Motorcycles help reduce the maternal mortality in Indonesia

Health for All operates in NTT (Nusa Tengara Timur) which is the province which despite major improvement still shows the highest rate of death rate for mothers in Indonesia. The result of a National Health Survey in 2004 showed that in Indonesia as a whole the death rate of mothers reached 307 per 100,000 live births. NTT had a rate of 554 per 100,000 live births.
In 2007, the Health Demographics in Indonesia showed the national decrease reached 208 per 100,000 while in NTT 306 per 100,000 live births. Although the NTT rate had decreased it was still higher than other provinces.

By way of comparison the rate for the United States in 2005 is 11 per 100,000. Further information on this topic can be found at http://en.wikipedia.org/wiki/Maternal_death.

The infant mortality rate in 2004 in Indonesia was 52 per 1000 born alive while in NTT there was an improvement from 62 to 57 per 1000 born alive.

The result of Basic Health Research in 2007 showed that in NTT 77,1 % of delivery services were done at homes, 6,9 % in government hospitals, 6,5 % at public health or sub public health centres, 3,5 % at village maternity houses, 3,0 % in maternity private hospitals and 0,7 % at other places.
Healthworker in NTT with expectant mother
Basic health research in 2007 shows that 46,2 % delivery were done by trained traditional midwives, 36,5 % by midwives, 11,5 % by the member of the family, 4,1 % by doctors, 1,2 % by medical staff and 0,5 % by others.
From the facts above it is clear that many births take place with no health facilities.

A woman’s mortality is caused by unskilled medical staff and unsterile equipments. A causal factor of infant and maternal mortalities is the minimum means of transportation. This applies both to the families and also to the medical staff who lack the means to reach remote areas.

HealthService (1)
Healthworker in NTT with expectant mother

Ideally, during the pregnancy period, a mother should get a health check-up and service called Ante Natal Care (ANC). Ante Natal Care is given to an expectant mother during pregnancy according to the standard of midwifery service. This includes the measuring weight and height blood pressure, measuring fundus uteri height and checking tetanus imunisation status and toksoid tetanus, giving minimum go ferum blets during pregnancy, routine and specific laboratory check-up.There are typically four check-ups, minimum once in the first 3 month, once during the second three months and twice in the third three months.

Due to the condition of NTT and the island’s hilly topography in general women do not get the standard health check-ups during pregnancy. One way the health service solves this problem is by providing motorcycles for the use of health staff. The motorcycle is chosen since this means of transportation is capable to reach the remote areas.
By: Mansetus Kalimantan, HfA Field Coordinator

With Motorcycle I am Optimistic to Achieve Health Service Targets

Markus

It is tiring indeed to take trip from the Southern tip of Solor Island where Lewotanah Ole is situated to Rita Ebang health center in West Solor. But that is the demand of service responsibility that has to be done by Markus as a field health worker.

As a health provider working in a very remote area and far from subdistrict capital, Markus has to maintain regular contact with the subdistrict health center. Aside from taking a stock of medicines and vaccines, he also has to attend meetings and other adminstrative works. This regular trip to subdistrict capital is just part of his travels. His work in the villages and subvillages is another story.

Fortunately after he gets HfA motorcycle, he feels more facilitated and useful in carrying out his responsibilities starting from visiting people in the villages, visiting in-house patients, giving vaccination, disseminating health service and health information in integrated community health center, etc. As well as his regular works it also improves his contact with the subdistrict health center. In short HfA motorcycle truly helps smoothen his works.

“Many demands from District Health Office have to be fulfilled and if one is not provided with a vehicle (such as a motorcycle), it would be very difficult to handle. In the meantime all health services have specific targets. For instance, pregnant women, babies and children have to be attended to the activities in monthly integrated community health center. However, on the scheduled day most mothers are working in their farms. Knowing this situation I have to go around with motorcycle to call them. In addition I have to attend to the call of the famies in order to give health service to the patients, even at night. Thanks to the Health for All motorcycle I can do all this”.

