Breaking a Dangerous Tradition in Indonesia

By Sagita Adesywi, ChildFund Indonesia

Yuliana, a mother of five, lives in far eastern Indonesia in a simple house made with bamboo, tree bark and other wood.

mother and daughter in Indonesia

Yuliana and her daughter at a rumah bulat, or roundhouse, where women in their village stay with their newborn babies for at least a month.

Like many others in her community, Yuliana’s family has a wooden rumah bulat or “roundhouse” that serves as a kitchen and a storage place for harvested crops. The outbuilding has a door but no windows, and the walls and ceiling are black from smoke.

Aside from these uses, the rumah bulat is also a birthing room. According to local tradition, mothers and their newborns need to be “baked” to become strong and healthy. Mother and child lie on a wooden platform with a fire burning underneath it — often for a month or more.

Yuliana did this for all five of her children, but now she discourages other mothers from doing the same. “It was so hot, I felt like dying, but we didn’t dare to say no to our village elders,” Yuliana recalls. “It was such a miserable time. My children fell ill easily when they were younger, coughing all the time. As I now know the harmful impacts, I want people here to stop doing this.”

health care volunteer weighing a child

Yuliana, a local health-care volunteer, weighs a child at her home.

Today, Yuliana is a volunteer with a health project in the village called REACH. ChildFund and UNICEF work in partnership with community-based organizations, training health volunteers to raise awareness about proper health care for expectant mothers and young children.

The rumah bulat practice contributes to a significant number of young children suffering from chronic respiratory diseases and malnutrition. “It is not easy to change people’s views, since traditional norms are held in high esteem in the community,” Yuliana notes. “From the training, I understand it is not just about what a bad experience it is, but most importantly how badly it impacts the health of the mother and the baby. I want people here to understand this too.”

As part of her efforts, Yuliana helps the local midwife facilitate counseling sessions at the village health post. She carries a first-aid kit and keeps information about basic health care with her at all times.

“I am very happy to have Yuliana as a health volunteer,” says Adel, another community member. “She visits pregnant mothers regularly and discourages the rumah bulat practices.” It’s difficult to break old habits, though.

“I still underwent this practice for my niece when she gave birth,” Adel says. “I know it is wrong, but I was terrified of going against the village elders here. Yuliana has been telling us we shouldn’t keep doing this, but we’ve been told we will be cursed and that if we don’t follow the practices we will go crazy.”

new mother in Indonesia

Adel (right) was afraid to go against the rumah bulat tradition with her niece, a new mother, but they are performing the ritual in a healthier way.

However, Adel did make some adjustments to the norm. Her niece was confined to a rumah bulat with a bamboo wall that allowed more ventilation than the customary solid wood wall, and Yuliana checked on mother and baby.

Indonesia’s government supports the abolition of this practice, having introduced a new fine of US$30 if a woman gives birth at home instead of at a health center. This is a hefty fine in Yuliana’s province, where the average income is US$17 a month. The government’s regulations and the sharing of health information among mothers are helping to reduce the harmful custom.

“I was really scared of the rumah bulat practice. I chose to stay at my uncle’s house in town so that I could give birth at the health center,” says Dorsila, who, inspired by Yuliana, has also become a community health volunteer.

Community Members Band Together to Improve Childbirth Practices

By Sagita Adesywi, ChildFund Indonesia

In Indonesia’s low-income communities, the expenses related to childbirth lead to difficult decisions. Mulyana, a trained health-care volunteer (locally known as cadres) in Pakan Sari, had a miscarriage when she was three months pregnant.

“The treatment at the hospital cost me about US$400,” she recalls. “We have enough money for food, but we couldn’t afford to pay the hospital. Thank the Lord, I received an allowance from the government and have a childbirth savings account as well. Otherwise, I don’t know how I would be able to pay.”

Indonesian health cadre

Mulyana, one of the health cadres, has dealt with the costs associated with having children herself.

