Sunday, January 28, 2018

Solutions to disease and malnutrition in Papua remain elusive

Solutions to disease and malnutrition in Papua remain elusive
By ALEK K KURNIAWAN JANUARY 28, 2018 3:41 PM (UTC+8)
The deaths of 67 children due to measles and malnutrition in Asmat regency, in Indonesia’s Papua province, is a jolting tragedy. Let us hope that we do not see it as a mere statistic.
For the leaders of any country, even those who are thoughtful and conscientious, it would be difficult to face such a tragedy. Maybe there are exceptions among leaders in Indonesia.

Third-world disease is endemic in Papua. Malaria, malnutrition and leprosy are widespread, but “modern” diseases such as HIV/AIDS also circulate in this land.

In March 2017, endemic diseases resulted in the deaths of 64 Korowai people, and 201 people died in Lanny Jaya regency. In 2015, 


such diseases killed 54 people in Mbua regency. In 2016 and 2017 there were 37 deaths in Mbua regency and 54 in Jayawijaya regency. All died from endemic diseases, according to Tim Peduli Kesehatan dan Pendidikan Rimba Papua.
Papua Police Chief Boy Rafli Amar said more than 10,000 children in Asmat regency were currently suffering from malnutrition.
The lack of health facilities is the driving factor of many chronic 

diseases in Papua. Alix Boudewyn in his thesis “Maldistribusi Tenaga Kesehatan di Kabupaten Asmat Provinsi Papua” (2014) concluded that the implementation of the distribution of health personnel in Asmat regency had not gone well.
The maldistribution of health workers in Asmat takes two forms, vertical and horizontal. Vertical maldistribution refers to the imbalance of health-personnel dispersion among responsible agencies, starting from the level of the Public Health Service to Community Health Centers (Puskesmas), Supporting Health Centers 
and Village Maternity Lodges. Horizontal maldistribution refers to unequal distribution of health personnel among the districts.
The problem of vertical maldistribution relates to non-conformities with professional or specialist backgrounds, lack of appointment decisions, and poor placement of work.
Some maldistribution is the result of health workers wishing to stay near major centers, rather than outlying districts. Field work in rural communities is difficult, with poor access to local health facilities, inadequate salaries or benefits, inadequate career-development opportunities, and inadequate education and training facilities for health workers.
So, what is being done to tackle such maldistribution? The answer is not yet clear. The head of the Papua Provincial Health Office, Aloysius Giyai, says Papua still needs around 36,000 health workers to be placed in remote areas.
The Ministry of Health has only deployed additional health workers to Asmat regency after outbreaks of measles or extreme hunger. There are 39 new health workers there now, but it is still not enough.
Another problem is poor nutrition. The Indonesian elite convince themselves that children die in Papua only because of illness, backwardness, and their unhealthy lifestyles.
This view is actually blind to fact that various diseases are the body’s reaction to the lack of nutrient intake. According to 2015 data, around 10,000 people in three districts in Papua (Lanny Jaya, Puncak Jaya and Nduga regency) suffered nutritional deficits and 11 people died because of them.
The staple food in Asmat is sago, which has a carbohydrate content that is not inferior to rice. Sago carbohydrates are durable and low in sugar. Even diabetics are strongly recommended to consume sago.
But the availability of sago in Papua is increasingly depleted. Indonesian President Joko Widodo has opened up millions of hectares of land for rice cultivation in Merauke, south of Asmat regency, to realize food security. But the wisdom of this project is doubted by many agricultural economists. A similar rice-cultivation project has already been tried by president Suharto in Papua in the previous era and failed.
Because the staple food of the Papuans is sago, they are better at planting sago than rice.
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Saturday, January 27, 2018

Papua’s deadly measles outbreak shows decades of neglect: experts



Note. photos in article.

Papua’s deadly measles outbreak shows decades of neglect: experts
by Kiki Siregar/AFP

Indonesia’s battle to stem a deadly measles outbreak striking malnourished children in Papua is doomed to be repeated unless the government helps lift the isolated region out of grinding poverty, observers said.

