Social Medicine in Timor Leste

Abstract

‘“Social medicine”, a  concept notably developed in Latin America by Salvador Allende in the 1930s, links up a broader model and ethos of public health with processes of social transformation. In recent years that influence has spread to Timor Leste, through a very large Cuban health cooperation and training program. This paper considers to what extent an endogenous “social medicine” might be developing in Timor Leste. Such a development would require transition away from the existing model based on small, private clinics. The paper accepts Guzmán’s observation that Latin American social medicine is a wider, more dynamic and participatory model than that presented from European epidemiology – the ‘social determinants’ approach – but asserts that there are different forms of social medicine, conditioned by distinct histories and cultures. If earlier Chilean social medicine was a key element of that country’s radical social democracy, and Cuban social medicine expressed revolutionary solidarity and internationalism, what might be the character of an East Timorese social medicine? This paper traces the idea of ‘social medicine’ from Chile, through Cuban solidarity aid, to the synthesis emerging in Timor Leste. This is an interpretive history, making use of past analyses, contemporary information on the Cuba-Timor Leste health program and the East Timorese responses. It includes a number of interviews and direct observations of pedagogy and practice. It concludes that a transition to social medicine in Timor Leste has some advantages: the large scale of the new training program; a sympathetic culture; and potential leadership. Less certain is the exact form of East Timorese social medicine. However the ideas seem set to be absorbed into a domestic culture of community solidarity, inclusive Christianity, and an independent spirit.