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

Timor-Leste Health Care Seeking Behaviour Study | 200951Some community members appreciated health care staff allowing family members to take thepatient home temporarily when the hospital treatment did not appear effective as in these cases acustom-related cause was thought to be probable and needed to be resolved first before the patientcould return to hospital fortreatment (Bobonaro). SomeBox 14: Provider accommodation of custom asunderlying cause of illnessWhy are some people still thinking like this [perceivingcustom as cause]?For example, people first look to custom as causing theillness - they think that they neglected their ancestors,only after that do they seek treatment, otherwise itwould have no effect. Some come here [health facility]and at the same time go elsewhere to settle theunresolved custom matter. I have explained to some ofthem: as human beings we have come from God andfrom the ancestors, but when we fall ill we should go to ahealth facility because illness is caused by a virus. Weshould not think first of custom but should goimmediately to a health facility, and then at the sametime resolve any unsettled matter of custom. And don’tforget to pray to God.Nurse, sub-district level health post, Baucau Districttraditional providers such asmatan dook acknowledged theefficacy of hospital treatment,and claimed to send people tolocal health facilities after theyhad determined and resolvedany custom-related causes.Some providers expressedfrustration that patients andtheir families located far fromDili, such as in Oecusse, refusedto be referred to Dili fornecessary surgery as the familyperceived that the local facilityhad necessary equipment andstaff. The requirement forfamily agreement, particularlythe support of male familymembers, for referral wasanother cause of delay mentioned by a Dili-based midwife. One provider explained that rejection ofa referral for caesarean by a woman’s husband had resulted in the death of his wife. In relation tothird-level delay (receiving treatment in the facility), regulation to prioritise patients based onseverity was suggested.Section 5 – Discussion5.1 LimitationsBoth the survey and the qualitative component of the HCSBS had limitations. Time in each area wasa major constraint given the requirement that the study be truly national and carried out in alldistricts. Development of research instruments and training of field staff took longer thananticipated but was an essential part of local capacity building and central to achieving the researchoutcomes. More detailed ethnographic study was not possible, however this Study has identified anumber of areas in which such in-depth work would be of value (see 5.4, below). The concurrentconduct of the two components of the study did not allow for subsequent quantification ofbehaviours and preferences identified through the qualitative work.The survey covered three enumeration areas in each of the 13 districts; some randomly selectedenumeration areas were unable to be included because they had recently been surveyed as part ofthe TLSLS Extension Survey and household heads have begun to report dissatisfaction at repeated