Solutions to disease and malnutrition in Papua remain elusive
The deaths of 67 children due to measles and malnutrition in Asmat regency, in Indonesia’s Papua province, is a jolting tragedy. Let us hope that we do not see it as a mere statistic.
For the leaders of any country, even those who are thoughtful and conscientious, it would be difficult to face such a tragedy. Maybe there are exceptions among leaders in Indonesia.
Third-world disease is endemic in Papua. Malaria, malnutrition and leprosy are widespread, but “modern” diseases such as HIV/AIDS also circulate in this land.
In March 2017, endemic diseases resulted in the deaths of 64 Korowai people, and 201 people died in Lanny Jaya regency. In 2015, such diseases killed 54 people in Mbua regency. In 2016 and 2017 there were 37 deaths in Mbua regency and 54 in Jayawijaya regency. All died from endemic diseases, according to Tim Peduli Kesehatan dan Pendidikan Rimba Papua.
Papua Police Chief Boy Rafli Amar said more than 10,000 children in Asmat regency were currently suffering from malnutrition.
The lack of health facilities is the driving factor of many chronic diseases in Papua. Alix Boudewyn in his thesis “Maldistribusi Tenaga Kesehatan di Kabupaten Asmat Provinsi Papua” (2014) concluded that the implementation of the distribution of health personnel in Asmat regency had not gone well.
The maldistribution of health workers in Asmat takes two forms, vertical and horizontal. Vertical maldistribution refers to the imbalance of health-personnel dispersion among responsible agencies, starting from the level of the Public Health Service to Community Health Centers (Puskesmas), Supporting Health Centers and Village Maternity Lodges. Horizontal maldistribution refers to unequal distribution of health personnel among the districts.
The problem of vertical maldistribution relates to non-conformities with professional or specialist backgrounds, lack of appointment decisions, and poor placement of work.
Some maldistribution is the result of health workers wishing to stay near major centers, rather than outlying districts. Field work in rural communities is difficult, with poor access to local health facilities, inadequate salaries or benefits, inadequate career-development opportunities, and inadequate education and training facilities for health workers.
So, what is being done to tackle such maldistribution? The answer is not yet clear. The head of the Papua Provincial Health Office, Aloysius Giyai, says Papua still needs around 36,000 health workers to be placed in remote areas.
The Ministry of Health has only deployed additional health workers to Asmat regency after outbreaks of measles or extreme hunger. There are 39 new health workers there now, but it is still not enough.
Another problem is poor nutrition. The Indonesian elite convince themselves that children die in Papua only because of illness, backwardness, and their unhealthy lifestyles.
This view is actually blind to fact that various diseases are the body’s reaction to the lack of nutrient intake. According to 2015 data, around 10,000 people in three districts in Papua (Lanny Jaya, Puncak Jaya and Nduga regency) suffered nutritional deficits and 11 people died because of them.
The staple food in Asmat is sago, which has a carbohydrate content that is not inferior to rice. Sago carbohydrates are durable and low in sugar. Even diabetics are strongly recommended to consume sago.
But the availability of sago in Papua is increasingly depleted. Indonesian President Joko Widodo has opened up millions of hectares of land for rice cultivation in Merauke, south of Asmat regency, to realize food security. But the wisdom of this project is doubted by many agricultural economists. A similar rice-cultivation project has already been tried by president Suharto in Papua in the previous era and failed.
Because the staple food of the Papuans is sago, they are better at planting sago than rice.