Building infrastructure while building capacity: improving the quality of health services in rural Timor-Leste

 

 

In Timor-Leste’s Ermera District, 102 out of 1,000 children die before their fifth birthday which is the highest child mortality rate of all the country’s thirteen districts.[1] This ominous statistic clouded my mind in early March as I stood in front of the Gleno Community Health Center, the primary referral center for Ermera’s population of approximately 117,000, when an ambulance careened around the corner of the maternity building carrying a woman in labor.

Gleno Maternity Ward staff participate in newborn resuscitation training conducted by Health Improvement Project partner St. John of God Health Care.
Gleno Maternity Ward staff participate in newborn resuscitation training conducted by Health Improvement Project partner St. John of God Health Care.

Considering that 78% of births are delivered at home and only 30% of births are attended by a skilled provider in Timor-Leste, the arrival of this woman marked an important event: she was one of only 15 women to deliver at the Gleno maternity ward in March. Given the limited transportation options for emergency referrals, it was even more remarkable that a functioning ambulance transported her there.

As I watched the ambulance pull up in the muddy lot facing the maternity ward, I thought of the incredible odds against the passenger inside – not only based on statistics, but based on my observations of the facility itself. Prior to the young woman’s arrival, I had completed a tour of the community health center’s three buildings, including inpatient, outpatient and maternity wards, with my colleagues from USAID’s Health Improvement Project (HADIAK) and members of the U.S. Navy Construction Battalion – known as “Seabees.” Our team was there to assess the improvements required, both through technical assistance and infrastructure, to improve the health center’s standards of service.

Project staff and U.S. Navy Seabees excavate and examine the water pipes at the Gleno Maternity ward to assess their viability.
Project staff and U.S. Navy Seabees survey the water pipes they constructed to connect the water tank to the maternity ward.

The initial assessment revealed that there was no running water in any of the buildings, despite the presence of a water tank on site. While community members were using this reservoir to wash clothes, the water was not available for the births happening less than 100 feet away. We learned that midwives were paying children to carry buckets of this reserve water to the maternity ward during deliveries for the washing and cleaning of equipment, therefore dramatically increasing the chances of infection for the mothers and newborn children. Our team also noticed the broken conditions of the maternity beds and the electrical equipment necessary for childbirth sitting uselessly to the side, functionless without power.

Over the months of April and May, the Seabees lay a gravel driveway leading to the maternity ward that ensured a clear path for the ambulance and proper drainage, and they connected piping between the water tank and all facilities to ensure a continuous flow of running water. They also replaced non-functioning lights and fans and connected a generator to the outpatient and maternity wards to ensure 24-hour electricity. The HADIAK team and our partner, St. John of God Health Care, oversaw trainings in basic hygiene, hand washing with soap, and basic life support skills, and also assisted to assemble donated equipment in the maternity ward.

The entire project was the result of a successful collaboration of partners that also included the Australian Defense Cooperation Program, local community organizations, and local and national government agencies.

The Gleno Maternity Ward before and after undergoing renovations based on assessments made by the Health Improvement Project.
The Gleno Maternity Ward before and after undergoing renovations based on assessments made by the Health Improvement Project.

Being involved in this effort allowed me to see first-hand that forming partnerships is a powerful way to mobilize resources and achieve real change, even when using low-cost interventions. The resulting improvements guarantee that Gleno Community Health Center has all the equipment and standards in place for safe and clean delivery and for the initial stabilization of birth complications.

This June, we celebrated completion of the renovations in the presence of community members and several dignitaries, including the Timor-Leste Vice-Minister of Health, U.S. Ambassador, Australian Ambassador, and USAID Mission Director. News of the ceremony was featured in the Timorese media.

I often think of that mother who arrived at the facility in March. She survived that day, and I am hopeful that many more mothers and newborns will, too, as a result of the improvements.


[1] Timor-Leste Demographic and Heath Survey 2009-2010.

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