Aceh Rehabilitation and Reconstruction Project

The Aceh Rehabilitation and Reconstruction Project is a joint undertaking by

1. University Malaya Medical Centre (UMMC)
2. Faculty of Medicine, University of Malaya (FOM)
3. Malaysian Red Crescent Society (MRCS)

The group have adopted the Desa Blang Mangat which is situated on the east coast of the Aceh Province. The report presented here is the progress report from the visit to the village by the UMMC, FOM and MRCS team from the 09 May 2006 to 17 May 2006. This report was prepared by Associate Professor Dr Saimy Ismail, Dr Sanjay Rampal and Dr Victor Hoe.

BACKGROUND

The tsunami on the 26 December 2004 have struck many areas in South East Asia and South Asia, one of the most badly affected areas is Aceh province located on the northern most of Sumatra in Indonesia. Although the tsunami has been more that one year and the recovery is slow and painful. Desa Blang Mangat in Lhokseumawe is one of the areas hit by the tsunami, it is located the northern coast of Aceh province. It is made up of nine villages. This area had not only suffered from the tsunami but also from the years of conflict in Aceh. The Malaysian Red Crescent Society (MRCS), University Malaya Medical Centre (UMMC) and Faculty of Medicine (FOM) has adopted eight of the nine villages within the Desa Blang Mangat area and the aim is to assists in the improvement of the health aspect of the villagers.

The political climate in Aceh province has improved lately resulting in a progressively improving economic outlook in the Lhokeseumawe district. There is also a lot of development being carried out by the Badan Rekonstruksi and Rehabilitasi (BRR) but it will take time to redevelop the area. The delivery of health services to the Kampong has also improved. The BBR has been building access roads and houses in the area to house the villages.

Desa Blang Mangat is an area located in the Lhokseumawe the North coast of the Aceh province. It consisted of nine villages, out of the nine villages MRCS-UMMC-FOM have adopted eight of the villages; they are Blang Cut, Kuala, Mesjid Merasah, Jambu Timu, Blang Teu, Baloy, Tuang and Teugoh.

Four of the villages, Blang Cut, Kuala, Mesjid Merasah and Jambu Timu were more badly hit during the tsunami then the rest, the worst-hit area is Mesjid Merasah village. The other four villages condition is a bit better, they are more affected due to the conflict that had occurred in Aceh.

OBJECTIVES

The general objective of this exercise is to assist in the reconstruction of the health services and to empower the villagers of Desa Blang Mangat towards being self-reliant in health issues.
Specific Objectives:

1. To collect baseline data of the villagers
2. To assess the availability of health facilities and provision of care to the community
3. To determine the general health status amongst the village including nutritional status and prevalence of depression

ACTIVITIES

Desa Blang Mangat – the adopted area

As planned in Phase 1A, a pilot study was conducted in the eight villages form the 9 May 2006 through 17 May 2006. The pilot study consisted of a cross-sectional survey of the residents dwelling the eight villages in Desa Blang Mangat, Lhokseumawe, Aceh, Indonesia. The estimated population of the eight villages is 2000 residents residing in about 600 households. The activities also included medical treatment of villagers who are acutely ill and in need of medical assistance and advice.

Data Collection

Baseline health information and nutritional assessment were collected through interviewer-administered questionnaire followed by a basic physical examination. For the purpose of this study, three types of questionnaires (Community Social Health Network questionnaire, Household questionnaire, Individual questionnaire) were used.

The data were collected during the day and were entered in to the SPSS programme in the evening at the MRCS local office at Lhokseumawe town.

Change of the population setting

The group was not fully prepared for the change in the setting of the original population. The whole population group which was housed in the ten blocks of the longhouse during the last visit in early 2005 had returned to their original villages on the coastal shores about five kilometres away. When we first arrive the Palang Merah Indonesia (PMI) and the MRCS were not able to provide us with the distribution of the houses in the 8 designated villages in order for us to plan for a proper sampling within the original timeframe.

