What do MCHIP, the US Marines, and crocodiles have in common? In Timor-Leste, MCHIP coordinated a recent visit by the 15th United States Marine Expeditionary Unit, which arrived in country on October 10, 2012 for various activities, including a joint training exercise with the Timor-Leste Defense Force (F-FDTL). This operation, dubbed “Joint Exercise Crocodilo,” focused not only on military-to-military training, but also on community relations events such as school sports tournaments, book donations to schools, engineering training, and medical and dental assistance to Timorese citizens. So, where does “Crocodilo” come from? The crocodile is part of the nation’s creation myth, and the island on which this small country is situated is shaped like a crocodile. The crocodile is respected as the “friendly and wise” animal, so “Joint Exercise Crocodilo” was a natural name for an effort to encourage defense and humanitarian cooperation between the American and Timorese people.
Timor-Leste is a post-conflict, fragile state, and many of its health and development indicators, especially immunization coverage, are the poorest in the Asian region. Seventy percent of the population is rural, with most people living in small, scattered villages isolated by mountainous terrain and poor roads. Limited access to health facilities is one of the big challenges faced by the health system: Average walking distance from household to nearest health facility is about 70 minutes, and during the wet season, even short distances become impassable. As a result, outreach activities are often postponed or never occur.
The Imunizasaun Proteje Labarik (IPL) project in Timor Leste, funded by the Millennium Challenge Corporation (MCC) and managed by MCHIP in collaboration with USAID/Dili, assists the Ministry of Health to identify and plan outreach activities from Community Health Centers to hard-to-reach communities. In spite of what is planned, many times these activities cannot be executed due to bad road conditions, heavy rain, and flooding, as well as shortages of staff and operational funds for transport and per diem. “Joint Exercise Crocodilo” was planned to take advantage of the US Marines’ helicopters as well as skilled professionals, which could enable services to reach communities in very remote areas. “Joint Exercise Crocodilo” carried out 10 integrated outreach activities in five Imunizasaun Proteje Labarik-focus districts, namely Ainaro, Baucau, Ermera, Manufahi, and Viqueque, from October 10-15, 2012. MCHIP mobilized communities through church meetings, community radio spots, community health volunteers and staff, and local leaders to inform the people that the services were coming to their village. The US Marines and the Ministry of Health offered the following services: surgery referrals to local hospitals, dental care, optometry screenings, eyeglass prescriptions, and medications for minor illnesses or injuries. MCHIP also managed the human resources, including vaccinators and translators, as well as other necessary immunization equipment to make the exercise successful. Mr. Thomas, a health staff member of Viquequevila CHC said, “ Since independence, this is the first time we have seen such activities in such remote areas where many patients received eye glasses at no cost, and many children [were] vaccinated.”
While this exercise was successful in immunizing over 60 children, these same children require additional vaccinations and many more children remain unvaccinated. The ongoing challenge to the Ministry of Health and MCHIP’s Imunizasaun Proteje Labarik project is to establish ways to enhance the equity of health services by reaching these poor, isolated communities on routine basis.
Imunizasaun Proteje Labarik is highly valued by the Ministry and other stakeholders. “They demonstrated capability to handle and manage such a big event,” said one Ministry of Health official at the closing ceremonies. US Marine Dentist Shukor described his experience, saying, “The 15th US Marine Expeditionary Unit is very happy to provide medical and dental care among the people in very hard-to-reach communities that are indeed in need. I would like to thank IPL for organizing such event and supporting us.” “Joint Exercise Crocodilo” was called a success by the Ministry of Health, as it promoted equity and enhanced access to basic health and immunization service while strengthening the partnership between the American and Timorese people. MCHIP’s Imunizasaun Proteje Labarik was honored to be included in this effort and is committed to continuing these efforts at its best.