Healthcare goes to marginalized communities in Indonesia

Indonesia has been building an expansive healthcare infrastructure throughout the country up to village level, while providing health insurance coverage to more than 92% of the populations. These, however could not assure that all people have the equitable basic healthcare, simple hygiene practice, access to clean water and sanitation to all people. There are spots of indigenous and marginalized communities that could not be reached by the system due to the lack of trust by certain ethnic group to modernized healthcare system for cultural and local belief systems. Those blackspots of healthcare are those among Baduy people living in mountainous forests in Banten (Java), Suku Anak Dalam in Jambi (Sumatera), Tengger community in Mount Semeru (Java), Suku Kajang (South Sulawesi) and Suku Bazui (Papua). Total numbers of them are not that large, less than a million as compared to more than 240 million Indonesians, but they have the right to access basic healthcare, hygiene and sanitation that most Indonesians have been enjoyed for more than 20 years. 

These people do not trust incoming technology from outside, for example they do not accept radio, television and mobile phone, and their leader sometime track and burn those appliances. They continue to live as simple as without proper clothes, no sandal, no body soap, no dental hygiene, and eat raw foods. We found that children in those communities are malnourished, and stunted, with symptoms of worms and other parasites. They refuse helps from trained birth attendants and nurses. While, being the healthcare workers most of the time do not have enough time and patience to reach those un-reach, and even do not want to make a contact and communication with them.  These communities are gradually open for tourist visits and charities, and they allow people to teach their children on alphabetic reading and math. 

First, we are about to find a simple house, nearby the domicile of two communities ((Baduy in Banten and SUKU Anak Dalam in Jambi) that could be serve as a simple library where the children of two marginalized communities could sit together and read comics and pictorial books for those having difficulties to read alphabets and numeric symbols.

Second, we are at the recruitment phase of young, energetic volunteers from neighbor communities who have the passion and willingness to live and learn the local language, belief and traditions. They are expected to teach children of those communities using pictorial books on basic hygiene and sanitation, and simple basic healthcare that community are able to do.

Third, if allowed, we would like to introduce solar powered generators for lighting and for charging the mobile technology, televisions and game stations, while searching for simple games and animations that could help children to understand basic hygiene and sanitation as well as basic health care they need. If these kinds of games and animations are not available in local language, we need translation services to make them available to those communities.

Four, to understand local songs, music and instruments, and explore further these arts for introducing basic hygiene practices, basic sanitation and healthcare. We will also explore the opportunities to these communicates to present their arts to outsiders and officials to get appreciation.

Five, identify local products such as traditional foods, palm sugar, flower honey, woven and caving and other art products that could be marketed to incoming tourists and to art events. This will help to empower local economic and people welfare.

Six, to keep communication and contact with community leaders (Jaro in Baduy and Kuwu in Suku Anak Dalam), to gradually gain their trust to widely introduce basic hygiene practices and sanitation and to rebuild trust to local health care system.

Seven, to facilitate the communication of local leaders with local health officials and providers, and transitioning out the simple technology solutions to both parties.

We are working with two different marginalized community: Baduy people in Lebak district in Banten (West Java, Indonesia) and Suku Anak Salam in Jambi province.

Baduy people are groups of families (20 thousand people), living in forest and mountainous area in Lebak district. They refused to be visited by local healthcare system but they are open for tourist visits. They speak old type of Sundanese which is not commonly used by the locals. They maintain their Hinduism after they were displaced during the occupation of Sunda kingdom by Moslem sultaness in twelfth century. The head of community has been too dominant and has the strong influence as he can expel those who accepted simple technology from outside. The solution will open up the mindset of people on basic hygiene and sanitation, and basic healthcare need, by introducing the topics through comics and animation to their children, and bring solar powered generators for charging simple technology for learning purposes. 

Suku Anak Dalam are group of people, around 10 thousand people, living in forest areas in jambi regions. They are displaced after the introduction of Islam in the region. They speak very old and traditional Sanskrit, which is not used and understand by other people. They are not welcomed outsiders and continue to live and eat fruits and animals in the forest. Similar to the solution to Baduy people, the solution will open up the mindset of people on basic hygiene and sanitation, and basic healthcare need, by introducing the topics through comics and animation to their children, and bring solar powered generators for charging simple technology for learning purposes. 

We are non profit foundation, working in the area of public health in several regions in Indonesia since 2004. Currently we are supporting the site for child learning in both communities, and about to introduce solutions to rebuilding the community trust to local healthcare system. We have a team of volunteers who have the passion to collaborate with the community leaders, gaining their trust gradually by educating their children through animation and comics. 

We learned their language, culture and belief system, and continue to maintain relationship with the community by facilitating the marketing of local products, woven and cardings. 

We will continue to discuss our planning with community leaders as well as with local healthcare providers and officials. We will heard their voices and idea and set agenda together.

Our most barriers are the simple technology solutions to educate children with limited understanding on alphabets and numeric symbol on hygiene practice and basic sanitation, and the basic need of healthcare. Designing animation on these topics would be very helpful, delivering the message through appropriate and proven technology in similar setting will be sought. 

Cultural barriers are another areas that our team are currently learning, and similar evidence from other setting may be helpful on how to reach these communities. 

As explained previously, we will also seek similar solutions to market local products, woven and carving to the local and international markets, and how to improve their capacities to make better and marketable products. 

Financial support is currently collected from local individual and some support is needed to maintain the simple library or reading places for children from these communities to sit and learn.

The problems, we are trying to address have been chronic and no single solutions have been successful.

Our solutions are to maintain contact and direct communication with these communities and their leaders, while learning the language, culture, beliefs and power relationship within communities that inhibit any efforts to address the issue for more than century.  

We will reach the communities by providing learning and education to their children with pictorial, comics and animation that could be easily to be understood, making the children to gradually learn the need for hygiene practices and access to clean water and basic sanitation to protect them from preventable parasites, and to understand that local healthcare system will provide benefits to them. Through the children, we will also rebuild trust from dominant community leaders to the healthcare system.

We would like to have more health education materials from comics and animations. 

For the next five years, we would like to create an access to women and girls on the basic needs on hygiene, sanitation, baby deliveries and reproductive health.

People access to basic health care such as hygiene education, basic sanitation and clean water, access to ways to protect from parasites and get better nutrition to children and women.

Bringing pictorial story and animations on basic hygiene practices, and access to sanitation and basic healthcare, will change the mindset of children to their current life and motivate them to influence the mindset of mother and other family members on the topics. This will then create a demand for improving their daily lives and health.

We seek guidance on the use of solar powered generator for charging mobile technology and simple displays for games and animations

We have 8 female and 4 male members. The local leadership comprizes of 5 female from total 5 leaders. We came from different ethnics, education, religious and cultural backgounds.

We provide services to the community for free, and on voluntarily basis

We put our efforts to facilitate the access to market to the local products, traditional woven and carving. We will try to buy from them sugar cane, roots, fruits and sell them to local markets, the revenue will be used to support the operating cost of the learning site and the living cost of volunteers.

We do not have any example to show worth exception to the private donations and small grant from Give2Asia to support MNH program in several districts.