In Sumba basic health services are deficient or non-existent. Most Sumbanese must walk five miles or more to get to a government clinic that often will not have the medicines needed to help. In the remote areas of Sumba there are no clinics within a half days walk or more. Many of the government clinics are dilapidated and few have reliable medical supplies or equipment. It really is a desperate situation. More than half of the Sumbanese children under the age of 5 suffer from malnutrition and anemia due to poor diets making them more susceptible to disease. Tragically in some areas an estimated 30% of the children die before the age of eight of preventable and curable illness. We are committed to providing improved healthcare for the Sumbanese people. We are doing this by building and operating our own primary care medical and malaria clinics. We also work closely with the government midwife clinics that are stationed in the most remote areas. We provide them with a steady supply of medicines and equipment and our volunteer doctors help improve their skills. We are also continually striving to strengthen the government’s capacity to deliver better healthcare via improved infrastructure and provision of medical supplies and equipment. Through our partnership with Direct Relief International, in 2004 and again in 2006 and 2008, we delivered more than 15 tons of supplies and equipment to three hospitals and 16 government clinics enabling them to better serve their people. The Foundation’s work in the health sector deals with a variety of needs, these are: the provision of water, providing health services and medical supplies, the rehabilitation of government midwife clinics and the construction of our own medical clinics, and dealing with food security and malnutrition. In June 2008, we opened two new clinics that we built and staffed. All of our five clinics have been strategically placed about 2 to 3 miles apart to allow for reasonable access for the sick coming from villages nearby.
We employ 13 Indonesian nurses and 1 Indonesian doctor at our clinics and we have an ongoing training program assisted by foreign nurses and doctors that are helping us to improve the diagnostic and treatment skills of our medical team. Our clinics have a reputation as being the best in the area and many people are actually walking miles past government clinics to be treated at ours. Dramatic improvements in the people’s health are now clearly visible throughout the large area that our network of clinics serve. We will need to employ and train more nurses to staff our clinics. They in turn will need motorcycles to be able to work, and in the clinics more medicines will be required.
Our focus on health services covers three key areas for 2009
PRIMARY CARE
MALARIA
MALNUTRITION
FARMING The following projects show what we need and how you can help.
Our health projects are now covering an area of approximately 60 square miles (96 square kilometers). We operate five clinics and are providing for the health needs of a population of about 20,000 Sumbanese who are living in 400 villages. We started our medical aid program in 2002 with the help of an American medical student. In the following years short term volunteer medical professionals assisted in the continued development and expansion of our health programs. As we grew it was clear that we needed volunteers who could give us long term commitments to train and improve the skills of our nurses. These volunteers were able to make great improvements but were hindered by the language barrier. Now we have hired our in house medical doctor and in so doing we have reached another milestone in the ongoing growth of our health programs. With our success comes a responsibility to the community for us to provide the best medical care possible. In the early years we were dealing with minor medical issues that over time became more complex. Now that our reputation is so high in the community people are coming to us with medical problems that our beyond our nursing staffs abilities to help and were faced with turning patients away. This year it was time to have a permanent doctor working with us. Accurate diagnosis and treatment are essential to properly meet the needs of the community. There is also the continuing need to train and improve the skills of our nurses and for the management of our five clinics. The doctor is rotating daily to our clinics throughout the week and is on call to deal with medical emergencies at all times, wherever they are. In so doing we have no doubt that our healthcare system is able to provide the absolute best there is on the island.
Most people in Sumba must walk to receive treatment at a clinic. For the sickest people and for pregnant women this is often not possible. Our medical staff needs to travel not only to the clinics but also to remote villages every day to care for those that cannot walk; they often are the most urgent and life threatening cases. If we are not mobile we are not effective.
The trip from our central clinic to the hospital is 45 minutes by car. Currently, two to four patients a week need emergency evacuation to the hospital and at times cars are not just available. Most of the life threatening cases that we deal with are women with birthing complications and infants with cerebral malaria, in all cases the patients are within hours of death. Our ability to mobilize and get patients to the hospital has saved those patients lives. However as we expand, in the most critical of situations, our ability to save lives will be dependant on being how fast we can respond and how fast we can evacuate those that need it.
