West Papua Information Kit

Health and HIV/AIDS

Executive Overview

During the Independence Period 1930-1961 with Dutch assistance the indigenous West Papuan people had developed urban and a growing professional sector. 4600 Papuans were employed in education, administration, public health, police, fire brigade, and hotel industry; 1600 in transport and communications; and 1200 in factories and workshops as well as 2300 employed in commercial agriculture and rural industries. Although there were only 194 indigenous health care professionals in 1961, in that year alone there were another 417 being trained and 8 others at the Port Moresby Medical School.

The UN stop this education and development of indigenous skills and social services, which was replaced after 1962 by Indonesia's colonial administration as "hundreds of Indonesians - teachers, scientists, doctors and nurses and civilian administrators - joined in the effort of UNTEA". Today the territory remains dependent on outside aid for medical and educational professionals and materials.

The following AusAID and other reports indicate West Papua currently suffers a growing HIV/AIDS epidemic, ongoing tuberculosis and malaria problems; and negligible health care or education for the indigenous population.

• HIV/AIDS infections rising fast at PNG, Indonesia border, People's Daily Online, Mar 2007
   

  HIV infection is on the fast rise in the West Sepik province of Papua New Guinea (PNG) and Jayapura in Indonesia's West Papua province, reported The National, a local newspaper, on Thursday.

  Reports said in the remote Lumi district alone more than five public servants had died this year after contracting AIDS and it is believed there may be more unidentified cases in other districts.

  People in the West Sepik and Western provinces were exposed because of frequent travels and exchanges with Papua province, which also has a high incidence of HIV/AIDS cases in Indonesia.

  Christian Brethren Church lay missionary and provincial AIDS trainer Wassam, who had been conducting awareness on HIV/AIDS for the last two years in most parts of West including Drekikir district in East Sepik, said sex products including pornographic materials were contributing to the spread.

  Wassam warned that failure by the community leaders and police to rein in such behavior would lead to more HIV/AIDS-related deaths.

  Wassam is stepping up his HIV/AIDS awareness campaign and is visiting Magleri village, in the Telefomin district next week.

  His last stop was at Angugunak village in Lumi, where he trained more than 30 participants, who will now work with East Sepik provincial AIDS council as volunteers.

  Source: Xinhua
   

• HIV found in more blood bags: Clinic, Jakarta Post Jan 2007
  Nethy Dharma Somba, The Jakarta Post, Jayapura
    An increasing amount of blood donated at the Jayapura Red Cross' transfusion unit in Papua is being found to be contaminated with HIV, an official said Wednesday. The unit's head, Reginal Hutabarat, said 116 bags of plasma were contaminated last year, an increase from 44 bags in 2005. All of the contaminated blood had been destroyed, he said. The unit received 6,066 bags of the plasma in 2005 and 6,905 last year.
    Unit staffer Kusnanto said most of the contaminated plasma came from those giving blood for relatives or friends, since there were not many voluntary donors. All donated blood is screened for four diseases: hepatitis B and C, syphilis and HIV, he said. All contaminated blood is destroyed. Despite the finding, only three people are recorded to have contracted HIV from blood transfusions in the province.
    From a population of around 2.5 million people, there are 2,770 people known to be living with HIV/AIDS in Papua, the highest percentage in the country. "We impose strict safety procedures here, which means that (when we reject) donors whose blood indicates the presence of HIV, they often get upset and accuse us of selling the blood. But we have no right to tell them their blood indicates HIV contamination, so we simply tell them they have a different blood type from the one we need," Kusnanto said.
    Health statistics as of September last year show 8,261 people in the country are recorded as HIV-positive, with 4,186 of developing AIDS-related illnesses. Local and international organizations, however, estimate the actual number of people living with HIV/AIDS is between 90,000 and 250,000 nationwide.
    By 2010, it is estimated that from one to five million Indonesians could be infected with HIV.
    Health workers say efforts to halt the spread of the virus are being hampered by the discrimination people living with HIV continue to suffer in the community.
    On Monday, a large group of HIV-positive people were among 43 delegates turned away from a hotel in Manokwari, where they planned to attend a conference on the virus. Papua provincial administration spokesman Dewi Wulandari said the people from towns in Papua and West Irian Jaya were planning to attend a week-long networking forum.
    The delegates were not turned away until they had arrived in the town. Hotel management refused to host the event because they worried other guests would be scared away. "The head of Papua's AIDS Prevention Commission, P.S. Ukung, and activist Nafsiah Mboi tried to explain to management that a person cannot get HIV simply by touch, but the hotel insisted they leave," Dewi said.
    The forum was moved to another hotel and will run until Friday.
    Papua Health Office chief Tigor Silaban said he was disappointed the hotel had acted inhumanely.
    "We really regret the incident ... such attitudes should not exist in this day and age, but they are still there," he said.
   