Some 800 children have fallen ill and as many as 100 others, mostly toddlers, are feared to have died in what Jakarta called an “extraordinary” outbreak that was first made public this month.
AFP reporters obtained rare access to an overwhelmed hospital in Agats, one of the worst-affected communities, witnessed rail-thin children with exposed rib cages lying on rickety beds or wandering foul-smelling hallways. 
One malnourished girl, hooked up to an IV drip, was seen lying on the floor of an under equipped hospital.
The disease has proven especially deadly here as malnutrition makes children more susceptible, weakening their immune systems.
Indonesian President Joko Widodo has ordered military and medical teams to bring supplies to remote villages in the far-flung province.
Observers blame the crisis on a complex mix of government inaction, lack of jobs, logistical hurdles in reaching remote communities and resettlement efforts that pose a serious threat to traditional hunting-based lifestyles.
A low-level separatist insurgency is also simmering in the region, fuelled by resentment over poor conditions and a fight for a bigger share of Papua’s rich natural resources.
Many Papuans live a semi-nomadic life in hard-to-reach areas of the jungle with almost no proper medical care, schools or other services, including access to clean water.

In Ayam village, a ten-hour boat ride from the nearest major city, a tiny clinic lacked almost everything — including doctors — as its few nurses struggled to treat more than two dozen measles cases.
Some locals worry what will happen when the medics leave.
“What we really need is medicine and food so our children here can be healthy again,” said 28-year-old father Yunus Komenemar, whose one-year-old son has measles.
“The government is paying more attention, aid is coming in and there are (positive) changes, but we want it to last.”
Some 12,000 children with no symptoms have been treated, including with vaccinations, according to the health ministry, but in the past many Papuans have refused the shots that are seen as key to preventing outbreaks.
– ‘Isolation’ –
Indonesia has opened new district governments across Papua and tried to settle locals into permanent villages, but many of the new offices are not equipped to handle the huge task ahead.
And resettlement forces locals to adapt to a new lifestyle including adjusting to imported foods that are often already expired by the time they arrive on the island shared with Papua New Guinea, observers said.
Complicating matters, many Papuans avoid the province’s few medical clinics because they do not think they need treatment, while some avoid larger communities for fear of coming into contact with Indonesia’s military, which has been blamed for human rights abuses.

Natalius Pigai, a former senior official at Indonesia’s government-backed National Human Rights Commission, warned that the future of Papua and its people was at stake.
“To stop (crises) from happening again in the future, we need to stop Papua’s isolation,” he said.
While some new plantations offer hope for the local economy, most workers are not native Papuans, experts said.
Jakarta took control of western Papua after hundreds of years of Dutch colonial rule and a UN-backed self-determination referendum in 1969 that was regarded by many historians as a sham, leading to long-simmering tensions.
When Widodo took office in 2014, he vowed to speed up infrastructure development and services, bolstering hopes for the region, observers said.
“What the government is saying is what we think is important to do (for Papua) is in fact not being done,” said Richard Chauvel, a Papua expert at the University of Melbourne’s Asia Institute.
“The question is whether these newly established (district) governments have the human resources, experience and skills to provide these sorts of services,” he added.
– ‘Lack of leadership’ –
Much of the blame lies with regional politicians and their “lack of leadership”, according to Freddy Numberi, a former governor of Papua.
The poverty-stricken region gets ample central government funding but much of it does not get used for improving health and education, among other services, owing to corruption and wasteful spending, he added.
“You could say it’s a paradox actually — they have everything but they blame the central government,” Numberi said.

Widodo lifted a travel ban on foreign journalists visiting Papua in 2015. 
But unofficial restrictions on access have allowed Indonesia to govern a region wracked by regular public health crises without accountability, said Andreas Harsono, an Indonesia-based campaigner for Human Rights Watch.
“As measles is easily prevented with a safe and inexpensive vaccine, these deaths should never have happened,” he said, adding that Papua has Indonesia’s lowest life expectancy and highest infant, child and maternal mortality rates.
“I hope this crisis will help some people here — at least those in power -— to change their minds, but if they choose business as usual another crisis will appear next year as well.”

