All out efforts to roll back malaria in South Halmahera
By Arie Rukmantara and Iwan Hasan
LABUHA 25 April, 2010 - Even the exquisite beauty of South Halmahera’s enchanting waters, frequently cited in the journals of European travelers’ dating back hundreds of years, fails to put a smile on Ahmad Abdullah’s face.
Although one year has passed, the 39-year-old still mourns his baby’s death.
“It took just one. Just one bite, then he died,” says Ahmad, his face a picture of pain and sadness.
All it takes is one bite from the female anopheles mosquito, for a single malaria plasmodium, or parasite, to kill a grown person - much less a baby.
Malaria is a mosquito-borne infectious disease widespread in tropical and subtropical parts of the world, including Indonesia, where it is entrenched in 80 percent of the country’s 500 districts, in which almost half of the population resides.
In South Halmahera District, situated in North Maluku Province in Eastern Indonesia, malaria has been the number one health problem for years - affecting the social fabric of the population and hindering economic development. But it is not the only health issue it contends with.
The swampy conditions, poor sanitation, chronic poverty and low levels of immunization means the population are vulnerable to a raft of preventable diseases and other health related issues. Especially pregnant women and children.
“Malaria kills pregnant women, babies and infants. It’s a serious yet neglected disease,” says Dr. Rita Kusriastuti, the Director of Vector-borne Disease Control, from the Ministry of Health.
The Ministry’s data shows that last year, Indonesia recorded more than 1.1 million cases of malaria, mostly from areas where the disease is highly endemic, such as East Nusa Tenggara, Maluku, Papua, West Papua, North Sumatra and North Maluku.
North Maluku’s Head of Health Office, Dr. Husein Kausaha warned, however, that the sheer numbers remain unclear because the geographical conditions of Eastern Indonesia make it almost impossible for health workers to record or verify all cases.
South Halmahera alone is made up of 400 islets, inhabited by 200,000 people, and around 75 percent of its jurisdiction is sea water.That is why the Head of South Halmahera District, Dr. Muhammad Kasuba, bravely decided to roll back malaria in this region once and for all.
“We have to scrub out this disease altogether so we can start developing our infrastructure,” says the man who has applied universal health care to his District since 2007 to ensure that his community receives free malaria treatment as well as other basic health services. These actions are seen as key to poverty reduction in the district.
South Halmahera has seen the number of deaths plummet from 226 in 2003 to just 4 in 2008, and dramatic improvements in the state of child health and ante-natal services for pregnant women.
Side by side with UNICEF Indonesia, Kasuba ignited a community-based anti-malaria campaign three years ago, which has yielded extraordinary results. The program includes the distribution of insecticide-treated bed nets for pregnant women, immunizing children, active community surveillance, and a series of capacity trainings for health cadres.
"Awareness is the prerequisite - if people don't know about the threat they won't fight to end it," Kasuba says, adding that he aims to free the next generation of South Halmaherans from malaria.
The district also embraces UNICEF’s Participatory Learning and Action (PLA) trainings, through which members of the community are asked to identify and solve their own health risks.
In one of the district villages, Cango, PLA volunteers have turned into fanatical advocates of swamp clearing, mangrove forest preservation and drainage construction.
“We will provide no place for anopheles mosquitoes to breed here,” says Anwar Nasir Rajaolang, the village head.
The village has even begun a “Clean Friday” movement, which obliges its 800 residents to come together and cleanup their village every week of the year.
About a two hour boat trip away in Bacan sub-district, students of Amasing Elementary School learn how to differentiate anopheles mosquitoes from other types of mosquitoes and second to fifth graders are all taught about malaria and how to safeguard against it during school hours.
The school’s principal, Hadijah Muhammad, says malaria is taught as part of the school’s local content curricula.
The school encounters no problems in integrating awareness on malaria into whatever schools subjects are being taught, thanks to a recently introduced UNICEF program that has turned the school into a Creating Learning Communities for Children (CLCC) school, where creativity, innovation and interactive teaching is actively encouraged.
South Halmahera has gone even further, by establishing its first ever disease control center, named the South Halmahera Malaria Center. The Center not only distributes free insecticide-treated bed nets for pregnant women and children, but also functions as a resource hub for malaria control, to “woo” other sectors to work together to fight the disease.
In appreciation of the district’s progressive approach towards fighting malaria, the Minister of Health Dr Endang R. Sedyaningsih, on 25 April or Malaria Day officiated at the opening of the Center, dubbing it an important “step forward” for malaria control in Indonesia.
UNICEF's Representative in Indonesia, Angela Kearney, acknowledges the significant progress the district has made, citing a recent report stating that support for malaria control in South Halmahera has seen the number of deaths plummet from 226 in 2003 to just 4 in 2008, and dramatic improvements in the state of child health and ante-natal services for pregnant women.
“UNICEF is thrilled to have been able to support this ground-breaking project, which has seen multiple positive knock-on effects throughout the District of South Halmahera, by integrating malaria control with ante-natal care and routine immunization” she says. “Given what we have learned, it is vital that this approach be taken to scale in other parts of the country. And for that we need resources.”
UNICEF Indonesia is working with the World Health Organization, the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), USAID, and the UK National Committees for UNICEF to control malaria in Indonesia.