Health promotion begins at grassroots

By Listiana Operananta

Cancer is a major illness being tackled by the Indonesian government. The Ministry of Health invited journalists from Jakarta recently to see the government's program in Sidoarjo, East Java, which is intended to showcase Indonesia's health promotion efforts to delegates and guests at this week's international conference on health promotion in Jakarta. This is our report.

SIDOARJO, East Java (JP): Cancer, like AIDS and other incurable diseases, is a dreaded word for most people.

Not for women in Sidoardjo.

They know what the word means and they know ways to prevent it, and what to do or where to go if they ever have it.

This is chiefly thanks to the Family Welfare Program (PKK), a government-supported grassroots movement run mostly by women.

In cooperation with the Ministry of Health and the Indonesian Cancer Foundation, PKK launched the Integrated Cancer Prevention Program (PKTP) in 1994.

Toeti Soelistiowati, head of family welfare at the Ministry of Health's local office, said PKK was helping disseminate everything there was to know about cancer virtually on everyone's doorstep.

"PKK has a very important role in spreading knowledge on cancer because it has regular meetings to discuss the program," Toeti said, underlining the importance of fighting the world's third most fatal disease.

"Besides, PKK is the easiest way for us to reach out to families on health," she said.

Sidoarjo, a small town about 25 km north of Surabaya, was chosen as the program's trial site because it typifies a burgeoning small Indonesian town. It has a growing industrial sector and a large farming and fishing community.

"All kinds of community are represented here in Sidoarjo," Toeti said.

Although Sidoarjo has a hospital which can adequately treat early stages of cancer, the town is within a 20 minute drive of Surabaya if anyone needs more complicated treatment in a larger hospital.

The cancer prevention program's chief message is to make women aware of the importance of early detection of cervical and breast cancer.

Cervical cancer is the largest cause of death among Indonesian women in their reproductive years of between 20 and 40 years old.

But the disease also strikes younger and older women.

Cervical cancer can be discovered with a simple Pap smear test. This method is regarded as the most effective way to detect pre-cancerous symptoms with more than 90 percent accuracy.

PKK plans to get round to tackling other types of cancer.

"We have to do it step by step. The first priority is to make people realize that cancer can happen anytime," Toeti said.

The town's main Health Community Center has a course on cancer for PKK members.

"All the members taught were village health clinics' doctors and specialists," Toeti said. "PKK members are the first in line in our target to make people aware of the dangers and seriousness of cancer," Toeti said.

The PKK has found that the campaign is successful chiefly because information is spread quickly by word of mouth among members.

"It worked effectively," said Suhartiyah Suparman, senior midwife at the Sidoarjo public health center (Puskesmas).

Songs, simulations and leaflets have been added recently to the campaign.

The most important thing was to ensure that they get the essence of the information, Suhartiyah said.

"We've had to work very hard because people here are shy and reluctant to talk about their private lives, even to doctors," she said.

Most people were initially reluctant to have Pap smear tests, she said.

"In early 1994, when PKTP was first introduced, we had to force those who were believed to be infected to have further tests. Now, with better understanding, they volunteer for a checkup," she said.

Cervical cancer could happen to women who married before their 20s, gave birth to more than two children or have had unprotected sex with more than one partner, Suhartiyah said.

But in Sidoarjo, many women with early symptoms of cervical cancer, were found to be married to long-distance truck and bus drivers, she said, adding that there had been no studies on this correlation.

All community health centers in Sidoarjo are now equipped with testing facilities. A checkup costs Rp 4,000 ($1.6).

Since the program began in 1994, five people in Sidoarjo have been found to have cervical cancer. One of them has died.

"One was cured completely while the other three are still receiving medical treatment," Suhartiyah said.

The campaign has also led to the discovery of more than 100 women in Sidoarjo with early stage symptoms of cervical cancer.

Alwiyah Asir, a former patient who has been cured, said she never realized that she had cervical cancer.

She had felt a little pain and only decided to take a Pap smear test after attending a lecture organized by PKK on cancer. "I was diagnosed in March 1992 and was sent to the Dr. Sutomo Public Hospital (in Surabaya) for further tests," she said.

She had surgery twice in August 1992 and has since had regular checkups.

Alwiyah said she was now actively involved in disseminating information on cancer in her neighborhood, sometimes through the PKK, and other times by just going door to door.

Another organization actively involved in disseminating information on cancer is the Indonesian Cancer Foundation.

The secretary of the foundation's Sidoarjo chapter, Theresia Soeradi, said the group had long been actively involved in distributing leaflets and helping medical personnel.

"Mostly, we gave seminars and training for women here," she said.