Timor Leste

	Country Snap Shot & Eyecare Profile
	Country Timor Leste Region South East Asia Capital Dili Area (sq/km) 15,007 Geography 1 Island Provinces / Districts 13 *Population 1,062,777 *Population Below Poverty Line 42% *Infant Mortality/1000 births 45.89 *GDP Per Capita ($US) $400 Schools of Optometry 0 Optometrists 0 Ophthalmologists 2 Optometrist Association No Vision 2020 Signatory  No Vision 2020 National Plan No National Eyecare Health Plan In Progress

Project Manager
Dr Suit May Ho

Project Personnel

Project Aim
To develop a sustainable eye care delivery system for Timor Leste.

Project Commencement
2000

Project Background / History
The nation of Timor Leste has an estimated population of 1,062,777. From September 1999 until early 2003, there were no active permanent eye care personnel to support the eye care needs of the population. Prior to 1999, eye care services were delivered by visiting Indonesian doctors. When the referendum for independence was held in 1999, these services discontinued and any existing eye care infrastructure was destroyed in the violence that followed.

ICEE’s involvement with eye care in Timor Leste began with participating in service delivery trips in 2000. Participation in these trips soon evolved into the development of permanent eye care services in partnership with the Ministry of Health (MOH) and other organisations.

Project Activities
The main activities that ICEE conducts in partnership with the Ministry of Health are assessing the need for eye care services and planning; development of the human resource base required to provide eye care; and creating infrastructure for an appropriate, accessible, affordable and sustainable eye care system. Close contact is also maintained with service delivery teams to promote integration of eye care activities in Timor Leste.

1) Assessing The Need For Eye Care Services And Planning
In collaboration with the Ministry of Health, ICEE provided support for the preparation and delivery of a National Eyecare Program planning workshop for Eyecare Nurses, Doctors and Managers, held in November 2004.

Financial support and technical assistance was provided by ICEE to assist the Ministry of Health in the implementation of a population based Eye Health Survey in the Dili and Bobonaro Districts between March-May, 2005. This survey found that almost 1 in 20 Timorese people older than 40 years is blind, with those living rurally and the poor most at risk. The information will be used by the Ministry of Health to assist in the development of a five year strategic National Eyecare Plan.

2) Human Resource Development
With the generous support of collaborating partners, over the past five years ICEE has delivered primary eye care training, refresher courses, and training workshops for nurses. In addition, ICEE sponsored five nurses to attend a one-year eye care training course at the LV Prasad Eye Institute in Hyderabad, India. Furthermore, optical technicians were trained to run the optical workshop in the Guido Valadares National Hospital in Dili.

Monitoring visits to the eye clinics of eye care nurses from the Los Palos CHC and Maliana Referral Hospital were undertaken by ICEE. Evaluations of the nurse’s skills and knowledge, were conducted in order to facilitate planning of continuing education requirements and for purposes of the Ministry of Health human resource skills database.

3) Creating Infrastructure
ICEE has established a permanent supply of affordable readymade spectacles in five districts, including the National Hospital in Dili and four district eye clinics. The establishing of an Optical Workshop facility by ICEE at the National Hospital in March 2005, including the training of three Timorese Optical Technicians to edge and fit spectacles, has enabled the ordering and distribution of custom-made spectacles to all eye clinics in order to service those with more specific visual requirements.

ICEE also procured equipment to enable the establishing of five eye clinics in Guido Valadares National Hospital, Maliana Referral Hospital, Suai Referral Hospital, Oecusse Referral Hospital, and Los Palos CHC.

4) Supporting Nutrition Programs
ICEE is also supporting the important work of Forum Comunicações Juventude Oratorio Don Bosco (FCJ) in providing food for street children in Dili. The program aims to give each child one meal a day, and supports up to 30 children each day. FCJ also provides teaching for the children who would not otherwise have access to education.

HIAM Health, a local Non-Government Organisation, that provides support for patients and outpatients at the Guido Valadares National Hospital, particularly those in extreme poverty who have no means of support while they are in hospital and away from their villages, has also received support from ICEE.

