In conclusion, I found Timor-Leste’s current struggle for self-determination very moving. As a small island nation that has won its relative independence at a historical time when the future of humanity and life on the planet hangs in balance, I see Timor-Leste like the proverbial canary in the mineshaft. Faced with looming climate change from global warming, the imminent end of its oil reserves, and the island’s unsustainable dependence on imported produce, what happens during the next few years in Timor may foreshadow what may shortly happen globally.

Let us hope the people of Timor don’t just listen to outside development pundits and corporate interests, but find the courage and resolve to collectively build a healthy and sustainable future.

Suggestions for Sustainable Health in Timor-Leste

Long-term Suggestions

  • Work toward an empowered, well-informed, politically alert population that can elect and hold accountable leaders who work toward sustainable health for all.

  • Transform public education to help children think for themselves, analyze common needs, and work together for the common good.,

  • Use Discovery-based learning and Child-to-Child “Education for Change” activities to help prepare them as future agents of change.

More Immediate Suggestions

  • To increase the responsibilities and relevance of the PSFs, prepare and enable them to play a more direct health-promoting role in their communities:

    • Enable the PSFs to diagnose and treat common health problems such as diarrhea and pneumonia in children.

    • Teach PSFs to make their own simple beam balances (scales) for weighing U5 children. Then, in their aldeas, have them go to the homes of the mothers who do not take their babies to the SISCa events, weight and measure them, and take appropriate measure to help the underweight or sick babies become healthy.

    • To do the above successfully, more community-based research is needed to learn why so many children under 5 stop gaining weight when then go onto weaning foods.

    • To conduct such research NGOs like SHARE—hopefully in cooperation with the health and education ministries—might undertake pilot participatory study projects, finding our precisely who mothers are feeding their weanlings, trouble-shooting the problems/obstacles (at all levels) and experimenting with other, hopefully more optimal, feeding alternatives.

    • In the SISCa projects and the training of PSFs there seems to be a big gap in their training when it comes to childhood pneumonia—reportedly one of the biggest causes of death in Under-5s. If PSFs could recognize the common signs of pneumonia and see that children get early antibiotic treatment, this single intervention could significantly lower the Under-5s mortality rate.

  • Try to find ways to gain MoH acceptance, support, and upgrading of skills of TBAs—following the very successful model of Dr Aida. In view of the fact the at least 50% of babies are still delivered, unofficially, by lay midwives, this is imperative. Every effort needs to be made to wake up WHO to this need and stop its “expert” from imposing their mandates on countries w/o fully understanding the local situation.