In a country comprised of thousands of islands, some of which have never been explored by outsiders, one of the most isolated regions in Indonesia is Asmat District, six and a half hours by plane from Jakarta to the Papua capital of Jayapura, then another hour’s ride in a 10-passenger Twin Otter or Caravan, followed by a nine-hour fast ferry ride across the Arafuru Sea.
It is a journey that can only be regarded as risky and not for the faint-hearted, given the possibility of extreme weather that can and does capsize vessels and that causes some passengers to stay on uninhabited islets to await the next boat rather than dare forbidding looking clouds.
This is the southern coast of Papua, nearly 30,000 square kilometers of forest, rivers and swamp with only 90,316 people in a district about the size of Belgium. Surrounded by mangrove forests and rivers, Asmat City is built on wood and boards over a swamp. The ethnic Asmat coastal tribes live as fishermen. Motorcycles can only be found in Agats, the capital of Asmat district 30 minutes down the river by boat. In more remote villages, the majority walk or use boats.
Prone to Illness
In January, Asmat faced an extraordinary crisis when 646 children were affected by a measles outbreak, a disease eradicated in the Americas and much of Europe. With 144 children recorded as suffering from malnutrition, the two diseases killed 70 people. With a global mortality rate of 19 victims per million people, measles is not a deadly disease and its treatment is not difficult. But 70 lives are an expensive price for a preventable tragedy.
It isn’t the first time famine and disease have taken the lives of under-five children in Papua. Asmat's children look at incoming visitors expectantly with bloated bellies and breastbones that stand out, a common indication of malnutrition, apparently hoping the arrivals mean food. A total of 55 residents of Yakuhimo District died of starvation in 2005. Twice in the same area, as many as 100 residents have died. Another 95 residents of Tambraw District died because of the same issues in 2012.
Malnutrition is inevitable because there is no real food security. The marshy soil is not suitable for agricultural use. Consequently, nutritional intake for children is far from ideal, a problem made worse by the limited availability of clean water. With the soil unsuitable for wells, clean water is obtained from rainwater catchment, a problem in the dry season.
Although water is available from nearby rivers, it is unhealthy because villagers, unaware of sanitation and clean water provision, defecate on the banks where they obtain drinking and cooking water. The rivers and swamps are murky at best and the water is unfit for consumption.
Rare Health Facilities
There are only 16 health care centers, known as Puskesmas, serving 23 districts and 224 villages. However, Asmat is not the only region in Papua with minimal health care facilities. In an area of 319,000 sq km – an area the size of Poland or Norway, with a population of just 3.5 million people, Papua has only 589 health service units. Compare that with Jakarta, with 2,763 health units covering 664 sq km.
The low number of health care facilities in Papua is proportional to the lack of health personnel. In such a vast territory, Papua has only 17,000 medical personnel. In comparison, in West Java with an area of 35,000 sq km, there are 119,000, approximately seven times as many as Papua.
The Agats district has only one surgeon and seven general practitioners. It has no pediatrician although the hundreds of cases of malnutrition in infants and toddlers require handling by specialists in childhood diseases and afflictions.
What Needs to Be Done
Asmat’s isolation is a fundamental issue affecting the availability of public services such as health, education, and others. However, the central government is not turning a blind eye to the existing development gap. Between 2002 and 2017, Papua has received a special allocation of almost Rp58 trillion (U$2.4 billion). Another Rp8 trillion has been budgeted for 2018.
With Asmat District having been allocated not less than Rp173 billion for health care, it is almost incomprehensible how famine has always repeated itself there. However, funds go unused because the sick don’t or can’t seek hospital care. A trip from one village to another requires long hours of boat travel, and few even own boats. Take Atat village, located on the banks of the Mamat River and surrounded by swamp. To reach the closest district hospital in Agats, residents must rent a boat costing Rp3-4 million (US$210-292) for three hours’ travel time. Just finding money to pay for food is difficult. Renting a boat is out of the question.
If the trillions of rupiahs allocated to the local government aren’t utilized on fundamental issues, the situation isn’t going to change. The hungry continue to be hungry, the sick will get sicker. What is really needed in Asmat is the opening of road access. Where they exist, 43 percent or Asmat’s roads are unpaved and 56 percent are made of wooden planks. Only slightly less than 1 percent of the district’s roads are made of concrete.
The construction of roads and transport facilities is vital to contribute to the eradication of various issues of low quality of life in Asmat. The opening of access would facilitate the transfer of goods and services to contribute to the mobility of the public to use public facilities such as access to health care. The availability of proper transportation of access would also allow the construction of other crucial facilities such as hospitals, schools and water treatment. But given the district’s isolation, it is a daunting task. Just getting there is hard enough.
Muhammad Zulfikar Rakhmat is a doctoral candidate at the University of Manchester. Dikanaya Tarahita is an Indonesian freelance writer. They are regular contributors to Asia Sentinel.