Health, a specter for Irian Jaya

Health, a specter for Irian Jaya

By Hera Diani

JAYAPURA, Irian Jaya (JP): "There are five noted figures in
every village. The teacher, head of the village, religious
leader, doctor and agriculture instructor," Irian Jaya Deputy
Governor of People's Welfare Bram Ataruri said here recently.

If Irian villagers were asked which one of those figures was
God, Bram added, they would no doubt choose the doctor.

A joke, of course, but his remark was not an over exaggeration
as health problems remain a dilemma for over two million people
living in outlying Irian Jaya.

A combination of natural conditions and education have put
health care development in the province behind that of other
provinces.

The ratio of all doctors -- general practitioners, specialists
and dentists -- to the population is a staggering 1:10,000.

The province also does not have a medical school, and only now
is the government making preparations to open one, with
expectations that it can be set up in the next decade.

To help curb this divergence, the government has had to resort
to hasty short-term programs while it continues with a larger
blueprint to develop better health care services in the province.

It was during a two-day health workshop to launch one of these
programs that Bram made his analogy.

At the workshop, which was also attended by Minister of Health
Achmad Sujudi and Ministry of National Education's Director
General of Higher Education Satryo Soemantri Brodjonegoro, is
part of Health Ministry's intensive health care program which
started on Friday last week.

It is aimed at improving community health in Indonesia's
easternmost province, which is below the national standard.

The government has allocated some Rp 18 billion (US$2.25
million) for the program.

It includes providing medicine and medical equipment, a polio
immunization campaign and distributing high dosages of vitamin A
to some 292,000 infants below 5 years of age.

Director General of Communicable Disease Control and
Environmental Health Umar Fahmi said vitamin A was needed to
prevent pneumonia, which is the leading cause of death among
infants below 5 years in Indonesia.

"The prevalence of death caused by pneumonia among infants in
Irian Jaya and the eastern provinces is high," Umar announced
earlier this month.

Umar noted that in eastern provinces, like West Nusa Tenggara
and Irian Jaya, 70 out of every 1,000 infants less than a week
old die from pneumonia. This number is much higher compared to
other provinces which only have a rate of about 45 out of every
1,000.

Pneumonia is also the most common health concern among adults
in Irian Jaya.

But the most common disease here is malaria, with a prevalence
of 47.53 percent, followed by respiratory infections, 16.39
percent; infectious skin diseases, 5.43 percent; diarrhea, 5.23
percent; and other diseases.

As for polio, Umar said that immunization was conducted in
anticipation of the rainy season because the higher the rainfall,
the more likely the humid conditions would help the polio virus
to spread.

Another major health concern is that Irian Jaya tops
statistics with the highest number of HIV/AIDS cases in
Indonesia.

The spread of the Human Immunodeficiency Virus (HIV) which
causes the deadly Acquired Immune Deficiency Syndrome (AIDS) has
shown a steady rise.

Official statistics show that since 1996, there have been 393
cases of HIV/AIDS recorded in Irian Jaya.

But health activists say this number could be just the tip of
the iceberg as many cases remain undocumented.

Resources

The main cause of the poor health conditions, according to
officials, is a classic case of a lack of qualified human
resources and medical facilities. In the case of Irian Jaya,
limited accessibility due to the formidable natural terrain is
also an equally arduous challenge that cannot be overlooked.

Covering an area of 421,981 square kilometers, Irian Jaya is
three times larger than Java, with a population of 2,098,310.

Eighty-five percent of the people live in rural areas which
are difficult to reach.

"To reach these people, we have to use helicopters. But it
costs Rp 700,000 (US$87.5) for each person to go back and forth
while to visit an area we need at least four medical staff," said
Jozep Oyong, the director of Mitra Masyarakat Hospital in Timika,
a one-hour flight from Jayapura.

"Sometimes, a two- to three-day trek has to be added to the
helicopter trip to reach the desired location"

Therefore, the Ministry of Health has also included
cooperation with the Navy and Missionary Aviation to reach rural
areas.

According to the ministry, there are only 21 hospitals and
1,034 community health centers (puskesmas) throughout the
province.

Doctors are also few and far between with only 200 general
practitioners, 40 specialists and 58 dentists. They are assisted
by 7,508 other medical staff.

"The turnover of doctors here is very high. For this year
alone, 61 will finish their three-year period as nonpermanent
employees (stationed in the province)," said the head of Ministry
of Health's provincial office, W.E. Kalalo.

"Only 10 out of 60 will stay longer, while there are only 11
doctors due to come here," he added.

Kalalo said most doctors were reluctant to work in rural areas
in Irian Jaya, especially because their salaries were low.

A specialist, for example, would earn about Rp 500,000
(US$55.5) a month.

The 1,034 puskesmas, which form the backbone of health
services in the province, are supported by just 128 doctors.
These clinics are mostly buttressed by medical staffers and some
2,214 midwives.

"That's why we decided to open a medical school, to increase
the number of doctors. Hopefully, more locals can become
doctors," Achmad said, adding that the ministry had recruited
nine more specialists to be placed here.

But talk of Irian Jaya's first medical school is still
premature.

"Maybe it will take at least 10 years to be realized. But it's
a start; we have to be optimistic," Achmad said.