Direct Relief International is providing us with one 20 ft. container of urgently needed medicine, supplies and equipment each year. This is enough medicine and equipment to support our clinics as well as improve the services at the 3 government hospitals and its 16 clinics. Each year we send many emergency patients to the hospitals for treatment that we cannot provide. Therefore we feel it is important to continually improve the facilities at the hospitals so they have the tools they need to work with.
The demand for our healthcare services continues to rise now that we have proven to the people that we are serious about helping them and that we are here for the long term, we have earned their trust. Now, because of our established reputation for quality healthcare, people are traveling many miles to seek treatment at our clinics. As we take our healthcare system outwards to new areas we will always need to employ more nurses, they are our most important asset. We provide our nurses with housing, 3 meals per day, health coverage, life insurance and a pension plan.
It is truly heartbreaking to see a child or young adult afflicted with a disability that can be cured. These children are often shunned from the society. Many do not go to school and the girls will probably never get married and have children of their own. The hospitals in Sumba do not have the facilities, nor do the doctors have the ability, to perform plastic or orthopedic surgery. And even if they could, in most cases, the parents of the afflicted children cannot afford it. These were children and teenagers with club feet that need orthopedic surgery, others with massive facial tumors, and infants with hydrocephalus and heart conditions. These cases require numerous operations and several journeys to Bali often staying a month or more each time. For them we have been able to organize surgeons in Bali to perform the operations and already five have been successfully treated. This year we have two more children who desperately need someone to help them. We have contracted several rooms nearby the hospital in Bali and our staff checks in on the patient and the accompanying family member each day while they are there.
Each year malaria kills more people worldwide than HIV/AIDS (about 3 million people), with the majority of the deaths occurring in children under five years of age. Unlike AIDS, malaria can be prevented and cured. Sumba has one of the highest occurrences of malaria in Asia. An estimated 20% of all children die or become severely brain damaged by malaria before the age of 10. Based on our clinical surveys of targeted villages, 62% of the children below the age of 5 and 30% of the total population had malaria. That number has now been drastically reduced by 85% in the children living in the villages that are covered in Phase 1 of our Malaria Control Program. To address this urgent problem, in 2004 we retained a world renowned malaria expert, Dr. Claus Bogh, and began Phase 1 of our comprehensive Malaria Control Program covering 603 people in 6 villages. In 2006, our Phase 2 expansion reached 4,600 people living in 51 villages. In 2007 & 2008 we expanded out even further and now this program is benefiting more than 18,000 people living in 400 villages. 6,000 treated mosquito nets have distributed free of charge with more than 10,000 people sleeping safer and protected at night. Hundreds of lives have been saved annually. Our project has expanded rapidly thanks to funding primarily provided by private donors who recently have been joined by Rotary International clubs from Western Australia. We started expanding our project fivefold in 2007 with the work continuing into 2008 and 2009. Hundreds of villages and thousands of more people are now benefiting from the work we are doing. However as we expand in the field we also need to hire and train more staff and to improve our infrastructure. We also have to maintain, diagnose and treat those that are now under our aid umbrella. Funding is crucial to the long term sustainability and success of our work. Our comprehensive approach includes; conducting baseline testing to establish existing malaria infection rates and a population census for each village, the distribution of insecticide treated mosquito nets for each household, on-going testing and treatment for malaria cases. We are also constantly upgrading our clinics capabilities for malaria diagnosis and treatment and consistent monitoring of bed net usage and maintenance. Our goal is to eliminate all deaths from malaria in our project areas and to reduce the number of malaria cases by at least 90%. Donors are very welcome to visit the villages and the people they are helping. If the project director, Dr. Claus Bogh, is in Sumba he will be happy to discuss the projects and give a tour of our malaria clinic and our microscopy facility where you will have the opportunity to see what malaria parasites look like.
