Reimagining rural healthcare in Timor-Leste: from the sky up.

Timor-Leste is a country of dramatic beauty and difficult terrain. Its mountains roll into valleys with barely a road in sight. In the wet season, landslides frequently wipe out bridges, severing communities from vital services. Even in the dry, a “short” trip to the capital can stretch into an exhausting two-day journey.

For the 70% of Timor-Leste’s population living in rural areas, the consequences of this isolation are dire. Access to healthcare is limited and uneven, with many clinics understaffed, under-resourced or unreachable. In emergencies, treatable conditions like infections, complications during childbirth, or trauma from road accidents can quickly become fatal.

This is where Mission Aviation Fellowship (MAF) comes in. MAF serves as the country’s only air ambulance, flying emergency medevacs to the national hospital in Dili. With a small fleet of aircraft, MAF pilots are often the difference between life and death, transforming a treacherous eight-hour road journey into a 30-minute flight.

Since launching in Timor-Leste in 2007, we at MAF have learnt that our life-saving programs are about more than providing critical transport. They are most effective when equal access to healthcare, dignity, and community trust are placed at the centre. Just as important is aligning with government priorities, ensuring our work strengthens and complements Timor-Leste’s broader health policy goals.

Eight decades of experience, one mission.

MAF’s work in Timor-Leste is part of a much larger story. The organisation was born out of a post-war vision in 1945, when a group of WW2 veterans resolved to use their aviation skills for good. What began with a single aircraft now includes a fleet of 117, operating in more than 24 countries around the world.

Today, MAF supports over 1,500 partner organisations, flying doctors, midwives, pastors, disaster relief workers and patients to get where they are most needed. Our aircraft have responded to earthquakes in Nepal, tsunamis in Indonesia and outbreaks of Ebola in Congo. One of our planes famously flew the BBC team that reported on the Ethiopian famine in 1984.

In Timor-Leste, our focus is on meeting urgent medical needs while also centering dignity, culturally sensitive education, equitable access to healthcare and building long-term trust with local communities.

Atauro Island airstrip. – Photographer: Lobitos Alves.

Going beyond the flight: Dignity in the details.

In 2024, Juvita Soares Gomes’ two-month-old baby, Amorcisa, developed a severe lung infection on Atauro Island, a stunning but remote location surrounded by ocean and accessible only by boat. The journey to Dili’s Guido Valadares National Hospital (HNGV) could take up to three hours by sea. With her child deteriorating rapidly, Juvita feared the worst.

But help came from the sky and a MAF medevac was able to land on the island and transport baby Amorcisa to hospital in just 15 minutes. But our support didn’t end when the aircraft landed. Recognising the vulnerability of medevac patients in such emergency situations, we have also developed an accompanying care pack initiative. Each care pack contains hygiene items, clothing, snacks, information in the local language, Tetun, and other essentials. These seemingly small gestures offer practical support and emotional comfort to families who have left home in a hurry and often arrive with nothing. As MAF’s “Closing the Loop” coordinator, Estella Noronha, says, “When they receive a bag, it shows we care. It means so much that I can remind people they are not forgotten.”

For Mrs Gomes the care packs were a vital part of the experience, “When we came from Atauro, we didn’t bring sufficient supplies. But, when we arrived in Dili, the MAF team gave us a care bag containing basic needs… This meant a lot to us because we did not bring enough supplies for an extended hospital stay!”

Building trust with every take-off.

For many Timorese, MAF flights are also their first experience of aviation. This means that taking a MAF flight can be daunting, especially if it happens during a medical emergency. Recognising the clear need to build trust and confidence with the communities we work with, in July 2024, the MAF team further launched our community outreach initiative: “Flying is for Everyone”.

Over two weeks, MAF visited six municipalities – Maliana, Suai, Same, Viqueque, Lospalos and Baucau – offering introductory flights to local community members. The goal? To demystify flying, reduce fear and build familiarity before a crisis ever hits. Pilots explained safety procedures, answered questions and shared how medevac flights operate.

The effort paid off. Since launching the Flying is for Everyone program, our local staff have reported a noticeable rise in bookings for medevac and charter flights, a sign that trust is growing. Iria Mutu Soares, a 53-year-old mother from Maliana, was nervous at first: “I was afraid when the aircraft took off because it was my first time aboard an airplane… but now I’m happy and want to gain more flight experience.”

Working with local government priorities. 

Since 2007, we have also partnered with Timor-Leste’s Ministry of Health to ensure that every flight serves the country’s own priorities and enables the government to deliver its health programs to the most hard-to-reach places.

In 2022, a MAF aircraft carried the Vice-Minister of Health and his team to Atauro Island for the launch of a new tuberculosis vaccination program. The following week, another MAF flight transported Ministry staff back to the island to monitor vaccination services and meet with the newly inaugurated municipal administrator. These journeys weren’t just about getting people from A to B, they were about making sure life-saving public health initiatives reached communities that might otherwise be left behind.

By working in step with local authorities, we are prioritising turning national health plans into reality, even in the most remote corners of the country. It’s a model that respects local leadership, strengthens existing systems and ensures that every flight is part of something bigger – not just an isolated trip, but a step towards long-term change.

Estella Noronha (right), Coordinator for the Closing the Loop program in Timor-Leste, with Salomon’s family. Photographer: Lobitos Alves.

Small gestures, lasting impact.

Whether through a care pack, a community flight, or a timely medevac, we have learnt that our work must be centred on dignity, education, equitable access to health care and a community-first model to have the most impact. The model isn’t flashy. It’s relational, slow and responsive to government health priorities. It’s built on listening first, and flying second.

In a country where geography can be the difference between life and death, MAF is not only bridging the gap, it’s shortening the distance between fear and hope, between crisis and care.

And in doing so, it’s helping Timor-Leste reimagine what’s possible. And the sky is the limit.

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Eleanor Rivers is Head of Communications, PR and Engagement at Mission Aviation Fellowship (MAF) in Australia, where she has spent the past eight years sharing powerful stories of impact from some of the world’s most isolated places. With a background in communications and strategy, Eleanor leads the development of messaging that connects supporters with MAF’s mission, builds public awareness and strengthens organisational reputation.

Mission Aviation Fellowship (MAF) is a humanitarian aviation organisation that overcomes barriers of isolation so people in remote communities can access the help they need. Founded in 1945, MAF now operates a fleet of over 115 aircraft across more than 24 countries. Each year, MAF works with over 1,500 partner organisations, flying doctors, relief workers, educators and patients to places that are otherwise unreachable.

From delivering urgent medical evacuations and disaster relief, to enabling long-term development and community programs, MAF’s work is centred on ensuring no one is cut off from essential care and support. With 80 years of experience, MAF continues to connect people, transform lives and shorten the distance between crisis and hope.

Feature image: Children attending the ‘Flying is for Everyone’ events in 2024″. Photographer: Lobitos Alves.