Reza Abel – MSF Health promoter filariasis campaign.

In July 2008, MSF, in partnership with the Indonesian Ministry of Health, launched a health campaign in the remote district of Asmat, in Papua.  The project, which should last for two and a half months, provides prophylaxis treatment for filariasis to the semi-nomadic population of the district. With the help of government staff, drug administration should continue over a five-year period in order to eradicate the disease, which has a high prevalence rate in the area.

MSF health promoter, Reza Abel, describes his daily work and explains why liaising closely with the population is critical for the success of the campaign.

“Every morning an MSF team of two health promoters, travels to the villages by boat to inform the population about the visit of our medical teams in the next few days. We need first to meet up with the village chief and explain about filariasis and why we want to provide treatment to the population. Once they have agreed, we set a time for our teams to come back and the local health workers, also called kaders, help mobilising the villagers.

In general the medical teams work either in the village health centre or perhaps in a school or in a church. We bring the drugs, paper cups, and gallons of water, as well as health materials, flyers, and pictures.

At the same time, our medical teams also offer basic health care screening for malnutrition and for cases of  hydrocele - swelling of the scrotum. Those with clinical signs can make an appointment for a medical consultation with a surgeon in Agats. MSF restored the operating theatre at the Agats health centre and surgery is now available.

What kind of the challenges do you face?
The logistics are tricky; the villages can be difficult to reach so we use speedboats. We need to reach the whole population. That's hard because they are semi-nomadic so they constantly move between their village and the jungle, where they stay for weeks hunting, fishing and collecting wood. They would then normally stay in temporary shelters called bevaks, several families under one roof. We also visit the bevaks along the river but it's very hard to track down the population and make sure we reach all of them. Nobody knows their exact number and we only have an estimation of the population given by the Ministry of Health. 

Why is health promotion so important for the campaign?
Health promotion is very important because the population can't see the immediate benefit of the campaign.  It can be tricky, people here are not used to western medicines. It's very new to them; sometimes they don't know what to do with the pills and we have to take a pill in front of them to show them how to take their drugs.

Explaining about the treatment is challenging in itself. But it's critical for us to correct any misunderstandings they might have. For example, there's been a rumour in a village saying that some people have died after taking the drugs. This, of course is only a rumour, but it really has made our work more difficult. Today, everywhere we went the villagers were really reluctant to take the pills. We had to clarify everything including the possible side effects so they are not scared of them. Establishing a good relationship and dialogue is critical to gain the population's trust.

What about the work in itself, is it difficult?
It can be hard but the team is very motivated. We have to travel several hours by boat. Sometimes it's very hot, sometimes it's raining all day. The river and the sea can be agitated. If the weather is bad and we can't come back to the base then we have to stay in a bevak, it's uncomfortable but we're happy to do it. On the other hand it's rewarding because the drugs will help eradicate this disease from Asmat.  It's really something for the people there. In some of the villages we struggle because they are worried about the treatment; in others they trust us and it's easy. It really varies.

What has this experience brought you?
It's my first time in Papua, I come from Ambon and although we are from the same country, Papua is so different! I like the job. Every day is like an adventure. The people of Asmat are different and very interesting. They live close to nature and have a unique culture. By talking with them, we get to know more about them and develop a relationship; it's a very interesting experience.