UNICEF health program targets remote island chain

M. Azis Tunny, The Jakarta Post, Ambon

The acute maternal and infant mortality rates in small and remote islands in Maluku province has prompted the United Nations Children's Education Fund (UNICEF) to launch a new system of healthcare in the island chain.

Saumlaki, the capital of Southeast West Maluku regency, currently operates as an area health center due to its relatively complete facilities and manpower capabilities. However, access to Saumlaki is not easy.

It takes between six and eight hours to get to Saumlaki from Seira Island, the farthest island in the chain, and between one to two hours from Matakus Island, the nearest, provided the weather is favorable.

To charter a boat from Seira Island, it costs Rp 2.5 million (approximately US$280).

"This is quite a burden for people who are mostly poor," said Juliana Carolus, head of the Southeast West Maluku Health Office, adding the high maternal and infant mortality rate was due to geographical factors, lack of modern medical equipment and costly transportation.

In the past two years, around 30 women died during childbirth, while the Saumlaki community health center recorded 16 cases of death to mothers and infants since August this year.

To get adequate medical care, they have to cross the sea to arrive in Saumlaki. However, during the monsoon season, such a trip is often impossible.

"Our regency is made up of islands which are characterized by fierce tides. There are also areas on the same island without overland access, so those people have to travel by sea as well. Imagine if a young expectant mother has to cross the sea with fierce waves to get medical help," said Juliana.

Juliana said the high maternal mortality rate was also attributable to local traditions.

"Let's say a patient is hemorrhaging profusely and has two hours to get help. (Often she) is not taken to the nearest community health clinic immediately because the community requires her to go through a ritual first. As a result the patient cannot be saved."

The UNICEF program aims to develop five island chains in the regency -- North Yamdena, South Yamdena, Babar, Lemola and South Daya -- to curb the maternal and infant mortality rates.

Juliana said the mortality rate would never decrease under the former healthcare system.

UNICEF representative head for Maluku, Widodo Suhartoyo, told The Jakarta Post the project, which was still being evaluated in the South Yamdena island chain, was aimed at facilitating health services for expectant mothers, especially in providing services closer to them.

"We wish to bring healthcare closer to pregnant women by using the island chain approach," said Widodo.

UNICEF maternal health specialist in Indonesia, Widjajanto, said the concept was aimed at creating independent healthcare units.

"They should be able to resolve the problems ... without referring to hospitals in the regency capital. It is the most effective strategy for an island chain, keeping in mind obstacles such as bad weather and transportation.

"We will train nurses and midwives on the islands so they are able to perform operations during deliveries and provide other healthcare without referring the patient to a hospital in the city. The presence of independent medical facilities in strategically located islands is expected to improve people's accessibility to healthcare, even while they live on remote islands," said Widjajanto.