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Dr Dan Murphy 

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Last updated: 8 June 2004

URGENT FINANCIAL SITUATION FOR BAIRO PITE CLINIC


Doctor Dan

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Doctor Dan received his MD from the University of Iowa. He spent 6 years working with Ceasar Chavez at a clinic for farm workers, where he was involved with legislation against pesticide abuse. He has also worked a doctor in Mozambique, another former Portuguese colony, Laos and Nicaragua. Doctor Dan has worked in East Timor since September 1998, although the Indonesians forced him out in early 1999 during the post-independence ballot destruction of the country. He returned in September 1999 and had been steadfastly working since to provide health care though the Bairo Pite Clinic.

Primary health care is a top priority for the Bairo Pite Clinic; upwards of 600 patients are seen each day. Services provided by the Bairo Pite Clinic include:

Tuberculosis (TB) treatment and control. There are now more than 1,000 patients registered in the TB program, which includes treatment, education, and follow-up care. Beds at the clinic are reserved for those TB cases too sick for outpatient treatment or for those coming from distant areas. Twenty additional beds for longer-term TB treatment are located at Sister Lourdes Kolohun site, which is visited by Bairo Pite staff twice a week.

Maternity and infant care. Four beds are devoted to maternity services at the clinic, which averages 60 deliveries per month. Bairo Pite Clinic participates in the national midwife training program.

In-patient services. Ten in-patient beds are used primarily for diseases, such as malaria, gastroenteritis, and pneumonia.

Dental services. Dental care is now limited to extractions but will soon expand to restorative work and training as part of an Australian overseas aid project.

Vaccinations. Childhood vaccinations, as part of a wider UN supported programme, are given at the Bairo Pite Clinic twice weekly.

Health outreach. The clinic participates in many mobile clinics in the remote and often-neglected mountainous areas, and receives patients from all over the country. Dr. Murphy is working to develop a program of health promotion and prevention with links to mountain villages, with the Bairo Pite Clinic serving as the training site for village health workers. However, more funding is needed to make this program a reality.

Training for East Timorese health care workers. Doctor Dan has been working with ten Timorese medical students who began their studies in Indonesia. They are unable to return to their former schools in Indonesia to finish their education. Five students have been able to resume studying overseas, and Doctor Dan is assisting the others in their attempts to attend Western medical schools. Nursing students from La Hane, East Timor also rotate through Bairo Pite clinic as part of their training in practical skills.

In addition, the Bairo Pite Clinic operates a medical laboratory, pharmacy, kitchen and laundry. The clinic has a water supply system and a power generator to supplement unreliable local supplies.

Dr Dan Murphy MD. (Photo Tracey Nearmy)

Dr Dan hamming it up for the camera. (Photo Mark Raines)

Dr Dan doing morning rounds in the TB ward (Photo Mark Raines)

Dr Dan and the RAV 4 donated by the Japanese Group IVY (Photo Vicki Beaumont)


"Dinner with Dan"

Tuesday September 23rd, 2003

Dr Dan Murphy of the Bairo Pite Clinic in Dili, East Timor visited Sydney on Tuesday, September 23, 2003. During a busy day he met Timorese students at Wollongong University, and had productive meetings at medical institutions in Sydney. These meetings were intended to promote co-operation between these facilities and the Bairo Pite Clinic, in order to help address some of the current and future health issues in East Timor.

At a dinner in the evening at Paddington RSL, Dr Dan spoke to a group of interested and appreciative people about his experiences in East Timor, the present state of the clinic and some of his hopes for the future. A short video of footage taken by Vic O'Callaghan at the clinic in East Timor recently was shown and it highlighted some of the special cases needing treatment there at the moment.

Dr Murphy has been inspirational in his dedication to providing free medical care services to the East Timorese people since 1998. He worked through the period in 1999 when the militia brutality was rampant and courageously spoke out publicly against it, whilst governments in the region were in denial. In mid 1999 the Indonesian government required him to leave to get his visa renewed, but when he did they refused to allow him back into East Timor.

In September 1999 he was back, with the Interfet forces, and set up a clinic at Bairo Pite in Dili. Since then the clinic has been providing an expanding range of medical services and has taken on local and overseas training of promising Timorese medical students. Regular visits from foreign doctors have complemented the services available at the clinic. Dr Dan is now looking to further expand the workings of the clinic in order to meet the medical needs of the future in East Timor.