Many women in Mulyana’s region go to traditional birth attendants instead of the hospital, which is often better prepared if a mother or baby encounters complications during birth. Improper medical treatments have contributed to the high number of deaths of mothers and babies. Indonesia’s maternal mortality rate, 228 deaths per 100,000 births, is among the highest in Southeast Asia; its infant mortality rate is 28 deaths per 1,000 live births.

Traditional birth attendants charge much less than a hospital, but that advantage sometimes comes at the expense of current medical knowledge, properly maintained equipment and even good hygiene.

To reduce the number of maternal and infant mortalities, a government program called Desa Siaga (Alert Village) has been rolled out by the Indonesian Ministry of Health targeting rural and poor regions.

Indonesian health cadre

Yayah, another health cadre.

Desa Siaga programs aim to encourage self-reliant communities that actively address their own health challenges, such as maternal and infant mortality. Through this initiative, the government provides a childbirth allowance that pays all expenses incurred at a state hospital. Women must first go to their health post for prenatal appointments to receive the allowance.

In Pakan Sari, community members started a forum to discuss needs and healthy practices surrounding childbirth and pregnancy. Everyone in the community — husbands, neighbors, community leaders, midwives and health cadres — has a role to play in promoting birth preparedness. This participatory approach is aimed at raising awareness that pregnancy should not be a private concern affecting women only.

Supporting this initiative, ChildFund works with its local partner organization, Warga Upadaya, strengthening the health cadres’ capacity to assist midwives in the community. Health cadres attended training on monitoring of pregnant mothers, breast feeding, nutrition for children from birth to age 5, household economy management and community organization.

Each pregnant woman’s health status and due date is recorded, as well as who will assist with transportation or give blood if it’s needed. The record also shows the family’s financial resources, aside from the government allowance.

“We have endorsed the rollout of the Desa Siaga program in our neighborhood for the last year,” says Sigit Murjati, a community leader. “We have developed a community savings system to prepare for the costs of childbirth.”

These financial contributions are used to offset the costs of transportation and medical care during and after childbirth.

Indonesian health official

Sri Dwi Lestari, an official at the local health department (left), attends the launch of Desa Siaga.

When a state hospital is full, and the mother is then referred to a private hospital, the savings play a critical role since the government pays only for a stay at a state facility.

With the community preparedness system in place and health cadres all trained, Pakan Sari can better meet the needs of mothers and newborns. At the launch of the Desa Siaga program on May 15, 99 health cadres from 22 health centers came to Pakan Sari, as well as the sub-district head.

“This launching of Desa Siaga by the sub-district head is recognition from the government to the health cadres and the entire community,” says Sri Dwi Lestari, a community leader who works for the local health department. “This makes the community feel that they own the program, since the health cadres are all community volunteers. If the community doesn’t feel like they own the program, the program would not run so well.”

50 Days: Keeping Women and Girls Healthy

 By Kate Andrews, ChildFund Staff Writer

For 50 days, ChildFund is joining with numerous organizations to demonstrate support for government policies and programs that will allow women and girls to be healthy, empowered, and safe — no matter where they live. Improving the Health of Women and Girls is this week’s theme.

Senegalese mother and daughters

Sadio and her twins, Awa and Adama.

Visiting the doctor is usually a mild inconvenience in the United States. It may entail a drive across town and a sit in a waiting room filled with people coughing and sneezing. But in Senegal, which has only 822 doctors serving a population of more than 12 million, seeking medical attention is a major undertaking.

For some families, it’s too much. Sadio is the mother of 2-year-old twin girls in the village of Pakala, which is often flooded during the rainy season. This makes it difficult to travel 6 kilometers (more than 3 miles) to the nearest health post staffed by nurses. Awa and Adama suffer from respiratory problems, and Adama is especially sickly, having come down with a debilitating cold that required a doctor’s care — a 30-mile journey from home to a hospital. 

Senegal health hut

A health hut in a Senegalese village.

