Tiny health posts mean a lot to Kalimantan villagers

By Primastuti Handayani

SANGGAU, West Kalimantan (JP): The road to Sei Kelik village is bumpy and muddy. The motorcycle is the only vehicle that can travel it. Every month paramedics from Batang Tarang subdistrict have to pass this way to visit mothers and their babies.

Around midday, about 40 women with their toddlers have gathered at the health post, waiting for their turn.

One of them is 43-year old Asih, who has come with her three- year-old son, Paul.

Asih says she is a regular visitor to the health post.

"My son is quite healthy now," she said. "It was different when we didn't have this post."

She recalled that two years ago, before the health post was established, Paul and his two brothers and two sisters were very frail.

Then, she had to trek four kilometers to get to the nearest community health center.

For the paramedics from the Batang Tarang Health Center, Sei Kelik is one of 45 off-the-beaten-track health service posts that they have to visit each month.

Nurhaida Simanjutak, one of the paramedics, said that the most common diseases found in the area are diarrhea, respiratory illness, particularly pneumonia, and skin ailments.

The paramedics also monitor the weight of children and administer various inoculations.

The villagers' enthusiasm for and anticipation of the paramedics's arrival reflect their growing awareness of the importance of good health care, Nurhaida said. This newfound awareness she attributes to the Sanggau Child Survival Project.

The program was launched three years ago by World Vision International Indonesia (WVII) in cooperation with the Ministry of Health. World Vision has also enlisted the cooperation of the Samaria and Harapan Katulistiwa foundations.

The project is currently run in Batang Tarang and the neighboring Tayan Hilir district, both in Sanggau, which is 250 km east of the West Kalimantan capital, Pontianak.

The Child Survival Project goes beyond simply looking after the health of the villagers and their children. It also helps villagers with basic sanitation.

At Tae, a village of 1,300 people, five km west of Batang Tarang, the program has installed a gravity-flow piped water system to get water from the spring.

Alfred Gontha, training coordinator of the project, said that in the old days villagers used the dirty swamp water for bathing and washing.

"The clean water has improved their health. We don't have severe dehydration cases of diarrhea here," he said.

Five years ago, 16 people, including children, died of diarrhea in the village. "We used the calamity to convey our message about the importance of sanitation and to ask them to pay more attention for their health," he said.

The water system is operated and maintained by the people. Each family pays Rp 200 a week to cover the maintenance costs.

Gontha said the Child Survival Project uses simple everyday illustrations to convey its messages to Tae's villagers, most of whom work as rubber tappers.

"We compare their situation when they are healthy and sick. When they're sick, they're not earning money," he said, noting that, as a rubber tapper, a villager can earn Rp 6,000 a day.

Rp 6,000 a day is the income they stand to lose if they fail to take care of their health, he said.

Untung Sidupa, project manager, said Batang Tarang and Tayan Hilir were chosen for the project because of their high maternal and infant mortality rates

The two districts together have 27 villages and 84 hamlets.

Because of the geographic conditions, not all the villages are covered by World Vision's project.

The US$860,000 project was originally financed jointly by the United States Agency for International Development and World Vision Relief and Development.

Officially, the project finished last month, after three years. But World Vision International Hong Kong picked it up last month and injected $100,000 funds into it this month.

Edy Sianipar, WVII area manager for Jakarta, West and Central Java, Sumatra and Kalimantan, said that the Hong Kong-based foundation has decided to support the project because it found that the project has been very useful for the community.

"The amount may be small, but we are sure that it will be very helpful," he said.

The chiefs of Batang Tarang and Tayan Hilir districts confirmed this.

Abdul Karim, chief of the Batang Tarang, said the project has been effective in encouraging villagers to pay more attention to their health, especially that of mothers and children.

M. Syafarani Mastar, chief of Tayan Hilir, asked if the project could be expanded to all the villages in his area.

"The project has successfully changed the bad habits of the community here, especially with regard to their health," he said.

"By having clean water, they have started to use the toilets instead of going to the river," he said.

But neither Abdul Karim nor Syafarani are confident that the villagers could run the project by themselves if, one of these days, World Vision decides to pull out of their areas.

Ascobat Gani, a member of the evaluation team, agrees that the sustainability of the project will not be established quickly.

"It should go step by step, to keep the community health system working after the project no longer exists," he said.

Ascobat, the dean of the Public Health School of the University of Indonesia, said the community and the local authorities must be thoroughly prepared.

The project has not been without obstacles, he said.

"Usually the main obstacle is the culture in the community, like ganjur here," he said, referring to the one-week traditional celebrations of a good harvest, which often involve gambling and alcohol.

Sally K. Stansfield, a professor of medical epidemiology at McGill University in Montreal, Canada, heads the project evaluation team. She said the fact that most husbands and wives work has caused problems for children's nutrition.

"When mothers leave their children to go to work, the people who are responsible for the children do not pay much attention to taking care of the children," she said. "They are not fed enough," she added.

Stansfield said she has proposed the establishment of children's care centers in the villages. "Through such a center, we could provide additional nutritious food," she said.

The new idea might not be easily accepted by the community, Stansfield said, but it is worth to try.