We Come with Our Hearts, Even If They Think We Are Traveling Salesmen
Puskesmas officers are demanded to be more active in reaching out to the people and providing services outside the puskesmas.
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·5 minutes read
Kompas/Angger Putranto
Midwife Dayu Ummu Kholisyah, 44, visiting and examining the health condition of Satrah, 87, in her house in Kertosari, Banyuwangi, Monday (15/1). Since 2014, Puskesmas Kertosari has a Fast Action Response movement, which a proactive effort for residents with high health risks.
On Saturday (13/1/2018), Yulinda Tiyas, 28, was busily completing the files scattered on her desk. The midwife in the Kertosari community health center (puskesmas) in Banyuwangi regency, East Java, is a casual worker managing the puskesmas\' administration.
Beyond her administrative duties, Yulinda also needs to deal with patients as a midwife, especially in the afternoons and evenings when she carries out the Healthy Indonesian Family Program (PIS-PK).
The program is a Health Ministry initiative to strengthen the quality of public health at the primary healthcare service level. In the program, puskesmas officers are demanded to be more active in reaching out to the people and providing services outside the puskesmas. The hope is to reinforce public health campaigns and to tackle sicknesses at puskesmas without having to refer the patients to hospitals.
“We survey the conditions of the local neighborhood, including the lifestyle and public health. We don’t just collect data. We also carry out health interventions. The simplest thing we can do is check blood pressure,” Yulinda said.
In line with the government’s stipulations, the PIS-PK targets to treat 30 percent of families in a service area.
“From August to December 2017, my target was to visit 200 families. I often did these visits after I finished my work at the puskesmas. To achieve my target, sometimes I arrived home at 8:30 p.m.,” Yulinda said.
Exhaustion is par for the course for Yulinda, as she often needs to sacrifice her family time in the evenings to carry out the health program. Despite the increase in workload, she said the PIS-PK program enabled her to meet with and talk to many people.
Her exhaustion disappears when she meets with families who receive her warmly and are open to her suggestions on hygiene. However, she also often faces rejection.
“Sometimes, people don’t even open their front door for me as they think I am a sales agent offering cooking pans. I just keep on knocking on the door and say that I’m a health officer from the puskesmas. I say that I came to check on their health and not to sell cooking utensils,” she said.
Another memorable experience for Yulinda was when she saw a couple bickering during her visit. The problem was quite trivial, in that the couple could not find their family card. The couple blamed each other. Family cards are instrumental in health surveys.
Floating puskesmas
The government’s family health initiative can be done in numerous ways, depending on the area’s geographical condition, sociocultural characteristics and puskesmas officers’ creativity.
In East Kalimantan, for instance, the Mahakam Ulu regency administration has been providing a floating puskesmas since 2016 to reach out to the people living along Mahakam River.
The floating puskesmas uses two big speedboats with 400-horsepower engines. One speedboat carries medics and the other carries medical equipment and medicines. The floating puskesmas visits patients once a month.
Mahakam Ulu, a new regency partitioned out of West Kutai regency, is located on the upstream part of the 920-kilometer-long Mahakam River. Due to poor road conditions, people rely on the river for speedy access into and out of Mahakam Ulu.
The floating puskesmas provides nutrition counseling, checks by general practitioners, tooth extraction, ultrasound tests, electrocardiogram tests, medical checkups and assisted deliveries. Its medical team is usually comprised of 15 doctors, including general practitioners and dentists.
“Sometimes we bring in medical specialists from hospitals in West Kutai. The team travels for 10 to 14 days a month. They go to hamlets to provide counseling,” said Mahakam Ulu health office head Agustinus Teguh Santoso.
The floating puskesmas usually receives between 150 and 200 patients a day. Floating puskesmas coordinator Magdalena Long said hypertension, diabetes and toothache were the three most common health problems in the past 18 months.
It has not always been smooth sailing for the floating puskesmas. The medical team members are putting their lives at stake. Their speedboats and wooden boats have capsized countless times as they sailed through the rocky Mahakam River with its fast current.
After completing their travel of at least 10 days, the floating puskesmas medical team members went home to Mahakam Ulu capital Ujoh Bilang. They return to their work as staff members of the local health office while awaiting the floating puskesmas’ next scheduled travel.
It takes a lot of hard work and patience — and money — to manage the floating puskesmas. The neighboring regency of West Kutai established a similar service using a motorboat in 2008. However, West Kutai’s floating puskesmas no longer operates due to the steep operational costs.
For one trip, the speedboat needs 400 liters of solar. The price is cheaper compared to the money locals need to spend to traverse the river for hours to reach the district’s puskesmas. Agustinus said he understood the risks. “We will keep doing our work to serve the people,” Agustinus said.
