Husband and wife Dr Bethany and Dr Jeremy Beckett are working hard to make a difference in the young state of Timor-Leste.
Western Australian GPs Dr Bethany Beckett and Dr Jeremy Beckett have long wished to take their medical skills to a country that really needs their help.
‘We wanted to make a contribution, something that would be professional and challenging and satisfying,’ Dr Jeremy Beckett told Good Practice.
Everything in the Becketts’ careers helped to prepare them for their eventual move. Both completed their general practice training at Perth’s University of Western Australia, with a focus on procedural skills for working in rural and remote areas. The couple’s 2009 move to Geraldton, a coastal town in the mid-west region of Western Australia, allowed them to practise these skills in local hospitals. They also continued their medical education in topics such as tropical medicine and international health and development.
While they considered Indonesia and Papua New Guinea as possible destinations for their overseas move, the couple found that Timor-Leste (or East Timor) kept coming up in the conversations. Many of their Geraldton neighbours had connections with the country, including a group of nurses who had worked there and some local high school students who travelled to perform outreach work.
The Becketts found that the more they looked at Timor-Leste, the more it made sense: they could easily register as medical professionals; the capital city, Dili, offers access to an international school for their children; the country’s native language, Tetun, is relatively easy to learn; and it is close enough to home that they could retain connections to family and friends. Timor-Leste is also a place where their skills would be of genuine use.
Decades of Portuguese colonial rule in the country were followed by occupation by Indonesia, which meted out retribution after the Timorese overwhelmingly voted for independence in 1999. The military crisis that followed saw up to 70% of the country’s infrastructure destroyed or rendered unusable, with three quarters of the population displaced.1
‘[Timor-Leste] lacks for very basic systems and administrative structures that the rest of us take for granted. That feeds into enormous social and health needs,’ Dr Jeremy Beckett said.
After Dr Jeremy Beckett secured a position in Dili in May of this year, the Beckett family – Jeremy, Bethany and their four children – made the move to the hot, humid and mountainous country of Timor-Leste.
While the Becketts have found great satisfaction working in Timor-Leste – Jeremy as Medical Director of Bairo Pite Clinic and Bethany delivering workshops in obstetrics and gynaecological issues to the clinic staff – their relocation has not been without its challenges.
‘Simple things are difficult [in Timor-Leste],’ Dr Jeremy Beckett said. ‘From cars that break down every week to administrative hurdles like getting new visas every month.
‘And then having four kids in the midst of that is a challenge. But, having four kids under seven is probably pretty busy no matter where you are in the world.’
The Becketts work hard to ensure their children have a positive experience in their new home.
‘We send our kids to the international school, which is our biggest expense,’ Dr Bethany Beckett told Good Practice.
‘But we try to balance that with not living in a bubble, being aware of what’s around us, and explaining to the kids what we’re doing and why we’re doing it.’
The Becketts are committed to their move and plan to stay for a significant amount of time – at least five or six years – to have the best chance at implementing lasting change.
‘When you come here, you become aware of the opportunity to do something really constructive and positive,’ Dr Jeremy Beckett said. ‘But to do that you need to dig in and spend some time working with local partners, and not just try to bring your own things from the outside.’
American Dr Dan Murphy founded Bairo Pite Clinic in an abandoned Indonesian military clinic in 1999.
‘Dr Murphy was providing free emergency care for war wounds and for civilians caught up in [the military crisis],’ Dr Jeremy Beckett said.
These origins cemented a strong relationship between the community and clinic, which remains very popular with local patients to this day. Bairo Pite cares for an average of 200 outpatients per day, delivers more than 100 babies per month and treats 2500 patients in emergency per year. All healthcare is free to patients.2
The clinic is a non-governmental organisation (NGO) funded entirely by donations. Juggling the finances is a challenging job and medical resources that can be taken for granted back in Australia, such as blood tests, are much more expensive and harder to access in Timor-Leste.
‘The annual budget is under $1 million [AUD], and that’s for employing over 100 staff and seeing over 100,000 patients a year. We have to make the money stretch,’ Dr Jeremy Beckett said. ‘It affects every decision we make about what medications we can prescribe, what tests we can order, what sort of staff we can employ, and how much we’re able to pay those staff.
‘So it’s a constant battle … a daily limitation on what we can do.’
Common presentations at Bairo Pite include malnutrition, tuberculosis (TB), hepatitis B and rheumatic heart disease. While the effects of these are obviously physical, the illnesses themselves often have roots in social factors. TB, which Dr Jeremy Beckett describes as endemic in Timor-Leste, is a pertinent example.
