Jakarta, Indonesia – Timor-Leste, formerly known as East Timor, has a creaky healthcare system and is one of the poorest countries in Asia, but even as neighboring Indonesia grapples with one of the region’s worst epidemics, it has managed to keep the virus at bay.
The country had only reported 44 COVID-19 infections with zero deaths on Monday, leaving it with the second smallest outbreak in Southeast Asia after Laos, according to Johns Hopkins University.
Experts credit the government’s swift action, imposing strict border controls and ramping up testing and health facilities within weeks, as well as its willingness to work with experts for the relative success of its response.
Michael Ryan, executive director of the World Health Organization (WHO) health emergencies program, said on December 5 that Timor-Leste “has relied heavily on support from the United Nations and NGOs.
“It is very encouraging that countries with very fragile infrastructure that continue to emerge as nations, still need a lot of external support to be able to demonstrate that they can achieve reasonable control over a devastating disease like COVID,” did he declare.
In reality, Timor-Leste, with a population of over 1.2 million, has no choice but to act decisively.
Experts say its weak health infrastructure and economy have been grappling with a sudden spike in infections.
Timor-Leste had a per capita income of $ 1,560.51 in 2019, according to the World Bank and although it has kept the virus under control, its economy is expected to contract further by 6.8% in 2020 – the worst drop since its independence. The country is not only facing COVID-19, but also a political crisis earlier this year.
Sense of urgency
Timor-Leste was a Portuguese colony for centuries before Indonesia invaded the territory in 1975. During more than two decades of brutal rule, hundreds of thousands of people have died.
The country finally gained formal independence in 2002 after more than three-quarters of the electorate voted to leave Indonesia in a UN-administered referendum.
Mariano Ferreira has worked as a researcher in the NGO La’o Hamutuk, based in Dili, for a dozen years and oversees the operations of government agencies in the country.
He says the government’s swift action in imposing a state of emergency a week after the Catholic-majority nation reported its first case on March 21 has been crucial in the fight against the pandemic.
“All public and private activities, as well as government services were closed, even the masses were not allowed, so we felt it was really an emergency and everyone went back to their hometowns. [from Dili] and stayed there, ”he told Al Jazeera, adding that schools were also closed.
The state of emergency has been extended until January 2 and the borders will remain closed to most foreigners except residents, with international flights suspended except for government and humanitarian purposes. Those who enter the country are quarantined for 14 days at government-run facilities.
Strict border control
The municipality of Cova Lima borders Indonesia, which has reported the highest number of infections in Southeast Asia with more than 719,000 cases.
Traditionally, the border has been quite fluid and many Timorese have strong ties to Indonesia, crossing the border informally to see relatives and enjoy family reunions.
The pandemic has forced a change as borders have been closed and quarantines imposed.
“In Cova Lima, the races sometimes arrive once a week. But [only] goods entering, not people, ”said Domingos Gavrila Amaral, Cova Lima office manager of the Timor-Leste Red Cross (CVTL).
Communities have also played a role.
People have made their homes available to the government to quarantine thousands of people and closely monitor those entering the country by land from Indonesia. The border is open once a week for citizens wishing to return home, but those who return directly home without first being tested and going through quarantine, are being reported.
“The government has also tightened controls in border areas to anticipate transmission of COVID-19 from Indonesia,” said Anacleto Bento Ferreira, general secretary of CVTL.
The WHO office in Dili said the country’s strict border controls and quarantines have given the nation “precious time to strengthen its health system.”
The months that have passed since the start of the pandemic have transformed some health services.
At first it had no testing capability – samples were sent to neighboring Australia and results were not received until about two to four working days later. It had no isolation or quarantine facilities and limited surveillance capacity.
He is now able to do tests in the country, has designed a testing strategy and implemented active surveillance.
‘Limited test capacity’
The health ministry said Timor-Leste had carried out more than 16,400 coronavirus tests on Monday – far fewer than neighboring countries such as Singapore, although the city-state has a larger population and is richer.
And while there is likely to be underreporting, the situation on the ground suggests that there is not a huge amount of undetected infection.
Augustine Asante, senior lecturer at the School of Population Health at the University of New South Wales (UNSW), says it would be “very difficult to rule out under-reporting” in the country with ” limited test ”like Timor-Leste.
“I’m not concerned about this at this point because, of all indications, the healthcare system hasn’t seen a spike in patient numbers, or an abnormal increase in deaths,” said Asante, who conducts research. in the country since 2009.
“There is no suggestion that COVID is wreaking havoc in Timor-Leste and that it is covered.”
Experts who work closely with the Ministry of Health agree.
Jeremy Beckett, director of the Dili-based NGO Maluk Timor, which works to strengthen the quality of private health services in the country, says he is “absolutely convinced” that the number of positive cases is reported accurately and transparently.
“The tests therefore continued without interruption and did not slow down at all. The national health laboratory continues to process a large number of tests, ”he added.
Other health challenges
Despite improvements in health care in Timor-Leste, the country still has minimal capacity to manage critical care.
“There are a limited number of intensive care units across the country. More importantly, there is limited clinical expertise to manage critically ill patients on ventilators, ”the WHO office in Dili said.
Asante, who is also a UNSW health economist and health systems expert, says the country is already facing significant pressure from one of the world’s highest TB rates – around 500 cases per 100,000 people.
“In addition, there is chronic malnutrition, high smoking rates and poor quality health care, which complicate the government’s efforts to bring TB under control and improve overall health outcomes,” he said. at Al Jazeera.
“But perhaps the biggest challenge is widespread poverty, nearly 42 percent of the population lived below the national poverty line in 2014. If the COVID situation deteriorates, poverty would likely get worse,” he said. he added.
Beckett from Maluk Timor notes that “Timor-Leste’s health system is still relatively young”.
“And it takes many, many years to develop a sophisticated and efficient health system capable of handling such a major impact,” he told Al Jazeera. “I think this exposes areas that are not yet fully developed.”
A legacy of the pandemic could still be a better health system for Timor-Leste, but even as COVID-19 vaccines finally begin to roll out elsewhere in the world, the WHO says the small states approach contains lessons for others.
“Really swift and robust action” has helped these countries cope with the virus, said Maria Van Kerkhove, WHO COVID-19 technical officer, noting that these measures “have succeeded in preventing these initial cases from spreading and to really take off “.