Malaria spreads more suffering for the country's rural poor

Malaria spreads more suffering for the country's rural poor

Years of spousal abuse and poverty finally took their toll on
Sariati, a mother of three from Kalisari hamlet, Margoyoso,
Magelang in Central Java

After 16 years of marriage, the 38-year-old woman decided to
leave her husband, who took custody of her two older children.
She returned to her mother's shack in a neighboring village where
she suddenly found herself as the breadwinner for her elderly and
ailing mother, her sister, nieces and her own youngest child, 19-
month-old Rama Desta Ariani.

It takes treading carefully on a slippery footpath, ducking
tree branches jutting here and there and negotiating the flimsy
bamboo bridge across a small stream before reaching the wooden
house surrounded by palm trees where she now lives.

"I got tired of being beaten up for no reason," Sariati said,
breastfeeding her baby while sitting by the hard wooden bed with
no mattress, covered by an insecticide-treated bed net that the
local puskesmas (community health center) gave her.

Following the separation, Sariati no longer had to work hard
selling tofu cakes to supplement her husband's meager income as a
fireworks vendor; now she has to work hard selling tofu cakes
from a village factory, sometimes also palm sugar, to feed
herself and the six others in the household.

She makes palm sugar -- which means days and hours of hard
work cooking the sap tapped from the palm trees -- and sells it
on market days. She makes less than Rp 5,000 (less than US$1) a
day.

One day, in late 2002, Sariati began to have dizzy spells,
muscle pain and fever that she first blamed on being caught in a
downpour. She felt nauseous, had a bitter taste in her mouth,
vomited repeatedly and suffered from painful headaches. She
simply had to stop working and care for her baby.

"I was really badly off... and my baby was demanding
attention," she said.

After three days of being laid up with adem panas (cold and
hot spells), Sariati forced herself to get up and go the village
doctor -- which meant walking many kilometers from where she
lived to the main road.

She was told she had malaria, just as many other villagers at
the time, and was given some medication.

Three days later, the juru malaria desa (village malaria
worker), a man known by the name of Mas Adhi, visited and began
to treat her.

"The puskesmas was closed at the time because it was Lebaran
(the Muslim holidays marking the end of the Ramadhan fasting
month), so I had to stay at home," she said.

"I couldn't work, but my family had to eat so I had to sell
the last of my jewelry, some eight grams of gold rings and a
necklace, that I managed to purchase and keep while I was still
living with my husband."

The money did not last long, but after weeks of feeling so
weak she could not leave her bed, she managed to get well soon
enough before she again had to work for her family.

"I am now completely cured of malaria," Sariati said. "I can
go to work again and feed my family."

Sariati works as hard as she ever did and thinks she would
never be "cured of poverty", but she says at least she is now
strong and healthy enough to earn money for all members of her
household. She has hopes that she will remain strong to raise her
youngest child and someday be able to send her to school.

In another house, Urip stares at a person standing over her
bed, and a slow, pretty smile begins to light her fair-skinned
face. She then does a trick which people call "clever", doing the
splits so that her body forms a T.

The smile and the trick, however, are about all that the
three-year-old child can do -- so malnourished that she weighs
only 6 kg, is unable to talk or even lift her head.

Indeed, Urip, whose name means "life", has stayed in the hard
wooden bed almost from the day her mentally ill mother,
Muhamsaitun, gave birth to her. Almost nobody is available to
feed or change her when she wets or soils the bed until her
father, Sutadin, comes home from his work of tapping the sap of
the palm trees for other people.

The bamboo hut is dark, dirty clothes strewn about the place
and the dirt floor unswept. In the kitchen, Muhamsaitun sits
before the fire, feeding it hay and small pieces of wood, while
stirring the palm sap that slowly thickens and turns dark brown.

How long does it take to heat and stir the sap before it
hardens into palm sugar?

"From morning to noon," Muhamsaitun answers shortly when asked
how long it takes, before starting to mutter to herself again.
Not once does she stop stirring even when visitors are at her
door. She is oblivious to all, including Urip, who does not make
any sound at all.

"This is one of her lucid days," said Yohana, the village
midwife, who for the past 10 days has been feeding Urip with food
supplement. As the result, Urip's skin has begun to look rosy and
supple.

"Most of the time, Muhamsaitun does not talk to other people.
She talks to herself. But funnily, she knows enough to be jealous
whenever another woman, including the village health worker,
comes to help take care of her baby," Yohana said.

Yohana is possibly the only woman that Muhamsaitun does not
dare to be jealous of, because the midwife exudes such authority
as she strides into the house to check up on Urip.

Other women in the village would not take the risk because
when Muhamsaitun is jealous, she would rant and rage and throw
things around. Her husband would then have to stay put before
peace is restored in the small household -- which would mean no
work or income, especially when Muhamsaitun also stops making
palm sugar that he usually sells for less than Rp 10,000 every
other day.

Late 2002, however, Sutadin's family life fell into disarray
when he first felt the signs of malaria. The hot and cold spells,
the headaches and muscle pain forced him to stay in bed.

Several days later, their nearest neighbor, Sabilah, who has
been trained to take blood samples from suspected malaria
patients, came to take his blood and minister to him. This was,
unfortunately, also the time when his wife fell into yet another
fit of rage-yelling at the top of her lungs and telling Sabilah
to stay away from Sutadin.

"Urip became even more neglected and she fell really ill, just
as her father was laid up with malaria," said Dr. Yuniar of the
Salaman II community health center. "We had to bring Urip to
another's village health center where she was admitted for
several days. Thank goodness, she did not have malaria".

Indonesian villagers are resilient folks. Thanks to the hard
work of Mas Adhi, who took Sabilah's place delivering drugs from
the clinic, Sutadin recovered several weeks afterward.

He then began the new habit of sleeping inside the
insecticide-treated bed nets that the local administration
distributed -- for which he had to pay Rp 10,000 -- to prevent
another malaria infection. He is now back at work, Muhamsaitun is
palm sugar-making again and Urip has new hopes of survival.

-- Santi W.E. Soekanto