Malnutrition paints a gloomy picture in poor region in C. Java

Blontank Poer, The Jakarta Post, Wonogiri

The sun is just starting to lean to the west while Misni, 41, shifts peeled cassava being dried on plaited bamboo trays and places it on the ground to get direct sunlight.

The cassava looked recently pealed when The Jakarta Post arrived at the small house in Setren Pojok hamlet in Lemahbang village in Wonogiri regency, Central Java.

"The cassava has just been pealed and then laid out to dry by Misni himself," said Misni's mother Sanikem, 73.

Misni's younger brothers, Simun, 38, and Samino, 32, came out and greeted the Post, while Samidi, 35, was not around, still helping fix his neighbor's house.

Just like the other village residents, they are hospitable and always try to strike up a conversation even though they cannot speak a single word.

Misni and his three younger siblings are mute, the victims of malnutrition. More specifically, they had an iodine deficiency when they were in their mother's womb. They can only communicate using sign language.

Since Sanikem and her late husband moved to the hamlet in the 1960s, they -- as well as other residents living on the slopes of hills where only corn and cassava can be grown -- practically never travel, only waiting for harvest time for their staple food.

The only thing that comforts Sanikem is that her four children can still socialize in a normal manner.

"They always help people," she said. "When someone is having a social occasion they will pick up the dirty plates and wash them without being asked to. They also never bother their neighbors," said Sanikem.

For decades now, Misni and his younger siblings have been cultivating the land behind their house -- from planting seedlings to harvesting, although someone has to guide them during the fertilizing process.

"We only eat rice when there is a special occasion, or when we hold ceremonial meals for the birth of our children," said Sanikem.

Every day, they only eat tiwul, or dried cassava which is steamed before eating. Salt is hard to get and to make it tastier, grated coconut is added to it.

The only indication that they are suffering from cretinism -- a congenital condition caused by an acute deficiency of iodine -- is seen from the difference in their growth from their other older siblings, Jemari, 50 and Sano, 46, who now live outside of the hamlet.

Both Jemari and Sano were born when Sanikem still lived in another village that was not far from town.

"When I was pregnant with Jemari and Sano, I frequently ate rice with enough vegetables. We used iodized salt to cook meals. But when we moved to Setren, we couldn't afford to buy good quality salt because it was expensive," she said.

The hamlet -- situated in the hills between Wonogiri and East Java's towns of Pacitan and Ponorogo -- is located not more than 20 kilometers from the district capital but it takes 75 minutes to reach by car. The road is steep and rocky and only wide enough for a small vehicle.

The only means of public transportation is a small pick-up truck which operates once in three days, serving 265 families or 1,300 residents wanting to buy their daily needs at Purwantoro market in the nearby town.

Poverty and the poor access to the hamlet has not only effected Sanikem's four children.

In the hamlet, out of its some 800 residents, some 36 people are suffering from cretinism and 20 others from thyroid problems. From those with cretinism, three have been paralyzed and one has a condition where both eyes are pushed inward.

The number of people suffering from cretinism in Lemahbang village stands at 64, with Setren Pojok the worst affected.

Based on the cases found in those born in the 1960s until 1979, the Wonogiri Health Office conducted a drive to consume iodized salt. "We don't want our future generation to face such a fate like our elder brothers and sisters," said head of the office, Sukeksi.

The office recorded 2,175 malnourished children below the age of five, of which 503 were severely malnourished in the regency as of May this year.

"A lot of salt with no iodine is still being sold in the market. It is even packaged in a similar way to the iodized salt that has a certificate from the Ministry of Health," she said.