Project Achievements

1) Eyecare Service Delivery
ICEE directly co-ordinated the service delivery teams in the early years of the program. Typically, teams comprised of 2-6 staff and volunteer optometrists who worked in eye clinics that traveled to various locations for a two-week period.

Since 2003, ICEE has supported and continued to liaise with groups responsible for the delivery of interim services and attempted to integrate these with the development of local capacity. To date ICEE has contributed to the screening of 30,000 people and the dispensing of 18,000 spectacles.

2) Human Resource Development
In partnership with the Ministry of Health and the National Centre for Health Education and Training, ICEE has made the following contribution to Human Resource Development:

• Primary Eye Care training for 22 nurses from all districts of Timor Leste, and refresher training for 15 of these nurses.
• Onsite-monitoring visits to these nurses to understand barriers to the implementation of their training.
• Refresher training to nurses at the Eye Clinic at the Guido Valadares National Hospital.
• Supported five nurses to undertake one year of ‘Vision Techniques’ training at LV Prasad Eye Institute (LVPEI), India. The course has a strong emphasis on community eye care and clinical techniques, including refraction. LVPEI is a leading eye care training facility with expertise in eye care training, research and development and prevention of blindness activities.
• Undertook mentoring visits to these eye care nurses at their clinics.
• The head of the Non-Communicable Diseases Unit at the Ministry of Health was supported by ICEE to undertake a three week training program ‘Planning and Management of Eyecare Programs’ as preparation for the development of the National Eyecare Plan.
• Trained three optical technicians to edge and fit spectacles, in order to provide spectacles for the National Program.
• Two ophthalmologists from Guido Valadares National Hospital were trained by ICEE program personnel in the use of A-scan and Keratometer equipment, provided by ICEE, for pre- and post-surgical assessment of cataract patients.

3) Creating Infrastructure
In partnership with the Ministry of Health and Guido Valadares National Hospital, ICEE has made the following contribution to eye care infrastructure:

• In 2003, established a permanent supply of affordable readymade spectacles at the eye clinic at the National Hospital. A seed donation of spectacles was given and a rotating fund established, whereby further spectacles are ordered as required, and the small profit invested in the local delivery of services. This system includes subsidization for those individuals who cannot afford to pay the price of the spectacles (USD3). In 2005 another range of spectacles became available at a price of US$1.
• Equipment was procured for the eye clinics at the National Hospital, Maliana, Los Palos, Suai and Oecusse Hospitals.
• Procurement of equipment for the Optical Workshop at the National Hospital.

4) Research
In 2005, ICEE in partnership with the Ministry of Health, conducted a survey to investigate the prevalence and causes of visual impairment, utilization of eye care services, willingness to pay for services and vision related quality of life. The results of this survey will serve to inform the development of the national eye care plan.

Project Partners
Ministry of Health Timor Leste
ProVision
East Timor Eye Program

Project Sponsors
Paul Brown Optometrist
Silverton Foundation
Ian Melrose
ProVision
Optometry Giving Sight

	PerSONAL STORY
	Alito Soares from Maliana and Joao da Cruz from Los Palos completed a one year eye care course at LV Prasad Eye Institute in 2003-2004. ICEE has equipped two clinics where Alito and Joao will be based. The clinics will serve a rural population of approximately 120,000, whereby people suffering from eye problems can access eye screening and refraction services by the trained eye care nurses, a service that was previously unavailable. In their own words: “The training we have had will be very useful for the people of East Timor as there is a big need for eye care there. We hope the good cooperation between ICEE and the Ministry of Health continues in the future. I have learnt many useful skills and I hope ICEE continues to work in East Timor so we can continue to upgrade our skills. I look forward to working with and for the people of East Timor – I know they are waiting for us to get back to begin our work!” Alito Soares “There are many barriers to people being able to use eye care services in East Timor, so we will need to work with our communities to overcome these together. After this training I want to use what I have learnt to benefit the people of East Timor - I now feel much more confident to manage their eye care problems and I look forward to beginning my work. ICEE supporting me to come and study eye care in India has been one of the best things to happen to me. I want to say thank you to ICEE and to everyone involved in making this possible.” Joao da Cruz