Hope for malaria-stricken poor in Central Java<\/p>\n
Santi W.E. Soekanto, Contributor, Magelang, Central Java
\nsanti_soekanto2001@yahoo.com<\/p>\n
Every year, malaria kills approximately 32,000 people in this
\ncountry, meaning 87 people die every day because of it.<\/p>\n
Malaria is a disease of the poor, those living in remote areas
\nwith scant access to health services.<\/p>\n
It is also a disease of a poor environment -- the mosquitoes
\nthat spread the disease breed and survive in stagnant water like
\nswamps, dark areas such as salak (zalacca or snakefruit)
\nplantations unreached by the sunshine, unattended shrimp
\nhatcheries and blocked streams during the dry season.<\/p>\n
When Indonesia plunged into the economic crisis in 1997, it
\ndescended into a ravine of outbreaks of diseases and
\nmalnutrition. As many as 87.5 million Indonesians could not
\nafford to eat more than once daily, according to an official in
\nAugust 1999.<\/p>\n
News reports of hunger-related deaths, mainly among children,
\nstreamed in to the shock of many Indonesians -- "As many 165
\nmalnourished babies died this month here", "At least 36 children
\ndied of marasmus this month there", and "A total of 7,202
\nchildren suffered from malnutrition elsewhere."<\/p>\n
It was also the time when malaria made a deadly comeback to
\nthe country, especially in Java which in the years of 1986-1987
\nhad been free of the disease. Between 1998 and 2001 malaria broke
\nout in 11 of the country's 30 provinces, 13 districts and 93
\nvillages.<\/p>\n
The outbreak could not have taken place at a worse time --
\nwhen millions of Indonesian had begun to feel the brunt of the
\ncrisis in the form of job losses and even famine, and when the
\nnewly introduced regional autonomy policy meant more
\ndecentralization of poverty than the granting of greater
\nauthority in managing the regional resources.<\/p>\n
"During the worst of the outbreak, not a day went by without
\nus having to find a means of transportation to bring some sick,
\nfeverish residents from the outback of this village to the health
\ncenter," said Djuwadi, head of Margoyoso village in Magelang,
\nCentral Java.<\/p>\n
"In those days, more than 60 percent of all schoolchildren
\nmissed days of schooling because they were either down with
\nmalaria or having to help around the house because their parents
\nwere ill with malaria," said Sutjipto, the deputy head of
\nMagelang regency health office.<\/p>\n
"So many mothers became anemic, so many buruh penderes (palm
\nsap tappers) had to stop working. At the height of the outbreak,
\nwe had 42 babies sick with malaria within one month. In a
\nneighboring village in Purworejo, 300 people were sick with
\nmalaria at one time."<\/p>\n
According to Dr. Yuniar of the Salaman II community health
\ncenter, her clinic was overflowing with patients.<\/p>\n
"Imagine, they had to spend up to Rp 10,000 for transportation
\nto get to the clinic, they had to stop working while their
\nchildren, of course, could not stop demanding food. Some of them
\ndidn't even realize they had malaria, they continued working and
\n(the potential) to spread the disease," she said.<\/p>\n
For at least three districts straddling the foot of the
\nMenoreh Hills in Central Java and Yogyakarta, namely Kulonprogo,
\nPurworejo and Magelang, help came when it was sorely needed. In
\n2001, the Ministry of Health, the World Health Organization (WHO)
\nand the U.S. government launched a malaria control project in the
\narea.<\/p>\n
Mass fever and blood surveys, drug administration and
\ninsecticide-treated bed nets distribution as well as fumigation
\nprograms were organized with "an epidemiological approach",
\nSutjipto said. "The number of cases decreased drastically
\nfollowing the project."<\/p>\n
Actual statistics may not provide the whole picture, but
\nimprovement is definitely evident over a long period. A WHO
\nreport of the Menoreh Hills malaria control project confirms that
\nthe total number of malaria-positive cases decreased in the three
\ndistricts in 2001.<\/p>\n
The village of Margoyoso serves as an example. In 2000, a
\ntotal of 270 cases of malaria were treated there. In 2001, the
\nnumber was up to 480, but with a significant decline recorded in
\nJune after implementation of several actions, including mass drug
\nadministration. The recorded cases in June were 91 while in the
\nfollowing month the number declined to 36, followed by 18 cases
\nin August, 26 in September, and 17 in October.<\/p>\n
In Krasak village in 2002, the rate was high in the early
\nmonths, but declined significantly by the end of the year; in
\nDecember only five cases were recorded. The number of cases
\nbetween January and May in 2003 was 28 -- as opposed to 309 in
\nthe first five months of 2000, 370 in 2001 and a whopping 380 in
\n2002.<\/p>\n
Not only did the project improve disease management, it also
\nmade a positive impact in terms of capacity building for the
\nhealth center doctors and staff, especially on how to detect and
\nadminister drugs to malaria patients. Villagers were given
\ntraining in the health centers on how to identify malaria cases,
\npreventing malaria and distributing the drug.<\/p>\n
"Expecting the total eradication of malaria here may be as
\nunlikely as telling an old grandmother to compete in the World
\nCup, but we are now better armed," Sutjipto said.<\/p>\n
The poor people in Menoreh Hills may not soon be "cured of
\npoverty" but obtaining better health brings hope for them.<\/p>",
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