MBI regional activity in Sulawesi, Indonesia
Sustainable development is achieved by long term, broad-spectrum interventions that include consideration of the community; its health, the environment and its economic influences. Global health initiatives often fail to sustain impact due to vertical programming. Health and wellbeing in rural communities is intimately tied to their livelihood status. The University of Sydney’s Faculty of Agriculture has been working with cocoa farming communities in Sulawesi to improve farming methods, leading to higher productivity and increased incomes. These farming communities have expressed a need for a holistic, multi-disciplinary approach to improve health literacy at a societal level.
Professor Walton and Dr Hill-Cawthorne of the Marie Bashir Institute travelled to Polewali Mandar and talked with cocoa farming communities to find out about their main healthcare concerns. Common symptoms included upper and lower respiratory tract infections in adults and fevers in children. Often the villagers would use traditional medicines to treat fevers in the first instance and seek healthcare only when there were signs of severe fever such as dehydration and a reduced conscious level.
The healthcare needs of the villages are served by small free-at-the-point-of-use primary care clinics together with larger primary care centres. Basic diagnostic blood tests are available, together with a sputum smear test for the diagnosis of tuberculosis. However no cultures are performed for any infectious diseases and patients are treated with empirical antibiotics for the majority of symptoms.
A particular concern for many villagers was a lack of antenatal services and of women’s health services. Pregnant women were reviewed to assess for the potential of a complicated labour but no other education was given nor screening tests performed. The level of training was a significant issue for many rural healthcare providers with staff being either quite junior or having not had updated skills training for a number of years.
We will now be conducting pilot research into the effects of providing information about prevention, immunisation, early symptom recognition, hygiene, animal housing and sanitation. We will select and train appropriate female leaders from the community as “Good Health Advocates” and then measure whether their new role increases the number of visits to maternity clinics, use of skilled birth attendants, immunisation uptake, appropriately early healthcare seeking behaviour and overall improvements in health across a range of measures. We will also gather baseline information on cases of fever and diarrhoea and start training for early presentation of sick children to health care. The outcomes of this pilot research will be to jointly gain a better understanding of the environmental and economic impacts, on predicting human behaviours and likely health outcomes in a remote farming community in Sulawesi, Indonesia.