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1) Health team tackles measles outbreak in 117 villages in Asmat


2) HRW blames Papua measles on govt
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https://en.antaranews.com/news/114422/health-team-tackles-measles-outbreak-in-117-villages-in-asmat

1) Health team tackles measles outbreak in 117 villages in Asmat
Reporter:  





Illustration. TNI soldiers chatted with residents while waiting for queue for treatment at health center in Bayiwpinam village, Akat District, Asmat District, Papua. (ANTARA/M Agung Rajasa) ()



Jayapura, Papua (ANTARA News) - An integrated health team has successfully served 117 villages spread in Asmat District, Papua Province, to tackle malnutrition and the measles outbreak.

The team comprised elements from the Health Office of Papua Province, health team of the Indonesian National Army, and the Ministry of Health.

"The first wave of the integrated health team should have been withdrawn, as the team has successfully treated children with measles and malnutrition in 117 villages," Yusuf Wona, a member of the integrated health team from the Health Office of Papua, stated when confirmed from Jayapura, Papua Province, on Saturday.

The first wave of the integrated health team managed to suppress the spread of measles and malnutrition cases in 117 villages.

According to Wona, on Jan 23, the first team had conducted an evaluation and reported the results to the health task force from the Ministry of Health.

"The results of the evaluation data were submitted on the sidelines of the meeting to release the integrated health task force from the Ministry of Health," Wona noted.

The integrated health task force comprised personnel from some hospitals in Jakarta, medical specialists, a joint health team of the Indonesian National Army and Navy, Indonesian Police, non-government organizations, such as Dompet Duafa, and some nurses.

The health task force will continue to offer health services that the first wave of the integrated health team had provided in 117 villages.

"Health services have been started since Thursday (Jan 26) for the next 10 days for rehabilitation, prevention, and treatment," he remarked.

The Indonesian government has deployed various resources and taken utmost efforts to tackle the measles epidemic and malnutrition that have affected Asmat District since September 2017.

The epidemic is believed to have been caused by food shortage, poor environment, and lack of medical personnel and facilities in Asmat, which also has very difficult terrain.

Based on information received on Jan 25, a total of 12,398 children in Asmat have been offered medical check-ups and treatment. 

Of the total children, 646 are confirmed to be infected with measles, 144 are undernourished, four are suffering from both measles and poor nutrition, and 25 others are suspected to have measles.

The children are residents of 117 kampongs in 23 sub-districts: Suator, Kolf Braza, Sirets, Fayit, Aswy, Tiga Isle, Akat, Agats, Jetsy, Kasuari Beach, Der Koumur, Auyu, Suru-suru, Unirsirauw, Sawaerma, Joerat, Ayip, Atsy, Betcbamu, Kopay, Safan, Joutu, and Koroway.

Reported by Musa Abubar
M052/INE/o001
EDITED BY INE 

Editor: Heru Purwanto
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2) HRW blames Papua measles on govt







