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Malaria: The view from Indonesia

Isolation and poor access to hospitals complicates malaria treatment.

An Acehnese child covers his nose as a South Korean volunteer uses anti-mosquito fog in Banda Aceh, on the Indonesian island of Sumatra, on Feb. 5 2005. (Beawiharta TW/Reuters)

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.