Sadio and her husband Moussa, a farmer, have experienced loss before; their first child, Matar, died in 2007 at 13 months from diarrhea and a respiratory infection. But today their village has a health hut, which is staffed by a matron, community health workers and birth attendants. They can help patients with basic needs, but more complicated illnesses and ailments still call for a trip to the health post 3 miles away or 30 miles to the hospital.

Sadio reports that her diet improved during her pregnancy with the twins after receiving advice at the health hut, but her girls still face challenges from the respiratory infection; also, they were born underweight.

Senegal mother and children

Sadio, the twins and their 4-year-old brother, Assane.

The health of women and girls is important to ChildFund, as we work with local partners to provide access to health care in isolated villages as well as underserved urban areas in developing nations. In Senegal, ChildFund is leading the implementation of a $40 million grant from USAID to establish community health care services for children and families in great need.

Over five years, we plan to establish 2,151 health huts and 1,717 outreach sites throughout the country, along with a sustainable national community health policy working in partnership with USAID and other key community development organizations. By the end of the project, we expect to have helped more than 9 million Senegalese people in 72 districts.

A Frightening Brush With Malaria

By Silvia Ximenes, ChildFund Timor-Leste

Cristina Moniz was busy as usual one morning three years ago, getting her children up for school and preparing breakfast for them and her husband, Joaquim Lopez, a police officer in the Timor-Leste district of Covalima. She passed by her 7-year-old son Deonizio’s room, and to her surprise, he was still in bed asleep.

Approaching his bed, Cristina discovered that Deonizio had a fever.

mother and sons

Cristina and Deonizio (with his youngest brother) spend time at their home in the Covalima district.

“I felt not well at all, got headaches and vomited all the time,” Deonizio recalls today. “With all those conditions, it prevented me from going out; I couldn’t go to school or play around with my friends.”

It turned out that Deonizio had malaria, one of the deadliest diseases in the developing world, especially for children. He and Cristina first went to the village health post, Salele Community Health Center, which referred Deonizio to the hospital, where he had a blood test analyzed.

Cristina was shocked that her son had malaria, but the health center’s staff advised her to give Deonizio anti-malarial medication on time and keep the home clean and mosquito-free. This isn’t an easy task for Cristina, who now has five children and many duties. But insecticide-treated bed nets that arrived from ChildFund in 2011 have helped.

“Before getting the bed nets, there were many mosquitoes around the house,” Cristina says. “We are happy because there are no more mosquitoes, no more sickness.  Now, my family and I can sleep safely away from mosquitoes. No more malaria in our family. Deonizio can go to school any time,” she notes.

boy and baby on bed

Deonizio and his baby brother are protected by a mosquito net.

“I feel sure that mosquito will no longer bite me when I sleep under the bed net,” adds Deonizio, who is 10 now. “I’ll be freely doing my daily activities as usual, going to school, playing with friends.”

Having recognized World Malaria Day recently, we’ve learned about how many children are at risk of contracting this preventable disease in developing countries like Timor-Leste. Malaria kills 200,000 children worldwide each year, and many more become sick. However, the gift of a medicated mosquito net can mean good health, education and fulfilled potential for children in need like Deonizio and his brothers.

Malaria’s Threat to Children

By Meg Carter, ChildFund Sponsorship Communication Specialist

IWorld Malaria Day logomagine a world without mosquitos. Some scientists believe we could eradicate them without disrupting the ecosystem, and experiments to that end are underway.

Why? Because every minute, malaria takes the life of an African child. That’s an important fact to remember as we mark World Malaria Day.

How Malaria Spreads
A parasitic illness spread by female Anopheles mosquitos, malaria is the leading cause of death in children under the age of 5 in Africa. Every year, malaria kills 10,000 women and 200,000 infants worldwide. It’s especially dangerous during a woman’s first and second pregnancies. Infants become vulnerable again at 3 months, when the natural immunity they shared with their mother begins to wane.

Mosquitos bite mainly between dusk and dawn, and they carry four different parasites. The most lethal — and most common — malarial parasite is Plasmodium falciparum. Anopheles mosquitos in Africa have long lifespans and prefer to bite humans rather than animals. As a result, 90 percent of all malaria deaths occur in Africa, although India also has a significant problem. The Gambia, Guinea, Liberia, Senegal and Sierra Leone, all countries served by ChildFund, have the highest occurrence rates in the world.

