After decades of turmoil Timor-Leste is re-building its healthcare system. Resource limitations are severe. Opiates are unavailable on the wards and used sparingly in theatres. Minimal staff training, inadequate medication supply and cultural acceptance result in poor pain management. This audit examines post-operative pain management in 85 patients thought reasonably to require post-operative analgesia. Despite medication being charted 20 patients (24%) received no post-operative analgesia, (before review). This group had a mean verbal numeric pain score of 5.8+/-2.2, median 6, range 2-9. Thirty-four patients (41%) received some of their charted analgesics. This group had a mean pain score of 5.1+/-2.2, median 5, range 1-9. The remaining 31 patients received their analgesics as charted and, unsurprisingly, had the lowest pain scores, mean 4.3+/-2.3, median 4, range 1-8. No patient received prn analgesia. More than 40% of patients reported pain scores greater than 5, with 15% reporting pain scores of 8 or 9. Forty-seven patients (55%) were unsatisfied with their pain relief. Fifty-one patients (60%) received additional analgesia as a result of review. Despite cultural expectations Timorese patients would welcome additional post-operative analgesia. To achieve this there are significant hurdles to overcome in training, drug availability and attitudes towards pain relief.