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Empowering Puskesmas through Pencerah Nusantara
Using V-Scan, a health staffer checks a pregnant mother in Lesan Dayak Village, Kalimantan
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Using V-Scan, a health staffer checks a pregnant mother in Lesan Dayak Village, Kalimantan. (Courtesy of CISDI) (Courtesy of CISDI)
Using V-Scan, a health staffer checks a pregnant mother in Lesan Dayak Village, Kalimantan. (Courtesy of CISDI)
Young university graduates take part in the yearlong Pencerah Nusantara (PN) program to provide education to rural communities, including those in far-flung and hard-to-access areas to foster a health paradigm.
A mother fumigates a newborn. It sounds weird, doesn't it?
But it does still happen in a remote area in Ende, East Nusa Tenggara. In Ogotua, Central Sulawesi, there are mothers who hang their newborns under trees. And there are many other similarly 'odd' stories in off-the-beaten-track places in the country.
Some of the above exemplary baby-delivery traditions may captivate those fond of archaic and exotic things and prompt them to ask why they do it. Fumigating newborns is believed to free the baby of evil spirits; while hanging the infant under a tree is intended to expose the neonate to sunshine.
The old custom-related stories that spread from word of mouth, however, are considered improper by modern schools of thoughts on health.
'Medically, the traditions pose a high risk and we believe many villagers do not understand it,' said Anindita Sitepu, program director of the Center for Indonesia's Strategic Development Initiatives (CISDI), which manages PN.
'We do not prohibit them from using the old ways of baby delivery but we tell them how the tradition can be potentially harmful to the infants and give them better alternatives,' she said.
'Many do it due to ignorance and in such cases, it is our obligation to solve it and give them other alternative ideas,' she said.
PN is an extension of the Millennium Development Goals (MDGs) program, with health as the focus area. With a vision of improving the welfare of Indonesian people, PN aims to empower community health centers (Puskesmas) across the country and to build a health paradigm among communities.
Carefully selected teams, with each comprising a young doctor, a midwife, a nurse, a nutritionist and a specialist in health issues from various backgrounds, carry out yearlong voluntary work in the respective targeted regencies.
The targeted locations for the three-year program that kicked off in 2013 and will end this year are Mentawai Islands, West Sumatra; Karawang, West Java; Pasuruan, East Java; Berau, East Kalimantan; Toli-toli, Central Sulawesi; Sigi, Central Sulawesi; and Ende, East Nusa Tenggara.
As Anindita Sitepu put it, the old traditions were one of the challenges facing PN teams, especially when it came to implementing their task of providing preventative services, part of the impactful functions of Puskesmas.
How frequently the 'weird' birthing traditions are seen varies from one region to another.
In Kelay district, Berau regency, such ancient ways of baby delivery have been gradually decreasing over the past few years thanks partly to continued efforts by the local health office and friends of PN, which started three years ago through education and counseling, according to Arnel Panimpa, head of the Kelay Puskesmas.
Building more Puskesmas
Arnel said the unusual ways of giving birth in Berau were closely linked to people's livelihood activities, conducted deep in the forest, leaving them further away from health facilities and services.
Currently, Berau, one of the PN-targeted locations, has one standard Puskesmas, situated in Kelay, about 100 kilometers from the regency or two-and-a-half hours by land.
Its targeted medical service coverage is 14 villages in the region, of which six are exceptionally hard to reach due to geographical challenges. 'To provide mobile Puskesmas services, we have to take what we call ketinting [long boat] to reach one of the six villages and we have to stay the night there.'
'Along with friends from Pencerah Nusantara, we discussed the problems, with the end result of proposing to build two more standardized Puskesmas as a breakthrough solution to the severely challenging access problem,' he said in a phone interview.
PN has received overwhelmingly positive responses from young university graduates but of the many applicants, only a few male doctors are interested in the program. Among the few was Shaftan Dostur from Banda Aceh, who took part in the first generation in 2013.
Shaftan said that he had his own views on his profession as a doctor, which led him to decide to stop working at a hospital and join the program. He said being a doctor should be seen in a broad perspective in terms of medical activities, which should not be confined to treating patients in hospitals but the 'most challenging and important thing is how to prevent people from being ill.'
'Sick people do not only have to bear treatment costs but also become unproductive. Many rural people in remote areas face difficult access to medical facilities and services. This is why I joined the program in 2013,' he said.
He added that he knew about the geographical challenges facing volunteers carrying out their tasks in hinterland areas but said 'the real challenge was greater than expected. What helped us in this regard is that we work in a team'.
Brakeless 'ojek'
Disclosing the severely rough and challenging roads in the field, Anindita, who joined site visits to all locations during the assessment phase, said, 'In hilly Lindu, most ojek [motorcycles taxi] are brakeless and they use their legs to stop the vehicle because the roads are muddy. So you can imagine, I took a brakeless ojek on a long and winding up-and-down road, with ravines on my left and right side,' she said.
According to Shaftan, villagers in Kelay have a tradition of leaving their village to go to the forest to work on the land, which also poses another challenge for the team, especially because 'we cannot set a schedule for meeting with them as we expect. Therefore, we have to make adjustments to suit their schedule. They usually return to their village on national days, during harvest season and rainy season'.
He said the one-year experience in the field had made him 'more aware that promoting health and preventing people from being sick are more beneficial to people than healing'.
Anindita said that local Puskesmas were only one of the partners that CISDI established relationships with to execute the program as it involved many aspects, some of which required academic expertise, such as the University of Indonesia's School of Medicine and School of Psychology that helped in the recruitment phase.
'We [also] partner with GE which provides funds for the program's operation. Partners are needed in every phase of implementation.'
She disclosed that in the field, its partners included local regional administrations, health offices, NGOs, etc. 'We are not 'picky' when it comes to partners. The important thing is as long as we have the same vision, values, and ethics, then go ['¦ We] are equally open to the public and avoid exclusivity ['¦] we are a social movement. There is no significant challenge in this regard ['¦] because they need us ['¦] and all support us,' she said.
According to her, partnerships will continue despite the end of three-year program because 'partners are given room to give input according to their capacity in targeted locations that they support. We hold a leaders' meeting once in every six months, with leaders of the team and partners invited to attend and we also share info updates on the movement through a newsletter,' she said.
'I think Pencerah Nusantara is one of the best practices. It is very good. Alumni of Pencerah Nusantara now work in hospitals everywhere and some of them move to other institutions, which is good in terms of talent development,' said GE's CEO Handry Satriago.
'Another essential thing is impact. They provide education to villagers on how to give birth in a medically healthy way. Hopefully, this will change the mindset of mothers, who, for example, cut their own babies' umbilical cords, making them highly susceptible to infection, etc,' he said.
The year 2015 marks the end of the Pencerah Nusantara program in the seven targeted locations, as well as the handover of the program to the respective targeted Puskesmas.
According to Anindita, the issue of handover is part of the program's design, which has been thought out since the beginning, to ensure the program's sustainability.
'Planning, implementation, monitoring, evaluation and handover were all well considered from the start. Why would we complete the implementation of the program, which is intended for the community, but then not know the continuation? That would pose a risk to the community,' she argued.
'So, first, second and third generations of PN should be seen as united, complimenting each other.
The first generation of PN focused on assessment of need, the second on implementation of intervention and the third on handover, she said. 'All make a synergy. Each team in the respective generations has different persons but essentially, they are the same,' she said.
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Partners for Change
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