How low can malaria go in Irian Jaya?<\/p>\n
By Simon Sinaga<\/p>\n
TIMIKA, Irian Jaya (JP): Werry Kogoya lounged in an open area
\nin front of the main ward of a public hospital in this southern
\ntown in the easternmost region of Irian Jaya. As liquid spilled
\ncopiously from a drip he was carrying along, Kogoya said he was
\nadmitted to hospital because of malaria.<\/p>\n
This was the second time in as many months the 40-year-old man
\nwas hospitalized. Arriving by air from the highlands in Wamena
\nonly three months ago to visit his brother in lowland Timika in
\nsearch of work, he felt he had bought a ticket to the nightmare
\nof malaria symptoms including chills and intermittent fever after
\na month's stay.<\/p>\n
Kogoya is just one of seven malaria patients of a total of 10
\npatients at the hospital - Rumah Sakit Mitra Masyarakat (RSMM) --
\na modern public hospital run by Caritas Foundation, which is
\nfunded by a mining company.<\/p>\n
"Even though malaria can be cured and is preventable, this
\ndisease has continued to be the leading cause of death in the
\nprovince of Irian Jaya," said Didik Irawan, head of the
\nprovincial health agency in Jayapura, the province's capital.<\/p>\n
Official health figures show that the annual incidence of
\nmalaria was still more than 10 percent of the population up until
\nthe early 1990s. It was 176 per 1,000 people in 1994 and was only
\ndown to 101 per 1,000 people in 1998. While in certain areas the
\nincidence of malaria has been significantly lowered, it remains
\nhigh by any health standards. In fact, in far-flung villages and
\nin areas newly opened to development, the level of malaria was
\nonly recently successfully lowered to near that level. In Timika
\nand surrounding villages, for example, the rate was as high as 80
\npercent until the early 1990s.<\/p>\n
However, that level of malaria seems stubbornly reluctant to
\nreduce any further in most recent years. Irawan said doctors and
\nmedical workers have to cope with daunting challenges to further
\nreduce the malaria mosquito population given Irian Jaya's sheer
\nsize and rugged terrain. "Our target is to cut the malaria
\nmosquito population to two percent but I think it will be
\ndifficult to reach," he said.<\/p>\n
Efforts to reduce malaria have included treatment for
\npatients, use of malaria drugs, extermination of vector
\nmosquitoes and eliminating potential breeding places. The
\nundertaking was started by the World Health Organization in 1971
\nand has been continued by the government.<\/p>\n
Insecticide had been used to break the chain of the spread of
\nthe parasite. But over time, the vector -- Anopheles species --
\ngrew resistant to insecticide. Besides, it is virtually
\nimpossible to use insecticide over so many areas in the province
\nand it also has a harmful effect on other insects.<\/p>\n
Elimination of mosquito breeding places has also been more
\nwidely practiced in recent years. But this takes time and is very
\nmuch connected with the way people live. Efforts of the Irian
\nJaya health agency have been far from adequate, impeded by the
\nshortage of manpower and funds.<\/p>\n
In Timika and surrounding villages in southern Irian Jaya,
\nefforts to tackle malaria have continued to received major
\nsupport from mining company PT Freeport Indonesia, which is also
\nobliged to undertake efforts to ensure its areas of operations
\nare free from the disease.<\/p>\n
The company's Malaria Control and Public Health department
\nuses an annual US$3 million budget to combat malaria and train
\nlocal government and community health workers about malaria. The
\nactivities center around reducing the malaria mosquito in the
\ncommunity and reducing areas conducive to the breeding of the
\nAnopheles mosquito.<\/p>\n
Efforts cover drainage projects, water hyacinth control,
\nlarval monitoring and control, house spraying and door-to-door
\nblood tests.<\/p>\n
Indeed, the eradication of Malaria seems to have a long way to
\ngo in this easternmost region. Clinically alone, parasites in
\nhuman bodies from the two most common malaria vectors --
\nPlasmodium Falciparum and Plasmodium Vivax -- have shown
\nresistance to certain drugs such as chloroquine and quinine,
\nwhich are the first medicine to be prescribed for malaria
\npatients.<\/p>\n
A subsequent form of treatment currently used is mefloquine.
\nBut this should be taken in consultation with a doctor because
\nindiscriminate use could well promote resistant forms of
\nPlasmodium Falciparum. Sulphadoxime\/pyrimethamine have also been
\nused in treatment of malaria. Many public health clinics in Irian
\nJaya however are not well equipped to provide this treatment and
\ndo not have available doctors.<\/p>\n
How much further can malaria go? Few can answer. In fact,
\ndoctors acknowledge that the malaria issue is much more complex
\nthan coping with medical and geographical challenges alone.<\/p>\n
"In Irian Jaya, malaria is as much a social issues as a health
\nissue," said Fransiskus Krisna, a senior doctor at RSMM hospital.<\/p>\n
He said that malaria had much to do with the issues of
\neconomic well-being, education and way of life. Irianese who live
\nin far-flung villages, for example, have little idea about the
\nAnopheles mosquitoes' life cycle and their habit of relaxing
\noutdoors at night before going to sleep makes them susceptible to
\nmosquito bites. Highlander Kogoya, for example, who knows little
\nof malaria, only found out that the disease was related to
\nmosquitoes after he was hospitalized.<\/p>\n
Doctor Krisna went as far as to say that malaria could well be
\none of the main reasons for the low level of academic achievement
\nin Irian Jaya since the disease makes people not in the mood for
\nstudy or hard work. "The future of many Papuan children is a
\nmajor question if malaria continues to afflict the people at
\ncurrent levels," he said.<\/p>\n
In addition, the physical and socio-economic challenges vary
\nfrom one district to another. Malaria is largely prevalent in
\nlowland towns and villages but during the dry season it could
\naffect highland areas, which are difficult to reach and are more
\nsparsely populated. In certain areas the people are better
\neducated, whereas in other areas few have graduated from high
\nschool. Some areas receive support from the private sector while
\nothers have to rely on the government program.<\/p>\n
"It will take a lot more specific studies in specific areas
\nbefore we undertake pilot projects together with the local
\npeople. The pilot projects will help us to study how we can best
\ndeal with malaria in Irian Jaya," said Didik Irawan.<\/p>\n
At least, Kogoya need not have contracted malaria had he known
\nthat he should not stay out during certain hours to avoid being
\nbitten by a malaria-carrying mosquito.<\/p>",
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