Timor-Leste Health Care Seeking Behaviour Study - Secretaria de ...

Box 7: Setting aside medicine forfuture use“They get [medicine] from health staff atthe time of consultation, they keep/storethe medicine [rai hela] then whensomeone falls ill they just give it, e.g.diarrhoea, headache, and they think thatthe kader/PSF will help first, it is not thatthe health staff give permission tokeep/store the medicine but they do itprivately and for their neighbours”.Xefe sucoSeveral users who lived a long distance from ahealth facility and without access to apharmacy or kiosk, ensured their access tomodern medicine by setting aside part of acourse of treatment (mentioned as raimeaning to keep or to store) for use at a laterstage (see Box 7). When a child subsequentlyfell ill (with such symptoms as diarrhoea,headache or itchy body), parents administeredthe medicine from the stored supply. Severalinformants mentioned obtaining the drugsfrom a relative or neighbour who had recentlysuffered the same illness and may have setsome medicines aside, thus avoiding the longjourney to the health post. These strategieshighlight people’s demand for modern medicine and the difficulties encountered by families ingetting sick member (child or adult) to distant health facilities (see Box 8).Drugs were also purchased from kiosks,obtained from teachers or villageleaders, or from health providers (outof-hours)at home. One village headmentioned a retired nurse who hadestablished a small business sellingmedicine and administering injectionsfor a fee. Where a health post waslocated nearby a market, and both weredistant from the village, a few users andproviders spoke of taking theopportunity to ‘get medication’ byvisiting the service when they took theirproduce to market.4.2.8 ReferralBox 8: Storing medicine as a response todistance from health facilityWhy did you choose to come to this healthfacility?“I asked for medicine from them. If we did notcome [to SISCa], we must take sick children [to thedistant health post]. When the [SISCa] nursesarrive here, it is better to ask for medicine in orderto be prepared for someone falling ill, then we cangive medicine immediately because the healthpost is so far away”.Service user, BaucauA provider may recognise that the user’s condition is beyond the capacity of that level of healthfacility to treat, and recommend referral. Some users did not perceive this as a problem unlessdelay in getting to the facility of referral resulted in a negative outcome. Many actually expressedsatisfaction that the provider had the institutional support to refer to a higher level facility toincrease the likelihood of a positive outcome. Positive views of services are conveyed to others; sotoo are negative experiences.There was general appreciation of the health service referral system, with capacity for addressingemergencies at higher levels. However, users resisted referral for elderly patients where theybelieved a negative outcome (death in hospital) would result. A doctor working in the nationalhospital also mentioned that providers need to better identify illnesses for which referral isappropriate and may result in a positive outcome. In the event of a negative outcome, particularlydeath of a patient, the provider may be blamed. (In cases other than death, it appears that providerTimor-Leste Health Care Seeking Behaviour Study | 200934