No subject

North Sumatra to meet local authorities and obtain information regarding the 
latest development of Acehnese IDPs in the neighbouring province. 

Population Movement 
Vice Governor of North Sumatra, Lundu Pandjaitan, reported to the UN Inter-
Agency Mission on Wednesday (18 Dec.) that some 23,096 families are currently 
displaced in North Sumatra. This number has been clarified by a verification 
team from the Local Government. He mentioned that based on the latest 
information (16 Dec.), some 5,884 IDP families have received the termination 
funds of Rp. 8.75 million from the Government. The distribution of this fund, 
which was prepared by the Central Government, was still on going in order to 
cover up to 12,000 IDP families. 

Food Security and Agriculture 
During the UN Inter-Agency and IOM Mission to NAD and North Sumatra from 16 
to19 December, the Acting WFP Country Director, Bishow Parajuli, stated that 
WFP would look into the possibility of providing food assistance to the most 
vulnerable groups, returnees and others most affected by the conflict. The 
assistance was aimed at filling the gaps, which have not been covered by the 
Government. 

Education 
During a meeting with the UN Inter-Agency Mission on Tuesday (17 Dec.), the 
Vice Bupati (District Administrator) of Pidie encouraged UNICEF to take part in 
rebuilding the remaining 14 burned schools. 69 schools were burned since the 
conflict escalated in 1999. 

Economic Recovery and Infrastructure 
ICMC travelled with its donor, OCPR, to Pidie district on Wednesday (18 Dec.) 
to monitor their female-headed households targeted programme. 

Others 
Oxfam has developed a proposal for an income-generating pilot project for 
conflict-affected communities. The project includes activities that will 
increase the communities' confidence in their own coping skills and will 
encourage dialogue with local authorities concerning their needs and the 
protection of their livelihoods. Two to three local NGO's will participate as 
partners in the project, which includes a substantial training component. Once 
approved, partners and geographic areas will be confirmed and operations will 
begin in February 2003. 

CARDI travelled to Bireuen district from 17 to18 December along with its local 
partners, SSG and Gardamadina, to provide additional training for women sewing 
group in Peudada sub-district, and to monitor the procurement and distribution 
of basic foods in Samalanga sub-district. 

3. CENTRAL SULAWESI 

General Situation 
According to local newspaper, Nuansa Pos, on Saturday (14 Dec.) the Central 
Sulawesi Chief of Police said that the Anti-terrorism law would be efficiently 
implemented in Poso. He also claimed that the police had identified the actors 
of the bombing in the Local Government office in Poso and of the shootings in 
Kawende. However, no arrest had been done so far. The extra fund of Rp 150 
million has been received by the Central Sulawesi Government to build 142 
poskamling (neighbourhood security posts). 

A local newspaper, Radar Sulteng, cited the South Sulawesi Police Chief saying 
that the Agung Hamid group still had 33 bombs. The targets of the bombings were 
not yet known, but the police suspected the bombs would be used for terror 
purposes in Sulawesi. 

A local newspaper, Radar Sulteng, reported on Friday (20 Dec.) that there was 
fighting between two villages, Kotapulu and Kotarindau of Dolo sub-district, in 
Donggala district on Thursday (19 Dec.). 

Population Movement 
A group of 101 Christian IDP families is ready to return to their place of 
origin in Tongko village, Lage sub-district, accompanied by a local NGO, LPS 
HAM. The NGO has facilitated reconciliation with the Muslim community, which is 
now ready to receive the returning families and give assistance in constructing 
barracks. According to the NGO, the current main obstacle is the lack of RTS 
(temporary houses). 

Assessments 
CARE conducted a participatory appraisal in East Pamona, North Pamona and Poso 
Pesisir. 

Food Security and Agriculture 
CARE distributed basic food to 4,000 households in five sub-districts (Poso 
Pesisir, Poso Kota, Lage, North Pamona and East Pamona) of Poso District. 

CARE distributed supplementary food for 200 infants in Moengko Lama, Bone Sompe 
and Lawanga, Poso Kota. 

Health 
IMC operated two mobile clinics in Wuasa, Lore Utara, which treated some 197 
patients, consisting of 60 women (7 of them were pregnant) and 55 children. Six 
Government health staff also assisted the clinics operation. The 
pharmaceuticals used by these clinics were borrowed from another IMC programme. 