The PMI and MRCS are willing to assist in the tagging process of all the household in the eight villages before the Phase 1B of the programme (Proper Survey). As a result of the lack of proper sampling frame, the team did not proceed with the random sampling as originally planned; instead, they conveniently sampled 5 to 9 households from each of the eight villages.

Health Delivery System

There is a Pusat Kesihatan Masyarakat (PUSKEMAS) or community health centre for the Desa Blang Mangat situated at Blang Cut village that is fully operational. During our visit, we were informed that PUSKEMAS Blang Cut was functioning well according to their capacity. The health delivery system to the villages is based on the Indonesian model, which is different from the system in Malaysia. Thus, the standard of care received by the villagers is very different from that received by average Malaysians.

Maternal Child Health Services

Maternal Child Health (MCH) services are delivered in Desa Blang Mangat by the government through the local primary care centre, PUSKEMAS Blang Cut. It has a Bidan Desa (Bides) Coordinator who is in charge of the nine villages in Desa Blang Mangat. Each village has a designated Bides who delivers the appropriate health care to the pregnant mothers and children under 5 years-old though she does not stay in that particular village. We visited the local Bides at the Kampung Teungoh on the 12 May 2006.

During the conduct of the survey we had the opportunity to visit the Pusyindo (local health station). We interviewed the Kadir (Cadre) about the activities of such a centre.

The designated Bides visits the village once every month. All pregnant women will have their blood pressure checked and their weight recorded. She also immunises all the relevant children and records their weight until they are 5 years-old. Though the pregnant women are routinely examined by one Bides, they travel to the houses of the Bides either in Puntuet or Bayu for child delivery. The payment varies depending on insurance coverage of the individual. Many of the mothers have to pay from out of pockets.

This initial information from Teungoh village kindled our interest in how exactly the MCH services were delivered in the relevant villages. We were interested in finding out whether any variations existed in the delivery of MCH and health-seeking behaviours of the mothers.

We visited Kuala Merasa village on the 13 May 2006 and have the opportunity to meet Suryati, the head Kadir for this village. According to her, the Bides for this kampong makes monthly visits; during these visits she would examine the pregnant mothers and children. Supplements will also be given by the Bides according to the governmental guidelines. There are five Kadirs under the Bides, with Suryati being the head Kadir. Suryati was 20+-year-old and had graduated with a Diploma in Finance but had failed to secure a job. She now lives in her village and functions as a Kadir. She helps out the Bides during her monthly visits. During other times, she functions as a point reference for any maternal emergencies. She gets paid 15 thousand Rupiah (RM6) per month for her service as a Kadir. She considers her work as a form of contribution to her community.

According to Suryati, all the mothers in the village have their ante-natal care through one specific Bides but may go anywhere to deliver their babies. The nearest birthing centre is at the Bides’ house in Puntuet, roughly five kilometres away. The government has planned to permanently station a Bides at each Polyindas.

The Bides in Desa Blang Mangat followed the following prescribed immunisation schedule:

• BCG At birth
• Hepatitis B 0, 1 and 6 months
• DPT/OPV 3, 4 and 5 months
• Measles 9 months

There are 2-3 families who have refused immunization for their children on grounds that they are fearful for their child’s health frightened of the associated fever leading to fits. Vitamin A supplements were also being given periodically. There are currently 11 pregnant women in this village. Data on children was not available during our visit.
Jambo Mesjid village was the second village we visited on the 13 May 2006. The local PMI members with our group took us to one of the Kadir’s house, Ismiyati. She helps out Bides Yusnelli during her monthly trips. The frequency of the Bides visits ranges from once a week to once a month. She and the other Kadirs were given two days of training by the Bides before starting their work. They help to identify pregnant mothers and un-immunised children for the Bides. They too were paid Rs 15 thousand a month in one lump sum and consider it communal work. They do get some additional income through other vertical programs such as the Pulse Polio Program by UNICEF.

