Dr Jennifer Yan is a paediatrician and paediatric infectious diseases physician at Royal Darwin Hospital, as well as a senior research fellow at Menzies School of Health Research.

At Menzies she leads projects in Timor-Leste with Dr Josh Francis, including STRONG TL and the Fleming Fund Country Grant for AMR surveillance. The work that Dr Yan and Dr Francis lead in Timor-Leste has been integral to the Timor-Leste COVID-19 response and establishing in-country testing at the National Health Laboratory. Dr Yan is also involved in rheumatic heart disease research in the Northern Territory (NT) and Timor-Leste.

We asked Dr Yan about her work during the COVID-19 response both in the NT and Timor-Leste.

Could you briefly describe a typical day for you?

There aren’t many typical days for anybody in the world right now. COVID-19 has definitely changed things for me. Paediatric handover is done remotely now, as are many other clinical and project meetings. I see patients in Royal Darwin Hospital who are admitted, but most outpatient appointments now are via telehealth. I’ve been involved in preparing for and responding to COVID-19 in Top End Hospitals, which has meant lots of meetings and discussions, and recent trips to Katherine and Nhulunbuy to meet with hospital staff there.

I've been lucky to work with a great team of doctors, nurses, midwives, allied health, personal care assistants, cleaners, administrative staff - the team that together, will look after children, pregnant women and their infants with suspected or confirmed cases of COVID-19 in hospital. Usually I travel to Timor-Leste around once a month for project work, and to Maningrida once a month for clinic visits, but travel restrictions have put a pause on these visits for the time being.

Have these changes been challenging?

There are new challenges, definitely. Everyone has had to deal with a raft of changes and added uncertainty, at work if we are lucky enough to have had continued employment, and in our personal lives. I think some of the biggest challenges for us at work have been the restriction on travel to remote communities and the difficulties getting patients in from remote communities to Darwin for care, with many more patients managed remotely.

So much is gained by meeting children and families in their home town, and seeing them in their normal context, to better understand how to help them with their health needs. For children who are sick, some have been too afraid to travel into Darwin, or perhaps even to seek care in clinic. Some have been able to be managed by GPs remotely, bearing the burden of a greatly increased workload. But the restrictions have been key to the NT and Australia’s success in managing the situation this far and in helping to protect remote communities from the potentially devastating effects of COVID-19. In every day practice on the wards, we still try and show our patients kindness, care and fun, despite the barriers of wearing important but sometimes scary-looking personal protective equipment - the gowns, gloves, goggles and masks that hide our smiles and grins. 

How did you first become involved with health systems strengthening in Timor-Leste?

I came to Darwin in part because I was interested in the work that was happening in Timor-Leste, as well as the opportunities to be involved in Indigenous health. I have seen how effective health systems strengthening work can be in a similar context, when I was working for a period in Laos. As I finished my training in paediatric infectious diseases, I wanted to stay involved in global health work, engaging with local health systems and working to improve health outcomes in places with greater need. 

How has the Menzies Timor-Leste projects team responded to the COVID-19 pandemic in Timor-Leste?

The work that Menzies has been doing in Timor-Leste for the last two years, has been focused on strengthening the health system responses to infectious diseases, through improving surveillance, clinical and laboratory capacity, and helping these key areas to function well together and not just in their own silos. This sort of approach is really important in responding to crises like the COVID-19 pandemic. Our work has had ongoing focus on these three areas. In the laboratory, we have helped the National Health Laboratory to establish real-time PCR testing for COVID-19, enabling rapid access to test results within the country. Testing capacity is being scaled up further, as we speak, with support from the DFAT Indo Pacific Centre for Health Security and the Australian Embassy. We continue to work closely with the Timor-Leste Ministry of Health’s Surveillance Department to deliver training and continually revise the strategy for COVID-19 surveillance, based on the ever-changing situation. And we are working closely with our clinician colleagues on issues around the recognition, diagnosis and management of COVID-19. 

The NT and Timor-Leste both, at the time of writing, have no active cases of COVID-19. Dr Yan says this is an enviable and lucky position to be in.

“Congratulations to people in both places for supporting measures that have allowed it to be so. We hope it stays this way!” Dr Yan says.