A further 20 community health KAP (Knowledge and Practice) questionnaires were 
completed in Lore Utara. 

Other 
In cooperation with local NGOs from Tentena and Poso, Mercy Corps held a five-
day workshop on Water/Sanitation technical skills and Participatory Rural 
Appraisal Tools. The workshop was facilitated by LKAB, a local partner of Mercy 
Corps in Ambon, and by the Mercy Corps Civil Society team. 13 NGOs and 18 
representatives of both communities attended the workshop. The objective of the 
workshop was to strengthen the assessment capacity of local NGOs and to prepare 
them for a more active role in water and sanitation programmes. 

4. MALUKU 

General Situation 
Some incidents were reported during the week: on Saturday (14 Dec.), a bomb was 
discovered near a security post in Batu Meja area (Ambon city); on Monday (16 
Dec.), two self-made bombs were discovered at Halong Atas water reservoir at 
Halong Navy Complex in Ambon city suburb; and on Tuesday (17 Dec.), a suspected 
package of a self-made bomb was discovered on Jl. Ponegoro, Urimessing village 
of Ambon Island. However, after further investigations it was found to be 
firecrackers. 

A local newspaper, Ambon Ekspress, on Wednesday (18 Dec.) reported that some 30 
IDP representatives from 4 villages (Waipoti , Wainabe, Waikase and Waiula) in 
Buru district, held a peaceful demonstration in front of the Maluku Governor's 
office on Tuesday (17 Dec.). They demanded attention from the Government on 
their relocation issue. The government had agreed to accommodate IDPs who were 
willing to relocate to Buru Island until 16 December 2002. However until today, 
this agreement has not been implemented yet. 

Assessments 
CARDI started an assessment process of community development programme 
proposals. A total of 50 proposals have been received by CARDI. 

MSF-B has sent a team to assess the situation of water and sanitation condition 
in West Seram. 

AcF has sent a team in Tehoru sub-district on Seram Island to assess the 
possibility of implementing income-generating projects. The team also conducted 
a post monitoring of previous activities, which has already been completed. 

AcF presented a report on a recent assessment in Northeast, North and Northwest 
Buru districts regarding food security, and water and sanitation problems. The 
report concluded that most areas are severely suffering from inadequate food 
and water supply. Traditional coping mechanisms have been badly affected and 
there is need for food assistance. AcF is planning to provide food assistance 
and to conduct an inter-agency assessment mission to see the possibility of 
implementing a joint intervention for a long-term solution. 

MC Ambon staff went on mission to Tual district, Southwest Maluku to conduct a 
preliminary monitoring of water and sanitation projects, and to assess the 
usage of the new Economic Empowerment guidelines provided by the organisation 
during a workshop in Ambon recently. 

Health 
IMC reported that a total of 383 consultations were provided by its health 
stations in Wamsisi, Leksula and Waemulang sub-districts of Buru district. Some 
diseases identified were malaria, diarrhoea and URTI (Upper Respiratory Tract 
Infections). In Seram district, a total of 1,184 consultations were made in: 
health centres in Taniwel, Werinama, Kobisonto; mobile clinic in Masohi; and 
Masohi hospital. In consultations with KESGAP (Military Health Unit) medical 
personnel, the paediatrician of IMC's mobile clinic in Masohi reported that 30% 
of children in Masohi area suffered from clinical pulmonary tuberculosis. 

In collaboration with the local health department from Tulehu sub-district on 
Ambon Island, MSF-B health team provided 468 consultations through their mobile 
clinic in Ambon, and carried out 237 vaccinations for measles in Tengah Tengah 
village on Friday (13 Dec.). 

MSF-B also supplied essential drugs to Al Fattah hospital for the treatment of 
the casualties of Asilulu/Ureng fighting reported last week. 

Water and Sanitation 
Mercy Corps funded a crisis centre in Tual district to implement a water and 
sanitation project in Bombay Village, Kei Besar. The organisation also provided 
funding for a local NGO, Yayasan Tagalaya, to implement a water and sanitation 
project in Ohoiren village on Kei Kecil Island of Tual district, Southwest 
Maluku province. 

AcF water and sanitation team have completed the construction of a connecting 
pipe in Batu Tagepe (1,2,3), and Lorong Putri 2 villages on Ambon Island. 
Meanwhile, the projects in STAIN, Wara and Lorong Silale villages, on Ambon 
Island, are still on going. 