• Autonomy brings little progress to Papua: Study, Jakarta Post Jul 2006
    Papua's "special autonomy" status has not brought significant progress to the people because it has failed to address their fundamental needs, a survey suggests. The survey was conducted by National Solidarity for Papua (SNUP) .. .. .. 323 respondents were from different backgrounds and locations across six regencies. They said their welfare has not improved because the local political elite, the bureaucracy and non-governmental organizations are out of touch with the common people. Seventy-six percent of respondents said autonomy has yet to strengthen basic services in the areas of health care, education and the economy. This, they said, is closely related to rampant corruption and nepotism among those in power. .. .. .. Forty-six percent of respondents said that the newly-established Papuan People's Assembly (MRP) and political parties had not paid serious attention to their fundamental problems, and that the increasing number of security personnel did not improve their sense of security. Instead, respondents felt their freedom of expression had been hampered. Seventy-six percent said the administration at all levels in the two provinces needed reform, and that NGOs should be encouraged to closely monitor the implementation of autonomy in outlying areas. .. .. .. "Jakarta remains suspicious that the local political elite and bureaucracy are sympathetic to the separatist movement," .. .. .. no significant progress has been made on health, education, transportation and the economy, four sectors given high priority by the law .. .. ..
   
• Australian Government AusAID Feb 2006
  Impacts of HIV/AIDS 2005-2025 in Papua New Guinea, Indonesia and East Timor
  An excellent 164 page report
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    Cultural taboos inhibit communication about sex and underwrite what Indonesian sexologist Dr Whimpie Pangkahila (cited in Bennett, 2000) has called a "culture of shame" which contributes significantly to the reluctance of Indonesian women, particularly those who are unmarried, to access reproductive and sexual health services (Bennett, 2000). Sex outside marriage and alternative sexualities or sexual practices are proscribed. Open discussion about condoms has been more inhibited than discussion about other traditional prevention practices (Sedyaningsih- Mamahit, 1999).
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  2.11 MIGRATION
    Indonesia has become one of the world's major sources of unskilled migrants (Hugo, 2001). Migration for work, to cities, mining areas and overseas, has long been a necessary economic strategy for Indonesians (Surtees, 2003), and labour export extends back to colonial times (Hugo, 2001).
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    The types of labour migration in Indonesia implicated in the spread of HIV infection are: migration to mines plantations and other areas of natural resource exploitation; rural to urban labour migration; the transfer of civil servants; and migration to particular border locations (Hugo, 2001). Workers with itinerant jobs such as fishermen, seafarers, seaport workers, transport workers and traders are also at elevated risk of infection. In Indonesia sex workers themselves frequently constitute a migrant labour population (e.g. to East Timor).
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  3 The social and economic impact of HIV in Papua, Indonesia 2005-2025
  3.1 INTRODUCTION
    As noted above Papua has been presented within its own section because the epidemiology of the HIV epidemic and related risk factors are so markedly different from the rest of Indonesia.
    There are over 250 linguistically distinct cultural groups in Papua, including isolated, nomadic, forest dwelling tribes of the interior of the province as well as people from the northern and southern shores where coastal trading, intermarriage and migration has occurred since the 17th century. As a part of the Suharto New Order regime and in response to the high population growth in other regions of Indonesia, there was a large transmigration to Papua.
    While Papua is extremely resource rich, poverty is endemic; it was ranked the second lowest in the Indonesian Human Development Index of 2004. This is despite its GRDP being ranked the fourth highest in Indonesia based upon income from the trading of its rich natural resources (oil, mining, and forestry). Health services need boosting and on many health indicators those in Papua are worse off than in other parts of Indonesia. Programmatic responses to HIV in Papua have been primarily impeded by the lack of health system infrastructure. The level of sexual violence amongst indigenous Papuans is a particular concern.
    These factors all point to the possibility of an explosive HIV epidemic in Papua. Our epidemiological projections see HIV prevalence increasing throughout the province. HIV will impact most strongly at the level of Papua community and political life, taking a toll on women, men and young people. Indigenous Papuans face specific HIV-related risks, and HIV intervention efforts have been notably unsuccessful in reaching this group (Butt et al., 2002a). A lack of information rather than a lack of willingness may be the biggest barrier to effective HIV prevention among indigenous Papuans.
  3.2 HIV PREVALENCE IN PAPUA 2005-2025
    Increasing HIV prevalence in Papua will impact on individuals, families, and communities. By 2025 the overall prevalence rate will be 3.61 per cent. However, the group in which prevalence rates will have the greatest impact is in the 15-49 year old age cohort.
