Women refugees in Ternate and Sampang need immediate help

By Santi W.E. Soekanto

JAKARTA (JP): A young woman, one of the thousands of refugees sheltered in cramped makeshift centers in Ternate, North Maluku, complained of incessant pains in the lower part of her abdomen. She revealed to a gyneacologist that six months earlier, when she was hiding and running in the forest from the attackers, she may have miscarried because she bled profusely at one point.

Unsure of her condition, as soon as she reached safety the woman went to a traditional midwife (dukun) who "did things" to her. The gyneacologist examined the woman and found a thin, 15 centimeters long stick of cassava (singkong) still lodged inside her body.

Prita Kusumaningsih, one of a team of 30 doctors sent out by the Ministry of Health for a six month period of service in conflict areas in North Maluku, said softly, "how fortunate that the position of the stick was such that it did not pierce and damage other organs such as the rectum or urethra."

Dr Prita, who only recently returned to Jakarta, sighed when speaking about the condition of thousands of women refugees in Ternate as well as in other places such as Sampang, Madura Island.

"In Ternate, most of the cases that I handled were neglected labor -- very often lack of transportation meant that the women did not get immediate help when complications arose. Sometimes the mothers or the babies died because help came too late," she said.

Two other problems that were often found among women refugees in the camps of Muslim refugees were unsafe abortions, and sexually-transmitted infections. "Sometimes the women sought abortion because they did not believe in carrying their pregnancy to term when already the family had to live in misery and uncertainty in refugee camps."

As of today, there are approximately 70,000 refugees in Ternate. Up to 400 refugee families, for instance, are still sheltered in one large warehouse the size of a soccer field. Each family is apportioned a small cubicle partitioned by cloth or cartons -- privacy is of course a nonexistent luxury, while sanitation and hygiene are worse than ever.

While working at the Ternate Public Hospital and serving both refugees and local women, Prita conducted a survey of almost 100 women and found that a staggering 62.5 percent of the refugees suffered from postpartum depression as opposed to 3.5 percent of the non-refugees.

Prita acknowledged that many factors caused depression in women after they gave birth -- lack of family support, for instance, or hormonal imbalance, as well as the birth itself, which was always a grueling and stressing event. However, Prita is also concerned about the long-term impact of the situation.

"Depression often incapacitates a new mother from caring for her baby, her other children -- something which may also have a longer-term impact," she said.

Her survey showed that the factor that contributed the most to depression was the suffering caused by living in the refugee center. "A woman told me, 'How can I help not feeling sad when I no longer have anything, my house has been burnt down, and my family and I have nowhere else to go.'"

Prita also found that many pregnant women in the refugee camps suffered from malaria and were anemic. Those women, she said, had double doses of problems that threatened their pregnancies and their babies. The general outlook was poor because most of the women were undernourished, which contributes to early labor, and suffering from a symptom called hyperemesis gravidarum -- excessive vomiting in the early stages of pregnancy -- that required hospitalization.

"I found many women were so pale even though bleeding during childbirth was not heavy. I discovered that their HB count was low, only between 4 or 5 while normally it should be 12. They were anemic. I don't think the iron pills distributed by some clinics were enough or reach all of the women refugees who needed them," she said.

According to Prita, a mother of four and married to an orthopedic surgeon, an epidemiological calculation showed that some 6,000 pregnant women were found within one year among the refugees in all North Maluku.

A team of volunteering doctors in Sampang, Madura, estimated that more than 1,000 women refugees there are currently expecting, while at the same time, more than 20 villages in the regency do not have any health facilities.

"When I had just arrived in Ternate, I found that most of those women chose to give birth in the refugee centers despite poor sanitation, because they could be close to their families there," she said. Another reason was because many thought that they would have to pay high sums to give birth at the hospital.

"I told them the service is free, but of course when there were complications and the patients needed more medicines than were allotted for the refugees, they would need to pay," she said.

Patients' reluctance was the least that Prita and her colleagues had to deal with. In their report at the completion of their six months service in March 2001, the doctors said that in almost all of the 27 subdistricts and 716 villages of North Maluku health facilities were scarce.

"The situation worsened because many of those facilities were later burned down or vandalized during the clashes," the report said.

There were, for instance, 46 village clinics (puskesmas) in the province but 21 of them were either razed to the ground or were damaged. There were 33 mobile clinics but only nine were in a good condition and operating.

What was more saddening was the fact that as soon as the sectarian conflict -- which erupted in 1999 -- degenerated into full-fledged war most of the health workers in the region abandoned their posts, along with almost 200,000 people who went to refugee centers.

Of the 37 doctors assigned to various village clinics before the crisis, only 11 stood their ground and remained. Of six dentists in the province's village clinics, only one stayed.

In hospitals (there were four in the whole province), three internists, a pediatrician, and an oculist stayed. During the crisis, there was no radiologist at all in the hospitals, while of the general practitioners affiliated to the hospitals, there were only five who stayed behind.

Security was also one of the concerns of the team of doctors sent out by the Ministry of Health. So why did Prita and her husband, dragging two of their youngest children with them, choose to volunteer and go to North Maluku?

"There were two reasons for that. First, I wanted to apply my skills and knowledge to help others. Besides, working in outer regions is often a better experience than working in large cities like Jakarta -- there people need you more and you feel that what you are doing is more meaningful.

"The second reason was that I wanted to earn the divine rewards of jihad, if Allah pleases," she said, adding that she hoped that the refugees would eventually be able to return to their own homes and land without any fear.

She suggested that the provincial government stop trying to push the refugees to go home before they were ready. "That is like forcing the different groups to live together as they had done before the conflict. That's not feasible for now. Maybe, for now, the government should let Muslims live in their own territory, Christians in theirs.

"Maybe one day, this tolerance and ability to co-exist will return, why not? But before we can achieve that, those refugees' rights must be restored and the party that initiated the conflict must ask for forgiveness."

"That last part is difficult to achieve, isn't it? The Muslims believe the Christians are to blame because they started the war, but the Christians, too, believe the Muslims are to blame. I don't know how this will all end."

The writer is a journalist at The Jakarta Post.