Economic Recovery and Infrastructure 
AcF has completed an Income Generation Programme in Baguala, Haruku, Salahutu 
Piru and Teon-Nela-Serua (T.N.S) sub-districts and is currently processing the 
data. 

Other 
CARDI organised kite competition in Wayame and Pohon Manga villages. Some 110 
children and youth decorated kites with peace messages and flew them. The 
organisation also facilitated a training on Participation Methods for 20 youths 
facilitators in Pohon Manga village. CARDI also assisted the communities in 
preparing Christmas events in Paso, Wai and Suli. Children and youth were 
involved in the preparations of poetry reading and music performances. 

A local newspaper, Ambon Ekspress, reported that a community meeting was held 
on Tuesday (19 Dec.), at Pattimura University in Ambon. The meeting was aimed 
at formulating an agreed way to support the government policies in order to 
solve issues relating to the conflict in Maluku. The meeting was facilitated by 
Pattimura University and was attended by local kings, community leaders, 
religious leaders, and young people of Ambon and Central Maluku. The meeting 
concluded with a seven-points agreement to support the government policies in 
order to solve the conflict in Maluku. 

5. NORTH MALUKU 

General Situation 
The election process of the Regent (Bupati) of Central Halmahera district has 
been completed and approved by both the Provincial and Central Government. 
Hassan Doa, who is nominated by Golkar Party, will be officially installed as 
the new Regent next week. 

Population Movement 
At an IDP workshop in Ternate, the North Maluku Social Affairs office clarified 
that the total number of IDPs from North Maluku, who were still living in 
Manado and Bitung, North Sulawesi, was about 9,000 people, instead of 26,000 as 
previously reported. 

Food Security and Agriculture 
WVI conducted training for some fishermen groups in Toniku, Tataleka and 
Gamlenge villages, in South Jailolo sub-district from 16 to 18 December, and 
assisted the fishermen groups in Talapo, Matsa and Ngofakiaha villages in 
Malifut sub-district and in Akelaha Pasir Putih, and Dodingan villages in South 
Jailolo sub-district, to prepare a proposal for fishing kit tools. 

Health 
WHO-EHA sponsored the Provincial Health Office in conducting training on 
sexually transmitted infections (STI) syndrome targeted to doctors from 16 to 
19 December. The training was attended by 29 doctors from both communities. A 
similar training session for nurses will be conducted from 20 to 23 December. 
Trainers from WHO Jakarta facilitated the training. 

Water and Sanitation 
UNDP has completed their water supply project in Soatobaru village to provide 
the community with three wells and a water pump. UNDP has also completed the 
servicing of 12 wells and provided 2 water pumps in Duma village. Both villages 
are in Galela sub-district. 

Water and sanitation (WATSAN) team from CARDI is travelling to Bacan from 19 to 
23 December to conduct an assessment activity. 

Shelter and Non-Food Items 
WVI distributed roofing kit assistance in Tiley, Tiley Raja, Wayabula, Aru 
Irian, Lusuo villages in North Morotai sub-district from 12 - 18 December. 

Education 
WVI in Tobelo sub-district distributed building materials for school 
renovations of SMPN 1 Tobelo, SDN Wari and SD GMIH Gorua from 12 to 16 
December. WVI also held meetings with all WVI Zone II Education and Magazine 
staff. 

UNICEF carried out an assessment to determine the level of interest and 
opportunity for a "catch-up" workshop in Galela sub-district together with 
their local partner, LML, for their peace education programme. 

UNICEF presented the Convention on the Rights of the Child at the Media 
Workshop for local journalists organized by OCHA. 

UNICEF together with CARDI travelled to Jailolo and Sahu to monitor their 
School in a Box project, school tents project, textbook distribution, and 
CARDI's youth programme funded by UNICEF. 

Economic Recovery and Infrastructure 
WVI monitored and sosialised their CRP II project in Bobisingo, Limau, Roko, 
Pune, Lalonga, Mamuya, Togawa, Luari, and Togoli villages of Tobelo and Galela 
sub-district and in Malifut sub-district. WVI also made proposal for their CRP 
I project in Gamsungi and Dum-Dum villages in South Jailolo. 

WVI distributed local materials for MCK Type 1 project in Matsa village and MCK 
Type 2 in Ngofagita village of Malifut sub-district from16 to17 December, and 
for Polindes in Togawa village of Galela sub-district on Tuesday (17 Dec.). 

