Saving mothers and babies in the Spice Islands

Original piece was published by The Jakarta Post non July 06, 2008

by Arie Rukmantara

This story is published to honor the spirit of Dr. Widjajanto, Sp. OG, who passed away in the midst of his fight to establish better health services for mothers and infants in archipelagic areas.

A young fisherman, Oktovanus Batmetan, lives on Yamdena, the largest island in Maluku Tenggara Barat district in the northern part of Maluku province, known globally as the "Spice Islands".

As a fisherman, he walks on white sandy beaches and admires untouched coral reefs every day of his life. He has no problem earning money with the abundant supply of fish and other sea creatures in nearby waters. He also grows vegetables and fruits on his own land.

He thanked God every day for the paradise he lives in. Until that gloomy day arrived. On July 24, 2007, he lost his beloved wife.

Sophia Batmetan, his partner of four years, passed away shortly after delivering her fourth child, Demianus.

"I can't believe she's gone. I loved her so much. I don't know how to raise my four girls alone," Oktovanus said.

Oktovanus' mother, Angela Batseran, and his mother-in-law, Dominggas, watched Sophia struggle for more than 10 hours to deliver the baby, and she died a few hours after the baby was born.

Angela and Dominggas did everything they could to help, to no avail.

"She was bleeding all day. We didn't know how to stop it, we didn't know what to do," Angela said.

"We tried to call a midwife for help, but she wasn't there," Domminggas said. "The nearest midwife was in the city of Saumlaki, a one-and-a-half hour boat trip away from here."

In desperation, Dominggas called a ma biang, a traditional healer, to help her daughter. Without the necessary skills and equipment, the ma biang could do nothing to save Sophia.

"Had only a good and well-equipped medical team been here, my wife would have been holding this pretty baby now," Oktovanus said.

Oktovanus is not alone. Just a few houses away, his neighbor, Heronia Lelemase, is also mourning. She just lost her first baby.

"I went into labor at around three o'clock in the morning. But he wasn't breathing. He was already dead in my womb," Heronia said.

She said her family members had tried to seek a midwife's help, but no one was available.

"The midwife is in the district's capital, Saumlaki, I had to deliver without her help," the 30-year-old, who claimed that she had had regular prenatal care whenever a midwife visited her village, said.

Her family had tried to get a boat to ship her to Saumlaki, but high tide barred them from sailing.

Unfortunately, these stories are all too common. Without increased support for pregnant mothers, Oktovanus and Heronia will not be the last to mourn.

"We have to stop mothers and babies from dying. We must find a solution and do our utmost to help these women," said Dr. Yuliana Catharina Ratuanak, the head of the Saumlaki Community Health Center that manages Yamdena and the surrounding islands.

According to a study co-organized by UNICEF and the Health Ministry, Maluku Tenggara Barat district had recorded 28 maternal deaths in the last two years.

This year alone, data from Saumlaki Community Health Center shows that from January to August, at least six maternal deaths and 18 infant mortalities occurred in the area.

"Most of the mothers died of prolonged bleeding and most of the babies died in the wombs of the mothers," Yuliana said.

Nationally, the maternal mortality rate stands at over 300 per 100,000 live births. Indonesia is aiming to cut this rate to 125 deaths per 100,000 births in 2010. The country also records a high infant mortality rate of 25 per 1,000 live births.

It intends to cut both maternal and infant mortality by half in 2015 to meet the United Nations' Millennium Development Goals.

Experts believe that the target can only be achieved once basic health care is accessible in the most remote areas in the country.

The study, organized by the University of Indonesia, found the high maternal and infant mortality rates in Maluku Tenggara Barat District were caused mostly by geographical barriers, high transportation costs and a lack of health care facilities and health workers.

There are only 11 doctors, 67 midwives and 173 nurses working in the district that is populated by over 160,000 people, the study found. Most residents are spread out over 88 of the 133 islands in the district, forcing doctors and midwives to travel, mostly by boat.

Working closely with the Health Ministry, the UN agency is developing a proposal to support safe maternal care in remote and isolated archipelagic areas.

The agency is developing an idea of setting one central health facility in a cluster of islands to work toward self-reliant health services.

"This strategy is the most appropriate for archipelagic regions based on the consideration that there are specific constraints, including weather and transportation, that can be very expensive and uncertain," said the position paper developed by the agency's Health and Nutrition Unit.

The proposal said that a self-reliant model of health care service exist in each cluster of islands, to ensure that local clinics can service local patients without transferring them to other hospitals.

Maluku Tenggara Barat District has five clusters of islands, spanning across more than 125,000 square kilometers.

With such a concept, inter-island journeys will not be hampered by unfriendly weather, unlike when a patient has to travel to the district capital of Saumlaki. The proposal said a clinic can also be established in one specific isolated island.

To maintain the principle of self-reliance, a medical officer should stand by, fully equipped with the appropriate skills and facilities to deal with a range of emergencies.

Arie Rukmantara  works at UNICEF's Health and Nutrition Unit. Any opinions contain in the stories reflect his personal view.