    As Figure 3.2.1 indicates, adult HIV prevalence increases under the baseline scenario to almost 7 per cent in 2025. This indicates a prevalence rate similar to that currently in Kenya and Haiti, and much higher than those in the rest of Asia. Even Cambodia, which is considered to be the country with the highest HIV prevalence in Asia, peaked at 3% and now has around 2 per cent adult HIV prevalence. In Kenya, for example, high prevalence of HIV (currently 6.7 per cent) (UNAIDS, 2004) has resulted in sickness and mortality due to AIDS, dramatic depletion of savings, the loss of key skills and organizational capacity and a fall of up to 50 per cent in food production in households where only one member was sick with AIDS (ILO, 2002). In Haiti, HIV prevalence has aggravated Haiti's tuberculosis (TB) epidemic. With adult prevalence of 5.6 per cent (UNAIDS, 2004), the country has the highest infant, child, and maternal mortality rates in the hemisphere and the lowest life expectancy. These data indicate that the impact of HIV in Papua may be severe.
  3.3 SEXUAL RELATIONS AND SEXUAL HEALTH
    While we project a small number of injecting drug users will be HIV positive under the baseline (just over 1,000 but with a 44 per cent prevalence rate), the major source of transmission in Papua is sexual.
    A major factor contributing to the high number of people infected is a lack of knowledge about HIV and methods of transmission and prevention. In addition, indigenous Papuans tend to distrust medicine and medical centres (Butt et al., 2002a). At some government and mission operated clinics Papuans diagnosed with an STD must pay a fee before they are provided with medication. There are very real logistical barriers to the delivery of services and information across areas of the province. For example, even in towns condoms are not readily available.
    AIDS research in Papua has also identified indigenous Papuan youth as another group particularly vulnerable to infection with and transmission of HIV. Up to a quarter of the population aged between 16-29 are likely to be mobile, to drink, to have sex at a young age to have several sexual partners and to engage in what has been termed 'secret sex'(Butt et al., 2002).
    It has been convincingly argued by other researchers that indigenous culture is not the critical problem in Papua (Butt et al., 2002) but that much needed information and services to the indigenous Papuan population are not yet adequate.
  3.4 DEMOGRAPHIC IMPACT
    Over the next twenty years, Papua will face increasing HIV prevalence and death rates due to AIDS-related conditions. The population growth rate will decline (although it is not projected to become negative). Figure 3.4.1 graphs the population size by age group at 2025, with and without AIDS (and if the response to HIV is not scaled up). The pale bars indicate the increase in population size without AIDS. All age groups show some decline in size, however the percentage decrease is most noticeable in 20-49 year age groups. Under the baseline scenario, by 2010 over 23,000 people will have died, rising to nearly 97,000 people by 2025. Deaths will mostly be in the 15-49 year old age group and will considerably skew the population pyramid. Of these deaths just under a third will be adult women. At present, birth rates are around three births per mother but the illness and deaths of women will cause a loss in reproductive capacity, and fertility rates will also decrease. The impact of deaths will be felt in families, communities, the workforce, and social service provision, and may have a flow-on effect to the nation as a whole.
    Deaths will affect children, grandparents, family relationships, community cohesion, farming and food production. The death of parents and loss of household income damages human capital - the mechanisms that generate human investment in children and young people, a cycle which further damages the next generation. The loss of family members, children and partners will jeopardise the levels of care that family members receive, care which is primarily carried out by women.
    The difference between the size of the workforce if AIDS had not occurred and the baseline scenario is significant. Projections to 2025 show the baseline number of adults is 5 per cent smaller than if AIDS had not occurred. If a high response is brought to bear, there would be a total of 32,000 fewer adult deaths (between 2005-2025) (see Figure 3.4.3 below). Taking into account, however, the reduced number of births from the adults who died, plus the children with AIDS who don't make it into adulthood, the real figure of lives saved with a high response to HIV is 42,000.
    Under the baseline scenario by 2025 the total number of AIDS related adult deaths will be over 84,000. Most of these deaths will be felt in the agricultural sector.
  3.4.1 MATERNAL ORPHANS
    Under the baseline scenario, there will be over 33,000 maternal orphans by 2010, rising to over 166,000 in 2025 (see Figure 3.4.4). This number will decrease dramatically under the high response scenario, particularly at 2025, where we project almost a quarter the number of orphans.
    The possible large number of maternal orphans will provide Papua with an enormous set of challenges. Given indigenous Papuans are heavily reliant on subsistence agriculture, under the baseline scenario children may be taken out of school in order to tend gardens. In Haiti, an FHI report showed that between 5 and 7 per cent of children had lost one or both parents to HIV, and over 7 per cent live in families with an HIV-positive member. They state, "as a result, Haiti has and will continue to have a growing number of disadvantaged young people and an ominous threat to the country's future economic development" (FHI, 2000:1). In Papua, as in countries with a high number of orphans, land inheritance may become an issue, and the stigma of HIV may marginalise Papuan children orphaned by AIDS. Education standards may suffer and orphaning tends to reduce school attendance. 3.5 PROVINCIAL ECONOMIC IMPACTS
