One women of 70 years with muscle wasting, subcutaneous fat loss and wrinkled skin. Clinical signs of malnutrition included:
One family of 5 weeks was too sick to grow vegetables. One person reported she could only go to buy fish if she was well. Factors contributing to the poor nutritional status appear to be:
Metinaro has received food distribution later than other areas. Nurses reported 14 cases of malnutrition. There is no clinic in Metinaro, but we were advised that the Canossian sisters in Dili would come to Metinaro if they had transport. Hera currently has three teachers and Metinaro has 15. WOMEN’S GROUP The women’s group in Hera is a branch of OMT (Organizacão Mulher Timor). Representatives include Maria Elias and Philomena Pereira. The women’s group will engage in basket and cloth weaving. Previously more than 10 women provided hot meals twice a week in the primary schools, and at 2 clinics meals were provided for under fives. The women are interested in doing this program again, but they need food ingredients and suitable cookware. List of materials needed:
CONCLUSION The Hera community has strong leadership and a number of people who have skills and motivation. In general, they are keen to get their industry and their society functioning again. They have been very clear about their material assistance they need from humanitarian agencies. For the most part, they need specific goods, medicines, and fishing equipment. There is no evidence of a trend toward dependence on aid, quite the contrary, it appears all requests are genuine needs. A number of the needed supplies have recently been provided, negotiations to revive the fishing industry are continuing, and a number of jobs will become available soon. The community is making good progress toward rehabilitation and in some ways could be a model for development of other less fortunate communities. REFERENCES Foreman MJ, Foreman TA. Medical Report – Hera. January 2000 Timor Aid. ACKNOWLEDGMENTS The writer express thanks for the assistance of Pedro Ribeiro, Maria Cooper, Mike Cooper and Eugenio Lemos.
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