Herlina’s journey to combat wasting in South Papua

In the community of Agats in the Asmat District of South Papua Province, Herlina Kamepict is a symbol of hope for tackling severe malnutrition. Growing up in Agats, Herlina witnessed several health and nutrition challenges first-hand, motivating her to pursue a degree in nutrition. Now serving at a primary healthcare centre (Puskesmas), Herlina calls her deep commitment to children “a calling from God.”

South Papua has high rates of wasting (13.8%) and stunting (25%) among children under five, according to the 2023 Indonesia Health Survey (SKI 2023). Asmat is one of Indonesia’s hardest-hit regions by malnutrition, with severe wasting outbreaks in 2015 and 2018.

Lack of awareness about how to craft nutritious diets and poor child-rearing practices contribute to widespread malnutrition. “We have plenty of fish, but people sell them to buy instant noodles and alcohol,” Herlina laments. “The focus is on filling stomachs, not on nutritional value.” 

Agats, the capital of Asmat, which is home to around 24,000 people, including 3,450 children under five, faces severe malnutrition. Surrounded by polluted water and reliant on rainwater for daily needs, the community struggles to grow food. Most food items are imported and expensive. Its remote location, accessible only by boat, complicates these challenges. 

Since 2021, UNICEF has been working with the government in South Papua to strengthen health systems and empower communities to prevent, detect and treat child wasting. This includes training healthcare providers on Integrated Management of Acute Malnutrition (IMAM) – a model for identifying and treating severely wasted children.

Endorsed by the Ministry of Health, IMAM can successfully treat over 85 to 90 per cent of severely wasted children at home without requiring hospitalization, if identified early. It includes screening children for wasting at household and community levels, using a simple mid-upper arm circumference (MUAC) measurement tool.  

Before the IMAM training, severely wasted children in Asmat had to be referred to the district hospital. Now, they can be treated at the Puskesmas by Herlina and other healthcare providers. Since 2022, when Herlina was trained, she has identified over 60 cases of severe wasting. 

One of her most emotional memories is trying to save a severely wasted child. “We referred the child for standard treatment, but it was too late to save him,” she recalls, holding back tears. Despite such heartbreak, Herlina and her team work tirelessly to save others. Her efforts include distributing therapeutic food and educating mothers about nutrition during home visits. 

The nomadic lifestyle of the Asmat people, who often move during treatment, makes it difficult to track and treat severely wasted children. Yet Herlina perseveres, visiting children daily to monitor their progress. She often visits families early in the morning before starting her work at the Puskesmas, helping caregivers prepare and administer therapeutic foods.

Her dedication has resulted in 20 children recovering from severe wasting and achieving normal nutritional status. “Seeing them cured is the greatest reward,” she says, beaming.

Herlina shares what she has learned with colleagues, including nurses and midwives at the village-level sub-Puskesmas (Pustu). She also collaborates with ECD and Sunday school teachers, training them to use MUAC tapes for early detection of wasting. 

She understands that they are up against deeply ingrained habits that will take time to transform. "Changing behaviour is hard, but it’s possible,” she says. “It doesn’t come overnight. Education is key.”

Herlina’s ambitions go beyond treating severely wasted children. Her dream is to change her community’s attitudes toward food and nutrition. “I believe every change starts with small steps,” she says, with an optimistic smile. “Through self-love, we can begin to take better care of our health.”

The IMAM programme is now active in 175- districts across Indonesia. Close to 3,000 health workers and almost 15,000 community volunteers have been trained since 2021, resulting in 42 per cent of 3,942 primary healthcare centres in seven provinces providing IMAM services. UNICEF is advocating for continued expansion of IMAM services, in an effort to save the lives of millions of children.

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