    By the 1990s, Papua had become integrated into the Indonesian economy, with transportation and communication links established. Papua enjoyed economic growth during the 1990s attributable to high population growth, high levels of public expenditure and diversification of the economy. The special autonomy law of 2001 saw increased government revenues pass to the provincial government, further boosting the economy (McGibbon, 2004).
    However, the effects of this growth are experienced differentially both within and outside Papua. While the Papuan economy has grown, and Papua has the fourth highest GRDP per capita in the country, it also has the highest headcount measure of poverty in Indonesia (53.4 per cent in 1999) (Booth, 2004). The number of people living below the poverty line in Papua was estimated at 41 per cent in 2002 (GoI, 2004), dropping to 38 per cent by 2004 (Statistics Indonesia, 2005). Papua's high GRDP per capita is explained by the large mining sector, which contributed to over half Papua's GDP in the mid 1990s (Booth, 2004). The district of Fak-Fak in Papua can be characterised as an enclave, where there is a large US-based mining company operating. In enclaves local natural wealth generally does not transform into increased community welfare (Tadjoeddin, et al. 2001). The enclave activity and tiny proportion of people employed in the mining sector is projected to largely protect the province's GRDP from the impact of HIV and AIDS - see Figure 3.5.2, below 'Employment by sector'.
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  3.5.2 HUMAN DEVELOPMENT INDICATORS
    Development indicators clearly portray the extent of disadvantage in Papua:
  > In 1999, infant mortality was 64.7 per 1,000 births compared with 52.2 in the whole of Indonesia.
  > The maternal mortality rate is three times greater in Papua than in the rest of Indonesia.
  > The literacy rate is 44 per cent for women, and 58 per cent for men
  > Only 10 per cent of Papuans have a high school education
    Most importantly, basic services are not yet available in remote communities. Moreover, tribes in remote areas have had fewer improvements in health, education, and other basic services in recent years. The Marind and Asmat tribes of the south have enjoyed virtually no access to public services (McGibbon, 2004). These services will be crucial to any stepping up of HIV prevention, education, care and support necessary for a high response to the epidemic.
  3.6 EDUCATION
    The vast majority of indigenous Papuans remain at the margins of the modern economy. The participation rate of the Papuans in education is generally poor, and the annual increase of participation is very small. Only fifty per cent of Papuans have received any formal education or have graduated from primary school and only 10 per cent are high school educate.
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  3.8.3 IMPACT ON HOSPITAL BEDS
    In the province of Papua, there are over 1,300 hospital beds in Ministry of Health and provincial government hospitals (GoI, 2003). Literature
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  3.9 GENDER RELATIONS AND HIV
  3.9.1 GENERAL POSITION OF WOMEN
    Labour arrangements associated with the mining industry's monetarisation of local economies are transforming definitions of masculinity and femininity and the distribution of the power between men and women in Papua (Robinson, 2002).
    Indigenous Papuan women are more likely to suffer impoverishment and bear the highest risk of personal violence. Compensation or royalties paid by mining companies are only negotiated with and paid to men (Simatauw, 2002). In this way, women have been stripped of their traditional means of acquiring wealth and status and become more dependent on men who have more access to and control of the benefits of mining development.
    Due to economic development, the risks to women of other STIs, family violence, rape and prostitution - often fuelled by alcohol abuse and a transient male workforce - are increasing. Indigenous Papuan women in mining towns are especially vulnerable as they have low levels of literacy and knowledge about HIV and there are increasingly high levels of alcohol related violence, infidelity, rape and prostitution as large inflows of money pour into once remoter regions (Silitonga, 2002). Women deprived of the opportunity to eke out a livelihood from traditional subsistence production need to undertake sex work for income.
    We would expect the position of women to further deteriorate with a high prevalence of HIV. By 2025, under the baseline scenario, non-sex workers will account for two-thirds of all HIV in women. 40,610 Papuan women will be HIV-positive, with a prevalence rate of 4.3 per cent among this group, and 21,000 women will have died.
  3.9.2 SEX WORK
    The newfound economic prosperity of some areas together with development activities throughout the province has resulted in a proliferation of brothels and sex workers, exacerbating the growing HIV problem in the area. The majority of sex workers in Papua are women (Butt et al., 2002a). It has been estimated that there are approximately equal numbers of regulated sex workers, street sex workers and women who engage in more informal or 'secretive' sexual exchange (Butt et al., 2002a). Few women are full-time sex workers, they are generally driven by family pressures or survival need and often engage in sex work on a casual or temporary basis (Butt et al., 2002a).
    Because of lack of access to services and the near absence of knowledge about condom use, street sex workers are particularly vulnerable to HIV infection. In the next twenty years, under the baseline scenario, female sex workers will account for a third of the HIV infections amongst women, but the prevalence of HIV amongst this group will reach over 40 per cent. Even under a high scenario, the prevalence rate stays extremely high (21 per cent).
