Episode: "The Compromise"

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Indonesia

Country Background:
During the last five years Indonesia has seen a string of political and economic upheavals. The 1998 Asian financial crisis wreaked havoc upon Indonesia’s economy, and was closely followed by the fall of the Suharto government after more than three decades of autocratic rule. In 1999, East Timor voted for independence from Indonesia, sparking violent reprisals by Indonesian military and pro-Indonesian militia that forced hundreds of thousands of Timorese to flee their homes.

In keeping with Indonesia’s remarkable geographic and ethnic diversity, however, MSF’s work has been extremely varied throughout the archipelago nation. Health care for people displaced, impoverished and otherwise harmed by the tumult of the country’s recent past has remained an imperative for MSF.

But in isolated West Papua, MSF has concentrated on increasing emergency preparedness in the region’s remote communities and HIV/AIDS treatment in its cities.

Emergency Preparedness in the Mountains of West Papua

In this episode, MSF nurse Solfrid Gunderson travels deep into the mountains of rural West Papua, Indonesia. It would be hard to imagine a more remote location than Landikma, the village that Solfrid visits, where people live life much as they have for many centuries. Simply getting to the village requires a long drive on a rugged dirt road followed by a six-hour hike along mountain paths.

The geographic isolation of villages in this region of Indonesia renders them extremely vulnerable to epidemics of infectious disease. A malaria outbreak in Landikma, for example, could go largely unnoticed in the lowland cities and towns of West Papua – without a reliable means of recognizing and responding to an epidemic, the village would be at the mercy of the disease.

As the only medical non-governmental organization (NGO) in West Papua, MSF has focused on averting an epidemiological disaster in the region’s remote areas. Since 1998, MSF volunteers have worked on training local health workers and putting the mechanisms into place that would enable communities like Landikma to diagnose and treat infectious diseases and, just as importantly, to alert the outside world when danger signs do occur.

The work that Solfrid is doing in Landikma in this episode is typical of MSF’s emergency preparedness program in West Papua; she checks the diagnoses made by a local health worker and makes sure that new malaria cases are being logged, then establishes a radio reporting system which will allow Landikma’s residents to communicate with the nearest hospital in the event of a health emergency.

HIV/AIDS Treatment in Meruake: Addressing a Growing Threat

As MSF prepares outlying villages for potential epidemics, elsewhere in the region a serious disease outbreak is already well under way. West Papua has only 1% of Indonesia’s total population, but more than 35% of its AIDS patients, and the infection rate is steepest in Meruake, a port city with a thriving commercial sex trade.

Paradoxically, Meruake’s growing AIDS problem has been exacerbated by newfound economic prosperity. Under the “decentralization” policy currently in effect in Indonesia, West Papua is permitted to keep most of the revenue brought in by the region’s mineral wealth and logging industry. As money has flooded into West Papua’s city, the number of brothels has multiplied.

Since “The Compromise” was filmed, MSF has begun an HIV/AIDS project in Meruake which focuses on training Papuan health staff, testing, counseling, prevention, and most important, a steadily escalating treatment program run in collaboration with the government hospital.

The project’s goal is to increase the number of people on lifesaving antiretroviral drugs (ARVs) by five-to-ten people each month. As in any MSF AIDS treatment project, the program in Meruake will not be able to treat every person living with HIV/AIDS in the community – at least for the foreseeable future. Instead, MSF’s intent is to work alongside the Indonesian Ministry of Health to build an effective and sustainable treatment program that can be expanded as needs and capabilities increase.