Hope for malaria-stricken poor in Central Java

Santi W.E. Soekanto, Contributor, Magelang, Central Java santi_soekanto2001@yahoo.com

Every year, malaria kills approximately 32,000 people in this country, meaning 87 people die every day because of it.

Malaria is a disease of the poor, those living in remote areas with scant access to health services.

It is also a disease of a poor environment -- the mosquitoes that spread the disease breed and survive in stagnant water like swamps, dark areas such as salak (zalacca or snakefruit) plantations unreached by the sunshine, unattended shrimp hatcheries and blocked streams during the dry season.

When Indonesia plunged into the economic crisis in 1997, it descended into a ravine of outbreaks of diseases and malnutrition. As many as 87.5 million Indonesians could not afford to eat more than once daily, according to an official in August 1999.

News reports of hunger-related deaths, mainly among children, streamed in to the shock of many Indonesians -- "As many 165 malnourished babies died this month here", "At least 36 children died of marasmus this month there", and "A total of 7,202 children suffered from malnutrition elsewhere."

It was also the time when malaria made a deadly comeback to the country, especially in Java which in the years of 1986-1987 had been free of the disease. Between 1998 and 2001 malaria broke out in 11 of the country's 30 provinces, 13 districts and 93 villages.

The outbreak could not have taken place at a worse time -- when millions of Indonesian had begun to feel the brunt of the crisis in the form of job losses and even famine, and when the newly introduced regional autonomy policy meant more decentralization of poverty than the granting of greater authority in managing the regional resources.

"During the worst of the outbreak, not a day went by without us having to find a means of transportation to bring some sick, feverish residents from the outback of this village to the health center," said Djuwadi, head of Margoyoso village in Magelang, Central Java.

"In those days, more than 60 percent of all schoolchildren missed days of schooling because they were either down with malaria or having to help around the house because their parents were ill with malaria," said Sutjipto, the deputy head of Magelang regency health office.

"So many mothers became anemic, so many buruh penderes (palm sap tappers) had to stop working. At the height of the outbreak, we had 42 babies sick with malaria within one month. In a neighboring village in Purworejo, 300 people were sick with malaria at one time."

According to Dr. Yuniar of the Salaman II community health center, her clinic was overflowing with patients.

"Imagine, they had to spend up to Rp 10,000 for transportation to get to the clinic, they had to stop working while their children, of course, could not stop demanding food. Some of them didn't even realize they had malaria, they continued working and (the potential) to spread the disease," she said.

For at least three districts straddling the foot of the Menoreh Hills in Central Java and Yogyakarta, namely Kulonprogo, Purworejo and Magelang, help came when it was sorely needed. In 2001, the Ministry of Health, the World Health Organization (WHO) and the U.S. government launched a malaria control project in the area.

Mass fever and blood surveys, drug administration and insecticide-treated bed nets distribution as well as fumigation programs were organized with "an epidemiological approach", Sutjipto said. "The number of cases decreased drastically following the project."

Actual statistics may not provide the whole picture, but improvement is definitely evident over a long period. A WHO report of the Menoreh Hills malaria control project confirms that the total number of malaria-positive cases decreased in the three districts in 2001.

The village of Margoyoso serves as an example. In 2000, a total of 270 cases of malaria were treated there. In 2001, the number was up to 480, but with a significant decline recorded in June after implementation of several actions, including mass drug administration. The recorded cases in June were 91 while in the following month the number declined to 36, followed by 18 cases in August, 26 in September, and 17 in October.

In Krasak village in 2002, the rate was high in the early months, but declined significantly by the end of the year; in December only five cases were recorded. The number of cases between January and May in 2003 was 28 -- as opposed to 309 in the first five months of 2000, 370 in 2001 and a whopping 380 in 2002.

Not only did the project improve disease management, it also made a positive impact in terms of capacity building for the health center doctors and staff, especially on how to detect and administer drugs to malaria patients. Villagers were given training in the health centers on how to identify malaria cases, preventing malaria and distributing the drug.

"Expecting the total eradication of malaria here may be as unlikely as telling an old grandmother to compete in the World Cup, but we are now better armed," Sutjipto said.

The poor people in Menoreh Hills may not soon be "cured of poverty" but obtaining better health brings hope for them.