    The extremely high prevalence even under the high response scenario in the sex industry is due to the poor conditions faced by many sex workers. For example, most Indigenous Papuan street workers have sex in 'open sites', i.e. outdoors, on the beach, behind buildings, in unsafe temporary shelters or rural makeshift locations. They receive less money and access fewer state services than their non-Indigenous counterparts, many of whom work in regulated brothels or hostess bars. Sex work proliferates beyond large urban centres and extends to all rural and semi-urban centres in the province. Many sex workers have no financial alternative. Husband supported or family brokered sex work is also an important pattern in Indigenous Papuan street sex work (Butt et al., 2002). It is not uncommon for young women to have sex in exchange for food and protection, and these women would not consider themselves sex workers.
  3.9.3 CLIENTS OF SEX WORKERS
    Sex worker clients come from all walks of life; from military personnel to dock workers to rural tribesmen. Street sex workers provide services to men from a wide range of socio economic backgrounds. Indigenous Papuan clients are less likely to use condoms (Butt et al., 2002). Figure 3.9.2 indicates that the HIV prevalence rate amongst clients of female sex workers will increase rapidly under the baseline scenario, to close to 10 per cent by 2025. While it will be halved under the high response scenario, a prevalence rate of 5 per cent puts the non-paying partners of these clients (girlfriends and wives) at great risk of HIV. Transvestites (waria) have been identified as being at heightened risk of HIV infection because of involvement in sex work. Indigenous Papuan waria are increasingly prominent on urban streets, although indigenous men do not tend to use waria sexual services. Clients often have poor knowledge about the risks of unprotected sex with waria (Butt et al., 2002; 2002a).
  3.11 GOVERNANCE CONFLICT AND SECURITY IMPACTS
    Approximately 40 per cent of the Papuan population is living in poverty in remote areas where government aid does not reach. Hospital facilities are rudimentary at best and indigenous Papuans tend to distrust offcial medicine and medical centres. The development of HIV responses and interventions offers an opportunity to enhance the participation of indigenous Papuans in the planning and delivery of health services. If HIV prevalence increases as projected to levels approaching 10% of the adult population there is likely to be a destabilising impact on communities.
  3.12 CONCLUSION - PAPUA
    Under the current (baseline) response to HIV in Papua, by 2025 prevalence will be high by world standards, at nearly 7 per cent amongst adults 15-49 years and nearly 100,000 deaths. HIV is mainly sexually transmitted in Papua, thus affecting both men and women, with the majority of those with HIV living in rural areas. There will be around 150,000 maternal orphans. The health sector will be placed under increasing stress as it copes with increasing AIDS-related morbidity. Social and economic impacts will be felt most at the rural household level, and the structure of the household will alter as family members die. Women will be put under considerable pressure, both in terms of caring for their families and financial pressure to support their households. However, under a high response scenario outlined here, with appropriate political support, legislative and policy changes, and the financial resources, the rapidly expanding HIV epidemic in Papua can be tempered. But this will rely on a policy and fiscal environment that increases prevention programs not only targeting sex workers and their clients but the general population. To make an impact these must move beyond small scale and ad hoc to wide-scale coverage.
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• Indonesia 2004
  .. .. .. Dr. Julius Surjadi and his wife, Debby, knew God was calling them to ministry .. .. .. When Julius and Debby moved to the island of Papua, far away from family, they found their presence welcomed. "They opened their hands to us because a very limited number of doctors want to stay in the remote places of this island," he says. He got in touch with Mission Aviation Fellowship (MAF), who had just finished mapping the untouched areas of the island. "They said in some areas, they found people who were living isolated from civilization," .. .. .. Dr. Julius relocated his family to the town of Nabire to work more closely with MAF. From here, he travels with the pilots into the interior. The terrain is so rough and mountainous, that travel by foot is dangerous and takes many more days. Traveling by airplane and helicopter is not without its dangers .. .. .. Dr. Surjadi is the only doctor working in this capacity. He travels to the villages to provide a temporary clinic, to train local people in community health, and to distribute medicines to the evangelists. "All of our ministry area has not been touched by anyone else, including the government," .. .. .. His mission is to teach community health care to these villages where there has been no health intervention. "The issues we are most concerned about are the natives' totally different ways of thinking and their values of health," .. .. .. in the past five years. "We have trained more than 100 evangelists who serve in five different areas of the unreached people group in Irian Jaya," Dr. Surjadi reports. "Sixty-seven very remote villages have medicines for their people, and half of these villages are distributing medicines to other unreached groups. We have had 112 kids in our literacy programs in the remote villages .. .. ..
   