This includes the purchase and distribution of specially made mosquito nets that are imported from India. The nets are produced from synthetic fibers that are impregnated with Pyrethrum, a natural mosquito repellant. Also includes, dipstick blood testing, medical treatment with anti-malarial medicines, hiring and training of village health workers, and the on-going compliance monitoring and maintenance of the program. Malaria is a debilitating disease that kills many of the young and older people in the villages, controlling this disease is crucial to our goal of improving the health and well being of the Sumbanese.
This includes the purchase and distribution of mosquito nets, blood testing and medical treatment with anti-malarial medicines, the hiring and training of village health workers and the on-going compliance, monitoring and maintenance of the program in the village.
Limitations in good laboratory diagnosis have always been a limiting factor in achieving effective health care in the developing world. This is particularly true for malaria where good diagnosis is essential and malaria is a disease that mostly affects remote and poor areas.
Microscopy remains the reference standard for malaria diagnosis in clinical care for much of the world today. However, it is well known that microscopy is an imperfect standard prone to errors such as: limited training of the microscopist, experience, motivation, laboratory resources and quality of equipment. To control malaria and save lives it is essential that expert malaria microscopy is available in endemic areas such as eastern Indonesia.
Over the past four years the Sumba Foundation has established a comprehensive Malaria Control Program that now covers a population of 18,000 and diagnosis is provided through the Foundations 5 medical clinics. To further expand the reach of our malaria control program to all of Sumba and also its neighboring islands of Flores, Timor, Alor and Sumbawa we propose to establish a Malaria Microscopy Training Center that will benefit the tens of thousands of people suffering from malaria on a daily basis.
The project will be executed by The Sumba Foundation in close collaboration with the Eijkman institute and NAMRU-2 as well as the four district health offices of Sumba. To cut costs, the center will initially be established in rented premises and further developed over the coming years. Approximately 50-60 microscopists will be trained and certified within the first year of operations and we could train up to 80 each year thereafter. This is by far the fastest way to expand our malaria work. In so doing we can save lives and help hundreds of thousands of people each year.
We are now addressing the problem of malnutrition in the community. This is a new project we started in early 2008 and one that is extremely important. If we want to improve the overall well being of the community, with the end goal being for our neighbors to have the ability to be more productive, then we must find solutions to all of the problems facing those living in the coastal regions of the island. Malnutrition is the result of marginal dietary intake compounded by infection. In turn, marginal dietary intake is caused by household food insecurity, lack of clean water, lack of knowledge on good sanitation, and lack of alternative sources of income. It is also compounded by inadequate care, gender inequality, poor health services, and poor environment. While income is not the sum of total of people's lives, health status as reflected by levels of malnutrition is. In Sumba a staggering percentage of children and adults are undernourished or malnourished. The island has the unfortunate distinction of being one of the poorest in Indonesia with a history of abject poverty, crop failure and famine. It is estimated that more than half of the Sumbanese children under the age of five suffer from malnutrition and anemia due to poor diets, thus making them more susceptible to malaria, tuberculosis and a wide variety of severe gastro-intestinal illnesses. The impact of anemia on children is debilitating. A mild case can impair intellectual development and can lower a child's IQ by between 10 and 15 points. Signs of undernourished and malnourished children are visible everywhere. A quick look around in any school and you will see children with visible signs of stunted growth. In a recent survey at the Anakaka School we found that 202 children out of 258 are severely malnourished, this is a staggering number! In the Villages it’s the same however there we are also finding children too weak to attend school and some of who are near death. The problem stems from the protein poor Sumbanese diet, the shortage of food in the region and the parent’s lack of knowledge. They do not understand the causes and consequences of a poor diet and they do not recognize the warning signs of malnourishment, nor do they know what to do about it. We have developed a teaching program that focuses on Nutrition education. This program is now being taught in all eight of the schools we support. We also take direct intervention in the most critical cases. Mothers are taught about nutritious food and how to cook healthy meals for their children. They are given powdered milk, eggs and vegetables for up to six months until the child recovers. Every week our staff monitor the child’s progress until they have fully recovered.
