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.