Hope Amidst COVID-19

PAPUA, Indonesia – Mujiasih was carrying out her role as a malaria cadre (community health worker) that afternoon when we met her. Asih, as she is usually called, has been a malaria cadre for the past six months in her village of Sanggaria in Keerom, Papua.

Keerom, along with the other five districts in Papua, has the highest number of malaria cases in Indonesia. To bring malaria diagnosis and treatment services closer to the most affected areas, UNICEF supported the Ministry of Health to start a community-based malaria programme.

Concerned for the health of her neighbours, Asih decided to attend the first trainings for malaria cadres in November 2019. Since 1997, she has been active as a Posyandu volunteer, and in the past two years, she has also volunteered with the Family Planning Agency.

“I felt a calling to help reduce the number of malaria cases in my village. That’s why I volunteered to become a malaria cadre,” she explained.

Her colleague Olivia also attended the trainings. “We learned about malaria – its transmission and prevention, as well as how to recognize a sick person, perform a rapid test, administer malaria drugs and collect data for reporting,” recalled Olivia. “But what differentiates malaria cadres from other health cadres is that we are trained to diagnose and treat patients.”

Every day, the malaria cadre must schedule visits to their neighbours’ homes to look for someone who is sick and to conduct a malaria test. “We usually start the house visit in the morning. We then go back home for a bit, and then start again in the afternoon. But we are available 24 hours for services,” explained Merry, another malaria cadre. “Fortunately, my husband is very supportive, so whenever we get a call, we go.”

Besides conducting malaria tests and administering treatments, the cadres also conduct awareness raising, monitor malaria patients and ensure they take their medications, and check for bed nets.

“One time, it was 2 A.M. and an old man came to my house,” recalled Merry. “He was very sick. I asked him why he didn’t just call me, and he said he didn’t have any phone credits. I cried.”

“That’s when I felt that we really need to help each other,” she said.

The COVID-19 pandemic has made their jobs more challenging. In Papua, the local government introduced social distancing and travel restrictions which has directly affected the delivery of health services, including malaria. In areas such as Keerom where the burden of malaria is high, stopping health services will result in increased deaths caused by malaria.

In response to these restrictions, the malaria cadres quickly adjusted their routines. Although they stopped visiting homes, they continue to provide malaria test and treatments for their neighbours with added precautions to ensure safety. The malaria cadres have even started to test people with symptoms in their own homes.

When they receive someone in their house, the cadres always wear a face mask and require the visitor to use one as well. They also make sure that everyone washes their hands before entering. The cadres keep a safe distance, use disposable gloves and wash their hands with soap and water before and after touching the patient.

Asih even provides free cloth masks to patients visiting her house. “If they come without a mask, I can’t tell them to go home,” she said. “So I provide a cloth mask that I sew myself at home.”

Not just active as malaria volunteers, Merry and Olivia are also volunteering as part of the village’s COVID-19 team, helping to ensure that the homes in their village have a handwashing facility and soap.

“As a volunteer, I’m very busy. But this is a calling for me – I have been given a responsibility as a volunteer. So even when I’m tired, because this is about other people’s lives, I still go to give my service,” said Olivia.

“I hope there’s no malaria cases anymore in my community. With the existence of volunteers, my community is healthy.”