From Africa to Asia...

The heady smell of clove cigarettes and durian fruit lingers in the air, a constant reminder that I now find myself transplanted in Indonesia nearly 16,000 kilometers from where I began my mission in Sierra Leone.

I have come to work alongside Marcy Erskine, the Canadian Red Cross malaria program advisor, to assist her in supporting the Indonesian Red Cross, the Indonesian Ministry of Health and UNICEF with malaria prevention.

In Indonesia, approximately 100 million people (nearly half the entire population) are at risk of malaria infection, with an estimated 42,000 dying of malaria annually. Health care is often not affordable in a country where an estimated 18 per cent of the population lives below the poverty line and 49 per cent of the population live on less than US$2 per day. In some regions, basic health services are not even available.

Following the tragic Indian Ocean tsunami that took the lives of 150,000 Indonesians, fears of a malaria outbreak amongst survivors and the availability of money led some UN agencies and Non Governmental Organizations to conduct malaria control efforts in tsunami-affected areas. This has stimulated government Ministry of Health efforts to also improve malaria control outside of the tsunami-affected regions, to areas where the malaria burden is as high as the most malaria-endemic regions of Africa.

In the isolated and marginalized communities of Indonesia’s outer islands, approximately 43 per cent of two – nine year olds were infected with malaria, while infection rates for all age groups were found to be in excess of 60 per cent. High malaria incidence contributes to the high rates of anemia and malnutrition, and in Indonesia 40 per cent of pregnant women, and 48 per cent of children under five are anemic. Anemia, malnutrition and malaria function to contribute to the overall precarious health status of populations in Indonesia, furthering the cycle between disease and poverty.

While statistics such as these highlight the scale of the malaria problem, they often do little to convey the human suffering caused by this brutal disease. In its early stages malaria causes fever, chills, headache, body pains, and anemia that weaken and incapacitate you, preventing you from working, farming or going to school. In its advanced state, painful convulsions lead to an excruciating death and leave families marred by the loss of loved ones, especially young children.

There is an urgent need for rapid scale-up of malaria prevention in Indonesia, especially in eastern Indonesia. Improved diagnosis and treatment, improved community outreach, and some tentative exploration of the utility of environmental management to reduce transmission are under way. However, high coverage of long-lasting insecticide treated mosquito nets is needed to rapidly bring down transmission to ensure that other strategies have maximal impact.

An integrated vitamin A supplementation and net distribution campaign is currently planned for six provinces in Sumatra. Our role in this campaign has largely been to offer best practices and lessons learned from past campaigns in other countries. This type of support has helped ensure success from country to country and is a large part of why Canadian Red Cross is now recognized as an organization that can provide appropriate, timely and successful program support to countries embarking on mass net distributions.

Having arrived in Jakarta late on the 24th of December, Marcy and I enjoyed a low key Christmas day; the only evidence of the holidays, the reindeer antlers we donned to help mark the occasion. Soon we were back at work, meeting with the Indonesian Red Cross Society to help them plan and prepare for the training and mobilization of volunteers for the upcoming campaign in Sumatra. As with past campaigns in other countries, the Red Cross’ focus is on social mobilization, utilizing its vast network of local volunteers to conduct grassroots community and household education regarding the campaign, including the importance of vaccination and the correct utilization of nets.

One of the Indonesian Red Cross’ main strengths is its ability to mobilize a large number of well-trained and equipped volunteers to respond to frequent natural disasters, which affect Indonesia. They also assist the government in preventive health activities and with response to various health emergencies and epidemics. It was clear from meeting with them that involvement in malaria prevention is an area in which they have the capacity to be involved, as well as an area from which to expand further into community based health services.

Following our meetings in Jakarta, we headed to Bandar-Lampung in south Sumatra for the campaign micro-planning meetings. Over two days, regional representatives from the Ministry of Health, UNICEF and the Red Cross planned out the details of the campaign. Marcy was often looked to for technical advice and through a translator was able to help facilitate the planning process. While the meetings were conducted entirely in Bahasa Indonesian, it was interesting for me to see how the planning for a campaign of this scale comes together.

It was also interesting to see the cultural differences in how meetings are conducted. Both Marcy and I noted how acceptable it seemed to be that most of the room was talking while presentations were being conducted. Music was even playing from a lap top near the back of the room. That it was the song ‘Barbie Girl’ added to the oddity of the situation as I find the universal and long lasting appeal of that song a particularly strange phenomenon.

My own aversion to that song aside, that two young women wearing hijab, the Muslim head covering worn by many women, were listening to western pop is, in a way, a fitting example of the cultural complexity of Indonesia. In a country where the influences of both western and Islamic culture have been adopted and integrated in uniquely ‘Indonesian’ ways, there is a diversity here that often goes unnoticed when filtered through the headlines we read back home in Canada. From the modern sprawling cityscape of Jakarta to the remote rural villages of Papua, Indonesia is as varied in its cultural make up as it is in its famed biodiversity.

Indonesia’s diversity is one of many sources of incredible strength and capacity, but Indonesia has also experienced a great deal of tragedy in recent years. Faced with everything from conflict to tsunami, to earthquakes, to flooding, Indonesia has been marred by disasters, and often it is the most vulnerable who are affected. Malaria is one of the contributing factors to this vulnerability, one that can be greatly reduced by malaria prevention strategies such as the one we are here to support.