There are lots of ways we can help and support Dr Dan Murphy in his great work in East Timor. Of course he needs funding assistance, but also contacts and links with medical people and institutions that might be able to help with the more challenging cases. If you are in Australia and you feel can help, please contact Mike Hartnell on 0419 717382 or email at mikes@magna.com.au



U.S. doctor says need is still great in East Timor

By Joseph Eaton From The Asian Reporter, V13, #6 (February 4-10, 2003), page 9.

http://www.asianreporter.com/stories/local/03/06-03dr%20dan.htm

Dan checking his email (Photo Clive Pickering)

Dr. Dan Murphy and  patients  (Photo Max White)

Rebels with the bones of their feet smashed to bits were some of Dr. Dan Murphy's first patients when he arrived in East Timor in 1999. Scores of them wobbled up to his makeshift medical clinic after they were brutally tortured by the Indonesian army. "The soldiers would put a prisoner's foot under the leg of a chair and crush down on it," said Murphy. "You know how many small bones there are in the foot?"

Since East Timor gained independence from Indonesia in 2002, the wounds Murphy now heals are rarely the result of violence, but medical need in the region is no less urgent. If anything, Murphy says, the need is rising. A native Iowan, Murphy treats hundreds of patients a day at Bairo Pite, the small clinic he runs on a shoestring budget in Dili, the country's capital city. Except for a short stint abroad in 1999, when he was kicked out by the Indonesian government for comparing them in the press to Nazis, Murphy has been steadily advocating for Asia's newest country while curing its ills.

He begins seeing patients at 8:00am and finishes well after sundown. During that time, he usually diagnoses around 20 new cases of tuberculosis (TB), a disease that is on the rise and killing at a horrible rate in East Timor. The clinic currently has over a thousand patients in its tuberculosis program.

Murphy blames the conditions before independence for the epidemic. "Indonesia crowded these people together in maximum stress situations. The mountains where they fled, refugee camps, it was the perfect situation for the spread of TB, and we're now reaping the result of that."

Murphy is a monomaniac when it comes to TB. He collects obscure medical books on the disease, and you get the idea it's on his mind as he falls asleep at night. But TB isn't the only struggle his patients face. A year and a half ago, he diagnosed the first of many HIV-infected patients. His patients have malaria, dengue, hepatitis, encephalitis, and other deadly diseases. Bairo Pite also provides preventive care and assists with at least two births a day. 

Built and funded entirely by contributions, and aided at times by governmental and non-governmental organizations, Bairo Pite is a success story of foreign assistance. But as East Timor is replaced in the media by Afghanistan and other troubled regions, funding streams for projects like Bairo Pite are drying up, which has Murphy worried. 

Murphy runs the clinic on $3,000 a month with a staff of Timorese medical students, nurses, and midwives. Soon he may ask them to volunteer their time. "It's just getting tough to meet payroll," he said.

The clinic cannot afford to replace broken equipment or buy necessities. There is no vehicle to pick up the sick or take away bodies. There is none of the expensive technology common in developed countries, not even an x-ray machine. An x-ray machine, however, is last on Murphy's wish list. "You don't need all that stuff," he said. "Two hands and a heart, that's all you need. A stethoscope helps, though." 

Murphy does have a wish list. He hopes to start a medical school to train Timorese physicians and he wants to add a women's clinic to Bairo Pite. He's hopeful, but his optimism is tempered with the fear that funding will continue to dry up. "I will stay until health care in East Timor is equal to the high quality of care in the west," he said. "Or until it all falls apart and I am no longer effective." 

In Portland,  Bairo Pite Clinic contact person Max White can be reached at maxw@ease.com


A Vision for a People-Centred Health System in East Timor By Dr. Dan Murphy

East Timor has suffered as much or more than any other country in modern times. We can attribute this to the inadequacies and designs of the Western world powers, as well as to Indonesia. East Timor is poor because for 500 years they have had a boot on their neck.

Nothing can truly compensate the people for the tremendous loss of life and state of collapse in which East Timor finds itself. At the very least, however, these same world powers owe East Timor a huge debt.

A glaring problem facing this new country is the poor health of a population long neglected. The infrastructure is destroyed, qualified medical personnel are non-existent, resources scant. People have lost everything including housing, possessions, even clothing.

An overview of health reveals grinding poverty with all the attendant conditions, including infectious diseases worsened by complications of pregnancy and delivery, frequently resulting in the death of mother or child or both. Many villages have no access to any health care. 

Tuberculosis (TB) is a particular example of the kind of challenge faced by East Timor. Prior to last September, TB was already infecting people frequently. After the post-referendum turmoil, however, it is even worse. As a result, TB is now at an all-time-high and is killing people at an alarming rate. Like so many of the other health problems, TB is at least as much a socio-economic problem as
it is a physical infection.