By: Mansetus Kalimantan, HfA Field Coordinator

Translation from Indonesian by Willy Balawala

The motorcycles used here are provided and maintained by Motorcycle Outreach via HfA

Anton Ruron: My Child was Saved with the Help of HfA Motorcycle

Ludfina Lelo Ruron, a 7 years old child was resting weakly on an old bed placed in the family room of a 6 x 7 meters house. Lying between 2 pillows, Ludfina was just silent looking at every person who came to see her.

LUDFINAHer eyes were blurred, the muscles of her neck were clearly visible and her ribs could be counted from afar. Any kind of food given was frequently thrown out. Understandably because this daughter of Anton Ruron and Anastasia Wungubelen had suffered from malaria for the last 2 weeks. However, her parents believed that the sickness of their first daughter was due to the “interference of night bird” (disturbance of bad night spirits) which is the belief of the locals. Meanwhile to seek medication in the health center, as proposed by some villagers was difficult to realize due to the expense as her parents are poor farmers.

The Indonesian government provides free medication for poor sectors of society via a special health insurance program but not all poor people qualify for this. Despite being a poor family, Ludfina’s parents do not qualify and had not received the required “card”.

“We are indeed a poor family. However, the allocation of cards for free medication for our village is limited and we are not able to get it. Objectively our family is much poorer than some of those receiving the cards. I have no idea what are the criteria being used to determine a poor family. The fact is we do not have sufficient money to pay for medication or for transport to the sub-district health center or hospital in town”, said Anton.
One day Anton was visited by Mr. Yeremias Mukina (a field health provider) who came by motorcycle offering to bring Ludfina child to the public hospital in Larantuka town, East Flores without cost.

“At first I was doubtful, would it be possible for my child in her weak condition to travel on a motor bike? But the health rider convinced me that I could come along in order to take care of the child. I accepted the offer and we immediately rushed to the hospital. This health worker also arranged my health insurance card so that my child could get medication without charge”, said Anton.

“I was really helped by HfA humanitarian assistance. It’s motorcycles when used by field health providers truly facilitate the villagers who lack access to transportation. I also give my thanks and gratitude to Mr. Yeremias Mukina who ensured that my child could be handled properly in the hospital. Currently Ludfina is still in hospital but her condition is improving. She can smile again and eat well. Hopefully in a few days we leave the hospital. And I also hope HfA can help more people as in remote villages as there are many people like us”, Anton finished story while caressing Ludfina’s hair.

By: Mansetus Kalimantan, HfA Field Coordinator

Translation from Indonesian by Willy Balawala

The motorcycles used here are provided and maintained by Motorcycle Outreach via HfA

HfA Motorcycles support School Health Service Unit

Klukenuking Elementary School, located in Kawela Village, Wotan Ulu Mado Sub-district, East Flores, Indonesia.

It is situated at 1,000 meters above sea level, very remote and far from the capital of the sub-district. The elementary students of this village rarely get information about health issues although their schools has a Health Services Unit. Although it has been launched in the 1980’s by the Indonesian Government and has become part of the school curriculum most students in remote villages rarely acquire health services or health information. The main obstacle is the limited transportation available to health providers to reach such villages.

According to Aloysius Riantobi, the Head of Kawela Village, presently there are a good number of health workers in the sub-district health center. However, health services delivered to schools in remote villages is a rare event due to the limited means of transport. “We are very lucky. Since 2003 our students here have accessed health information from the health providers coming from Baniona Health Center who in turn got motorcycles from HfA,” he underlined.

