Specs for Lospalos 2023 Trip Report

Report on the Mornington Peninsula Friends of Lospalos Optometry volunteer clinic and project inauguration visit to Lospalos, Timor-Leste - 26th August to 3rd September 2023

Summary 

The Specs for Lospalos clinic was designed to support the local Timorese community of Lospalos with their eye care needs. This clinic was led by visiting optometrist Colleen Hammond and conducted between 26 August and 3 September 2023. This was the second such clinic – the first having been undertaken in 2019.

Patient clinical testing diagnosed 77% required reading glasses. 23% were dispensed distance glasses, 9% of patients had significant cataracts, and notably 10% pterygiums – a chronic irregular growth on one or both eyes common amongst people who spend significant time in the sun.

Our recommendations include increasing awareness around eye-health, engaging a full-time optometrist in Lospalos and continuing to support the ongoing care necessary to attend to the issues of cataracts and pterygiums by liaising further with the Dili Eye Hospital through the local director of the Lospalos Centro Hospital.

The visiting volunteer team also were able to visit and officially inaugurate with the local communities projects previously funded by Friends working with the Shire. These included the Raca Village multipurpose building, the Cacavei community building which is being used for English and computer training.

The visit was recorded and broadcast by the RTTL, Timor’s national news program. 
  
Background

The Friends of Lospalos have been operating in various forms since the official restoration of East Timor independence and as a nation state in 2002. The Friends are now an incorporated association, a registered charity, and enjoys ATO DGR status. It works in cooperation with the Shire under a Memorandum of Understanding.

Over this time, the focus has been on funding numerous capital works projects - a bridge, school library, youth sports projects, multipurpose community buildings and in education with English language teaching and the regular provision of scholarships enabling young Lospalos Timorese to
undertake tertiary teacher training education – are all examples of the many projects.

Approximately 40% of the population of 1.5 million is under the age of 15. Estimated Timorese deaths from famine and violence during the Indonesian occupation are estimated at between 90,800 and 202,600 including between 17,6000 and 19,6000 violent deaths or disappearances out of a 1999 population of approximately 823,386. The ongoing needs of Timor-Leste are chronic.

Our close friendship relationship with the Timorese community of Lospopalos revealed the need for eyecare and spectacle correction. As a result, in 2019 Specs for Lospalos supported by the Friends and the Shire visited Lospalos for the inaugural 2019 clinic performing over 390 eye tests and delivered spectacles to over 88% of those tested.

Optometric and ophthalmic equipment donated by the Mornington Peninsula professions and taken over for the 2019 Specs clinic had been safely stowed at the Lospalos Hospital and was again called on for this second clinic testing 310 community members and dispensing 365 pairs of spectacles. These had been donated by the Lions Recycle for Sight program. Additionally, 28 individuals were referred to Dili Eye Hospital for necessary further review or surgery. 

The completed capital works projects were inaugurated with much local celebration in the Raca and Cacavei villages or sucos. The visiting team were delighted to enthusiastically participate in the inaugurations. This provided an excellent opportunity to see by whom, and by what measure each local community benefited from the completed projects. The location of the Raca project had been fixed after careful projections for future population growth so to ensure maximal usage of the facility.  

The Cacavei building is placed adjacent to another of our supported projects – a water filtration Sky Hydrant donated by The Rotary club of Dromana which was taken over on the inaugural 2019 Specs eyecare clinic.

Each of occasions listed on the visit itinerary were covered by RTTL (Radio and Television of Timor-Leste). Volunteers and recipient patients of the clinic and spectacles were all interviewed and the program broadcast nationally. 

