Tentang Malaria (Lagi)



From Emperor Nero to ‘Bung’ Karno

The Jakarta Post | Wed, 06/09/2010 9:52 AM | Feature
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Safety net: Insecticide-treated bed nets are recommended in areas like North Maluku, where malaria is highly endemic. Such methods of protection have been around since ancient Egypt. Courtesy of Asep SaefudinSafety net: Insecticide-treated bed nets are recommended in areas like North Maluku, where malaria is highly endemic. Such methods of protection have been around since ancient Egypt. Courtesy of Asep Saefudin

There have been many anti-malarial campaigns in Saketa and other villages in North Maluku, such as routine surveillance, mass blood surveys and water-drainage projects — a method used since the early Roman Empire.

Romans saw a connection between malaria and stagnant water and launched one of the first recorded campaigns against the disease. Emperor Nero drained swamps near Rome to rid the city of mosquitoes and malaria.

Mosquito nets are another centuries-old strategy. Nets were used in prehistoric times. Cleopatra, Queen of Egypt, is said to have slept under a mosquito net.

What is new today is a joint initiative of the health ministry, the North Maluku provincial health office and UNICEF to distributing insecticide-treated bed nets to vulnerable people.

Another initiative in South Halmahera, one of North Maluku’s malaria hotspots, integrates ante-natal care, immunization, and malaria control programs through distribution of bed nets to pregnant women and immunized children.

After the nets were introduced, deaths from malaria in South Halmahera, which is about 150 kilometers from Ternate, plunged to four deaths recorded in 2010 from 200 in 2006.

“UNICEF is thrilled to have been able to support this ground-breaking project, which has seen multiple positive [follow-on] effects throughout the district of South Halmahera, by integrating malaria control with ante-natal care and routine immunization,” said Angela Kearney, UNICEF Indonesia’s representative.

UNICEF Indonesia is fighting malaria in the country together with the WHO; the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM); the US Agency for International Development (USAID), and the UK National Committees for UNICEF.

However the threat is far from over. The skies of North Maluku will be ruled by swarms of buzzing, flying “syringes” as long as anopheles mosquitoes have places to breed.

More than 850 residents of Cango, South Halmahera, launched a weekly Friday Clean Movement to rid the swamps of their village of mosquito larvae.

“We will provide no place anopheles to breed here,” said Anwar Nasir Rajaolang, the village head.
Mobilizing people is an ancient method that was also practiced by Ronald Ross, the British army major who first classified anopheles mosquitoes. Ross’ research identified the insect’s habits and habitats and proposed a detailed action plan to control their breeding.

Ross was at the vanguard of the fight against malaria. He formed “mosquito brigades” to eliminate larvae from stagnant pools and marshes in an anti-malarial campaign in Great Britain.

Indonesia’s public health history also has a militaristic influence.

The Malaria Eradication Command (Komando Pembasmi Malaria, or Kopem) was formed by former president Sukarno’s government in 1963. It was Indonesia’s first health “militia” after independence and had the motto “total coverage”.

Kopem was a paramilitary organization with more than 36,000 soldiers; its senior officers were assigned the rank of commander. The organization was tasked with spraying every inhabited building in Indonesia with dichloro-diphenyl-trichloroethane, an insecticide that is better known as DDT.

In one year, Kopem’s troops sprayed buildings in over 170,000 square kilometers of Indonesia — almost 70 percent of the country’s inhabited territory — to protect an estimated 64.5 million people.

“A change of a government means a change of a policy,” says an old adage. Inconsistency in fighting malaria has led to complacency.

“Malaria is a serious — yet neglected — disease,” said Rita Kustriartuti, a physician and the health ministry’s director for vector-borne disease control.

The situation today is much worse than in 1963. Ill-conceived “man-made” development projects, such as dams and irrigation schemes, have created new habitats for anopheles and started a “man-made” malaria epidemic. Indonesia’s warmer climate also makes it possible for hill tribes to succumb to the parasites.

Reports show that 3.3 billion people in 109 countries – more than half of the world’s population — is at risk of contracting malaria. The disease is estimated to afflict between 350 and 500 million people every year.

The situation is grim. There are more cases of multi-insecticide and multi-drug resistance, the absence of cheap and effective prophylactic anti-malarial treatments, and functional immunity to Indonesia is impaired by ad hoc chemotherapy.

It is the same old deja vu all over again.

As the Spanish historian Santayana said, “Those who fail to remember history are condemned to repeat it.”

Arie Rukmantara