"It was our first time performing a thrombolysis procedure," said Dr Augusto Adelaide Pereira, an emergency physician at Suai Referral Hospital, located over 170 km away from Timor-Leste’s capital, Dili. He was referring to the case of a 41-year-old man who arrived at the hospital complaining of severe chest pain and shortness of breath while out for an evening jog. A swift diagnosis of a heart attack, followed by timely treatment in the hospital’s High Dependency Unit proved to be a timely life-saving intervention.
“It helped that the hospital had a functional High Dependency Unit, and that I had undergone multiple emergency and critical care trainings which gave me the confidence to handle such a case,” said Dr Augusto.
"I feel I am extremely fortunate to have received the timely emergency care that saved my life," said Vitorino Sequeira Magno, the patient who suffered the heart attack, who now works as the Chief of the ambulance service in Suai.
Suai Referral Hospital is one of 5 referral hospitals in Timor-Leste's remote, mountainous regions. Patients in need of higher levels of care were until recently transferred to the national hospital in the capital city, Dili. Some travelled for up to 8 hours, well beyond the ‘golden hour’ for timely interventions. When the COVID-19 pandemic hit, there was a clear need to have emergency and critical care services in all secondary care referral hospitals.
With long-standing support from the Universal Health Coverage (UHC) Partnership, WHO recently intensified its collaboration with Timor-Leste's Ministry of Health as a result of lessons learnt from the COVID-19 crisis to provide training, infrastructure, and equipment to support health professionals who need to provide emergency and critical care.
Strengthening infrastructure and capacities
Before the COVID-19 pandemic, the country had only 6 intensive care unit beds with ventilators, all located in Dili's national hospital. Following support from the UHC Partnership to improve emergency preparedness, efforts to establish High Dependency Units in referral hospitals began amid the pandemic, and open spaces were identified at each of the hospitals, making way for meticulously designed buildings.
WHO provided technical guidance, logistical assistance, and competency building for healthcare workers involved in critical and emergency care, and facilitated the provision of essential medicines, equipment, and consumables needed to operationalize the units.
Hospitals established isolation rooms for highly infectious or immunocompromised patients and equipped High Dependency Units with essential airway breathing devices, multipara monitors, invasive and non-invasive ventilators, and other critical care equipment.
Trained and competent health workers
Trained healthcare staff are essential for the optimal functioning of High Dependency Units. WHO provided technical assistance to develop the Emergency and Critical Care training programme, and Basic Life Support and Basic Emergency Care courses tailored to the country’s context.
Nursing and midwifery students undergo basic life support training in November 2023. Credit: WHO Timor-Leste/Emilia Moniz
As of today, more than 1 000 healthcare workers including doctors, paramedics, and nursing staff, have undergone Basic Life Support training. Multiple sessions of the Emergency and Critical Care Continuous Professional Development training were rolled out for emergency care personnel, and over 125 individuals have been trained so far. The Basic Emergency Care module was extended to High Dependency Unit and Intensive Care Unit staff, and over 200 healthcare workers have been trained, with 17 designated as master trainers.
Collectively, the 5 referral hospitals have attended to over 500 patients as of March 2023.
“Advanced healthcare infrastructures and adequate and competent healthcare workers are fundamental to achieving UHC. By enhancing infrastructure in referral hospitals, establishing Simulation-Based Skills Centers, and equipping healthcare providers with advanced skills, the burden of out-of-pocket expenditure on patients referred due to inadequate facilities can be significantly reduced,” said Dr Arvind Mathur, WHO Representative to Timor-Leste.
The UHC Partnership assists over 125 countries in accelerating progress to achieve UHC through funding provided by the European Union (EU), the Grand Duchy of Luxembourg, Irish Aid, the French Ministry for Europe and Foreign Affairs, the Government of Japan - Ministry of Health, Labour and Welfare, the United Kingdom - Foreign, Commonwealth & Development Office, Belgium, Canada and Germany.