Health workers face difficulties<\/p>\n
By Stevie Emilia<\/p>\n
BELU, East Nusa Tenggara (JP): Yeswelda Mali, a midwife in
\nLamaknen district, wakes up at the first cockcrow, bicycles to
\nthe Weluli village clinic, and often waits hours before a
\npregnant woman finally comes in for an examination.<\/p>\n
So great is the distrust of many local people toward health
\nworkers, and so great is their reliance on traditional untrained
\ndukun (midwives or healers), that Yeswelda realized early on in
\nher career that if the women wouldn't come to her, then she would
\ngo to them.<\/p>\n
Like many other trained midwives and health workers, Yeswelda
\nhas to cover dozens of kilometers on her bicycle every day,
\nriding through thick forests and over steep hills to ensure
\nwomen's pregnancies remain healthy.<\/p>\n
\"The majority of pregnant women are so reluctant to have
\nthemselves examined,\" Yeswelda said.<\/p>\n
The maternal mortality rate in Belu, which is 296 kilometers
\nfrom the province's capital Kupang, is 670 per 100,000 births,
\nwhile the provincial rate in 1995 is 911 per 100,000 births.
\nFourteen of every 34 women who died while giving births to their
\nbabies in Belu were attended by untrained dukun.<\/p>\n
Although the regency rate is lower than the provincial rate,
\nsome districts in Belu actually have much higher rates. Weluli
\ndistrict recorded a maternal mortality rate of 1,370 per 100,000
\nbirths last year while Biudukfoho recorded 7,070 per 100,000
\nbirths.<\/p>\n
The head of Weluli clinic, Nurse Veronica S., said that last
\nyear in Lamaknen village 364 women died in labor. Five of them
\ndied while giving birth in the fields, accompanied only by their
\nhusbands or close relatives, she said.<\/p>\n
\"Even if the women, who had gone to work up to the last
\nminute, wanted our help, it would have been too late because
\ntheir fields are so remote and difficult to reach,\" she said.<\/p>\n
No doctors have been posted to the clinic since April last
\nyear, she said.<\/p>\n
\"Even if there are complications in the delivery, such as a
\nbreech birth, the woman's relatives will first argue among
\nthemselves whether to ask for the help of a dukun or a trained
\nmidwife,\" she added. \"By the time the arguing is finished, the
\nwoman would probably be beyond help.\"<\/p>\n
Head of the Belu's health office Paulus M. Wignyohadi said
\nthat 91.3 percent of women give birth in their own homes rather
\nthan at community health centers or hospitals, and 52 percent of
\nthem are attended by untrained dukun.<\/p>\n
\"Pregnancy and delivery are considered a natural occurrence
\nhere, and most people trust the traditional midwives more then
\ntrained health workers,\" Paulus said. \"Besides, the dukun are
\ncheaper.\"<\/p>\n
Adirambu, a pregnant patient at Veronica's clinic, said that
\nalthough she has been examined at the clinic, she would ask a
\ntraditional midwife to help her deliver her baby.<\/p>\n
The health authorities have tried to solve the situation by
\ntraining traditional midwives. The program started in 1987 and it
\nwas trained midwives such as Yeswelda who had to travel long
\ndistances to seek the dukun and train them.<\/p>\n
There are currently 532 dukun who have been trained and 537
\nuntrained dukun in the regency.<\/p>\n
Attitude<\/p>\n
Experts have acknowledged that one of the most difficult tasks
\nhealth workers face in their efforts to reduce the province's
\nmaternal mortality rate, which is twice the national rate, is
\nchanging the attitude of the local people.<\/p>\n
\"Their belief in untrained dukun and their distrust toward
\nprofessional health workers are something that cannot be changed
\novernight,\" said E.H. Pelokilla, the governor's assistant for
\ncommunity welfare. \"There's no magic. We realize we have to work
\nhard over a long period of time.\"<\/p>\n
\"A total of 58 percent of women in labor turn to dukun instead
\nof doctors or skilled midwives,\" she said. \"Only 15 percent of
\nthem go to midwives and three percent to doctors, while the rest
\nask for their families' help.\"<\/p>\n
She pointed out that poor education is the main reason for the
\nignorance. \"Most women here won't go to the doctor unless they
\nhave severe complaints.\"<\/p>\n
Women are also reluctant because they think that if they seek
\nhealth workers' help too often, they'll be mocked because it
\nwould mean they had too active a sex life, according to Susi M.
\nDauselt Katipana, an officer of the United Nations Children's
\nFund (Unicef).<\/p>\n
Another problem that health workers have to contend with is
\nchanging the dukun's ways of assisting women in labor. \"We can't
\njust make them abandon their traditional ways. What we need to do
\nis help them see the importance of preparing a hygienic
\ndelivery,\" Pelokilla said.<\/p>\n
The province has a population of 3,473,000 spread through
\n1,626 villages in 42 of its 566 islands.<\/p>\n
Pelokilla said anemia is another reason for the high mortality
\nrate in the province. A total of 51 percent of women who died
\nduring labor were anemic, she said.<\/p>\n
There's a belief among the people that pregnant women should
\nnot eat eggs, fruit, fresh or fried fish. All of these are in
\nfact very important for their health, she said.<\/p>\n
In addition, there's the classic problem of having
\ninsufficient medical personnel and inadequate equipment,
\nPelokilla said. \"There's not much we can do about this. For
\ninstance, there's only one gynecologist serving the whole
\nprovince,\" she said.<\/p>\n
There are only two doctors, 13 trained midwives and 41 junior
\nmidwives in 13 community health centers serving the 228,000
\npeople in the eight districts in the Belu regency.<\/p>\n
Limited funds is to blame for the province's failure in
\nrecruiting more doctors, she pointed out. \"Doctors work here only
\nbecause they have the post-education three-year contract with the
\ngovernment. After that, they'll be gone,\" she said.<\/p>\n
In 1995 the average per capita income was Rp 550,000 (US$234),
\none of the lowest figures in the country.<\/p>\n
The provincial government, in cooperation with Unicef, has
\nbeen making great efforts to lower the maternal mortality rate
\nhere. Regretfully, not many people understand that hard work is
\ninvolved before the endeavor can succeed, according to Esthon
\nW.L. Foenay of the provincial administration.<\/p>\n
The head of the bureau in charge of setting up programs on
\nwomen and children's health said that local people, including
\nofficials, often see funds from donors such as Unicef only as
\nextra money to be spent.<\/p>\n
In 1993\/94, the local government allocated Rp 256 million for
\nthe women and children's health programs, while Unicef assisted
\nwith Rp 2.4 billion. In 1994\/95, there was Rp 416 million
\nallocated by the government, along with Rp 3.9 billion from
\nUnicef.<\/p>\n
\"The community should realize that the fund is there to help
\nwomen and children improve their health,\" Esthon said.<\/p>",
"url": "https:\/\/jawawa.id\/newsitem\/health-workers-face-difficulties-1447893297",
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