The veranda on the farm is drenched in sunshine, drying any trace of the crisp morning that needed the kitchen fire to be lit before I could enjoy my breakfast. This time last year I was living among palm trees, waking to the glorious warmth of Timor-Leste, one hour’s flight north of Darwin. I was living in Dili and volunteering at Klibur Domin, a rehabilitation facility 15 kms out of the city.

As a physiotherapist, my time at Klibur Domin (KD) centred around improving clinical systems and providing professional support for the hard-working clinical and care staff. Many allied health clinicians have visited KD over the years, originally to assist in opening the rehabilitation centre and provide direct care to patients, then to assist with projects to improve clinical care. Each brings knowledge and equipment to share.
During my time at KD there was one Timorese physiotherapist supported by a Japanese volunteer, three care staff and a clinical coordinator looking after up to 16 inpatients, 8 resident disability-support students, and 30+ remote cases, all seen at varying intervals.
The model of care is based strongly on the World Health Organisation (WHO) Community Based Rehabilitation (CBR) system of disability care. This focuses largely on community inclusion, through school, work and socialisation, access to clean water and sanitation. The team not only provided physiotherapy but would install water pumps and toilet facilities where needed. They worked closely with regional general practitioners, community nurses and local councils ‘xefe sucos’(chiefs).
It was a learning curve for me to think beyond the hands-on focus of my training into the wider aspects of each person’s day to day life. Each step in the CBR approach improved someone’s quality of life.
I dedicated time to learning some basic language skills in Tetum so I could establish what kind of support the team needed. There was a fully stocked equipment storeroom, a university-trained physio, a designated treatment gymnasium as well as a remote visit schedule. What seemed to be lacking was a way of optimising each of these resources and a system for ongoing professional education.
We set about arranging the physical spaces to optimise use. The gymnasium was divided into a paediatric and an adult space so it could be used simultaneously, the office desks were merged into a communal work area so all clinicians could access the one computer and the filing cabinet morphed into a simplified and more usable system. For each of these changes we held team meetings and discussed how best to approach each change. The filing system was the slowest project to take shape as first we needed to address writing daily progress notes and making easy-to-use forms for documentation. This required many rounds of staff feedback to ensure they would be used.
We then looked at regular weekly whole team meetings to plan which days the team would travel to le foho (mountains) and what the goals were for in-clinic times, as well as what kinds of equipment might be required. During my early discussions, team members expressed a lack of awareness of the priorities for the week, leading to less clinical cohesion and equipment boxes full of supports and walking aids being left untouched in the store room.
Finally, and with much enjoyment, we commenced in-house professional development looking at clinical case examples, providing manual handling training for all staff, education sessions for the large groups of nursing students and trainee general practitioners who came to KD on rotation.
To build better understanding of the clinical skills of Allied Health I supported the Timorese physio in leading tutorials on assessment and equipment use with both the nursing and medical students. His input was invaluable, and I enjoyed seeing the pride with which he shared his knowledge.
I also ran case conference and assessment training at the National Hospital with the physiotherapy department with an aim to establish a program which included other facilities once a month. The enthusiasm with which these sessions were received was inspirational and had me brushing up my powerpoint skills and checking clinical evidence for treatment protocols.
The Allied Health team in Timor-Leste, mainly physiotherapists, a few occupational therapists, two speech therapists and one psychologist, are incredibly motivated. They are in the process of forming a professional association. This will enable professional development, support and a standardised model of care across the small but mountainous country.
The term ‘Haree ba Futura’ (look to the future) is personified in everyone that you meet. It is a powerfully optimistic country which welcomes earnest input from those of us who go to support their continued growth.
Ideally clinicians going to work in Timor-Leste would have points of contact with national clinical staff and previous volunteers to ensure continuity of programs and be able to continue to improve the systems of care as soon as they arrive. My hope is that each clinical team that visits Klibur Domin or any facility in Timor-Leste, takes times to establish relationships with their Timorese peers and continues to offer professional mentorship and support from wherever in the world they may be. Given advancements in internet access, despite geographic distances, we are only ever moments away.
Prideaux