Abertina Belo Nutrition Coordinator and the Community Health Centre, Becora
On first meeting Mana* Bety, seems a shy and quiet woman, but you can feel an inner strength. Here is her story.
Forty-nine years ago, in the sleepy suku (village) of Kilikai at the base of Mount Matebian (Baucau Municipality) , Abertina Belo entered the world.
Born during the time of Indonesian Occupation, it was a difficult start to life as for almost everyone.
Bety was fortunate to be given a one-year scholarship to study in Indonesia. She wasn’t really sure what she had wanted to do and fell into studying a Diploma of Nutrition.
This was in the late 1990’s, and on her return to Timor-Leste, she started working in Baucau District Hospital. She said it was a difficult time – partly due to the Occupation, but also because of the lack of facilities and resources to deal with the ever-increasing problem of malnutrition.
Mana Bety had moved to the capital Dili, and was working as a Nutritionist at the Becora Community Health Centre (CHC). But soon after, the Occupation would reach a turning point with the Referendum for Independence in 1999. Because of the conflict was getting so dangerous, she wanted to flee with her family to safety.
Heavily pregnant, Bety with her two children went to West Timor with many others packed into the back of a truck with many other frightened Timorese. Eight months later and returned to a newly independent Timor-Leste.
On her return, she worked as a Nutritionist with a few NGOs focusing on health promotion, cooking demonstrations, malaria among other important health issues. She ended up working back with the Government in 2008, first in Ermera and then back with the CHC in Becora – where she is now the Nutrition Coordinator.
Timor-Leste is the most undernourished country in Asia, and child malnutrition is an ever present problem throughout the country. The prevalence of both stunting (low height-for-age, 51%) and acute malnutrition (low weight-for-height, 11%) are among the highest in the world.
- The causes are of malnutrition are of course not just simple:
- families economic situation; poor diet due to lack of money or lack of understanding;
- social issues such as families splitting up
- death of a parent
- domestic violence
- spending large amounts of money on cultural ceremonies and leaving no money for food
- to name a few
We talked about the rates of malnutrition during the Occupation compared to now. She said it was difficult to say, but that it was very bad back then. We didn’t have a proper system to identify malnutrition and we just did what we could. We were working under extreme pressure in those days, we felt afraid with the situation, everywhere there were soldiers and guns, and people were just not putting the attention needed to the problem. I saw so many cases. We could give some food for the pregnant women and children… it was a very difficult time.
By the time of Independence things were bad, we were coming out of conflict, everything was new; we had no systems nor basic resources. There was no Nutrition Department at the Ministry of Health back then, but we did the best we could do to provide health promotion. In 2008 things started to get better – we had nutrition guidelines, we had set indicators and a system, so treating malnutrition started to get better. The problem was not enough human resources to do the work and we still didn’t have a Nutritionist at each Health Post to deal with it, and some Posts only had one staff member (still the case today in some areas).
We are seeing an improvement in malnutrition today, though we are still seeing a rise in numbers. I believed that because we have a better system of identification, is why the numbers are still increasing.
We come back to her present job at the CHC. Bety and her team’s role is to identify and register normal to medium malnutrition in children. They screen all children under five years old who pass through the clinic – no matter why they have come.
All children receive Vitamin A and are dewormed.
Children with malnutrition receive family counselling in a group or as individuals. They also have a mobile clinic to the districts.
We are seeing positive improvements and progress. The counselling is an important part of what we are doing; we are seeing many cases with children putting on weight and recovering. Some stay the same (due to the complex issues we mentioned earlier), but if they are suffering from other diseases such as TB it can slow their recovery.
Another issue we often face is when we giver the children highly nutrition food packs, they often end up being eaten by other members of the family and not the malnourished child. This is difficult to stop this but we constantly explain the importance of giving it to the malnourished child.
I feel very lucky that I have been working together with Maluk Timor (MT); it is the only NGO in Timor-Leste that works with Primary Health Care. I especially love that MT partners with the National Hospital; working to strengthen the referral system for children so that after they are initially treated, they will get support and continued treatment in their local CHC. MT runs a regular Nutrition Networking meeting that is so helpful to get us all together, network and share ideas – I feel it is really inclusive and others are getting their voices heard.
I think for things to continue to progress is Timor-Leste to help reduce the malnutrition rate, we need to get better resources focused around follow-up with patients, particularly away from the capital. There is so much to be done, and we desperately to reduce malnutrition rates. For our country to be strong – we need a healthy country – and we need our children to be healthy for this to happen.. (* Mana is a term of address – big sister)