Health Services for Residents in Frontier Area
On Wetar Island, there are four sub-districts with 23 villages with a total population of 8,094. The island is one of the frontier regions of Indonesia, north of neighboring Timor Leste.
Yuliana (62), after checking her health at the Ilwaki Health Center, Wetar Island, Southwest Maluku Regency, Maluku, on Monday (8/8/2022).
Yuliana, 62, slowly entered the public health center (Puskesmas) in Ilwaki village, Wetar Island, Southwest Maluku regency, Maluku, on Monday morning. Her hands slightly trembled due to her illness as she handed her Indonesian health card (KIS) to the officer.
Yuliana, a resident of Ilwaki village, wanted treatment for diabetes and gout that she had been suffering from over the past few years. Sonya Lelametan, a nurse at the Puskesmas, listened to Yuliana's complaint. Sonya then checked her blood pressure and measured Yuliana's blood sugar level.
A few minutes later, Sonya brought back the results of the examination. “Your blood sugar is good, only 119 milligrams per deciliter. The uric acid level has also dropped to 6.9 mg/dL," said Sonya while stroking the back of Yuliana's hand.
Drug therapy for the treatment of blood sugar and uric acid in the last three months has been quite helpful. Previously, Yuliana's uric acid level reached 9 mg/dL or above the normal limit for a woman, which is 7.5 mg/dL. Her blood sugar had increased to 450 mg/dL or above the normal limit of age 60 years and over, which is 150 mg/dL.
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She only learned about her uric acid and blood sugar levels after going to the Puskesmas in Ilwaki. “Before having a health card, I didn't dare come to the Puskesmas because I thought it would be very costly. For treatment I used African leaves. I boiled it and drank the water,” said Yuliana. African leaves are a kind of local herbal medicine.
After joining the national health insurance program (JKN), the premium for which is paid by the government, Yuliana no longer hesitated to go to the Puskesmas for treatment. Health checks, medical services and medicine are all free of charge. "Thank God, now it's free,” she said.
Dince Lodwakla, 40, had a similar experience. She gave birth to her first child at home with the help of a traditional midwife for financial reasons. She was grateful for the smooth birth process. Mother and child are both healthy. However, giving birth at home does not always go smoothly. “After getting the KIS, I went to the Puskesmas to give birth to my second child. Every month we are routinely visited and checked by the midwife,” said Dince, who is also a resident of Ilwaki.
Dince Lodwakla (40), a resident of Ilwaki Village, Wetar Island, Southwest Maluku Regency, Maluku, shows his Healthy Indonesia Card on Monday (8/8/2022).
Ilwaki, which is the capital of South Wetar district, has a population of 923 people. The Ilwaki Puskesmas serves the residents of Ilwaki village and five other villages in South Wetar, who can only reach the Puskesmas by sea as there are no roads.
Frontier island
On Wetar Island, there are four sub-districts with 23 villages with a total population of 8,094. The island is one of the frontier regions of Indonesia, north of neighboring Timor Leste. Based on the information collected from each sub-district, more than 65 percent of the population of Wetar Island have joined the KIS national health insurance.
The head of the Healthcare and Social Security Agency (BPJS Kesehatan) in Ambon, HS Rumondang Pakpahan, acknowledged that not all residents have a KIS due to geographical factors. BPJS Kesehatan is the agency that is in charge of managing health insurance.
“Due to difficult access and high transportation costs, the public campaign to promote health insurance cannot be carried out at a maximum level. There are also many people who do not have a population identification number [NIK] so when they go to register they are rejected, because their data is not on record in the local population and civil registration office,” said Rumondang.
The Red and White flag flutters in front of a resident's house on Lirang Island, Southwest Maluku Regency, Maluku, on Sunday (7/8/2022). The island is directly adjacent to the country of Timor Leste.
As of the beginning of this month, 1.6 million residents (87 percent of the population in Maluku) have registered. Rumondang added that in order to attract more participants, his agency continues to coordinate with local governments for data matching. In addition, people who have difficulty with the registration process should be helped to obtain a NIK by issuing a family card.
However, the health insurance cannot guarantee that the residents who are seriously ill and needing emergency treatment, or mothers who are about to give birth, receive proper treatment because on Wetar Island there are no inpatient health facilities. The condition of the health center is far from ideal, not to mention the lack of health workers. Not all Puskesmas have a permanent doctor.
A kindergarten caregiver takes her injured student to the Ilwaki Health Center, Wetar Island, Southwest Maluku Regency, Maluku, on Monday (8/8/2022).
Emergency patients or expecting mothers have to be referred to the city of Kupang or Atambua in East Nusa Tenggara. They must also wait for the service of a pioneer ship, which operates once a week. The fastest travel time from Wetar to Kupang is 48 hours. As a result, many patients have died at sea.
Sometimes patients travel to Dili, the capital of Timor Leste, which is closer. Residents of Ustutun village, West Wetar district, often go to Dili by fishing boat, or they go to Atauro Island, Timor Leste, in order to take a plane to Dili.
Maluku Deputy Governor Barnabas N. Orno said that his office continued to work extra hard to provide health services for the residents, even to those living in the frontier area. In 2019, the Maluku provincial government planned to build a primary hospital on Wetar Island, but it has not yet been built.
A girl's smile on Lirang Island, Southwest Maluku Regency, Maluku, on Sunday (7/8/2022).
The national health insurance, which was first launched in 2014, has given hope for the community to obtain better health services. With the philosophy of gotong royong (mutual cooperation), underprivileged residents can now receive free treatment. However, this needs to be followed by the provision of adequate health facilities so that the community, even those living far away, can enjoy the benefits of the health insurance.
(This article was translated by Hendarsyah Tarmizi)