For a very small amount of money we can save an infant or young child. We provide eggs, fish and powdered milk for the parents to give to their children and our staff continually monitor the recovery progress of the child. Usually within a month there are signs of recovery but it can take up to six months for the child to fully recover.
This is an important project that needs donor assistance to succeed. We have one very qualified staff (she completed medical school) who is dedicated to helping make a change for her community. Every day Reni is teaching nutrition classes at the schools and in the afternoons she is in the villages feeding and monitoring the critically malnourished children. If this project interests you please consider sponsoring her work.
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“In many developing countries families depend on just one or two staple crops such as bananas, sorghum or cassava, for their entire diet. Poor nutrition contributes to more than half of the nearly 11 million deaths that occur each year in children under five.”…The Bill and Melinda Gates Foundation The staple diet in Sumba is primarily cassava, supplemented with corn and rice. In a good year a typical family will have rice available for about three to four months of the year. Once out of stock the family will eat their corn which may last them another three months, the remainder of the year they will eat cassava. Cassava is a low-protein starchy staple and although it is tasty and filling it is not a nutritious food. The fleshy roots contain poisonous compounds, (cyanogenic glycosides - compounds that liberate cyanide) that must be removed by processing before it is allowed to be sold in the western countries. In Sumba the people have no knowledge of this. Over the long term a cassava diet results in chronic protein deficiencies, as a food source it is unhealthy and can be debilitating. “In cases of human malnutrition, where the diet lacks protein and iodine, under-processed roots of cassava may result in serious health problems.” Perdue University This year we are starting to deal with the complex problems of food production in the local area. The coastal regions have up to 70% less rain than the inland regions and therefore these are the areas where people typically forced to forage for food in the draught years. The lack of food is one problem, what is being eaten is another. Combined, the poor diet and the lack of food create the foundation for undernourishment, malnourishment and even death. We have started to deal with these problems as two separate projects, Malnutrition and Farming, but both are closely linked and aimed at achieving the same goals, a healthier society that is more productive and better able to help themselves and their community rise above poverty. It is the alleviation of the devastating effects of poverty that The Sumba Foundation is dedicated to addressing and these projects will be core components to the success of our long term mission.
Before we can grow we have to irrigate. Sumba is a dry island with few rivers and water sources however we do have 40 wells spread throughout the area. Many of these wells can also support irrigation for small scale farming. With a small portable mechanical pump that can be placed by a well we can irrigate up to an acre of land, enough to meet the needs of a small village. Where feasible the pump will be shared on a rotating basis with other villages that are nearby and have wells. The pumps will be maintained by our mechanics. The farmers have agreed to donate a portion of the crop towards the maintenance of the pumps.
On average up to 50% of stored corn, rice and cassava crops are lost to weevils. Stopping this loss will nearly double the amount of food a family has to eat. It is a simple solution to the food shortage problem. By cutting off the oxygen in the stored food the bugs will die. In the villages families store their crops in woven bags allowing the bugs to eat until the food runs out. In air tight containers the bugs will die within two weeks leaving the harvest safely stored for the rest of the year.
Typically the community will work together to prepare land for the coming rain season when crops can be planted. The landowner has to pay those who help with daily meals and a portion of the harvested crop. Many cannot afford to buy the food required and the end result is large areas of non-productive land. We need to change this centuries old communal farming method and bring more food productivity into the area. In discussion with the farmers it is clear that with mechanical tractors, which can be shared within a community, many more families will be able to open farms on their land. With more land under till a big step towards food security will be made. We have worked it with the farmers who will contribute a portion of their crop to offset maintenance and fuel expenses and help supply food for the malnutrition project.
You can donate by credit card at Nihiwatu or on the Donations Page using Network for Good.
The Sumba Foundation 26271 Glen Canyon Ct Laguna Hills, California
92653-6327 USA
To donate by bank transfer to:
Bank of America
27571 Puerta Real
Mission Viejo
California
USA
Account name: The Sumba Foundation
Account #: 12204 02193
SWIFT#: BOFAUS6S
ABA#: 121-00-358