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Vaccinating children deep in Borneo’s jungle

© UNICEF/2009/Djuhari
A health worker navigates the rapids to bring the blue box with lifesaving vaccines.

By Lely Djuhari

RIAM DADAP, Indonesia, 25 June 2009 - The blue plastic cold box filled with lifesaving vaccines finally ended its long journey at a small village close to the equator, deep in Indonesia’s Borneo jungle interior.

Riam Dadap is just one of thousands of far-flung villages in this country’s vast archipelago. The remote location of many Indonesian communities presents a huge challenge to its immunization programme. Indonesian health agencies, supported by UNICEF, strive to ensure close to five million babies every year are fully vaccinated before their first birthday against childhood illnesses such as tuberculosis, measles, whooping cough, polio, hepatitis B and tetanus.

“Routine immunization is a cost-effective way to stop children dying of preventable diseases,” said Anne Vincent, head of UNICEF’s Child Survival and Development. Indonesia has achieved fantastic results through a series of national polio and measles immunization campaigns conducted between 2005 through to 2007. It has become polio free in the past three years and is on track to eliminate maternal and neonatal tetanus by 2012. Indonesia has also reduced fatal measles cases.

However, these programs are costly. To prevent future outbreaks, it is vital that kids are inoculated in time and in accordance with established protocols by health centres and outposts. Many Indonesian children do not complete vaccination programs, taking only one or two of several required shots.

UNICEF is striving to ensure that protocols are implemented properly by assisting the government in policy making, monitoring and procuring the vaccines during outbreaks when national campaigns are urgently needed.

Back in the village, the health workers’ job was not done at the journey’s end.

Using whatever mode of transport is available – speed boats gliding on the huge tributaries, trucks, and motorbikes speeding on muddy roads with gaping potholes and finally a motorised canoe dodging rocky boulders and shooting rapids – the vaccines were hand-carried from a district capital about 250 kilometres away to this village of 800 people.

Before taking a break for the night on the floor of the village head’s house, health worker Pius Hansip and Aloysius Dedi had to open the box to see if the ice pack underneath the flip top is still cold. Finding that it had melted during the 16-hour journey, they quickly changed the lukewarm water with cooler spring water. They also checked every single vial to see if the white squares in the round stickers have turned lilac – a warning indicating a ruined batch.

© UNICEF/2009/De Beer
A baby receives a vaccine shot.

All was fine. The next morning, as at the beginning of every month, this traditional long house on stilts was transformed into a makeshift health outpost. Bright colourful posters produced by UNICEF doted the wooden walls to help measure a child’s growth. Another poster portrays a helpful schedule outlining an effective vaccination programme.

Dozens of babies, smiling contently and occasionally yawning while nestled in their batik sling holders across their mothers’ arms, waited to be weighed and checked. Some opened their small mouths to emit lusty cries after being injected with single-use syringes.

“I was told my one-year-old baby is not putting on as much weight as she should,” said Maria Lusiana, a 19-year old mother. “I have to feed her a proper balanced diet of eggs and vegetables, and not just rice porridge. My baby will be weak and will get sick easily if I don’t have her immunized,” she quoted the health centre staff as advising her.

A sense of excitement permeated the village. This month, the villagers received brand new pink family health books to record weight gains, illnesses and vaccinations. Previously, the mothers had to make do with loose papers and their memory.  Later in the year, a newly graduated midwife will be based in the village to help achieve safer deliveries. In 2010, the village is slated to have its own dedicated health clinic.

For the moment, the local health centre is headed by Ardi and staffed by a 29-year old doctor and four male nurses who will have to make do with the resources they have. They must return the unused vials to the health centre, two hours away, which can only keep some several months worth of vaccines. The village itself has several hours of electricity a day powered by diesel generators. Solar-powered freezer boxes, which can keep a year’s supply of vaccines, are in the pipeline but the central government wants to ensure that they will be well maintained and kept safe.

Malaria also threatens lives of children and their families in the district.  At present, the best 'vaccine' against malaria is an insecticide-treated bed net, which can protect children for three years if properly used.  However, coverage of nets in Indonesia is still due to lack of sufficient money to purchase them.

Overseeing 12,000 people in this area is a daunting task but the staff’s dedication is unmatched.

“Every child has the same rights to survive and thrive even in the remotest village in Indonesia,” said Ardi, the health centre chief.

 © UNICEF/2009/Djuhari.
A dedicated health official at work.

Note: The village recently hosted a visit by Dutch journalists facilitated by UNICEF the Netherlands in retracing the steps of Charley Boorman to see immunization programmes in Riam Dadap. Mr Boorman’s travel programme, By Any Means, will be shown by the National Geographic Channel the Netherlands at the end of June as part of UNICEF the Netherlands month-long fundraising drive.



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