BERICHTEN UIT HET VELD: EBPP Posyandu Programme (Monthly mother-infant health posts in all 19 remote hamlets)

By Lindsay Burns, EBPP Vrijwilliger

Cretinism and goitre. Caused by acute lack of dietary iodine intake. A Govt. Survey in 1998 showed 85% goitre prevalence in Desa Ban – highest in Indonesia!

THE discovery of whole families left brain-damaged by their meagre diet led East Bali Poverty Project (EBPP) founder, David Booth, to seek international aid in 1999 – enabling EBPP to eventually initiate 27 hamlet-based health clinics, providing better access to health care for the 3,500 families and a drastic decrease in child mortality.

When EBPP team and expert health advisers surveyed some of the most remote hamlets in 1999, they encountered dozens of people whose physical and mental development had been stunted through acute lack of iodine in their diet. This was compounded by a staple of cassava, a “goitrogen” that blocks iodine absorption to the body and suppresses thyroid function, resulting in many visible goitres and extreme cases of acute iodine deficiency, called cretinism.

The charity got funding from UNICEF in 2000 for their programme to eliminate iodine deficiency by provision of iodine capsules to children and women of child bearing age. The programme was so successful that new donors were eager to provide funding for other essential health programmes.

The presence of cretinism was shocking, but the levels of easily treated, killer diseases like dysentery, viral diarrhoea and other water-borne diseases meant that nearly half of all babies born were dying before age one.

Dr Denise Abe, one of the charity’s expert medical advisers, said: “Because of the lack of access to dietary iodine or iodised salt, we saw many cases of cretinism. We rarely see people like this in the West. In one hamlet there was a whole family like this. We were able to get funding from UNICEF for iodine capsules – and with that programme, we started provision of basic health services. UNICEF was so impressed with our ability to reach every family in these 19 remote communities that they continued support for the next two years. In the second year, we focussed on Vitamin A deficiency elimination and the third year was working with the communities to establish the 27 posyandu, monthly health posts focussing on all the health needs of pregnant and lactating mothers and infants 0-5 years old.”

With no access to clean drinking water and unsanitary conditions, treatable diseases like dysentery, viral diarrhoea and other water-borne diseases were rife, and the infant death rate from these treatable diseases averaged 30% before age one and was as high as 50 per cent in some hamlets.

A major goal in the newly established posyandu was to ensure that every infant was given all essential vaccinations/immunisation against many easily avoided illnesses – and convince mothers who had never seen needles in their lives that this was a good idea.

From tackling infectious sickness and disease in children and adults to providing birth control and advice to new mothers, the 27 EBPP health clinics now have a wide remit.

Rather than dictating what must be done, staff at the EBPP lead by example and many of their own children have become bright, lively role models to the remote hamlet infants.

They also look for those with natural charisma and leadership qualities to educate through stories. Denise said: “We have some really switched on older women working here. If you have people who are really good story tellers, they have that credibility. These women are amazing. They really put on a good show. We took them around the villages to explain the importance of iodine in the diet and of attending each of the monthly posyandu.”

But still, tackling ignorance passed down through generations of women can be an uphill struggle for staff. One of the most shocking and destructive examples of this is the belief that new born babies can be fed chewed up rice or bananas from the age of about three months old – when mothers usually return to till the land with their newborns on their backs.

Ratih Wulandari, EBPP’s trained midwife responsible for maternal health, said: “You have to be gentle. You can’t scare them by telling them their baby will die. Many babies do die from this, but these women have been doing this for generations. If that baby dies they think it’s for some other reason. In plaats daarvan, we gradually convince them that breastfeeding to minimum one year old is the best way to ensure their baby grows up more healthy”

The hope is that if these mothers are exposed to these health messages they will gradually sink in over time.

Thanks to the another simple lesson in the posyandu that people make sure they and their families wash their hands after toilet and before eating, the numbers of people getting ill during the ‘sick season’ (August to November, the driest and coldest time of year before the rains start) dropped dramatically.

But the posyandu are not just about healthcare – they also double as playgroups for 0 to five-year-olds and their mothers. Not only does this give EBPP health team the chance to speak with mothers, it also gives the women the opportunity to meet other mums and their children: time interacting with their peers, joining group singing sessions and trying out stimulating, educational toys.

The posyandu also have male staff members who serve as role models for other dads, who may traditionally have left interaction with the kids to the women. Amy Cardamone, EBPP’s volunteer health advisor specialising in playgroup development, said: “In the west the “Sure Start” programmes have been incredibly successful because they give children who are living in poverty a chance to come to an enriched environment to learn,. And it gives medical staff a chance to pass on health information to mothers; and the mothers a chance to meet other women. For that hour it’s about them!

Another vital aspect of the posyandu is the close monitoring of children’s nutrition status and general health. It is important know they are growing properly, check them for signs of illness because emergency healthcare is hours away for these remote people.

Denise said: “Initially we thought some of the children were much younger than they actually were. You see, there were no records of birth and parents didn’t know their children’s ages – the field team had to guess them! Once we started to give them nutritious meals and fortified milk in school as part of our integrated education programmes in the six remote hamlet schools we launched between 1999 en 2007, their bodies started to catch up and in some cases, boys voices began to change within a couple of years! It turned out that children we initially thought were 7 or 8 were actually probably 11 or 12.”


Dr.. Indraguna testing for goitre on an EBPP student, 2003

EBPP Playgroup programme is the place for children learning by playing and interacting with others. Also for Mums to meet and share experience

EBPP posyandu programme key roles are to monitor children’s nutrition, gezondheid & immunisation status & the health of mothers

EBPP’s Nengah Semeng gives a child polio immunisation

Nu, through EBPP Posyandu programme, the community has access to health care they didn’t have before

Washing hands: essential hygiene/sanitation taught by EBPP team to all children & mums in the 27 playgroups

Playgroup dental hygiene training. EBPP hopes that some mums will soon start selling toothbrushes & paste to others!

The children having their nutritious posyandu meal and ADES mineral water together in EBPP posyandu

A mum and children enjoying their nutritious meal outside the posyandu with natural background of Desa Ban

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