AMI in Indonesia

Objective

Support the health system in the district of Teunom [province of Aceh, island of Sumatra] to treat populations affected by the Tsunami.

Intervention context

In order to help populations who suffered from the tsunami, in January 2005 AMI sent a team to the province of Aceh [north-western part of the island], a region strongly hit with more than 131,000 people killed and 800,000 disaster victims or displaced people. Faced with the extent of the catastrophe, AMI decided to support these populations highly affected psychologically with a mental health program. After the tsunami, 95% of health structures were out of service. It was thus necessary to help the reconstruction of a health system already weakened by 30 years of struggle between the government forces and the Free Aceh Movement [GAM], a rebellious group demanding autonomy for the province. This is the reason why AMI decided to support the rebuilding of the national health system. It was also necessary to rethink and restart programs to train health care staff, whose skills had diminished due to the destructured health system. The set up of AMI’s actions was complicated by the destruction of access and communications means as well as by the conflict between the government and GAM. The peace agreement signed on the 15th August 2005 allowed AMI’s teams to access GAM areas, thus extending its activities. Since this respite, the Indonesian government has been considering the possibility, once health structures are operational, of sending health care to this area again.

The activities of the mission focus on three areas

* Re-establishing access to free, quality primary health care for the entire sub-district of Teunom [18,400 beneficiaries]. AMI chose to help strengthen the restoration of the national health system, while answering accasionally the lack of service by treating people directly in mobile clinics.

* Helping the reinsertion of victims by giving access to psychological support in the area of the sub-district of Teunom hit by the tsunami [9,000 beneficiaries]. Providing psychological support was critical for disaster victims already fragile due to the 30-year long guerilla war. The program mainly focuses on helping most the vulnerable people, i.e. children

* Promoting the training of local health care thanks to the publication of the training magazine Health Messenger [see pages 38-39] distributed throughout the province of Aceh [22,000 beneficiaries]

Results

Re-establishing access to health care:

• Helping the reconstruction of the health care system by supporting 3 curative health posts [Pustus] and the district reference health center [Puskesmas] : laboratory, hospital service, equipment, emergency supply of medicines
• Training and monitoring health care staff
• Setting up 5 mobile clinics
• 6,200 curative health care consultations
• Epidemiological watch
• Re-launching the vaccination of children under one year old [hepatitis, BCG, polio, typhus]
• Participation in the referencing of patients to the hospital of Meulaboh
• 3 schools benefited from training in first aid and primary health care

Giving access to psychological support to disaster-victims

• Detection of people suffering from psychological disorders by the managing staff trained by AMI: 20 nurses and midwives and 8 community counselors, and increase awareness
• Psychological treatment: 396 people benefited from individual consultations and 407 from group consultations
• Setting up psychosocial activities [such as cooking or sewing] organized around a mediator for adults [mainly women], for approximately 700 beneficiaries
• Raising awareness on mental health problems: 600 people took part in the World Mental Health Day organized in Teunom by AMI, in collaboration with the US NGO International Rescue Committee
• Setting up activities for children living in camps and barracks and creation of adventure playgrounds, a space where children can express their affects
• Training 40 teachers from 3 schools in problems surrounding child development and mental headline

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Project definition in Indonesia

Localization

Island of Sumatra, province of Aceh, sub-district of Teunom Beneficiaries

• Population covered: 18,400 inhabitants
• Direct beneficiaries: 18,400 beneficiaries

AMI’s team on this project

• 6 expatriates: head of mission, administrator, logistician, psychologist, nurse, head of the Health Messenger magazine
• 60 local staff: doctor, logistician, administrator, psychologist, translators, nurses, etc.

Sources of Funds

Fondation de France [FDF], European Community Humanitarian Office [ECHO], AMI

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The 1st issue of Health Messenger Indonesia is out !

For several years, AMI has published magazines of continuous medical training for the local health agents, they are called: Health Messenger (the Messenger of Health).

The number one of Health Messenger Indonesia was out recently (the first copies were received on December 21st 2005). It is distributed at 5000 bilingual copies(English and Indonesian) in the zones of Medan, Meulaboh, and Banda-Aceh, this issue talks about the topic of the mental health.

If Health Messenger Indonesia falls under the programs of International Medical aid, it is also a working tool for all the local health agents of the area of Aceh. It enables them to look further into regularly various medical and psychosocial topics and holds account of the actual context of the area.

The concept of Health Messenger was created by the team of AMI Afghanistan located in Peshawar in the purpose of forming a network of insulated health agents. The first issue of Health Messenger Afghan (entitled Salamati, meaning good health in Indian millet) is published in 1993.It is the 1st born one of a family which will keep increasing thereafter. The idea will be taken by the AMI mission in 1995, for the Burmese refugees and the local health agents.Ten years later, during the summer 2005, the Thailand publishing was increasing to work with the design of first Health Messenger Kids, magazines intended for the children from ages 6 to 9, and Health Messenger Junior, for the young people from 10 to 15 years.In 1999, an edition in local language (khmère) was born in the provinces of the North-West of Kampuchea Since February 2004, the "Ponleu Sokha Peap" association takes care of the edition and the publication of Health Messenger Kampuchea

This 64 pages bilingual magazine - Pembawa Pesan Kesehatan /P2K, in Bahasa Indonesia - is produced by a team of professionals and deals with local health topics. The first issue (December 2005 – 5,000 copies) focused on “Mental health”, the second one (8,000 copies) deals with “Communicable diseases: control and response”, a major health concern in Aceh but also in the world.

In the aftermath of the tsunami (26 Dec 04), medical professionals were preoccupied with Measles, Cholera, TB, Polio, etc., due to the high risk of potential outbreaks. Preventive actions such as immunization and public awareness campaigns were set up and an emergency disease surveillance system were established. One year later, despite significant improvements in the general situation it is important to continue the work of developing routine and sustainable public health programs.

HM aims to be a support for AMI’s programs in Aceh, but its main task is to serve as a training tool for all local health agents in NAD and to have a regular, in-depth look at health and psychosocial and medical themes.

Enabling different actors (WHO, PHO, international and local NGOs, health workers) in the health field to express themselves in its articles, HM aims to be a place of exchange and encounters. Through sharing knowledge and placing diverse medical practices side by side, HM hopes to contribute to debate and bring a pluralistic view on medical and public health know-how, in order to improve our accounting of needs and our approach to them.

This second issue is the offspring of a partnership that AMI has initiated and coordinated by collecting information from different health agents, willing to participate in this adventure: International Rescue Committee (IRC), MENTOR Initiative, Médicos del Mundo, and AMI. All the articles have been proofread by the World Health Organization (WHO) and the Provincial Health Office (PHO, Dinas Kesehata Propinsi).

HM is distributed by AMI and to and by local and international NGOs, international institutions, UN agencies and Indonesian Health authorities in Banda Aceh, Aceh Besar, Aceh Jaya, Aceh Barat, Aceh Tengah, Bener Meriah, Gayoluwes, Aceh Tenggara, Aceh Nagan Raya, Aceh Barat Daya, Aceh Selatan, Aceh Singkil, Aceh Tamiang, Aceh Timur, Langsa, Lhokseumawe, Bireun, Pidie. A questionnaire is included in this issue and surveys on the form and content of the magazine will be regularly carried out in order to answer to the specific needs of our readers. The third issue on “Maternal health” will be out next July.

Julie Chansel, Publication manager indonesia.hm@amifrance.org

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