From doctor to researcher to minister of health

In East Timor, a TDR alumnus is laying the foundations for a healthier future

Long before he was the Minister of Health of the Democratic Republic of East Timor, Dr Nélson Martins served as a physician to his fellow countrymen as they fought for independence from Indonesian rule. Indeed, within months of earning his MD in 1998, the young doctor found himself heading up emergency health services for guerilla fighters and displaced populations in the country’s mountainous interior, where together violence and disease had taken a heavy toll.

“I was surprised to find so many people dying of preventable diseases like tuberculosis, dengue, malaria and pneumonia,” he says. “And every day there was shooting. Many people were afraid of going to the government hospital, so they came to our clinic for treatment.” Among his patients, he adds, was one Taur Matan Ruak, the country’s current president.

By 2003, the fighting had ended, but the diseases remained. And while a newly independent East Timor had begun to rebuild the infrastructure devastated over previous decades, the health sector was still strapped for resources and expertise. Working as a doctor to the poor, Martins had encountered many unknowns, he says. But in a country without the capacity to conduct research, he could find no answers to his questions.

Those questions formed the basis for Martins’ doctoral work at the Menzies School of Health Research, Charles Darwin University in Australia, where he enrolled as a PhD student in 2003. His goal: to help his country tackle the tuberculosis epidemic that had taken so many Timorese lives. And when he struggled to find funding for that work, Martins turned to TDR.

“With TDR support, I was able to conduct four different studies,” he says, including a 2003 case study of East Timor’s highly successful national tuberculosis programme. Founded by Martins and colleagues in 2002, the programme was a model of post-conflict reconstruction, achieving a treatment success rate of greater than 80% despite mass displacement and a dearth of infrastructure.

IMPROVING TB TREATMENT COMPLIANCE AND EXPANDING ACCESS

Several years later, that TDR support also allowed Martins to plan and conduct the first ever randomized controlled trial in East Timor — a study of the effectiveness of food incentives in improving TB treatment compliance (FITTCET) in the capital, Dili. The resulting paper was published in the British Medical Journal, marking a seminal moment in Martins’ career and an important step forward for the country at large. And that success, he says, “gave us a great deal of confidence.”

"To have an impact at the village level, we needed to integrate approaches.”

Dr Nélson Martins

When he was appointed Minister of Health in April 2007, Martins brought a wealth of knowledge and experience to the post, including years of training in the trans-disciplinary research methods that would inform his next big undertaking: an integrated community health services project known by its Portuguese acronym SISCa. Launched in 2008, SISCa aimed to extend the reach of basic primary health care to the poor in remote rural communities by mobilizing cadres of volunteer health workers to treat and prevent disease, collect health data and disseminate information on healthy behavior.

PROMOTING INTEGRATED APPROACHES

“After I finished my PhD, I really believed that to have an impact at the village level we needed to integrate approaches. And SISCa does that,” he says, strengthening everything from maternal and child health through increased immunization coverage and better antenatal care to nutrition and TB control. Indeed, while work on the latter has been underway since 1998, it wasn’t until 2009 that East Timor reached the case-finding target of 70% set by the WHO. “That’s the result of SISCa,” he says, adding that he and colleagues are now in the process of assessing the programme’s impact on family planning.

Six years on, SISCa remains a success. But as Martins well knew, only by strengthening the country’s research capacity could he ensure the continued development of the health system as a whole. To do that, he established the Cabinet of Health Research and Development (CHRD), East Timor’s first health research institute, with the mission of making evidence-based practice the norm in both medical interventions and policy.

SUPPORTING THE NEXT GENERATION OF RESEARCHERS

Martins’ tenure as minister came to an end in 2012, but his efforts to strengthen East Timor’s emergent health system continue apace. Now director of postgraduate studies and research at the National University of East Timor (UNTL), he’s passing on his expertise in TB to the next generation of Timorese scientists. And while he remains a prolific researcher, having authored 21 peer-reviewed papers, “my job now,” he says, “is to train young doctors and to encourage them to enter the field of TB.”

Last May, Martins and his Timorese colleague Joao Martins, Dean of the School of Medicine and Health Sciences at UNTL and himself a former TDR grantee, launched a new master’s programme in tropical medicine and community health. According to the latter, who was awarded TDR funding to study malaria control in East Timor, the school will offer new courses in pharmacy and nutrition as well as new master’s programmes in nursing and midwifery next year.

For a country ravaged by fighting—and one that counted fewer than 20 doctors as recently as 1999—these programs mark a remarkable turnaround for a long beleaguered health system. With TDR support, the Timorese have laid the foundations for a healthier future, and leaders like Martins have blazed a trail for their fellow nationals to follow. Long may they do so.

For more information, please contact

Jamie Guth
TDR Communications Manager
Telephone: +41 79 441 2289
E-mail: guthj@who.int

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