Timor Leste is a small impoverished nation of between 800,000 and 1,231, 000 in the southern Indonesian archipelago, and occupying the eastern part of the island of Timor.

Health issues for travellers

Timor Leste (including the islands of Pulau Atauro and Pulau Jaco) has a tropical climate with distinct rainy and dry seasons.

Diseases resulting from mosquito bites (malaria, Japanese encephalitis (JE), dengue fever and chikungunya) are a major concern to locals and visitors alike. Vaccines are available for JE, but not for the rest.

Unfortunately, hygiene standards are basic and gastrointestinal infection is common and represents the most common form of illness in travellers.

Nearly all health advice revolves around these two issues.

Recommendations

Medical care

Medical care is substandard throughout the country including Díli.  Adequate evacuation insurance coverage for all travellers is a high priority. In the event of a serious medical condition, medical evacuation to Singapore or Darwin is likely to be necessary.

Medical facilities are extremely limited and evacuation, at significant expense, is often the only option in cases of serious illness or accident.

Mosquito protection

Remember that bed nets, repellents and protective clothing are very important. All travellers should take repellents with them, but leave deodorants and perfumes at home.

The diseases –

1. There is a high transmission rate (equally between P.Faliparum and P.vivax) throughout the year. Travellers should decide between oral medications (Malarone and doxycycline) after discussion with their doctor; effective drugs may not be available in Timor Leste.  Antimalarials are recommended for all travellers; evening and night time insect precautions are essential.
2. Japanese encephalitis. Two vaccines (Jespect and Imojev are available) – see below, the first requiring two doses 28 days apart and the second is a single dose. Evening and night time insect precautions are recommended.
3. Dengue. Significant risk exists in urban and rural areas, including Díli. Transmission occurs throughout the year with highest activity from December through March. Daytime insect precautions are recommended.
4. Chikungunya. Risk exists throughout the country, especially in Champasak Province. Daytime insect precautions are recommended.

Traveller’s diarrhoea

Traveller’s diarrhoea is usually acquired when people from countries with a high level of hygiene travel to countries with a low level of hygiene. Developing countries in Latin America, Africa, the Middle East, and Asia are considered high risk.Individuals at particularly risk include young adults (prone to risk-taking behaviour and often on limited budgets); persons with immune suppression, inflammatory bowel disease or diabetes; and those taking medications that decrease gastric acidity, most notably proton-pump inhibitors (omeprazole, esomeprazole, lansoprazole, etc.). A high risk exists throughout Timor Leste. Food and beverage precautions are essential to reduce the likelihood of illness.

Do not eat:
Unpasteurised dairy products such as cheese, yogurt, ice cream and milk.
Leafy or uncooked vegetables or salads.
Undercooked, raw, or cold meat, seafood, and fish.
Cold sauces such as mayonnaise, salad dressing, chutneys, or salsas, which are usually raw and made by hand.

Do not drink:
Tap water or rinse toothbrush in tap water
Ice unless it is made from boiled, bottled, or purified water.     (Freezing does not kill the organisms causing diarrhoea.)
From wet cans or bottles—the water on them may be contaminated. (Dry wet cans/bottles before opening and clean all surfaces that will have contact with the mouth.)
Fruit juice unless it comes directly from a sealed container; otherwise it may have been diluted with tap water.

Travellers should carry loperamide and/or a quinolone antibiotic (eg azithromycin) for presumptive self-treatment of diarrhoea if it occurs and electrolytes for the replacement of loss.  Discuss the various options with your doctor.

Vaccines
Routine:
Travellers are advised to ensure that all routine vaccines (tetanus, diphtheria, pertussis, measles, mumps, rubella, chickenpox and hepatitis B) are up to date.

Recommended:

1. Travellers to Timor Leste are advised to have vaccination against hepatitis A and typhoid fever.
2. Japanese encephalitis varies with rainfall, but is presumed to occur all year round. Those with outdoor exposure (hikers) or those living in rural areas should consider vaccination.
3. Similarly, rabies vaccination should be provided to the young, backpackers or any who are likely to be exposed to dog or bat bites or scratches.
4. Influenza exists throughout the year in the tropics and vaccination offers a cost-effective protection.

Travel advisory

The Australian Government’s travel advisory (http://smartraveller.gov.au/zw-cgi/view/Advice/Timor_Leste) advises travellers to “Exercise a high degree of caution”.

•   We advise you to exercise a high degree of caution in Timor-Leste because of the uncertain security situation. The situation could deteriorate without warning. You should pay close attention to your personal security at all times. Monitor the media and other sources about possible new security risks.
•   Localised unrest occurs in Timor Leste, including politically-motivated street gang clashes and anti-government demonstrations. You should avoid spontaneous gatherings, demonstrations, protests, street rallies and other large public gatherings as they may turn violent.
•   Sexual harassment of foreign women, including groping and men exposing themselves, frequently occurs.
•   Opportunistic crime occurs and risks increase at night and if travelling alone.

Always register with SMARTRAVELLER.GOV.AU

History

European colonisation of South East Asia began in the 16^th century and the Dutch were the dominant power in Indonesia. However, the Portuguese established outposts in Timor and the Maluku Island group to the north.

Australian and Dutch forces occupied Portuguese Timor during the Second World War engaging Japanese invaders from February 1942. A close relationship developed between Australian guerilla troops and local East Timorese, but this involvement cost the civilian population dearly, Japanese forces burned many villages and seized food supplies. The Japanese occupation resulted in the deaths of 40,000-70,000 Timorese.

After the War, Portuguese Timor was handed back to Portugal. However, with its revolution at home and independence movements in all its colonies, Portugal was not up to the job. In East Timor, Fretlin declared independence in 1975; however, Indonesia invaded in 1979 and carried out massacres and deliberate starvation causing outrage around the world.

Eventually, the United Nations organised a referendum in 1999, which rejected Indonesian control and led to the implementation of UN protection until independence was declared in 2002. During this transitional period, a UN force consisting mainly of Australian Defence Force personnel was deployed to Timor Leste to establish and maintain peace.

In recent years, relations with Australia have been strained by disputes over the maritime boundary between the two countries. Canberra claims petroleum and natural gas fields in an area known as the ‘Timor Gap’, which Timor Leste regards as lying within its maritime boundaries.