Measles in eastern Indonesia’s Papua province has killed around 100 indigenous children this month although the disease is easily preventable with a safe and inexpensive vaccine. 
Human Rights Watch (HRW) said neglect of Papuan basic health rights is responsible while the Jakarta government blames the deaths in remote Asmat regency on nomadic lifestyles. Asmat children have been left out of national children’s vaccination programmes, the group said.
About 129,000 people live in Asmat, a swampy region criss-crossed by rivers that can only be accessed by a flight from Papua’s capital Jayapura followed by a helicopter and boat ride.
Asmat, like many areas in Papua, lacks proper health-care services for its residents and has a serious shortage of medics. Clinics often have no staff and medicines throughout the ethnically and culturally distinct provinces of Papua and West Papua, HRW said.
The resource-rich provinces, which constitute about 25 per cent of Indonesia’s landmass but only contain around 5 per cent of its population, generates massive tax revenue for Indonesia, with the Freeport-McMoRan’s Grasberg copper and gold mine delivering US$600 million in taxes per year.
But indigenous Papuans receive little benefit from Grasberg.
The archipelago’s poverty rates remain highest, in relative terms, in the provinces of Papua, West Papua and Maluku, all in the far east of Indonesia, according to Jakarta’s Statistics Agency.
Papua has the lowest life expectancy in Indonesia and the highest infant, child and maternal mortality rates.
The government increases health problems by restricting NGO access, including medical groups, such as Cordaid from the Netherlands.
Those restrictions are related to the prolonged ban on the foreign media access while a low-level pro-independence insurgency continues.
The United Nations special rapporteur on the right to health, Dainius PÅ«ras, reported after visiting last year that he was “concerned about the health status of ethnic Papuans” and called for greater health investment.
President Joko Widodo has promised to improve health care in Papua and to allow international access to the troubled provinces. But his government has focused instead on physical infrastructural investment, including digging roads through Papuan rainforest.
HRW said: “To prevent the deaths of more children, Indonesia’s health ministry should set up an effective vaccination programme in Papua. Additionally, the government should recognise that international organisations – and allowing media to freely report in Papua – will bolster official efforts to identify and address gaps in Papua’s public health delivery systems.“
An Asmat Longhouse. Picture credit: Wikimedia
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Friday, January 26, 2018

1) DEALING WITH MALNUTRITION AND MEASLES IN ASMAT


 Jan 27, 2018

Evacuation of children with measles and malnutrition in Asmat during health crisis – Jubi/supplied
 Dispatches
Andreas Harsono, Indonesia Researcher
A sick child walks after getting medical treatment at Agats village in Asmat district, after the government dispatched military and medical personnel to the remote region of Papua to combat malnutrition and measles, Indonesia, January 22, 2018.
 
© 2018 Reuters
A measles outbreak in Indonesia’s Papua province has killed an estimated 100 indigenous Papuan children this month. As measles is easily prevented with a safe and inexpensive vaccine, these deaths should never have happened.
The death toll underscores the Indonesian government’s neglect of Papuans’ basic health rights. The government blames these deaths, clustered in remote Asmat regency, on the nomadic lifestyle of Papuans there. But it has not explained why Asmat children were left out of national vaccination programs for measles and other deadly childhood illnesses.
Asmat, like many areas in Papua, lacks adequate healthcare services for its residents and has a serious doctor shortage. In my frequent travels throughout Papua and West Papua provinces over the past decade, I have routinely encountered clinics without doctors and doctors who had no medicines. That health service deficit is especially pernicious given that the resource-rich region generates massive tax revenue for Indonesia’s government, with the Freeport-McMoRan’s Grasberg copper mine alone delivering US$600 million in taxes annually.
But health indicators suggest little of that money trickles back to indigenous Papuans. Papua has the lowest life expectancy in Indonesia and the highest infant, child, and maternal mortality rates. The government compounds its health delivery inadequacies by severely restricting access of international nongovernmental organizations to Papua. They include groups that provide much-needed healthcare services,such as the Dutch aid organization Cordaid. Those restrictions are related to a decades-long ban on access of foreign journalists and other independent observers to the region, the site of a low-level pro-independence insurgency, on overblown security reasons.
After visiting Papua last April, the United Nations special rapporteur on the right to health, Dainius PÅ«ras, said he was “concerned about the health status of ethnic Papuans,” and called for greater government attention and resources to improve their health services. Although President Joko “Jokowi” Widodo in December 2015 vowed to improve health care in Papua, his government has focused almost exclusively on physical infrastructure investment in the region.
To prevent the deaths of more children, Indonesia’s health ministry should set up an effective vaccination program in Papua. Additionally, the government should recognize that international organizations – and allowing media to freely report in Papua – will bolster official efforts to identify and address gaps in Papua’s public health delivery systems. Asmat’s indigenous children should be neglected no longer.
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1) The US Should Not Be Rehabilitating Indonesia’s Abusive Special Forces


