Sun, 14 Sep 2003

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