Malaria: The view from Indonesia

NGRECO, Indonesia — For the people living in the tiny village of Ngreco, their isolation had always been a source of pride. The serene little island off the coast of crowded East Java was only accessible by boat, and that was just fine by them.

But like many parts of Indonesia, such a remote, secluded life meant access to basic things like health care was difficult, if not impossible. And as in many parts of Indonesia, malaria began to take its toll. Five years ago, Malaria had infected almost 80 percent of Ngreco’s population of 6,000 people.

With poor access to mainland hospitals, the numbers of those infected who eventually died grew shockingly high. The small community was in a state of panic when the town’s governor decided to take action. He organized his residents and they built a bridge to the mainland. In less than a year malaria incidents started to decline.

Health workers could suddenly come and go as needed. Anti-malarial drugs were distributed along with mosquito nets, and government workers came to spray insecticide. Villagers had access to hospitals in the country’s second largest city of Surabaya. Malaria infections dropped by 75 percent and fatalities in Ngreco almost ceased.

It was a much-needed success story in a country that has long been plagued by the mosquito-borne disease. Almost half of the country’s population of 240 million people lives in malaria-endemic regions. Only small pockets of heavily developed areas on the islands of Java and Bali are considered low risk, and even there malaria lurks. The nation is a collection of 17,000 far-flung islands, many of which lack airports or health centers equipped to fight the disease.

“As an archipelago, there are still many areas of the country that are unreachable by the health care system,” said Rita Kusriastuti, director of vector-borne diseases for the country’s health ministry. “So there are still many cases of malaria that go undetected. These cases are silent carriers enabling the continuous transmission of malaria among remote populations.”

Indonesia’s health ministry estimates that about 3,000 people die from malaria here every year. At a recent event, Siti Fadilah Supari, the country’ s top health official, said malaria is one of the most widespread diseases now affecting the nation and should be treated as a national emergency.

More than 2 million Indonesians, she said, are infected every year.

Exacerbating the situation is the country’s diversity of mosquitoes. There are more than 20 different kinds, which carry five different strains of the malaria virus.

“Malaria remains one of the most contagious and dangerous diseases in Indonesia,” Supari said.

Millions of mosquito nets and anti-malarial drugs have been distributed to the hardest-hit areas, but health officials admit that what remains the biggest obstacle to fighting malaria is the inability of health workers to reach remote areas.

Every month in Jakarta, workers walk through neighborhoods, spraying dark corners, sewers and ponds in order to kill off mosquitoes. In the province of Papua, however, where malaria is most prevalent, no such program exists.

“Access to remote areas is very important,” Kusriastuti said. “There is often no transportation in remote areas; health workers must walk for hours, sometimes days, to reach some places.”

The lessons of Ngreco, however, have not gone unnoticed, and there are renewed efforts across the country to improve infrastructure and access.

The Mentawai islands off the coast of South Sumatra have always been famous for their remoteness. Home to pristine white sand beaches where tribes retain cherished traditions, they have also been one of the most malaria-prone regions. Increased boat service and improved inland roads, however, have begun to help.

And now the government has a roadmap aimed at the total eradication of the disease here by 2030.

“Since 2000, a lot of progress has been made. In 2000 there were 15 million infections every year, now there are 2 million. Malaria in Jakarta and on the island of Bali has been almost totally eradicated,” Kusriastuti said. “Despite the many challenges, I believe the situation is improving and that we are on track to eradicating the disease completely by 2030.”

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