title: Surgical capacity building in Timor-Leste: a review of the first 15 years of the Royal Australasian College of Surgeons-led Australian Aid programme.
abstract: BACKGROUND
  Timor-Leste suffered a destructive withdrawal by the Indonesian military in 1999, leaving only 20 Timorese-based doctors and no practising specialists for a population of 700 000 that has now grown to 1.2 million.
  
  
  METHODS
  This article assesses the outcomes and impact of Royal Australasian College of Surgeons (RACS) specialist medical support from 2001 to 2015. Three programmes were designed collaboratively with the Timor-Leste Ministry of Health and Australian Aid. The RACS team began to provide 24/7 resident surgical and anaesthesia services in the capital, Dili, from July 2001. The arrival of the Chinese and Cuban Medical Teams provided a medical workforce, and the Cubans initiated undergraduate medical training for about 1000 nationals both in Cuba and in Timor-Leste, whilst RACS focused on specialist medical training.
  
  
  RESULTS
  Australian Aid provided AUD$20 million through three continuous programmes over 15 years. In the first 10 years over 10 000 operations were performed. Initially only 10% of operations were done by trainees but this reached 77% by 2010. Twenty-one nurse anaesthetists were trained in-country, sufficient to cover the needs of each hospital. Seven Timorese doctors gained specialist qualifications (five surgery, one ophthalmology and one anaesthesia) from regional medical schools in Papua New Guinea, Fiji, Indonesia and Malaysia. They introduced local specialist and family medicine diploma programmes for the Cuban graduates.
  
  
  CONCLUSIONS
  Timor-Leste has developed increasing levels of surgical and anaesthetic self-sufficiency through multi-level collaboration between the Ministry of Health, Universidade Nacional de Timor Lorosa'e, and sustained, consistent support from external donors including Australian Aid, Cuba and RACS.
authors.affiliation: Royal Australasian College of Surgeons, RACS Global Health, Melbourne, Victoria, Australia.|University Hospital Geelong, Deakin University and Barwon Health, Geelong, Victoria, Australia.
authors.forename: Glenn D
authors.initials: GD
authors.lastname: Guest
authors.affiliation: Royal Australasian College of Surgeons, RACS Global Health, Melbourne, Victoria, Australia.
authors.forename: David F
authors.initials: DF
authors.lastname: Scott
authors.affiliation: Guido Valadares National Hospital, Ministry of Health, Dili, Timor-Leste.
authors.forename: Joao P
authors.initials: JP
authors.lastname: Xavier
authors.affiliation: Faculty of Medicine and Health Sciences, National University of East Timor, Dili, Timor-Leste.
authors.forename: Nelson
authors.initials: N
authors.lastname: Martins
authors.affiliation: Royal Australasian College of Surgeons, RACS Global Health, Melbourne, Victoria, Australia.|Guido Valadares National Hospital, Ministry of Health, Dili, Timor-Leste.
authors.forename: Eric
authors.initials: E
authors.lastname: Vreede
authors.affiliation: Royal Australasian College of Surgeons, RACS Global Health, Melbourne, Victoria, Australia.|Guido Valadares National Hospital, Ministry of Health, Dili, Timor-Leste.
authors.forename: Antony
authors.initials: A
authors.lastname: Chennal
authors.affiliation: Royal Australasian College of Surgeons, RACS Global Health, Melbourne, Victoria, Australia.
authors.forename: Daliah
authors.initials: D
authors.lastname: Moss
authors.affiliation: Royal Australasian College of Surgeons, RACS Global Health, Melbourne, Victoria, Australia.|University Hospital Geelong, Deakin University and Barwon Health, Geelong, Victoria, Australia.
authors.forename: David A
authors.initials: DA
authors.lastname: Watters
mesh_terms: D000776:Anesthesiology; D001315:Australia / Q000453:epidemiology; D057191:Capacity Building / Q000379:methods*; D005194:Family Practice; D013502:General Surgery; D006280:Health Workforce; D006801:Humans; D007391:International Cooperation; D011231:Preceptorship / Q000379:methods; D012577:Schools, Medical; D013038:Specialization / Q000706:statistics & numerical data; D066231:Surgeons / Q000193:education* / Q000600:supply & distribution; D049648:Timor-Leste / Q000453:epidemiology
keywords: Australian Aid; Cuban Medical Brigade; Royal Australian College of Surgeons; Timor-Leste; capacity building; global surgery; health workforce; low income country; surgical burden of disease; surgical training