• International Red Cross and Red Crescent Feb 2004
  Information Bulletin No 2/04
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    The district hospital in Nabire was damaged in Friday's quake and patients are being treated in tents in the hospital grounds. Only one water tap is functioning in the hospital and no running-water latrines. The hospital waste-disposal system, not great before the quake, is dysfunctional. Some hospital staff, including doctors and nurses, are traumatized and afraid to go into the building. The district hospital has ten doctors (five of whom cover health posts in the outlying areas) and 36 nurses and paramedics. Not all doctors and nurses have reported for work since the quake, as their families have also been affected. The hospital reports lack of antibiotics, light surgical instruments, a generator and at least ten paramedics. Seven doctors (including two surgeons and an obstetrician) arrived from Makassar and Jayapura on Sunday to work alongside local doctors.
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  Red Cross and Red Crescent action
    The DM delegate will return to Jakarta on Tuesday, while his counterpart will continue the assessment supported by 10 trained disaster managers from nearby PMI chapters and a highly trained National response officer from Jakarta.
    The PMI team on Saturday brought in much needed blood supplies, body bags, tarpaulins and some 100 family kits. All these have been distributed and put to use. .. .. ..
   
• International Red Cross and Red Crescent Feb 2003
  Papua Public Opinion Survey
  A twenty two page report conducted and published within Indonesian guidelines.
   
