Child health in Asmat: where did we go wrong?

In early 2018, many children in Asmat were suffering from malnutrition and
measles. According to data collected from Asmat’s Health Office (Dinas
Kesehatan), there were 522 children with malnutrition and 651 children with
measles throughout this outbreak. Unfortunately, among them 12 children with
malnutrition and 66 children with measles were deceased.

PREFACE
Medical anthropology has been defined as the study of health, illness, and healing
through time and across cultural settings. Medical anthropology is actually multi-disciplinary,
and so broad that not even a single person can be an expert in its practice generally.
Anthropologists can work with epidemiologists, doctors, and other health professionals,
because of their ability to assess social, economic, and political factors using their linguistic
skills and cultural awareness, to gain the trust of indigenous people, and to communicate
across disciplinary boundaries both within and outside anthropology.
Health in a society is not only based on curative care, but also integrated promotive
and preventive efforts that can reach all members of the community, including in rural and
remote areas, to maintain health sustainability. An anthropological approach has much to
offer as a basis for interventions to understand human behavior and is expected to identify
sociocultural factors that may hinder the success of public health programs.
Asmat Regency is located in Indonesia’s easternmost province which encompasses
a total area of 31,983.60 km2, with Agats as the capital. The transportation cost is relatively
high due to swampy region cris-crossed by rivers that was hard-to-reach from the center to
the districts. These swamps also make it difficult for people to grow plants and get natural
spring water sources. Nomadic living culture has become a trademark to live for more than a
hundred years, and Asmat’s belief in their ancestors has formed their way of life and shaped
their behavior, choices, and attitudes towards health issues, such as poor awareness regarding
fulfillment of daily nutritional intake.
Asmat government has striven to ensure that the younger generations in Asmat can
receive education up to high school level, in order to improve their standard of living in the
future, and encourage a change in their mindset and perception of healthy living. Asmat
people adhere to the patriarchal culture that ‘denotes a structural system of male domination’.
Patriarchy is the main obstacle to the progress and development of females in society and
must be replaced by a system where equal and non-violent human rights are promoted and
accepted, since equal human dignity is a human right.
It is not uncommon for health problems to be considered trivial by the community
and may have a catastrophic impact later on. The late detection of disease and prolonged
referral interval to adequate health facilities will also lead to serious problems. During the
outbreak of malnutrition and measles in Asmat, in early 2018, more than a thousand children
were treated and 78 children under five years of age were deceased.
The purpose of this policy brief is to provide an overview of how anthropological
approaches may contribute to health promotion through medical anthropology. It should also
identify existing sociocultural factors which may inhibit health promotions, since public
health’s primary concern is to improve the health of a population.
 Figure 1. Asmat’s Outbreak News Headline

METHODS, RESULTS, AND CONCLUSION

The primary method used in writing this policy brief is participant observation. This
method entails the researcher’s close acquaintance and integration with daily activities of the
community over an extended period of time. The author worked as a missionary doctor in
Asmat, Papua, in 2011-2013, and published a book that contains semi-ethnographic writing
as a product of anthropological fieldwork material. It also includes a documentary research of
outbreak data report from Asmat’s Health Office (Dinas Kesehatan), 2018.
 Malnutrition Measles

Figure 2. Child Death Data

Child growth is recognized internationally as an important indicator of nutritional

status and health in the population. The outbreak in Asmat might have been prevented if
health workers paid special attention to children under five years of age from the beginning,
such as early initiation of breastfeeding. Many indigenous mothers do not breastfeed their
babies because of the belief that their ancestor spirits will take care of the newborn baby. In
the case of complementary feeding for babies, healthy food procurement was distributed by
the government as part of health promotion. However, sometimes this additional food for
children is being eaten by their parents. Frequently, the medicine and vitamins for children
are also consumed by the mothers.
Another problem in this Asmat outbreak is that measles infection is a highly
contagious viral infection that could be prevented by vaccines. However, the vaccination
program must cover all areas including isolated ones, while keep maintaining the quality of
the vaccines, especially regarding the cold chain storage. In such remote areas, it is a serious
challenge to provide quality control for the vaccines due to lack of electricity. A solar-
powered cold storage unit might be a suitable alternative to keep the vaccines cold. Gathering
the local people for vaccinations also poses as a serious challenge. They often go for a trip to
look for food, going deep into the forest for a long period of time, while taking their children
with them. Very limited amount of health workers may reach the entire community, and as a
result, the process of immunization and reporting are hampered.
We may conclude that Asmat local communities still need a lot of guidance to
understand a healthy lifestyle. Asmat’s belief in their ancestors has formed their way of life
and shaped their behavior, choices, and attitudes towards health issues. Malnutrition and
measles are two diseases that have caused an outbreak in Asmat in 2018. Other diseases may
also have harmful potential if ignored, and the problems may have originated from trivial
ones that require special attention such as lack of clean water, bad sanitation that may cause
skin diseases, and digestive disorders or diarrhea.

POLICY OPTIONS
The outbreak in Asmat is not a case that occurs suddenly but requires a lengthy
process developing in a negative direction. It can often be overlooked, so much so that even
the indigenous people themselves do not consider it as a problem. Addressing health
problems in rural areas is not a short-term program but requires sustained cooperation from
various parties to complement and maintain good health status.
  Medical Anthropology Team. Asmat government should initiate a medical
anthropology team to identify the social phenomena that can affect the health of a
society, understand problems in a specific area, and see the potential for health
prevention programs. This team must include indigenous stakeholders to gain trust of
the local people.
 Supportive Supervision on Immunization. The normal vaccination report is still
based on the coverage, however, we must make sure that the vaccines are in a good
condition before administered to the patients. There should be a quality control check
for the vaccination and facilitation for a non-electricity-dependent cold chain storage.
 Communication System Improvement. In Asmat, communication networks are
extremely limited. We can communicate via mobile phones only in a few districts.
The government should improve the quality of communication networks so that
health reports and programs can be controlled and managed properly. Health workers
can also work conveniently while being delegated to a remote area to guide the
community over an extended period of time.

REFERENCES
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ACKNOWLEDGEMENTS
Jodi Visnu is a research fellow at the the Center for Health Policy and Management,
Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta.
This policy brief was prepared based on a paper “How Anthropological Approach may
Contribute to a Health Promotion in Asmat, Papua”. The author did not receive specific
grants for this policy brief from any funding agency in the public, commercial, or not-for-
profit sectors.
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