Malnutrition: A sickness of government, society<\/p>\n
B. Herry-Priyono, Jakarta<\/p>\n
After SARS, there was the avian flu. After the avian flu, it
\nwas dengue fever, then polio, and then the graph descended even
\nfurther -- outlining a basic and preventable human malaise --
\n\"malnutrition.\"<\/p>\n
It is the same, sad old story that refuses to go away. With
\nevidence showing so many children struck down by malnutrition all
\nbravura about a suave and modern Indonesia vanishes. That
\nchildren continue to go hungry in this country is, as it should
\nbe, an embarrassment internally -- an indictment of Indonesian
\nsociety with its inefficient and corrupt public service providers
\nand politicians whose real commitment to eradicating poverty and
\nhunger must be questioned. It is also a slap in the face to a
\nnation conscious of international public opinion.<\/p>\n
It all started with a report of the widespread incidence of
\ncases of acute malnutrition in West Nusa Tenggara, east of Bali.
\nAs of May 31,487 children under five in the province were
\nrecorded as suffering from acute malnutrition, with dozens
\nalready dead.<\/p>\n
This, of course, is likely to be an understatement of the
\nseriousness of the problem. The reasons for the cases are also
\nplain for all to see. In neighboring East Nusa Tenggara, for
\nexample, of the 6,502 health centers in the province, only 40
\npercent are still functioning -- 60 percent have long been
\ninactive.<\/p>\n
The still-active health centers in the wider Nusa Tenggara
\nregion recorded 66,833 children under five as suffering from
\nmalnutrition in various degrees. Include the likely 50-60 percent
\nof children with no access to centers and we have a figure at
\nleast 100 percent higher. But is it possible that this province
\nmay simply be an exception, a statistical anomaly?<\/p>\n
For the answer we can take Jakarta -- for many Indonesians a
\ncity of glitter, glamor, wealth and power -- as an acid test. The
\nJakarta City Health Agency reported that 8,455 children under
\nfive are suffering from malnutrition (June 10). As mentioned,
\nthere is nothing new in this story. Sri Palupi of the Jakarta-
\nbased Institute for Ecosoc Rights, who has long documented
\nmalnutrition cases, noted that as early as 1998 there were 1.2
\nmillion children under four in Indonesia suffering from
\nmalnutrition (Kompas, June 9, 2005).<\/p>\n
The current uproar about malnutrition should actually be
\nheartening, it is an old problem that refuses to be swept under
\nthe carpet, but at least the public and politicians are standing
\nup and taking notice. But for how long? Presumably the cases of
\nmalnutrition did not only surface this year. And if we have
\nignored such shocking statistics before, we can ignore them
\nagain.<\/p>\n
It is also encouraging to hear President Susilo Bambang
\nYudhoyono's avowed personal interest in the cases: \"Don't cover
\nup development problems just to make me happy. I am keen to know
\nwhy malnutrition still exists,\" he said (The Jakarta Post, June
\n8). Indeed, Mr. President, we are all wondering why some members
\nof this country lead such a harsh and brutish existence while
\nyour economic minister makes brash claims about the country's
\nbuoyant economic conditions.<\/p>\n
Perhaps the widespread incidence of malnutrition has nothing
\nto do with economic conditions. Or is it that the claims of your
\neconomic minister are laughable and belie the sad reality that
\nIndonesia remains one of the most inequitable societies in
\nSoutheast Asia. One task of your leadership is to ensure the
\nclaims of your ministers are less extravagant, because these days
\nIndonesian citizens assume most politicians are lying even when
\nthey are being sincere.<\/p>\n
Of course, the widespread incidence of malnutrition cannot be
\nunderstood in terms of a single cause, it is a combination of
\nmany causes; structural failures that are economic, political,
\nmanagerial and social.<\/p>\n
To give Susilo some slack, however, it is also certain that
\nthe present government has inherited a problem not entirely of
\nits own making. Evidence shows that the Megawati Soekarnoputri
\ngovernment presided over a period where the provision and quality
\nof health services sharply decreased for the nation's poor. Even
\nso, the widespread incidence of malnutrition threatens to poison
\nthe new government's public relations campaign. And the speed
\nrequired to address the problem is parallel with the urgent
\nnature of the cases.<\/p>\n
Getting food aid to the people that need it, is indeed a big
\nbut not-impossible task, which calls for the best managerial
\ntalents. We would like to see the President, as the chief manager
\nof the country, whip his slumbering governors -- the same
\ngovernors preoccupied with megalomaniac projects, graft, nepotism
\nand cronyism and who often ignore dire straits of their
\nconstituents -- into action. Decentralization has no doubt
\nshifted some important aspects of authority from the central
\ngovernment to these governors. Autonomy will lose its raison
\nd'etre, however, unless it leads to a speedy redress of local
\nproblems at the local level.<\/p>\n
Second, it is equally important to note that the huge task of
\naddressing the problem of widespread malnutrition cannot be
\nundertaken by governments -- central or regional -- alone, if
\nonly because the causes of the problem go beyond the confines of
\ngovernment offices. I am drawn to this point by Tan Shot Yen, a
\nmedical doctor studying at the Driyarkara School of Philosophy,
\nwho for a long time has been observing the pattern of food
\nconsumption by children in this country.<\/p>\n
Her somber observations, for instance, show that many of our
\nchildren (and adults) have been seduced by the many deceptive
\nfood advertisements bombarding our television screens. Many foods
\nbeing advertised on TV are snacks with almost no nutritional
\ncontent. So, even if you have enough money to buy the healthiest
\nand most nutritious foods, there is no guarantee that your
\nchildren will not suffer from a lack of nutrition, if not the
\nmalnutrition suffered by poor families.<\/p>\n
Tan argues that we should not be surprised by a strange
\nphenomenon where the battle between \"food for health\" and \"food
\nfor commerce\" is won by the latter.<\/p>\n
Add to this the increasing difficulty the poor have accessing
\npublic hospitals and we are certain to create an underclass of
\nwretches who will live short, difficult lives -- their growth
\nstunted, their bodies sickly from a simple lack of good food.<\/p>\n
It is clear that addressing the problem of widespread
\nmalnutrition needs speedy action by the government. It also needs
\na massive publicity campaign that promotes \"food for health\".<\/p>\n
Otherwise, coming generations will continue to be affected by
\nthis preventable scourge.<\/p>\n
The writer is a postgraduate lecturer at the Driyarkara School
\nof Philosophy, Jakarta.<\/p>",
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