2) Papua's remote villages cry for help amid deadly health crisis

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1) The US Should Not Be Rehabilitating Indonesia’s Abusive Special Forces
The Indonesian military’s past abuses should not be forgotten.
By Andreas Harsono January 26, 2018

U.S. Defense Secretary Jim Mattis was seen laughing and smiling this week as he watched a military exercise in Jakarta in which Indonesian troops drank snake bloodrolled in glass, broke bricks with their heads, and walked on fire. The spectacle would hardly be amusing, however, to anyone familiar with the Indonesian military’s human rights violations, especially the record of its special forces unit, Kopassus.
Mattis’s visit was part of U.S. efforts to improve military cooperation with Indonesia. During his staym he discussed with Indonesian Defense Minister Ryamizard Ryacudu plans to resume U.S. assistance to Kopassus. Assistance to the unit had been halted in large part because of the U.S. “Leahy Law,” which bars US assistance and training to foreign military units known to have committed gross human rights abuses, unless the government has taken steps to remediate, address the abuses, and hold those responsible to account.
The U.S. military first announced plans to re-engage with Kopassus in 2010, hoping to train newer “untarnished” soldiers, but in subsequent years remained reluctant to proceed,  in part because Indonesia had largely failed to address past abuses.
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There are a whole series of abuses to address. The U.S. government first imposed restrictions on military assistance to the Indonesian military and Kopassus in 1999, after the military committed massive rights abuses during its scorched earth campaign in East Timor. Kopassus members were also implicated in abductions and enforced disappearances of student activists in 1997-98, and the murder of the Papuan activist and leader Theys Eluay in 2001.
But other incidents have also occurred since then as well. In 2003, Human Rights Watch documented how Kopassus soldiers used torture during military operations in Aceh. In a 2009 report, Human Rights Watch documented Kopassus soldiers engaging in arbitrary detention and mistreatment of civilians in Merauke, Papua, suspected of involvement in Papua’s independence movement. More recently, Kopassus has been involved in unlawful spying activities against Papuan civilians.
In an interview with journalists in Jakarta, Mattis suggested that Kopassus had reformed and removed abusive personnel from its ranks. But that is not the appropriate legal test for whether U.S. assistance can be resumed. As Senator Patrick Leahy said on January 23, “The question Secretary Mattis needs to answer is whether the Indonesian government has punished the Kopassus officers who ordered and covered up those horrific crimes, and whether members of Kopassus today are accountable to the rule of law.”
The answer to both those questions is no.
To be sure, there have been some prosecutions that the government has trumpeted. A military court found 11 Kopassus soldiers guilty in the case of the kidnapping of student activists in 1998. The men were never jailed, however, and after an appeal almost all of them were allowed to remain in the military. Their commanding officers were never even tried.
Likewise, in 2003, a military court in Surabaya found seven Kopassus soldiers guilty in the death of Theys Eluay. But the men were sentenced to only two to three-and-a-half years in prison, and human rights groups can’t even confirm that the men served their time. (At the time of their trial, Ryacudu, then the army chief, hailed the convicted soldiers as “Indonesian heroes” for killing a “rebel.”) Notably, the troops’ commanding officer, Lt. Colonel Tri Hartomo, was later promoted, now to lieutenant general, and heads Indonesia’s military intelligence agency.
Many other Kopassus officers involved in abuses in East Timor, Aceh, and Papua, have never faced trial. One commanding officer, Prabowo Subianto, alleged to have led the 1983 Kraras massacre in East Timor where more than 300 people were killed, ran for president in Indonesia’s last election and is now the leader of main political opposition party. Another officer, Muchdi Purwopranjono, was tried on charges relating to the 2004 poisoning and murder of Munir bin Thalib, a prominent human rights lawyer, but was acquitted.
To be sure, there have been overall improvements in the unit’s record, with few current allegations of abuse today—although that is primarily because there are no significant counterinsurgency operations underway in Indonesia as in past years. And in 2013, the military prosecuted 11 Kopassus soldiers for breaking into a prison and killing four detained civilians allegedly involved in a lethal bar fight with another Kopassus member.
But impunity for past abuses remains, and there has been little remediation of the unit’s record. The fact that abusive personnel have retired or transferred out of Kopassus cannot be seen as progress, and it certainly should not be mistaken for justice.
Only when the Indonesian government shows that it is serious about punishing past abuses and creating a culture of accountability should the U.S. government consider allowing U.S. military assistance to resume. For now, to restore assistance to Kopassus is to reward Indonesia for doing nothing.
Andreas Harsono is an Indonesia researcher at Human Rights Watch.
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2) Papua's remote villages cry for help amid deadly health crisis


