How a local surgeon is changing lives – and the future – overseas
With his groundbreaking medical program at a critical point, Hobart surgeon Nitin Verma has set his sights on fulfilling a long-held vision for better health in East Timor
Hobart surgeon Nitin Verma likens the eye health program he founded in the wake of East Timor’s bloody path to independence to a child coming of age. The original schedule of handing over to local Timorese in 2015 – when the program was aged 15 – has been and gone but not without significant gains being made. It will likely be another five years again before the eye hospital graduates from its reliance on overseas aid to becoming a local government-funded entity. Even then, Australian medicos will continue to provide support, Verma says. “It’s like nurturing a child,” says Verma, whom TasWeekend accompanies on a week-long trip to East Timor as he steers the eye program towards adulthood. “Even when it grows up and moves on, there is always a bit of guidance that’s needed.”
The eye hospital is a single-storey white building just inside the entrance to Dili’s main hospital, on a busy thoroughfare in what is still very much a third-world city. Just 45 minutes by air from Darwin, Dili is a fascinating mix of old and new. Shanty-like shops selling plastic household items are next to fruit and vegetable stalls and simple cafes serving avocado smoothies and noodle soups for US$1. Roosters are tied by string to posts outside every second or third shop and stray dogs trot along the streets.
Verma has come to love the dusty, exhilarating capital of this mountainous country, of which he is an honorary citizen. In a charity-supplied vehicle he has learnt how to negotiate the streets that are clogged with overladen scooters, trucks carrying passengers in their trailers and beaten-up yellow taxis. He is looking forward to the day he can come as a tourist. Verma moved to Hobart from Darwin in 2011 and his efforts in Timor have led to a strong bond between the young nation and Tasmanians.
Dozens of Australian surgeons and other health professionals, predominantly Verma’s colleagues from Hobart, have become regular volunteers, often funding their own trips to Timor to treat patients and teach local health workers. “Nitin is bloody hard to say ‘no’ to,” is how Brisbane surgeon and long-term Timor volunteer Kevin Vandeleur puts it.
A lot has changed since the early 2000s when the eye clinics were run entirely by visiting surgeons, making do with the instruments they brought in their bags and basic operating theatres borrowed from the Red Cross. Now, the permanent eye hospital is manned by Timor’s first fully fledged ophthalmologist, Dr Marcellino Correia, and five young surgical registrars following in his footsteps.
“Now the bulk of the work, the everyday bread and butter, is being carried out by the local ophthalmologist, whom we have trained, and the trainee surgeons,” Verma says. “In the past we did everything. Now when we come, we fill in the gaps.”
For the patients, having Verma on site provides the chance to benefit from the miracles of first-world medicine, including cutting-edge equipment donated by medical companies and advancements in the use of human eye tissue. For the Timorese trainees, it is an opportunity to learn from a surgeon known as one of the best.
One of Verma’s first patients is a young man who has already lost an eye to disease. His remaining eye has been diagnosed with incurable glaucoma. In a delicate operation Verma inserts a tiny silicone tube, which will drain liquid and relieve pressure on the eye, and hopefully stave off blindness. Once the tube is in place, Verma uses tiny sutures to cover it with a piece of donor human sclera (the white of the eye), which was donated by a New Zealand company.
Later, while examining a premature baby who is at risk of blindness, Verma cannot find a small enough eye speculum (a tool for holding open eyelids). He fashions one out of the looped ends of a metal paper clip, which he sterilises and uses to gently inspect baby Aldo’s eyes. The infant’s father watches on, his face grave with worry. Finally satisfied, Verma beams and gives two thumbs up to the dad, who nearly weeps with relief.
Watching a cataract operation for the first time is a confronting experience, but it is a pleasure to see Verma in action. The lifechanging operation, which involves replacing the damaged lens with an artificial one, is shown in close-up on a television screen in the surgery, for the benefit of the trainee surgeons and other medical staff.
A cataract patient, Orlando da Costa Belo, returns a day after his surgery to have his bandages removed. He can see properly for the first time in decades. “He says it was the Portuguese time when he remembers seeing so well,” a nurse translates, referring to the Portuguese colonisation of Timor, which ended in 1975. An old man at just 65, Belo had been unable to work or care for his six children and four grandchildren in their village of Baucau. Now, not only will he see those grandkids for the first time, he says he will be able to go back to farming.
Watching over Verma’s experienced hands are East Timorese trainee surgeons Frenky de Jesus, Julia Magno, Bernardete Pereira, Susani Sarmento and Valerio Andrade, and also Irene de Carvalho, a GP and obstetrician who is about to start her ophthalmology training. These medicos are the future of the program. They carry the burden of their nation’s hope proudly but with some trepidation. “At first I had a lot of problems because my hands were shaking a lot, but thank God I am learning now,” Sarmento, 31, tells TasWeekend.
More than 200,000 people died as a result of conflict, famine and disease during the Indonesian occupation of East Timor from 1975 to 1999. Australian-led international peacekeeping forces arrived in late 1999, and in 2002 the independence of the Democratic Republic of East Timor was declared. Now, of the 1.2 million people living in Timor, two-thirds are aged under 30.