The Bairo Pite Clinic where I work has been operational since September 1999. In that short period of time we have seen 100,000 patients. Maternity is very active and, as of yet we have not had a mother die in our care. We average 15-20 in-patients with conditions ranging from malaria, pneumonia, and diarrhoea to yaws, encephalitis, and leprosy. Visiting specialists are very helpful; a recent U.S. Naval eye team saw, in two weeks time, over 3000 patients. We have an extensive pharmacy, and an excellent laboratory. Kitchen facilities, laundry, and a new maternity ward will soon be operational. Ten East Timorese medical students help and learn at our facility.

Yet this is not at the heart of what must be done to improve the health of the country. Our patients may be well today only to return tomorrow with the same conditions. The only way to prevent this is to change village-level dynamics. For this reason, our next program will include going to the countryside to listen to the people, to learn what they see as their health problems. We will then discuss how the people can address these problems using local resources as much as possible.

We see ourselves as facilitators of this process, our clinic a referral source and training site for the village health worker. Preventative, rather than curative, strategies are at the centre. Local involvement and empowerment is the key. Village women are the number one health resource of East Timor. They, more than anyone, exhibit concern for health in the community.

Through this process, a national network of local health advocates could emerge. People would choose and support their own local health representative, who would then learn and become the link to the system. The same principles could apply in the cities. Neighborhood groups could organize around health care issues, choose a worker, and join the network.

Imagine what will happen to health when each community has a representative actively working through a national program. I envisage computer links to most places making communication much easier. East Timor has less than one million people and under 500 villages; these things are possible.

Of course curative medicine is still needed. Small clinics could treat several villages. Then larger polyclinics would be needed for the sub-district level, and hospitals with more surgical and specialty capabilities for each district. Dili has the national referral hospital. Links to foreign countries are needed for special cases such as open-heart surgery.

Training for Timorese doctors should take place locally. Again, computers could play a large role, supplemented by practical training at local hospitals and clinics as well as short courses by visiting doctors.

Bairo Pite Clinic waiting area  (Photo Tracey Nearmy)

Dr Dan Murphy MD. (Photo Tracey Nearmy)

 

Bairo Pite Inpatient Ward (Tracey Nearmy)

 

Consultation with Dr Dan (Photo Treacey Nearmy)

 

Dr Dan Murphy MD. (Photo Tracey Nearmy)


East Timor HIV Spills Over To Australia (AAP/19/06/01)

The HIV virus had taken hold in East Timor and spread into Australia, a Dili-based doctor said today. As many as 15 foreign workers, mostly Africans, evacuated from East Timor for treatment at the Royal Darwin Hospital, have tested positive to HIV, Dr Dan Murphy said.

A Darwin woman contracted the virus that leads to AIDS from having sex with an East Timor-based expatriate.

"There was a case of transmission from an expatriate in East Timor to a woman in Darwin," the American volunteer general practitioner said. Territory Health Service confirmed one of the five cases of HIV reported among Darwin residents since the United Nations moved into East Timor in 1999 was contracted through heterosexual contract with a foreigner based there. That woman then infected another local.

Darwin has become a popular recreation destination for East Timor workers. Darwin sex workers report African clients refusing to use condoms. Dr Murphy said the HIV-positive expatriates detected in Darwin had probably been infected before they reached East Timor.

But these same UN and non-government organisation workers were also patronising a clandestine sex industry flourishing in East Timor.

"It's (HIV) a problem but no-one knows how extensive because we don't do testing," Dr Murphy said.

While the extent of HIV remained invisible, Dr Murphy said his Bairo Pite Clinic frequently treated men suffering the more obvious sexually transmitted diseases from prostitution such as gonorrhoea.

Unchecked, Dr Murphy feared a major blow out in HIV among the conservative Catholic population resistant to condom use and sexual discussion. AIDS would prove devastating with the high rate of tuberculosis among the East Timorese, he said.

"TB will become more active and it'll attack more strongly because with AIDS, you don't have any resistance," Dr Murphy said.

Dr Dan Murphy MD. (Photo Tracey Nearmy)

 

Dr Dan and Godson (Photo Mark Raines)

Dan teaching a visiting medical student about tuberculosis treatment. (Photo Clive Pickering)


Dr Murphy on serious health problems in East Timor

Sun, 3 Oct 1999 From tapol@gn.apc.org (TAPOL)

 

On 27-28 August, Dr Dan Murphy paid a brief visit to London. After having spent nine months working as a doctor in Dili, he had just been refused entry into East Timor by the Indonesian authorities and was on his way to Washington to seek support to get the Indonesian exclusion order reversed. Now with Interfet operating in East Timor, he is back 'home' with the East Timorese.

The following are points from an interview he gave to TAPOL, which I have only now had time to transcribe. The information is urgent, in view of the extreme vulnerability of hundreds of thousands of East Timorese still in the mountains of East Timor (with the rainy season due very soon) and in West Timor.