Rainfall patterns, temperature and humidity affect mosquitos, so malaria infections peak during and immediately after rainy seasons. Epidemics occur when climate conditions change or when seasonal workers, immigrants or refugees lacking immunity move into malarial areas.

216 million annual cases of malaria Approximately half of the world’s population is at risk of catching malaria. In endemic areas, adults develop partial immunity through many years of exposure and illness, so most deaths occur in young children. In regions with lower infection rates, a sudden epidemic can decimate the population.

Links to HIV and Poverty
Mozambique and Zambia have high rates of cerebral malaria — which virtually guarantees death — as well as co-infection with HIV. More than 90 percent of their populations are at ongoing risk for malaria, and more than 10 percent have AIDS.

Existing HIV infection increases the risk of malaria and also the severity and complexity of the illness; HIV infection also interferes with the medications used to treat malaria, making death more likely. Malaria also increases the risk of mother-to-child transmission of HIV.

Malaria is endemic in 27 of the 31 countries where ChildFund works.Malaria is closely linked to poverty: The lower a country’s gross national income, the higher its malaria mortality rate. For children under 5, parasite prevalence is worst in poverty-stricken, rural communities, where lack of access to health facilities, effective diagnostics and treatment options is commonplace. Poor-quality housing offers little protection against mosquitoes, and the cost of insecticide-treated bed nets and indoor spraying with insecticides is challenging for those living on less than $1.25 a day.

To avoid malaria, families need to sleep under insecticide-treated nets nightly, and houses must be sprayed every three to six months. ChildFund is working to combat the spread of malaria in Guinea, India, Kenya, Liberia, Mozambique, Sierra Leone, The Gambia, Uganda and Zambia, and you can help by purchasing bed nets for children and families.

On World Malaria Day, let’s strike back against this threat to children.

View a video to hear a mother in Guinea describe how her children’s health has improved with treated bed nets.

Leaving Footprints on One Day Without Shoes

By Kate Andrews, ChildFund International writer

Last April, ChildFund workforce specialist Ann Latham-Anderson asked the children in her neighborhood an important question: If you didn’t have shoes, what would you miss most?

One Day Without Shoes

Ann Latham-Anderson’s winning feet.

Then she let them draw on her feet with magic markers, and her husband and daughter chipped in with drawings of children on her toes. The next day at work, she won our foot-decoration contest.  “It did take a while to get the ink off my feet,” Ann says with a laugh.

One Day Without Shoes, on April 16, is an engaging day at ChildFund’s international office in Richmond, with contests and music, but it also reminds us about the impact something simple like a pair of well-fitting shoes can have on children’s health, education and future opportunities.

In developed countries, “we have so many options of what kind of shoes to wear,” says Sadye-Ann Henry, a treasury assistant who won the pedicure contest last year. One activity, walking on rocks, showed Sadye-Ann “how tender our tootsies are” and a glimpse of the challenges the children we serve face every day.

Ann, Sadye-Ann and many more of us at ChildFund, including some of our national offices, are preparing to join in on One Day Without Shoes by going without shoes at the office. This event, started by TOMS Shoes six years ago, is meant to raise awareness about children’s education and health and how shoes play a role in helping create opportunities for a better future.

children's feet

Children in the countries ChildFund serves need shoes to stay healthy and attend school.

In many developing countries that ChildFund serves, children must have uniforms and shoes to attend school. Also, when children have only flip-flops or no shoes at all, they’re vulnerable to cuts, diseases and hookworm infection, which have long-term implications like stunted growth and compromised health.

Anyone can participate in One Day Without Shoes. Just kick off your shoes and join the rest of us in creating awareness of an important cause.

