Trisha Sertori, Contributor Jakarta Post, Bali
Indonesia's health statistics in 2007 started like too many other years with 16,000-plus cases of dengue fever reported by February.
Most reports came out of the nation's capital due to severe flooding in the opening months of the year. HIV/AIDS is on the rise in much of the country and Indonesia is now the record holder for the greatest number of deaths due to bird flu, with 91 victims.
In many parts of the country malaria is still the number one killer, and polio is yet to be wiped out. Infectious diseases such as these take a serious toll on the country's health services and its productivity and when tied with the country's regular natural disasters, such as earthquakes and volcanic eruptions, that health service is stretched to the limit.
Despite the grim reality these factors present, the nation, during 2007, has made huge strides addressing infectious disease and the speed and efficiency in emergency health services during natural disasters.
In many cases non-government foundations and corporations have been the prime movers of these positive community health outcomes; with the government services often at breaking point, it is these agencies that are backing up existing, or developing new health initiatives.
Malaria is endemic to Sumba, one of the country's most southerly islands. According to malaria researcher, Claude Ude, around 90 percent of the Sumbanese have had malaria; the island is home to all four strains of the deadly disease.
"Sumba is one of the worst places on earth for malaria - worse than the worst in Africa. Most places with malaria strains have one or two types - here we have all four," said Ude via telephone.
He added that the economic impacts of the community-wide illness were disastrous.have been coming here for the past 19 years. In the beginning I just thought the people were lazy. Since then I have had malaria 30 times and I know what it does to people you can not function at 100 percent, you are lucky to function at 50 percent. This takes a terrible toll on productivity."
Securing first a healthy water supply and then tackling the malaria in Sumba has been an ongoing project of the Sumba Foundation, which funds Ude's malaria eradication program. Simple solutions such as pyrethrum-impregnated mosquito nets supplied to every home within the program have seen productivity "quadruple in 2007", as infection rates decrease Ude explained. "The mosquitoes do not enter houses with the nets, even the head lice problem is eradicated and spiders and other insects also leave the houses".
In June, the Sumba Foundation also opened a new health clinic and completed a further nine clean water projects.
Further east in Papua, malaria in the lowlands continues in 2007 to be the "leading cause of death and illness with 60 to 70 percent of school children carrying the (malaria) parasite in rural areas," said Pasi Penttinen, medical advisor, public health and malaria control with International SOS and PT Freeport Indonesia, via email.
Penttinen stresses Papua "is facing typical developing country health issues, with very limited healthcare services available". This is reflected in limited immunization programs. Dysentery and even cholera outbreaks are common".
Like Sumba, it is NGOs and corporations stepping up to the healthcare plate in parts of Papua, with the Public Health and Malaria Control arm of PT Freeport Indonesian (PTFI), International SOS, and the PTFI-funded LPMAK providing clean drinking water, malaria control with household spraying and insecticide treated bed-nets, 200 kilometers of drainage and free medicine for all confirmed cases of malaria in Timika.
HIV/AIDS is on the rise around the country. In Papua the PTFI has supported a "comprehensive HIV prevention program through the Timika puskesmas (public health clinic)," writes Penttinen. Fourteen thousand condoms are distributed monthly, free healthcare and support are available, community education is ongoing, as is free diagnosis of all sexually transmitted infections.
The ongoing tuberculosis control program is also PTFI-sponsored as are the hospitals, with the International SOS and puskesmas treating almost 200,000 outpatients annually and around 12,000 inpatients.
A worrying trend in 2007 has been meningococcal meningitis cases in Mimika, Papua's highland populations, said Pentinnen. "This year we have seen 39 cases in the Mimika hospitals. All cases are contact traced and their contacts provided with antibiotics by PTFI malaria control. Local health agency and Medicins Sans Frontiers have done two active case finding missions to search for sub-clinical cases.
"I definitely hope we are making a considerable (positive health) impact. I would dare to say the PTFI community health response is a world leader among the mining community. Definitely the malaria control program is the largest of its kind in the world," Pentinnen said.
On the remote island of Halmahera, east of Sulawesi, an Australian charity organization, the Rotary Club of Berwick, Victoria, has this year added a desperately needed hospital wing to the Hohidiai Hospital.
Australian couple, Peter and Esther Scarborough, a registered nurse, moved to Halmahera some years ago with their five children after seeing how much medical assistance was needed in many communities.
They established the Yayasan Berkati Indonesia, Bless Indonesia Today, to augment existing medical services in remote regions of Hamahera.
The construction of leprosy and tuberculosis villages are two health targets, along with the 2007 hospital wing, according to the Rotary Club of Berwick's website.
On Bali, two bird flu deaths were a wakeup call for the community, according to Cynthia Sulaimin from the province's health agency.
"The major problem is public awareness. Communities do not know (the dangers of bird flu) and they don't want to know. We are going around Bali to raise awareness of bird flu, talking to teachers, students, heads of villages and women's organizations; they (women) want to know because they are in the kitchens every day dealing with poultry. They are on the frontline of defense and the most at risk," Cynthia said.
Getting the health message out is successful when students are involved, Cynthia added, because students take the message into their homes. During 2007, the Bali Health Agency has run a television, radio, brochure and flyer campaign to raise understanding of bird flu and how to identify possible outbreaks and prevention methods.
Maternal and child mortality rates in Indonesia are still the highest in the ASEAN nations, according to Robin Lim of the natural child birthing foundation Bumi Sehat in Bali. Robin Lim and Bumi Sehat won in 2007 the best foundation in Bali against 700 other humanitarian foundations.
She said the return to breast-feeding could slash infant mortality figures across the country.
Pop Singer Oppie Andaresta made headlines in 2007 when she decided on a natural birth at Bumi Sehat in Bali over hospitals in Jakarta. Oppie is the poster mother for First Lady Ani Yudhoyono and UNICEF's exclusive breast-feeding campaign, which kicked off last year.
Vaccines also play an invaluable role in community health. In 2007 the Indonesian government vaccinated 31 million children against measles during an integrated health campaign. Along with the measles vaccines, polio vaccinations and Vitamin A supplements were given and insecticide-impregnated mosquito nets were distributed in malaria-prone areas, according to U.S. newswire reports.
The government, NGOs and corporations have, during 2007, made huge steps in public health around the country. However it is clear there is still a long way to go when the country's best serviced and wealthiest capital, Jakarta, is also home to November's diarrhea outbreak, in which a 7-month-old baby was killed and more than 100 others infected, mostly children.
And if the World Wild Fund for Nature is right and global warming increases the risk of flooding and flood-related diseases, according to a report on WWF in The Jakarta Post, things may only get worse.
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