What is said by Riantobi is confirmed by Arkadius Balaweling, the Head of the Elementary School. He acknowledged that his students no longer have difficulty to get health information as health providers from Baniona Health Center regularly provide health services to the students. Thanks to the HfA motorcycles, the health providers dare to climb and reached this highly elevated location.
School Health Unit Services“Indeed since 1980s government inserted health as a subject into national curriculum of the elementary school. However, due to the lack of health personnel and of means of transport to remote areas, it was not done well. In the absence of health workers it is undertaken by sport teacher instead. As a consequence, health issues are not taught but instead we get sports (physical exercises). It is understood because sport teacher does not know the specifics of health education”, explained Arkadius who has been devoting the past twenty years of his life to this school.
The success of motorcycles for health deliveries in remote villages is also acknowledged by Marianus D. Wuring, a health worker in Baniona Health Center, Adonara, East Flores. He acknowledged that since he rides a HfA motorcycle he regularly visits the schools under his area of coverage and give information about primary health to elementary students.

Marianus_small
Marianus D. Wuring, a health worker in Baniona Health Center, Adonara, East Flores

Aside from giving hygiene and sanitation to the public, Marianus also regularly visits six schools in order to give services and information for around 1,500 students. The services given, among others, are health education and vaccination to the children. “We are able to do all this because we are supported by HfA with motorcycles which enable us to undertake our works well”, said Marianus.

However, Marianus further clarifies, “Surely there are still many schools that do not benefit from health services and information due to the lack of means of transport. This happens because there are still a good number of field health workers having no motorcycles that can be used to reach out remote villages”.

“They are not lucky as I am. I hope they are also supported with vehicles in doing their field work. There are a limited number of motorcycles provided by the government.but these are not well maintained and not sufficiently durable for the difficult mountainous road”, said Marianus before starting his health education class.

By: Mansetus Kalimantan, HfA Field Coordinator

Translation from Indonesian by Willy Balawala

The motorcycles used here are provided and maintained by Motorcycle Outreach via HfA

HfA provides multiple benefits

Covering her head with a rumpled cloth, the old lady was busy taking care of the fish caught by her husband. The fish were lifted one by one and put onto a pile of salt. This is the way to preserve the fruits of her husband’s work so that they can be sold in the market. Such work is performed every time her husband returns from the sea. Being a simple village woman with just barely enough to get by, she opts to preserve the fish the traditional way.

“I am mixing the salt with the fish in order to preserve it until it is sold in the market. If we do not this, it could not be sold when the day of the market comes”, said Mrs. Aminah.

Mrs. Aminah Tadong Labina
Mrs. Aminah Tadong Labina

Even though her age is just forty Mrs. Aminah Tadong Labina looks older. She has 4 children. Education was only provided to grade three of elementary school. Asked about her access to the health services, Mrs. Aminah replied that being “small people” (poor people) they rarely seek services from health facilities as these are located far from their village and they do not have enough money to pay transport.
“Our main benefit from the health services is from Mr. Dani Kerans who visits us regularly, especially at the day of Community Health Centre (Posyandu). Besides, since our village is located along the road which is normally passed by Mr. Dani, we always ask for his help when we get sick. Going to the main health center which has better facilities is only possible for richer people”, added Mrs. Aminah.
MrDani_smallShe recounted that since Mr. Dani Kerans, the only health worker in their area, received a motorcycle from HfA, the people of Kolidatang (the sub-village where Mrs. Aminah and family live), are always visited by him.

“Yes, it is true. It has been five years now since Mr. Dani got the motorcycle from HfA, now we, Kolidatang residents, regularly get health services. Before that when we needed him for medication we had to go to the branch of health center where he is based as he had no vehicle that could be used to visit villages. Now that he has an HfA motorcycle the Community Health Centre at Posyandu has come to life and the people here have more opportunity to access health services from Mr. Dani”, said Mrs. Aminah while pouring the fish onto a pile of salt in front of her.