Other 
OCHA and the North Maluku Government conducted a 2-day IDP workshop in Ternate 
from 18 to 19 December. The workshop showcased the performance of the North 
Maluku Government in resolving IDP problems, as well as discussed other IDP 
issues, such as property and land rights, and claims of IDPs. Provincial 
Government representatives from Aceh and Maluku, IDP representatives, local and 
international NGOs, Barkonas, and local Government officials attended the 
workshop, which was officially opened by the Vice Governor. 

6. PAPUA 

General Situation 
On Friday (13 Dec.), a demonstration was held in front of the district 
parliament's office in Timika. The demonstrators demanded the Chairman of the 
district parliament and the Head of District (Bupati) to facilitate a meeting 
with Tom Beanal, the Vice-Chairman of the Papua Presidium Board (Presidium 
Dewan Papua). The request was not met. 

A group of 50 people held a peaceful demonstration on Saturday (14 Dec.) at the 
Cendrawasih University campus site in Jayapura to commemorate the 14th 
Anniversary proclamation of the West Melanesian Republic by the late Dr. Thomas 
Wanggai, SH MPA. Three persons were held in police custody for intensive 
investigations. 

The Head of the Provincial Border Affairs, FX Suryanto, was the victim of a car 
shooting while travelling in Wutung, near the Papua and PNG borderline. 

This report and previous ones can be found at www.reliefweb.int 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The Jakarta Post.com
Latest News
12/20/2002 6:09:27 PM
Bishop Belo refuses to dignify RI court with appearance 

DILI, East Timor (JP): East Timor's outgoing bishop, Carlos Belo, hit back on 
Friday at accusations he had made a fool of an Indonesian human rights court 
hearing charges against Indonesian military officers, saying he would never 
appear before it. 

In a written statement released on Friday, Belo vowed that he would only 
testify before a United Nations court, amid widespread criticism that the legal 
proceedings in the Jakarta court were a sham. 

"I will only give evidence in front of an international court carried out by 
the United Nations in East Timor," Belo, a Nobel peace prize winner, said in a 
statement written in Portugese, as quoted by AFP. 

The Jakarta ad hoc court expected Belo to testify via a live video link from 
East Timor earlier this week, but he was never actually contacted about it. 

Belo's absence sparked an outburst from Binsar Gultom, a judge at the human 
rights court, who accused Belo of "making a fool of the court." 

"Belo's testimony was badly needed to explain discrepancies between statements 
in the official investigative report and witness testimony," Binsar said as 
quoted by Kompas on Thursday. "If he doesn't appreciate the court then he 
doesn't need to be appreciated. It's useless for him to be a bishop," Gultom 
added. 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Indonesia's Court for East Timor a "Whitewash"
Human Rights, Fri 20 Dec 2002 
(New York, December 20, 2002) 

The Indonesian ad hoc court for East Timor has utterly failed to bring to 
justice perpetrators of the 1999 violence in East Timor, Human Rights Watch 
said in a new briefing paper released today.

"The trials in Jakarta have been a whitewash. Indonesia has failed in its 
promise to hold the military accountable for the atrocities in East Timor." 

Brad Adams Executive Director of the Asia Division at Human Rights Watch   To 
date, only 12 people have been tried before the Ad Hoc Human Rights Court for 
East Timor in Jakarta, and 10 have been acquitted. Of the 10, nine were 
Indonesian military and police personnel. The court has convicted only two 
people; both are East Timorese. 

"The trials in Jakarta have been a whitewash," said Brad Adams, executive 
director of the Asia Division at Human Rights Watch. "Indonesia has failed in 
its promise to hold the military accountable for the atrocities in East Timor."

The United Nations secretary-general should commission an experts' report 
examining the failure of the ad hoc court, Human Rights Watch said.

In the 13-page briefing paper, Human Rights Watch stressed the obligation of 
the United Nations and its member states to ensure accountability for the 1999 
violence, which occurred after the people of East Timor voted for independence 
in a U.N.-administered referendum. In 2000, the secretary-general pledged 
to "closely monitor" Indonesia's trials to ensure that they were a "credible 
response in accordance with international human rights principles." 