‘TB is a bacterium that’s spread by coughing and sneezing, even talking,’ he said. ‘So being in close proximity in very small houses that are not well-ventilated and don’t have much light are the perfect conditions to spread the disease.
‘The answer to TB is obviously treating it with drugs like we are but, ultimately, it won’t be solved in this country until people live in spacious, well-ventilated and well-lit homes where they don’t have to share a bedroom with several other people.’
In addition, decades of colonial rule followed by occupation and a military crisis have left their scars, even into peacetime.
‘Timor-Leste is not war-torn anymore and it’s a fertile place; it’s not in drought or in a desert,’ Dr Bethany Beckett said.
‘But it’s had 40 years of occupation and loss of cultural knowledge, as well as a lack of things like modern education, understanding of calories and nutrition, and women’s rights, equality, empowerment and safety.
‘All of those big social questions are way up here, and they need to be addressed.’
The Becketts have found a population affected by widespread psychological damage.
‘There’s not a patient you could speak to who wouldn’t have a family member who’d been killed or tortured or raped during the conflict,’ Dr Jeremy Beckett said.
‘Although the scars are not often visible in day-to-day life, you don’t have to get very far beneath the surface to find that people are very psychologically wounded. It acts itself out in lots of different ways, through negative and risk behaviours and even the way people relate to each other in their own communities and families.’
The Bairo Pite Clinic works hard to address social, as well as clinical, problems with education and preventive measures.
‘Some of our Timorese staff function almost more as social workers, doing outreach, education in women’s empowerment, children’s rights and more general health stuff, like malnutrition and education and school attendance,’ Dr Bethany Beckett explained.
The Becketts are determined to ensure the work they do in Timor-Leste will help to enable the local people and equip them with skills for the future, rather than providing a quick fix.
‘[We have] a focus on education, training and capacity-building to make a useful change, and not to just be a medical tourist, do a short-term thing and go again,’ Dr Bethany Beckett said.
The Bairo Pite Clinic has always been a ‘foreign clinic’, run and sustained by overseas-trained staff. But the Becketts are keen to change this situation.
‘I’ve been really focused on trying to do capacity-building with Timorese clinical staff and develop them as the future leaders of the clinic, and in health, right across the country,’ Dr Jeremy Beckett said.
The wide-scale destruction that took place in Timor-Leste in 1999 resulted in a critical shortage of services and skilled professionals, including doctors.
‘The Timorese Ministry of Health faced an enormous challenge 10 years ago, when they didn’t have any trained Timorese doctors other than a few that had been around prior to the conflict,’ Dr Jeremy Beckett said.
The Timorese Government had to rapidly train a large number of doctors. Cuba came to the country’s aid, providing a local medical training course.
‘[The medical students] get a four-year course which has a really strong public health component, but it doesn’t have a lot of clinical experience built into it,’ Dr Jeremy Beckett said. ‘Timor-Leste doesn’t really have post-vocational training, unlike in Australia, where doctors come out more as raw apprentices that spend the next 10 years developing their craft.
‘[Timorese medical students] come out after four years with limited clinical experience and are expected to practise independently in a distant village or health centre where they have really minimal supervision, support and resourcing.’
Dr Bethany Beckett believes it is beneficial for Timorese doctors to also receive exposure to a more problem-solving approach to medical education.
‘[It’s helpful] to be able to make a more critical analysis of the situation, so you don’t miss something serious,’ she said.
The Becketts hope their additional teaching will not only help to save more lives, but also provide Timorese doctors with the skills and confidence to take the healthcare of Timor-Leste into the future. Dr Jeremy Beckett can already see growth in the confidence of the local doctors he and his wife have been training at the Bairo Pite Clinic.
‘We’ve been working really actively to develop [the Timorese doctors] and give them opportunities to build their clinical skills and competencies. Learning how to do ultrasound and manage in-patients, TB, paediatrics and everything else we do,’ he said.
‘We’ve seen them go from lacking confidence and being uncertain with what’s in front of them to really leading the way.’
Dr Bethany Beckett hopes their teaching approach will influence future generations.
‘We take our Hippocratic Oath as part of our Western philosophy of healthcare, and that includes contribution to ongoing medical education,’ she said. ‘We’re trying to instil that kind of attitude into these young students because they’re the future of Timor and they’ll become the leaders.’
- Dhar, S. Timor-Leste policy challenges for a new nation. Washington, DC: World Bank, 2002. Available at http://documents.worldbank.org/curated en/454971468261551473/East-Timor-policy-challenges-for-a-new-nation [Accessed 31 October 2016].
- Bairo Pite Clinic. Bairo Pite Clinic. Dili, Timor-Leste: Bairo-Pite Clinic, 2016. Available at https://bairopiteclinic.org [Accessed 31 October 2016].