• UN Office for Coordination of Humanitarian Affairs Feb 2003
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  Health
    Cenderawasih Pos reported on Tuesday (4 Feb.) that an outbreak of malaria, amoebic dysentery, and URTI occurred in four villages (Waga, Abusa, Tulem, and Wadanku) of Kurulu sub-district, Jayawijaya district of Wamena. The Head of District Health Office, Dr. Maurits Rumsayor, said that treatment have been provided and so far no people died.
    Cenderawasih Pos reported on Monday (3 Feb.) that an outbreak of measles, amoebic dysentery, and URTI occurred in five villages in Okbibab sub-district, Jayawijaya district (Wamena). 65 people were reported dead and 882 people affected. It was reported that no medicine has been available in the puskesmas since three months ago.
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• Survey Report
  of returnees from PNG to Irian Jaya
  The Office for Justice and Peace Diocese of Jayapura
  Feb 2003
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  Health-services
    There is a long established and still on-going programme to put primary health cadres in the village. The best known programme is the 'bidan desa' programme, which aims to place midwives in every village. As with teachers it seems that it is difficult to keep the cadre in the village as quite a number of the newly assigned nurses have left the village after serving for just some weeks, at the best some months. Isolation and lack of support are often at the reason for this. In reality the villages do not have a functioning health service and are completely depending on the central service in Mindiptana which given the lack of good communications is often hard to reach. Some sub-centres health facilities do exist for example in Waropko, but they seem ineffective. In Mindiptana there is just one doctor and it depends on the doctors enthusiasm and dedication whether he/she will make regular visits to the outlying villages. There seems to have been very few visits by the doctor to outlying villages in recent times.
    The diet of the people is quite traditional, based on sago as the staple food while additional foodstuff is grown in the gardens such as root crops and vegetables (often limited to leaves of the sweet potatoes). People can feed themselves as long as they are free to go to their sago groves and garden areas. The diet of the people is adequate but not a very balanced one, with a lack of protein and vitamins. This is illustrated by the high number of children in the villages with rather big bellies or reddish hair.
    While traditional housing is still the dominant pattern in the area, efforts are being made by the government to improve the housing especially by providing roofing materials. Nevertheless it should be said that there is nothing wrong with well-constructed traditional houses, using mainly local available materials, as long as parts of it are renewed periodically (roofing material taken from the sago-tree needs substantial replacement every 5 to 6 years). To replace the roof by corrugated iron sheets means that the roof lasts longer but does not lead to better health conditions as the iron roofing means the houses become very hot during the day. Important measures in the prevention of illness is the use of mosquito-nets to protect people against the malaria mosquito, the construction of hygienic toilet facilities, keeping food covered, keeping the house and yard clean and thus more hygienic. Government programmes however are mainly limited to providing construction materials, especially roofing materials, with no other more specific primary health care programmes planned or implemented.
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  9. Limited medicines are available in Mindiptana but are said to be expensive; this is not surprising, as even in Jayapura medicines are very costly. This means that a lot of people turn to "traditional medicines and medical help" (dukun), and often only look for modern professional help when it is already too late.
  10. As we have already mentioned there is no consistently implemented health programme in the area. When the national immunisation program was implemented in 1997, medical staff left the immunisation in the more remote villages to under-trained local people who had received a very short course on immunisation. An extension course on TBC and leprosy was mentioned in Waropko, but this was never followed up although promised.
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• ICRC budget for year 2000 tops
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  The ICRC's regional delegation in Jakarta needs Sfr 12 million (US$ 7.2 million; Euro7.5million) to encourage ratification of the humanitarian treaties and promote respect for humanitarian principles, and to support the National Red Cross and Red Crescent Societies in Indonesia, Malaysia and Brunei. In Aceh, Irian Jaya, Ambon, West Kalimantan and West Timor, it works with the Indonesian Red Cross (Palang Merah Indonesia - PMI) to protect and assist people affected by violence, especially detainees, displaced people and dispersed families.
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• National Center for Biotechnology Information Dec 1999
  El Nino and associated outbreaks of severe malaria in highland populations in Irian Jaya, Indonesia: a review and epidemiological perspective.
    Perennial malaria is a major public health problem for most coastal, lowland and foothill populations in Irian Jaya (western New Guinea), .. .. .. Malaria at higher elevations above 1,500 m is considered intermittent and highly unstable, providing a constant threat of epidemics. Beginning in late August 1997, a significant increase of unexplained deaths was reported from the central highland district of Jayawijaya. The alarming number of fatalities rapidly escalated into September, dropping off precipitously by late October. More than 550 deaths due to "drought-related" disease had been officially reported from the district during this 10-week period. The outbreaks occurred in extremely remote areas of steep mountainous terrain inhabited by primitive shifting agriculturist populations. Microscopical evidence and site survey data implicated malaria as the principal cause of the excess morbidity and mortality at elevations between approximately 1,000 and 2,200 m. .. .. .. Area delimited and isolated focal outbreaks of malaria are recognized as occasional, periodic events in these highlands. .. .. .. outbreaks occurring during the same period that overwhelmed the local health care and control capabilities. We predict communicable disease outbreaks, including malaria, may likely increase in periodicity in the Irian Jaya highlands as socioeconomic development and population movements increase. .. .. ..