by Kiki Siregar, AFP / 11:34pm AEDT



                                             Papua's remote villages cry for help amid deadly health crisis

Asmat (Indonesia) (AFP) - Worried parents braved long queues and scorching heat in the remote Papuan jungle to get their sick babies treated Friday, as the impoverished region grapples with a deadly measles-and-malnutrition outbreak.
AFP has been able to access the isolated village of Ayam, where houses sit on stilts and the only bare-bones clinic has no modern medical equipment, a few rickety beds, and overwhelmed nurses struggling to cope.
There are no doctors in the community of several hundred which has seen over two dozen cases of measles. Crisscrossed by rivers and swamps, Ayam is a 10-hour boat trip to the nearest major city Timika.
The Indonesian military has sent medical teams to Ayam and other remote locations across the vast region to prevent the spread of what they are calling an "extraordinary" outbreak.
Villagers are also suffering from other health problems like diarrhoea and respiratory infections.
"What we really need is medicine and food so our children here can be healthy again... that's what we need now," said 28-year-old father Yunus Komenemar, whose one-year-old son was diagnosed with measles.
Ayam is in the Asmat district where some 800 children have been sickened, while as many as 100 others, mostly toddlers, are feared to have died in the outbreak, which was first made public this month.
Harrowing images from affected communities showed rail-thin children lying on rickety beds with their rib cages exposed and a malnourished girl lying on the floor hooked up to an IV drip.
"I'm sad, I'm angry, and I feel pity," said Norce, a mother of a five-year-old being treated for measles in Agats, another hard-hit community.
In Ayam, nurse Abednego Bakay said his clinic was short of almost everything, including crucial vaccines.


"The equipment here is basic and so we can only try to serve people by giving them medicine" he added.
- 'Too late' -
The head of the military medical teams acknowledged that Jakarta's response was slow.
"Let's be honest, maybe the local and national governments became aware of this (outbreak) too late," Asep Setia Gunawan, the military's medical task force chief, told AFP.
"The conditions here are serious and that's why we are calling this an 'extraordinary' outbreak."
The problems in Ayam and other villages across Papua are a combination of myriad problems including years of national and local government neglect, a lack of jobs, and logistical hurdles in boosting the quality of life for remote communities, experts said.
They warn that this crisis will be repeated without more action to pull the province out of grinding poverty and end a low-level separatist insurgency fuelled by resentment over poor conditions.
"I hope this crisis will help some people here -- at least those in power -- to change their minds, but if they choose business as usual another crisis will appear next year as well," said Andreas Harsono, a Jakarta-based campaigner for Human Rights Watch.
Komenemar, whose young son was being treated for measles, worried about what will happen when the military leaves Ayam.
"The government is paying more attention, aid is coming in and there are (positive) changes, but we want it to last," he said.
Many Papuans live a semi-nomadic existence and lack proper medical care, schools or other basic services, including access to clean water.
Angelina Sanpai, a mother of six who was waiting to get treatment for her six-month old baby's diarrhoea, said putting food on the table is a daily struggle.
"I'm used to crying because we've got so little food," she said.