The briefing paper describes the refusal of prosecutors to indict senior 
leaders such as then-chief of staff General Wiranto, named by the Indonesian 
Human Rights Commission as responsible for the 1999 violence. President 
Megawati Sukarnoputri later described many of the military leaders involved in 
the violence in East Timor as "national heroes" for their role in fighting for 
their country and publicly urged the military to "carry out your duties and 
responsibilities in the best possible manner without having to worry about 
human rights abuses."

"Indonesia's political leaders have created an atmosphere of impunity for these 
trials," said Adams. "It is clear that the most senior members of the 
Indonesian military responsible for the violence will receive only perfunctory 
trials. Some Indonesian military officers implicated in atrocities have 
actually been promoted." 

While all of the accused have been charged with crimes against humanity, the 
indictments only allege that they failed to control their subordinates, not 
that they actually planned and ordered the attacks themselves.

Verdicts in remaining cases are expected in the next few weeks. The tribunal's 
mandate is due to expire on January 3, 2003. Among the cases still to be 
decided are Major General Adam Damiri, former chief of the Udayana Regional 
Military Command, who has been indicted on two counts of crimes against 
humanity. 

"We do not recommend an extension of the mandate, since this process has proven 
to be fatally flawed," said Adams. "We urge the United Nations and donors to 
think of a different means of achieving justice based on international 
standards."

Human Rights Watch commended the efforts of a parallel process in East Timor, 
while noting serious technical weaknesses. The United Nations has created a 
special investigation unit and a special court in East Timor to hold 
perpetrators there accountable. Human Rights Watch urged donors to provide more 
training and resources to judges, prosecutors and investigators and called for 
an extension of the mandate of the special court and investigators in Dili.

In September 1999, the Indonesian National Army and Timorese militias carried 
out a campaign of murder, arson and forced expulsion after the people of East 
Timor voted for independence in a United Nations-administered referendum. After 
almost 25 years of brutal occupation, an estimated 1,000 to 2,000 East Timorese 
civilians lost their lives in the months before and days immediately after the 
voting. Approximately 500,000 people were forced from their homes or fled to 
seek refuge.

Related Material:

Justice Denied for East Timor 
http://www.hrw.org/backgrounder/asia/timor/etimor1202bg.htm
HRW Backgrounder, December 20, 2002 

Indonesia Verdict Confirms Justice Elusive for East Timor Crimes 
http://hrw.org/press/2002/08/etimor081502.htm
HRW Press Release, August 15, 2002 

East Timor: Special Panels for Serious Crimes 
http://hrw.org/press/2002/08/etimor-ltr0806.htm
HRW Letter, August 6, 2002 

East Timor Amnesty Bill Flawed 
http://hrw.org/press/2002/07/etimor0718.htm
HRW Press Release, July 18, 2002 
--------------
© Copyright 2002, Human Rights Watch, 350 Fifth Avenue, 34th Floor, New York, 
NY 10118-3299, USA
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The Age (Melbourne)
Healing a nation's wounds
December 21 2002
-- Melbourne surgeon Alan Saunder discovers the realities of third-world 
medicine in Dili.

Cock-a-doodle-doo - another delightful Dili dawn, another wake-up call from the 
local poultry. As the sun emerges from behind the rim of hills encircling East 
Timor's capital, the air is already warm, the sky clear and the city stirring. 
It's 6.30am, time for a morning walk to the beach before beginning the day's 
duties at the hospital.

On the streets, those roosters are now frantically picking at the dusty road 
for invisible morsels. Pigs forage along the side of the street. Dogs scuffle, 
as if to get any disagreements out of the way before the heat of the day. 
People emerge, similarly keen to go about their business before the temperature 
rises.

At the bowserless petrol station, diesel is decanted, ready for sale, into 25-
litre plastic containers. Next door, the coffin maker displays a magnificent 
array of timber boxes in various states of readiness for the inevitable. 
Beyond, surveying the harbour, stands Jesus, 27 metres high, arms outstretched, 
looking down on the fishermen as they check their nets for the day's outing.

As I stride down the dusty road, I am greeted regularly with the friendly Tetun 
morning call, bondia, to which I happily reply the same. What a way to start 
the day - with such friendliness from such outwardly happy and desperately poor 
people.

I am mid-way into a four-week stint relieving Dr Glenn Guest as general surgeon 
at the Dili National Hospital, part of a program run through Ausaid and 
organised by the Royal Australian College of Surgeons. Already I find myself 
settling into a routine far removed from my Melbourne existence.