In Brazil, Advocacy for Clean Water

By Priscila Oliveira, ChildFund Brasil

Reflecting the fifth article of the Universal Declaration of Water Rights — ”Its protection is a vital need and a moral obligation of men to the present and future generations” — ChildFund Brasil strives to educate communities about water preservation for the benefit of future generations.

The project “Meu Meio, Minha Vida” (My Surroundings, My Life), is part of the Vigilantes da Água (Water Watchers) program and is a result of the efforts invested in the communities of Vereda, Bidó, Pedra do Bolo, Tombo and Empoeira, in the Jequitinhonha Valley, a semi-arid region in the state of Minas Gerais in eastern Brazil.

Brazil water watchers

A group of water watchers in Brazil gather at a pond.

ChildFund Brasil’s local partner organization, Municipal Community Association of Medina, carries out the program, which trains community leaders to monitor water quality and educate the community on advocating for their right to have access to clean water. Currently, 18 men and women monitor water quality, which benefits more than 200 families.

For Maria de Almeida, a 42-year-old farmer from the community of Tombo, participating in the program has been valuable. “This project made us learn more about the water we use,” Maria says. “And, knowing that it was contaminated, we now fight for improvement and for the preservation of the springs. I feel happy to participate in the project and for the opportunity to educate other people.”

Brazil water watcher

One water watcher gets a sample.

Paula Gava, coordinator at the Medina community association, notes, “The program is a way of working on environmental issues as a whole in the community, of making everyone reflect on the environment. At the moment, we discuss the situation of water availability.

“The reality is that there is a lack of water during this period of drought, and furthermore, we’ve detected coliform bacteria contamination,” he adds. “We already have people mobilized and aware of the bad water they consume. Our job is to provide information so that the community can organize themselves, feel empowered to demand clean water and become part of the solution.”

As the program continues, community groups are working with Minas Gerais’ rural extension agency and municipal health and agriculture departments to improve the quality of water.

Help Stop TB in Their Lifetime

By Meg Carter, ChildFund Sponsorship Communications Specialist

Tuberculosis is rare today in the United States and other developed countries, but in developing nations, it is a killer. Globally, TB has created 10 million orphans and is one of the top-three causes of death in women ages 15 to 44.

Today, March 24, we mark World TB Day by joining with the World Health Organization (WHO), the Centers for Disease Control and other international organizations to raise awareness and mobilize political and social commitment toward progress in the care and control of tuberculosis.

children in Sierra Leone

Sierra Leone has the world’s highest tuberculosis incidence and mortality rates by far.

Caused by an airborne bacteria, TB often attacks lungs and has developed strains that are resistant to multiple drug treatments. It also strikes people with weak immune systems, particularly those infected with HIV. In the 1800s, Western Europe saw the number of tuberculosis deaths peak at nearly 25 percent, but with better medical treatment and understanding, the TB mortality rate fell by 90 percent by the 1950s.

Now, as the virus mutates and resists standard drug therapies, developing nations are experiencing the same level of risk as Europe did a century ago. This year marks the second half of WHO’s two-year campaign Stop TB in My Lifetime, a program that is significant to countries ChildFund serves in Africa and Asia.

Globally, tuberculosis is second only to AIDS as the greatest killer from a single infectious agent. At least a third of HIV-infected patients worldwide are also diagnosed with TB, and in Sub-Saharan Africa, tuberculosis is often the infection that is directly responsible for death. In fact, testing positive for tuberculosis often masks HIV-positive status, which makes proper medical treatment far more difficult than for patients who have one disease or the other.

Ugandan girl holds memory book

In Uganda, TB and HIV infections are often combined, making treatment difficult. This child holds a memory book her HIV-positive parents created for her.

Despite the overall decline worldwide in incidences of TB and the development of rapid diagnostics, the combination of HIV and TB and its accompanying challenges have kept Africa from being on track to halve its tuberculosis deaths by 2015, a WHO goal.

WHO estimates that 500,000 children were newly infected in 2011, and 64,000 died. Tuberculosis is particularly difficult to diagnose in children; current TB tests are largely inaccurate for children.