Objectives

• Liase with Lions Recycle for Sight for procurement of prescription glasses that ranged from -7.00D - +6.00 D with an emphasis on smaller eye-sized frames to better fit the demography of the population as per data obtained from the 2019 visit.
• Encourage and educate on the importance of good visual hygiene; including the need to protect the eyes from sun damage with sunglasses. 
• Test the eyes of those in the Lospalos community to prescribe spectacles, offer eye-health advise, and refer major eye health problems for further treatment.  
• Meet with those members of the Lospalos Friends of the Mornington Peninsula (Commission) and the Director and staff of the Hospital to discuss the importance of an ongoing relationship with those in Timor-Leste to keep the available channels open to the Lospalos Timorese for ongoing eyecare.  
• Collect data on those tested to analyse the areas of greatest need for eye care in Lospalos. 
• Further strengthen by communication the relationship with the Commission in Lospalos for longevity of the Friendship agreement.  

Findings 

The Specs for Los Palos clinical optometry program was able to screen 310 people, providing spectacles to most of these people. Of those tested, 77% were given reading glasses and 23% given distance glasses.  

9% of those tested needed cataract surgery, with approximately half of those patients with cataracts desperately needed cataract surgery. However, a great difficulty are the many who declined further care due to the expense and distance of the National Eye Centre Dili where the surgery can be undertaken.

Other eye health issues identified, especially pterygiums. The risk factors for this condition being excessive exposure to sunlight. 

The further need for optometric care came from information that there was no longer a practicing optometrist in the Lospalos community. This circumstance has been an ongoing issue for over 5 years and was a driving factor in the need for the initial Specs for Lospalos clinic in 2019.

The results of the tests and the sheer number of patients highlighted a chronic need for not only full-time optometric care in Lospalos, but also for a more accessible referral pathway for those who need cataract surgery and further eye management.

As with any short projects, not all members of the Lospalos community could be tested with the probable risk many eyecare conditions and needs were not found. Our aim is to have a qualified, local medical professional trained to carry on the work of the optometrist previously attached to the Centro Hospital and deliver this care.
  
It was clear that many of the Lospalos community had not previously accessed eye care. Their expectations for visual improvement were very low. The volunteer optometry team noted many people affected by cataracts.

Clinically, cataracts reduce not only contrast but also vision. Therefore, the impact of these cataracts on individuals may include reduced vision, poor mobility, debilitating glare. These are problematic given the location and visual requirements of the community. For example, in driving, motorbike riding, weaving, agricultural activity and walking.

Despite repetitive explanation and translation of the benefits of having their cataracts treated, many of the patients affected by these cataracts (particularly those of the greatest significance), declined referral for further treatment because of the distance to Dili the journey was too great, or they reported that they had no family in Dili and obtaining accommodation there would be impossible.  

The Director of Central Hospital in Lospalos warmly welcomed the visiting optometric clinic. He expressed his thanks for the work of the visiting clinical Specs team and distribution of spectacles to the  community. Those patients requiring referral to Dili Eye Hospital received specific referrals from the Director and follow up information to patients requiring further treatment.

This may include support for post operative care, as well as simply outlining what to expect in the ophthalmological journey to treatment. A key step in the sustainability of our Specs clinics in Lospalos comes from our continued relationship with the Commission and the Director of the
Lospalos Central Hospital. 

The objectives of the optometry clinic program were broadcast to the Lospalos community as whole, including administrative officers, and local women sewing tias, and to the local agriculture community. 

Recommendations

• Engage a full-time optometrist who is fully qualified, including therapeutic endorsement, for the Lospalos hospital. 

• Schedule cataract surgery at Lospalos hospital or other suitable hospital on a regular basis (every 3 months) and provide the appropriate facilities. 

• Provide free transport and accommodation for those travelling to Dili for ophthalmological care. 

• Liaise with National Eye Centre for provision of spectacles.  

• Provision of a full-time technician to ensure all equipment in Dili and Lospalos are maintained and operating consistently. 

• Regular community education events focussing on the importance of lid hygiene (compresses), sunglass use, protective eye wear from foreign material and cessation of smoking for good eye health.  

Colleen Hammond,
Optometrist.
President, Mornington Peninsula Friends of Lospalos Incorporated