At home I am a vascular and transplant surgeon, a skill that invites wry 
amusement in Dili, given the absence of anything remotely like a transplant 
program. Here I am, surgery's equivalent of the jack-of-all-trades, and 
learning all the time.

At 7.45am, I meet my colleague, Dr Taco Walbeehm, an experienced Dutch surgeon, 
outside the hospital bungalows we call home, and the daily surgical routine 
begins.

We make our way to the intensive care unit. This is not intensive care as we 
know it in Australia - there are no machines for ventilating patients, cardiac 
monitoring, dialysis or the like. The "intensive care" comes in the form of a 
nursing ratio of two patients to one nurse. Today the unit has three patients 
to review.

The first is eight-year-old Moses. We operated on him yesterday to repair a 
tear in his small bowel - the result of a fall from a coconut tree. The injury 
had been straightforward to repair, and this morning he is surprisingly well 
and essentially pain free. Much of the credit must go to our anaesthetic 
colleague, Dr Dave Sandford, from Sydney.

We move on to Carlos, 34, who severely injured his spine weeks ago in a road 
accident. He shows few signs that he will recover the use of his arms and legs. 
He is in ICU because there is nowhere else for him to go. His prognosis is poor.

Our next patient is even more of a worry. Ely, 11, has tetanus - something rare 
in first-world medicine. The only other case I have seen was in Kenya as a 
medical student 20 years back.

Ely is from Atauro, an island about 20 kilometres north of Dili, and his family 
travelled overnight in an open boat to bring him to hospital. His spasms were 
difficult to control initially, and as he deteriorated he showed some of the 
classic features of tetanus: the sardonic smile that is associated with 
lockjaw, and extreme arching of the back with each spasm. His contortions are 
so violent he appears to have fractured his lower spine.

Dave, the anaesthetist, has got his hands on some midazolam, a short-acting 
sedative and anti-spasmodic. It has worked like a dream for the past 24 hours, 
but we know that by afternoon there will be no midazolam left in the hospital 
or, as it turns out, in the country. 

It is awful to watch this previously healthy boy in excruciating agony. Knowing 
it can be avoided by immunisation just makes it more painful. Anyone who has 
read this far and is overdue for their tetanus booster should visit their GP 
today!

A ward round follows. This morning we concentrate on the female and paediatric 
ward. 

The majority of patients are stable and recovering as expected. This is one of 
the great attractions of surgery - most patients do get better. However, there 
is one 10-year-old boy who has been here for months with extensive 
osteomyelitis (inflammation of the bone) in his left leg. Both our clinical 
assessment and the X-ray results are not encouraging. 

By 9am, it is time to go to theatre. As Dave prepares the first patient, Taco 
and I take a moment to support East Timor's struggling economy by buying a cup 
of coffee - the new nation's only agricultural export product.

Salvadore - our major case for the day - is prepared and on the table. Taco and 
I will work on him together. He has benign prostate disease, common in East 
Timor in older men, but here they seek medical attention much later than in 
Australia. The prostates are therefore enormous and, because of a lack of 
suitable telescopic equipment in Dili, most are removed by open surgery, 
cutting through the lower abdomen and the bladder. Taco acts as my surgical 
mentor, instructing me in this unfamiliar procedure. It's all over in less than 
an hour.

Taco and I tackle the remainder of the day's list separately. There's the 
removal of a benign breast lump; a burns dressing that needs changing; a 
fracture to be placed and set; a sigmoidoscopy (inspection of the rectum and 
colon); and a circumcision on an adult man.

Day surgery in Dili is simple. The patients turn up to the operating theatre at 
8am, await their turn and walk into theatre. They remove the appropriate 
garment once they are on the operating table, are anaesthetised and then 
operated on. 

The circumcision is under local anaesthetic, and at the end of it the man pulls 
up his shorts and walks out of theatre and home. Even day-case patients 
receiving a general anaesthetic will spend only 20 minutes or so in the 
recovery room before going home.

The last case of the morning is Jose, who has stripped the flesh from his lower 
leg down to the bone in a motorbike accident. This is his fourth journey to 
theatre to clean the exposed wound and prepare it for a graft. 

We emerge from the air-conditioned theatre just after noon. Walking back to my 
bungalow I hug the shaded walkway where I can. The sun burns as if concentrated 
through a magnifying glass. Lunch is a sandwich, a litre of ice-cold water and 
a 30-minute siesta in the blessedly cool bedroom.