Dr Murphy worked for nine months at the Motael Clinic which is an out-patient clinic, not a hospital. But when atrocities were committed, it received many people with serious gunshot and stab wounds and had to treat them as in-patients, although space was extremely limited, there were no laboratory facilities, qualified surgeons or anaesthetist. It some cases, all the medical personnel could do was to ease the dying patient's pain.

With regard to the thousands of people who attended the Clinic for treatment, Dr Murphy said that most diseases he saw were easily preventable and easily treated, as long as the resources are there. In his estimation, 50 to 100 East Timorese people were dying daily of preventable diseases.

The Number 1 killer in East Timor is tuberculosis. As a doctor with much experience of disease in third world countries, Dr Murphy said he had never seen such a high incidence of TB as in East Timor. He gradually came to the conclusion that his first line of diagnosis with almost every patient was to consider that TB might be the ailment.

Practising in East Timor had compelled him to deepen his knowledge of all the varieties of TB. It is a highly contagious disease and his fear even then was that it would take a heavy toll among Timorese living in insanitary conditions in refugee camps; at the time some 50,000 people were thought to be in camps controlled by the TNI/militias. TB is a disease caused by social and economic factors. Poor nutrition, housing, sanitation exacerbates the problem. Camp conditions are very likely to intensify the incidence of TB, he said.

According to Dr Murphy, HIV is now spreading in East Timor, having been introduced through prostitutes used as part of a racket run by members of the armed forces. People who are HIV positive are difficult to treat for TB because of their low level of immunity. The Indonesian authorities refuse to acknowledge the existence of HIV.

Tubercular-meningitis is a condition that develops when TB germs enter the brain tissue. Extremely dangerous unless diagnosed early when it is treatable. When he was forced to leave Motael, there were sixteen people being treated for this condition.

Ideally, people with TB need to be kept under treatment and observation for eight months, which is hardly likely for the people living as refugees.

Dr Murphy visited the General Hospital in Dili which had a 40-bed unit for the treatment of TB but found it empty, clear proof that East Timorese were not willing to go to an Indonesian hospital for treatment.

An additional problem with treating TB is the development of multi-drug resistant TB which often results when the treatment a patient undergoes is incomplete. In the course of uncompleted treatment, the stronger germs subsume the weaker ones. Once a patient reaches this stage, treatment is no longer possible and the disease will prove fatal.

The Number Two killer is malaria which is prevalent particularly in coastal areas. Dr Murphy thought that as many as 10 per cent of child deaths were caused by malaria. Many people have malaria in their bloodstream and it will flare up at moments of high vulnerability, such as during pregnancy.

In Dr Murphy's opinion, the best way of dealing with malaria is with community-based health care. There is a pressing need to train paramedics to diagnose malaria and to be able to treat the condition, in particular the under-fives. He said there was a pressing need for a Total Malaria Eradication Programme in East Timor.

From the visits he made to refugee camps in Liquica, he concluded that 75 per cent of the patients he treated had enlarged spleens, a symptom of malaria. They had been forced down to coastal regions which had made them very susceptible to malaria.

Regarding birth control, he was very keen to encourage mothers to breast feed because this inhibits ovulation and helps better spacing of child-bearing. In his experience, bottle-fed babies did not do well and were usually under-nourished. He felt that Timorese mothers usually stop breast feeding far too soon.

 Dr Dan discussing which  medication are vital for the Clinic with Pharmacists at the central Pharmacy (Photo Clive Pickering)

 Dr Dan without the baseball cap (Photo Vicki Beaumont)

He had not been able to undertake any investigation of the extent of infant mortality but could only say that most mothers he had treated had lost quite a few of their children. He once did a spot check of 200 infants for signs of malnutrition, measuring the thickness of their arms and found that 44 per cent were malnourished and hence at high risk to all kinds of illnesses.

While he described the heath situation as very bleak, he said that most of the diseases were easily treatable and could be helped by public health education. It was in this sphere that he hoped to devote much of his energies once he returned to East Timor.


Bairo Pite Clinic & Dr Dan Links

Doctor slams UN on E Timor tuberculosis

ETAN's News postings archive under 'Murphy'

A Doctor in East Timor: Diary of an Eyewitness (Radio National transcript, 23/05/99)

Dan Murphy, a doctor with a mission in East Timor by Sonny Inbaraj

Interpeace: The clinic at Bairo Pite in Dili.

Medical Aid for East Timor

American doctor treating victims of militia attacks

REPORT TO THE YALE SCHOOL OF MEDICINE ON HEALTH CARE IN EAST TIMOR

NSW Doctor April 2003 (Opens an Adobe Acrobat file)


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