The pregnant mothers have the following choice of birthing centres; some are free while others charge a fee:

• Rumah Sakit Umum
• PUSKESMAS Bayu
• Bides Mariayani from Bayu
• Bides Sanjaya Rahmah from Puntuet

There are currently 10 pregnant women in this village. No information was available for the children under 5 years-old. Other information is similar to Kuala Merasa village.
Jambo Timu village was the last kampung we visited on Saturday. The Kadir informed us that there were 16 pregnant mothers in the village at that moment. Bides Sarini visits the village 3 times a week and examines the mothers and children during her visits. She had also planned for regular education talks but there have been no talks for the past 4-6 months. The pregnant mothers in this village usually go to Bides Marianni in Bayu to deliver their babies. They feel that she had more experience in childbirth and can even conduct instrumental deliveries.
Some children are not immunised at birth but resume immunization after 3 months-old. According to the Kadir, all children are fully immunised after that. There has been no refusal in this village.

Housing

After the 26 Dec 2006 tsunami many of the villages in the hard hit areas, Blang Cut, Kuala, Mesjid Merasah and Jambu Timu were without proper housing, the other four villages that were not hit by tsunami also have housing problems. The main problems with housing in this area are due to poverty, most of the houses prior to tsunami are made of wooden houses without proper drainage and toilets. After the tsunami there were many international non-governmental organisation (NGO) who have come to this area to rebuilt houses for the villages. The type of houses provided by each of the NGO are different some have better facilities than others, most of them are made from cement and bricks, one of the NGO constructed wooden houses on stilt. Sometimes in one village there can be up to three different types of houses.

Although the tsunami has occurred more than one year, the construction of the houses have still not completed, there were still villagers in the most badly affected village, Mesjid Merasah who are still staying in tents. The observations that can be made about the housing constructed by the NGO are some of them still have a lack of sanitary facilities. Some of the villagers do not use the latrine provided as it is situated outside the house and it will be difficult to use it in the night, one of this villager constructed her own latrine within her house.

Water

Water is one of the main issues during any disaster, for the case of the Desa Blang Mangat, it continues to become an issue even more than one year after the tsunami. The main concern of the villages is potable water, for drinking, cooking and water for washing and bathing. There is no piped water to these villages and the water from the well has been contaminated with salt water during the tsunami, the problem is more profound among the four badly affected village. During the early stage of the post-disaster when the villages were staying in the longhouses there was supply with Reverse Osmosis (RO) equipment, after returning to the villages this RO equipment is kept lying idle.

The issue of water shortage can be solved partially by some simple solution, as this area is located in the tropics, where rain is plentiful during a certain time of the year, collection of rainwater as a source of water is an option. One of the villagers has actually constructed a gadget to collect the rainwater from the roof of the house donated by NGO.

Commercial activities

During the visits, we were still able to observe some commercial activities; which includes bicycle repair workshop, food shack, electronic equipment repair shop and embroidery workshop.

RECOMMENDATION FOR FUTURE DISASTERS

From the observations and the interviews with the villages, we have been able to make recommendations for the action to be taken during future disasters. Housing is a very touchy issue in any disaster, the villages will be comparing about the type of houses that the neighbour is given by the NGO, during any disaster there should be coordination between all the NGO in order to standardise the type of housing to be built in that area, the criteria for housing should also include the needs and the cultural make-up of the local community. The actual construction of the houses has also been an issue among the villagers, as some of the villagers commented that the construction has been given to “people” living outside the community. In a post-disaster situation the relevant authority and NGO should use the available resources from the local area, this includes material and man-power, as many of the villagers still have no work. On the water issue, the NGO and the local authority should look at the local situation to source for available water, they should not bring in too much technology where the villagers are not able to repair and use it if there is any breakdown. The local community will be the best source of ideas on how to solve the water problem, as was demonstrated by one villager who harvests rainwater.

CONCLUSION

This rehabilitation and reconstruction projects need to be continued because Desa Blang Mangat suffered both from the political conflict and the tsunami. The conflict had almost been solved and our assistance will partially give the villages a boost for their future development. Although this is a working trip, the team did manage to enjoy the local food, culture and weather.