By 2pm we're due back at the hospital for the outpatient clinic. Conducted in a 
covered open air area with one shared consulting room, this is what you might 
call a very public health system. The only privacy is provided by a screen 
around a couch and an adjoining room with a bunk for examinations.

Maria and Fatima, who run the clinic, advise that this afternoon we have 45 
patients to see. Many are here to have their dressings reviewed or to show us X-
rays of broken bones, which are all mending well.

A 12-year-old girl hops in, unable to put her right foot on the ground. Her 
forefoot is grossly swollen and an examination of the sole reveals a grubby 
closed wound under the tough plantar skin that is testament to her barefoot 
existence. She needs to be admitted to hospital so her foot abscess can be 
drained and then X-rayed to see if there is something buried in there.

Another patient has a chain of enlarged lymph glands down her neck - a typical 
manifestation of tuberculosis in East Timor. She will need to be treated by the 
hospital's sole physician.

One of the last patients I see is six-year-old Maria. She had a biopsy of her 
right leg six weeks ago after complaining of a slightly painful lump just below 
the knee. The pathology has taken all this time to come back, and reveals she 
has a bone tumour.

In Australia, chemotherapy and limb salvage surgery would give her about a 70 
per cent shot at a cure. But here, no appropriate chemo is available. The only 
treatment option for her is an above-knee amputation, which has a cure rate of 
about 10 per cent.

We discuss the possibility of her having treatment in Australia, if we could 
find a way to finance it. (As it turned out, this was impossible to organise. 
At last report, Maria was in the care of a local medicine man.)

After the clinic, we check the emergency room for any new arrivals and find 
Armino, a patient who had an emergency abdominal procedure some weeks back and 
has returned vomiting, emaciated, dehydrated and with a palpable mass on his 
upper abdomen.

It feels like a tumour, probably obstructing his stomach, but we have no 
medical notes to guide us on his history. Armino, 20, needs immediate 
intravenous rehydration. 

It turns out the earlier surgery removed part of a tumour in his small bowel. 
As with Maria, it has taken six weeks to get the pathology back from Melbourne 
and it reveals he has Burkitt's lymphoma. The drugs he needs will have to be 
imported - but will they arrive in time?

The care of such patients, many of them malnourished, in a tropical environment 
and with limited resources, is a real challenge. It makes me reflect on the 
extravagance of some of our own treatments and how much we take for granted in 
our hospital system.

I head for the small office where I have access to the world, my Melbourne 
practice, my surgical colleagues and my family via the Internet. Glancing 
outside, I watch some local boys play soccer in part of an old coconut grove. 
Their bare-foot skills are astounding, and I wonder whether the next Pele or 
Maradona is lurking here among the coconuts in Dili. 

Despite the heat, I need supplies - especially more fluids - so I make my way 
downtown to the Hello Mister supermarket. 

The landscape is notable for two things - the dust and the shipping containers. 
They are everywhere. The containers serve as offices. Stacked on top of one 
another, they are apartments. 

The neighbourhood is riddled with the burnt shells of what were once houses. I 
find myself wondering what atrocities have been witnessed in these streets.

Back at the bungalow complex, Taco and I talk shop and politics over Tiger beer 
before our thoughts turn to dinner. Taco is a veritable Age Good Food Guide for 
Dili. The influx of United Nations personnel has created a thriving restaurant 
scene. He recommends a local wairung and, along with Dave, we indulge in some 
of East Timor's fabulous fare.

Back in my bungalow afterwards, I call home, check the air-conditioner and 
light the mosquito coil. I read up on the nuances of an unfamiliar procedure I 
will be tackling in the morning, and dip into a phrase book to try to master a 
few more snippets of Tetun.

Drifting into sleep, I can't get past my good fortune: at being Australian; at 
being an Australian-trained surgeon with the capacity to contribute to this 
Ausaid project; at having a part to play in helping this poor, fledgling 
neighbour; at having supportive colleagues and a loving family back in 
Melbourne who have given me the chance to be here.

My mind turns to the roosters. How long till they crow again?
-- The Ausaid hospital program is organised by the Royal Australasian College 
of Surgeons, and provides a consultant anaesthetist and a general surgeon for 
Dili National Hospital for an initial period of three years. The program has 
just completed its first year.