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.