Timor-Leste. Health Sector Resilience and Performance in a Time of ...

Box 3: Maternity Waiting Camp – Some unanticipated effects experiencedSoon after the violence erupted there were reports that some women had given birth in IDP camps, at timeswithout a skilled attendant. Throughout the crisis access to comprehensive obstetric emergency care waslimited as a result of fear in seeking care at the hospital because of insecurity in its environs, and limitedambulance services. A maternity waiting camp was established at Guido Valadares National Hospital in response.The maternity waiting camp (MWC) sought to remedy the problems of access to birthing services and emergencyobstetric care. This strategy was largely based on the maternity waiting home policy that had been developedin 2005 [13]. After consultation between UN agencies, the Ministry of Health and hospital management 20 tentswere set up as a maternity waiting camp at Dili National Hospital in June. These tents were designated forwomen in the final stages of their pregnancy. A local NGO, Rede Feto, supported by the UNFPA, was responsiblefor locating, encouraging and transporting pregnant women from IDP camps to the MWC.Initially, miscommunication as to when the camp would be ready and what commodities would be offered wasevident. At the MWC pregnant women received three meals a day plus snacks (provided by the hospital), andnon-food items such as mattresses, washing tubs, water containers, baby clothes, stoves, hygiene kits andkitchen utensils (provided by the government, UN agencies and NGOs). Health promotion activities at theMWC were conducted by local NGOs, and included information on the risks associated with pregnancy, theimportance of skilled attendance at time of delivery, essential newborn care, breastfeeding and earlyimmunization.An evaluation conducted by Rede Feto in August 2006 found that 74 pregnant women had been transferred tothe MWC. The evaluation identified security as a major concern including lack of security during transfer to theMWC, difficulty for mothers and babies to sleep due to noisy conditions in the camp; postpartum women beingasked to return to their homes by hospital staff but were too frightened to do so; and some who did return homeexperienced intimidation and returned to the hospital camp [14]. More positively, the evaluation highlighted asbeneficial the safety women felt being close to medical assistance and the availability of good food.Negative experiences included the lack of security and overcrowding at the hospital. The hospital alreadyhoused a large IDP camp when the MWC was established, and because the 20 tents for pregnant women wereset up all at the same time, but women were brought in gradually, the tents that were designated for pregnantwomen became occupied by other families from the surrounding camp. Thus the MWC may have contributedto increasing the number and crowding of IDPs at the hospital. There were also issues of equality, with IDPs atthe hospital camp expressing resentment, and in some cases open hostility, toward women at the MWC becausethese women received significantly more food and non-food items.While the government tried to decommission the IDP camp at the hospital, the MWC continued to operate, andthe end date for the project extended. By 20th February 2007 there were no pregnant women staying at theMWC, and 49 postpartum women and their families occupied the tents. Once women had their babies, theywere reluctant to leave because they felt safe at the hospital and were provided with food [15].The hospital director complained and then I took the issue to [an international NGO] and asked them notto set up more tents. The Hospital Director didn’t feel brave to get them out of the tents. The otherproblem is that the police didn’t function at that time so it is difficult to control them, the IDPs didn’t trustus, and also the security guards ran away as well…the IDPs were angry at our midwives and thedirector of hospital because they did not want to get out from the tents, [but] they were told to get out. –Senior manager, Ministry of HealthDespite the effort made to increase access to birthingservices for displaced women, the actual number ofmaternity admissions to Guido Valadares in the latterpart of 2006 was down considerably from 2005 (Figure13, see also Figure 7). These reduced admissions tothe maternity ward probably reflects both the reluctanceto attend the hospital due to security fears and thereduced number of pregnant women in Dili as theyfled to the districts.Figure 13: Total number of admissions to the maternity ward atDili National Hospital, per month for 2005 and 2006. SourceTimor-Leste Ministry of Health24 TIMOR-LESTE HEALTH SECTOR RESILIENCE AND PERFORMANCE IN A TIME OF INSTABILITY