The Badung Market building, a sprawling, four-story structure, is viewed from the Kumbasari Arts Market across the Badung River. The Yayasan Rama Sesana (YRS) center is located on the top floor of the building. (JP/Jane Raniati)

If you've been to Bali's capital of Denpasar, you may have been drawn to the colorful bustle of this island's largest traditional market. Located in a four-story building at the busy downtown intersection of Jl. Gajah Mada and Jl. Sulawesi, Badung Market is a sprawling, vibrant market, with each floor featuring specific goods.

The first floor has fruit, vegetables, meat, flowers and incense while the second floor holds spices, modern household goods and plastic products while the third floor sells traditional household goods, baskets and Hindu ceremonial necessities. The top floor is for the market's administrative offices and, for the past four years, a small non-profit reproductive health center.

Just a stone's throw across the Badung River is another busy four-story market, the Kumbasari Arts Market. Kumbasari is popular with tourists, retailers and exporters for handicrafts, paintings, sculptures, textiles and clothing.

Fresh produce, flowers, Hindu offerings, prepared food and miscellaneous goods are also sold at outdoor stalls that snake around both markets and over the connecting bridges, spilling into the parking areas and down adjacent roads. The whole area is buzzing almost 24 hours a day.

Traditional Balinese markets are truly a woman's domain. Although there are men aroundguards, mobile vendors, drivers, some shopkeepersthey are operating in a woman's realm.

This is the perfect place to reach thousands of low-income women vendors and laborers who have little to no time or money that isn't already allocated for household survival and religious obligations. The market area is also filled with thousands of shoppers and suppliers who come from rural areas and towns on Java, as well as wholesale purchasers who buy goods here for their own retail stores located elsewhere.

All are potential clients, but also potential messengers that will pass on health information to friends and relatives far and wide.

Dr. Luh Putu Upadisari (Sari) is full of passion and drive for public health work, despite all the obligations of her life as a Balinese woman with a husband and three sons.

Dr. Sari founded Yayasan Rama Sesana (YRS) in 1999 to do hands-on community work, mainly focusing on prevention of HIV and other sexually transmitted diseases (STDs). In January 2004, she opened the YRS reproductive health center at Badung Market to provide tens of thousands of women with important health services and information.

The busy women market vendors and laborers, most of whom are married, Sari says, are not considered to be atrisk" and so rarely receive any accurate information about STDs or HIV from other sources.

But among a baseline survey sample of over 300 market women in 2003, about two-thirds perceived themselves to be at risk for STDs, including many who knew or suspected that their husbands had other partners or visited sex workers.

"The market is also home to dozens of young unmarried women who assist at stalls in the evenings, and who are informally involved in commercial sex transactions," said Sari.

The health center provides testing and treatment for STDs, and counseling and referrals for HIV tests, but it is not an STD clinic.

Sari emphasizes,these women have unmet needs for basic reproductive health services," like Pap smears, contraception, prenatal care, breast examination, treatment for vaginal infections, and health counseling and education.

The market women surveyed in 2003 complained that they had no time for long waits at public health centers, no money to pay for private services, and that the information received was minimal -sometimes they were never even given test results.

The YRS places a high priority on making sure their clients understand their choices and options, their diagnoses and medications, as well as discussing topics like HIV/AIDS to combat harmful myths, attitudes and risky practices.

The center sees more than 500 client visits in the average month. More than 100 clients per month are screened using a microscope and simple lab tests, using samples taken during a pelvic exam. The YRS also provides an average of 60 Pap smears per month.

Over the past four years, about 7 percent of clients have tested positive for gonorrhea.

Meanwhile, thousands have received personal counseling on topics including HIV/AIDS, cancer, drug abuse, domestic violence, self-breast exams, correct use of condoms, pregnancy, childbirth and breastfeeding.

General health services are also provided, and men are welcome.

The YRS staff makes approximately 300 contacts monthly during outreach work across the area, at all times of the day and night. They talk to people about health concerns, give out relevant pamphlets and make referrals for further services.

Every month, the YRS holds an open discussion session on topics such as STDs and HIV/AIDS, domestic violence, cervical cancer and sometimes current topics of concern like dengue fever, bird flu or diabetes. These public forums are usually attended by 30 to 50 women and men.

Clients pay on a sliding scalethat is, whatever they can afford. Often, clients can't afford even a quarter of the cost of medications provided. For Pap smears, clients can only afford about Rp 10,000 on average, although the real cost of this service is well over Rp 50,000.

Clearly, the YRS relies heavily on grants and donations to continue providing such services. Majority funding is from the Annika Linden Foundation via a Bali-based foundation, Yayasan Kemanusiaan Ibu Pertiwi (YKIP), but additional funding is always neededand gratefully welcomed.

Given enough funding, the YRS envisions opening similar programs at traditional markets in each of Bali's eight districts.

As the foundation's director, Sari knows her regular clients well, especially the group of about 15 peer educators who spread information to friends and relatives and refer fellow market workers to the program. Interacting with these women over the years has convinced her of the importance of the work the YRS does for these low-income women.

At a 2007 discussion session this writer observed, a guest with HIV spoke to the crowd about her experiences. The bold yet sensitive questions asked by women who are regular attendees showed how attitudes have changed since the program began, when 60 percent of surveyed women thought people with HIV/ AIDS should be ostracized.

After the session, everyone lined up to shake the speaker's hand or embrace her - somthing that would not have happened but for the important work the YRS is doing to educate and empower ordinary Balinese women.

For more information, contact Yayasan Rama Sesana (YRS) at: Tel/Fax: (0361) 247363 yrsbali@dps.centrin.net.id www.yrsbali.org

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