How low can malaria go in Irian Jaya?

How low can malaria go in Irian Jaya?

By Simon Sinaga

TIMIKA, Irian Jaya (JP): Werry Kogoya lounged in an open area
in front of the main ward of a public hospital in this southern
town in the easternmost region of Irian Jaya. As liquid spilled
copiously from a drip he was carrying along, Kogoya said he was
admitted to hospital because of malaria.

This was the second time in as many months the 40-year-old man
was hospitalized. Arriving by air from the highlands in Wamena
only three months ago to visit his brother in lowland Timika in
search of work, he felt he had bought a ticket to the nightmare
of malaria symptoms including chills and intermittent fever after
a month's stay.

Kogoya is just one of seven malaria patients of a total of 10
patients at the hospital - Rumah Sakit Mitra Masyarakat (RSMM) --
a modern public hospital run by Caritas Foundation, which is
funded by a mining company.

"Even though malaria can be cured and is preventable, this
disease has continued to be the leading cause of death in the
province of Irian Jaya," said Didik Irawan, head of the
provincial health agency in Jayapura, the province's capital.

Official health figures show that the annual incidence of
malaria was still more than 10 percent of the population up until
the early 1990s. It was 176 per 1,000 people in 1994 and was only
down to 101 per 1,000 people in 1998. While in certain areas the
incidence of malaria has been significantly lowered, it remains
high by any health standards. In fact, in far-flung villages and
in areas newly opened to development, the level of malaria was
only recently successfully lowered to near that level. In Timika
and surrounding villages, for example, the rate was as high as 80
percent until the early 1990s.

However, that level of malaria seems stubbornly reluctant to
reduce any further in most recent years. Irawan said doctors and
medical workers have to cope with daunting challenges to further
reduce the malaria mosquito population given Irian Jaya's sheer
size and rugged terrain. "Our target is to cut the malaria
mosquito population to two percent but I think it will be
difficult to reach," he said.

Efforts to reduce malaria have included treatment for
patients, use of malaria drugs, extermination of vector
mosquitoes and eliminating potential breeding places. The
undertaking was started by the World Health Organization in 1971
and has been continued by the government.

Insecticide had been used to break the chain of the spread of
the parasite. But over time, the vector -- Anopheles species --
grew resistant to insecticide. Besides, it is virtually
impossible to use insecticide over so many areas in the province
and it also has a harmful effect on other insects.

Elimination of mosquito breeding places has also been more
widely practiced in recent years. But this takes time and is very
much connected with the way people live. Efforts of the Irian
Jaya health agency have been far from adequate, impeded by the
shortage of manpower and funds.

In Timika and surrounding villages in southern Irian Jaya,
efforts to tackle malaria have continued to received major
support from mining company PT Freeport Indonesia, which is also
obliged to undertake efforts to ensure its areas of operations
are free from the disease.

The company's Malaria Control and Public Health department
uses an annual US$3 million budget to combat malaria and train
local government and community health workers about malaria. The
activities center around reducing the malaria mosquito in the
community and reducing areas conducive to the breeding of the
Anopheles mosquito.

Efforts cover drainage projects, water hyacinth control,
larval monitoring and control, house spraying and door-to-door
blood tests.

Indeed, the eradication of Malaria seems to have a long way to
go in this easternmost region. Clinically alone, parasites in
human bodies from the two most common malaria vectors --
Plasmodium Falciparum and Plasmodium Vivax -- have shown
resistance to certain drugs such as chloroquine and quinine,
which are the first medicine to be prescribed for malaria
patients.

A subsequent form of treatment currently used is mefloquine.
But this should be taken in consultation with a doctor because
indiscriminate use could well promote resistant forms of
Plasmodium Falciparum. Sulphadoxime/pyrimethamine have also been
used in treatment of malaria. Many public health clinics in Irian
Jaya however are not well equipped to provide this treatment and
do not have available doctors.

How much further can malaria go? Few can answer. In fact,
doctors acknowledge that the malaria issue is much more complex
than coping with medical and geographical challenges alone.

"In Irian Jaya, malaria is as much a social issues as a health
issue," said Fransiskus Krisna, a senior doctor at RSMM hospital.

He said that malaria had much to do with the issues of
economic well-being, education and way of life. Irianese who live
in far-flung villages, for example, have little idea about the
Anopheles mosquitoes' life cycle and their habit of relaxing
outdoors at night before going to sleep makes them susceptible to
mosquito bites. Highlander Kogoya, for example, who knows little
of malaria, only found out that the disease was related to
mosquitoes after he was hospitalized.

Doctor Krisna went as far as to say that malaria could well be
one of the main reasons for the low level of academic achievement
in Irian Jaya since the disease makes people not in the mood for
study or hard work. "The future of many Papuan children is a
major question if malaria continues to afflict the people at
current levels," he said.

In addition, the physical and socio-economic challenges vary
from one district to another. Malaria is largely prevalent in
lowland towns and villages but during the dry season it could
affect highland areas, which are difficult to reach and are more
sparsely populated. In certain areas the people are better
educated, whereas in other areas few have graduated from high
school. Some areas receive support from the private sector while
others have to rely on the government program.

"It will take a lot more specific studies in specific areas
before we undertake pilot projects together with the local
people. The pilot projects will help us to study how we can best
deal with malaria in Irian Jaya," said Didik Irawan.

At least, Kogoya need not have contracted malaria had he known
that he should not stay out during certain hours to avoid being
bitten by a malaria-carrying mosquito.