The power of investing in people: how collaboration and communication are changing diagnostic capacity in Timor-Leste

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Last May, a leading Australian health institute, Menzies School of Health Research, was awarded a grant of up to £4million by the Fleming Fund to improve laboratory diagnostic capacity and antimicrobial data use in Timor-Leste.

Timor-Leste is a small country with just over 1.3 million citizens. Most of its population live in rural areas, meaning reaching people with high-quality health care is a challenge. In addition, the country has historically had limited medical diagnostic capacity and high rates of malnutrition and tuberculosis, further challenging quality health care provision.

Menzies’ history of working in the country, and its existing relationships with the Ministry of Health and local clinicians and scientists, provided a solid foundation to begin Fleming Fund work. Since last May, programme leads Dr Joshua Francis and Dr Jennifer Yan have been working to improve communication between clinicians and scientists, strengthen data reporting systems and improve staff microbiology skills. “It comes down to investing in people. It’s about working together” says Jennifer.

The ongoing work of Menzies has resulted in considerable improvement in clinical and laboratory collaboration and testing. Nevio Sarmento, who has worked as a scientist in the Timorese health system for 10 years and has recently been recruited by Menzies said, “When I returned to Timor-Leste after my masters in 2015, we were testing 5-10 samples a day in the laboratory, now we test 30-50 samples. Menzies are never absent; they always help us interpret results. Every day they call in for our 10:30am meeting after morning rounds.”

Former Director for the National Health Laboratory, Ismael Da Costa Barreto, who now also works with Menzies, says it’s the organisation’s commitment to investing in people “on the ground” that has made the difference. “The Menzies team visit the laboratory and the hospital and then train local doctors to use the lab. Now we see the number of laboratory samples really improve.”

Nevio says better communication has also had a tangible impact on patient health. For example, in one case, test results from an intensive care patient showed the presence of a multi-resistant pathogen. New equipment from the Fleming Fund helped ensure testing accuracy and confirmed the pathogen’s antibiotic resistance pattern. As a result, the hospital closed the intensive care ward to completely disinfect the environment, avoiding further infection transmission.

In addition, Jennifer and Joshua say that although COVID-19 is not a focus of the Fleming Fund Country Grant, because the project doesn’t operate in isolation, their team has indirectly helped the country respond to COVID-19. Strengthening the laboratory system, in particular the National Health Laboratory, has provided vital support to the Ministry of Health in their efforts to protect the health of the Timorese people.

Over the course of the next year, Menzies will continue Fleming Fund work in Timor-Leste to strengthen laboratory diagnostics and AMR data use. “The Fleming Fund has provided a good opportunity for us. We now have a fully functioning microbiology lab,” says Nevio.