Since Mr. Dani got the motorcycle from HfA, he really works to help the people living within his coverage area. He even works outside of his working hours in case people need his help. He can come directly to their houses to give medication. When a patient needs to be referred to the main health center or to the hospital, he can drive him/her in case there is no public transport. In the same manner, he also can do so when the family of the patient does not have enough money to pay public transport. So he can drive the patient tens of kilometers to the main public health center or even to the hospital in the town which is further from the village, emphasised Mrs. Aminah.

“There were several NGOs previously working in our area but the program of HfA is particularly unique. HfA supports health workers by means of motorcycles in order to be used to visit and to render health services to the people in remote villages. At the same time the people in villages benefit from the motorcycle as well since they can access health services on the spot without spending transport money. HfA motorcycles truly have multiple benefits.”

Translation from Indonesian by Willy Balawala

My Life and My Baby were Saved due to the Readiness of Health Provider

In Flores, in general, around 99% of the population live as farmers in the villages far from access to health services. This is how I myself live. My house is in Demon Dei, a remote village in the hinterland of Adonara island, in Wotan Ulumado Subdistrict. Even though there is a midwife in the village, she is frequently out of the village so it is difficult for the people to get health services. The subdistrict public health center (Puskesmas) is located in the capital of the subdistrict, around 5 km away, and road conditions are bad.

Having been accustomed to the hard kind of life being experienced as a poor farmer, I did not feel special when waiting for the birth of my second child. However, it does not mean that I did not have my pregnancy checked by health workers. I visited the community health post (Posyandu) and had check ups in Puskesmas because the midwife in the village is not always there.

Mrs Anu Tukan
Mrs Anu Tukan

I do not recall exactly how many times I went to Puskesmas but maybe around three times in the course of my pregnancy. I do this as I am aware that health is the most important thing for me. With regard to education, I am lucky to have had it until senior high school, thus I am educated better than most people in the village. So for me good health is a treasure of immeasurable value.

Knowing that I regularly had consultation with health providers and got the information that my pregnancy was safe, I was expecting to have trouble-free labour. Evaluating such a situation my husband and I decided to have labour at home assisted by traditional birth attendant (TBA). The reasons we used were:

1). Midwife is always out of the village since she lives with her husband in the capital of subdistrict and just visits the village once a while.

2). The fee for labour assisted by a health provider is quite expensive, while we are just a poor family. Also, going to Puskesmas needs fee for renting transport as well.

On September 27th, 2006 our waiting days came to an end. My stomach was aching and I was sure I was having the baby. But after waiting for hours the baby was not appearing although three TBAs had been called to assist me.They made bio traditional medicine and gave it to me to drink. I had two glasses of medicine but my baby did not come out. In the meantime my condition got weak and I started to drop. I fainted and consciousness started to go down.

At this point my husband asked one of his nephews to seek assistance of a health worker in subdistrict Puskesmas. Riding a horse, he soon headed for Puskesmas and called a midwife to quickly go to the village to help me.

With the rest of my strength I was thinking, is is possible that the midwife can arrive soon to help me because the distance is five km with very bad road condition? Pessimism started to grow since several mothers died in the village due to child labor. That happened because the midwife was late arriving at the village because of the very minimal means of transport in the area.

However, I was very lucky. The awaited midwife finally arrived in relatively brief time. It took her 30 minutes to reach the village by motorcycle. Equipped with minimal tools she was able to assist the delivery and my baby was saved as well as me.

After my strength recovered a little bit I found my baby sleeping by my side. At that moment in a low voice I repeatedly expressed my thanks to God and to the midwife. Hearing what I said, midwife said. “The ability to help you is not from me alone. You are safe because, aside from God’s help, I can come faster due to the help of HfA / YKS in supporting our activities with motorcycles, so that we can come here quickly as soon as receiving the message. Being later by a few minutes could mean your life, and your baby’s, would have a different outcome.”

Testimonials

In the course of their work, Health For All staff gather stories which document the conditions and illustrate the impact which the charity is having on the area .

Mans enroute to health centre near Larantuka
Mans enroute to health centre near Larantuka