Poor communities and vulnerable populations also suffer disproportionately from TB. At highest risk are young adults, infants, diabetics, smokers, those infected with HIV, people who are malnourished and anyone living in crowded or unclean conditions — such as refugees and others displaced by a natural disaster, political oppression or civil unrest.

Because TB threatens the well-being of children where we work, ChildFund supports local government initiatives and public messaging. Here are some facts about ChildFund-supported countries and their exposure to TB:

Sierra Leone has the world’s highest prevalence and mortality rates; tuberculosis incidence there is one and a half times as high as in the second-ranked country, and Sierra Leone’s mortality rate is almost twice as high.

mother and child in a Timor-Leste garden

Timor-Leste has the world’s eighth highest incidence rate of TB, but good nutrition can make families less vulnerable to infection.

Cambodia ranks fifth for prevalence and Timor-Leste eighth, but both countries tie for fifth-highest mortality rate because Cambodia has an edge in successful treatment.

Joining those three nations as very-high-incidence countries are The Gambia, Liberia, Mozambique, the Philippines and Zambia.

Areas of high prevalence include Afghanistan, Ethiopia, Guinea, India, Indonesia, Kenya, Thailand, Uganda and Vietnam. Uganda, where TB and HIV infection forms a lethal combination, has a treatment success rate of only 71 percent.  Ethiopia and Guinea also have lower-than-average success rates: 83 percent and 80 percent, respectively.

The story isn’t entirely bleak, though. Some countries have made impressive progress. Between 1995 and 2011, 85 percent of all new infections and 69 percent of relapsing cases were successfully treated. And between 1990 and 2011, the overall mortality rate fell by 41 percent.

However, every year funding falls $3 billion short of WHO’s goal to make quality care accessible regardless of gender, age, type of disease, social setting or ability to pay. International assistance is especially critical for the 35 countries designated as low-income — including Afghanistan, Cambodia, Ethiopia, The Gambia, Guinea, Kenya, Liberia, Sierra Leone, Mozambique and Uganda. Of these, The Gambia, Guinea and Sierra Leone are not currently among the top 50 recipients of Official Development Assistance.

Please join us in taking action to end the burden of tuberculosis in the lifetimes of the children we serve. When you sponsor a child or make a donation to Children’s Greatest Needs, you’ll be helping to ensure that children in our programs live healthier lives.

World Water Day: Fátima’s Story

Reporting by ChildFund Mozambique

 To mark World Water Day on March 22, we’re focusing on the myriad challenges children and families face without a reliable source of clean water.

a girl drinks water from a cup

11-year-old Fátima.

My name is Fátima. I am 11 years old, I live in Gondola, Mozambique, and I attend Bela-Vista Primary School.

Formerly in my school there was no water source, which compelled us to walk long distances with a 20-liter container looking for water in other neighboring communities between 5 and 7 kilometers (3 to 4 miles) away from the school.

Consequently, our lavatories were unclean and classrooms floors were rarely mopped up, which exposed all of us to the risk of catching diseases related to poor hygiene.

Luckily, a water borehole has been dug on our school grounds by ChildFund, so now we are very happy because we do not need to walk long distances to access water anymore. Drinkable water can be obtained 7 to 10 meters (23 to 30 feet) away.

Our classrooms are not dusty anymore because we keep them neat, and our lavatories are always clean. We are less likely to catch diseases, as we now quench our thirst with treated water from the borehole.

women at a water pump

Fatima’s mother (in red coat) gets water at the pump.

This lady pictured in the red coat is my mother. She is pumping the water up here at my school for us to use at home. The beneficiaries of the water are not only schoolchildren but also the neighboring community.  We don’t need to walk long distances looking for water to drink, to cook, to wash our clothes and to give our animals to drink.

Were you inspired by today’s blog? Share your thoughts on the subject with your Twittter followers! This week, ChildFund is encouraging its supporters to “tweet-out” for World Water Day using the hashtag #Water4Children. Top tweeters will receive water gifts sent to a family in their honor. More details here.

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