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

Additional resources were mobilised to both providehealth services to displaced people in IDP camps andcontinue delivering mainstream hospital and CHCservices in Dili. The MoH, Hospital Director, and DiliDistrict Health Services had access to a unique additionalresource: the Cuban Medical Brigade (CMB). Based inDili, but distributed across the country, the CMB wasdirected to support areas of increased need.The CMB, working within the MoH and reporting directlyto the Director of Dili District Health Services, contributedFigure 15: Displaced staff accommodated in Districts.crucial “surge capacity” when mainstream services were Source Timor-Leste Ministry of Healthstretched. The hierarchical management structureallowed staff members based in districts to be rapidly deployed to Dili; with the fact that they were not party to theconflict enabled them to offer services without fearing for their own safety. Extensive 24-hour and mobile serviceswere established. The CMB also played a significant role in staffing Dili National Hospital .It’s an IDP situation in an urban environment where there are a lot of clinics and people are not living in thecamps 24 hours but the Ministry did a pretty good job of getting the Cuban doctors based there, understandingthat there were still some cultural differences between the Cuban doctors and the population and not everyonefelt comfortable going to them but they were there in the sense that in an emergency and if there was anoutbreak of chicken pox or whatever they could help to respond… - Manager, international NGO, DiliIn the early stage of the crisis, NGOs and UN Agencies assisted by providing or obtaining needed fuel and drugs tomaintain operations, especially in the peripheral districts.Bairo Pite Clinic provided its usual services and was well utilised; the service was known to be operational andtrustworthy. It was considered safe to attend, although in early 2007 violence in the Bairo Pite area affected perceptionsof safety. At the height of the crisis, the Bairo Pite ambulance was able to go to areas otherwise inaccessible to thenational ambulance services due to road-blocks, violence, or fear.Many services also redirected their limited resources and energies to where they were most needed; those consideredlow priority ceased.Things that were not too important at that time, like physiotherapy, we canceled it and all of the staff came tohelp … and also from the outpatient department, we needed them to cover all the wards, and also we askedhelp from the Cuban Doctor Brigade and their help was about getting the extra personnel [doctors andnurses] that they have in districts, so we had the support from nationals and from the Cubans.- Senior health services manager, DiliNo evidence of inappropriate charging for services was identified; health workers did not take advantage or seek toexploit the situation of need for personal benefit. Rather, the opposite is often evident with a number of policymakers and practitioners extending themselves to be of service to the community. This sense of commitment isespecially evident in the following quotes from TB program officers:As a human being I did not feel secure, but for the sake of our professionalism, our job and our nation, wemust be patient, despite my personal situation not being secure. I kept committed and maintained the principlethat when I did not commit any wrongdoing to other people during the crisis, I will stay to continue my work.That was the reality. When the crisis was getting worse, I still stayed to continue my work. I stayed in myTIMOR-LESTE HEALTH SECTOR RESILIENCE AND PERFORMANCE IN A TIME OF INSTABILITY 33