South Oenenu. It’s nine in the morning, and a group of women carrying babies and toddlers have gathered on the porch of a rundown house owned by the chief of South Oenenu village in North Timor Tengah district, East Nusa Tenggara province.
All eyes are trained on Esni Ewalde, a young woman teaching the mothers about nutrition and how to prepare simple, healthy meals for their children.
“Can I ask a question? Every time I feed my daughter with formula milk, she gets diarrhea, so should I not give her milk?” asks Maria Mano, one of the mothers.
Maria later says she realizes that it’s not the milk, but the other food she has been feeding her four-year-old daughter that is the problem.
“I used to feed her rice porridge without any side dishes. I didn’t give her any eggs or vegetables, but then I found out that my daughter was undernourished,” she says.
The women follows Eni’s class with enthusiasm as they tend to their children needs. They learn how to wash their hands and their children’s hands properly, and how to provide nutritious meals for their toddlers with food that is easily available in the area.
Esni, one of the five officials at the local integrated health post for women and children’s health, known as posyandu , patiently answers every question from the mothers. She also shows them how to prepare a nutritious rice porridge with vegetables, eggs or tempeh.
“Life is hard here in our village,” Agustinus Sasi, the chief of the village, tells the Jakarta Globe. “We don’t have a supply of clean water and most of our people live in poverty.”
There are 228 families in South Oenenu, located just six kilometers from Kefamenanu, the capital of North Timor Tengah districts, one of the newly established districts in the province.
Most of the villagers are subsistence farmers, restricted by the dry weather and rocky soil to growing corn, cassavas, yams and bananas.
“We can only work on our land during the rainy season [which lasts for three months out of the year], while for the rest of the year we have to find something else to do to survive, such as harvesting tamarind and selling it in the market,” Agustinus says.
The nearest health facility, a community health center or puskesmas , is located four kilometers away and can only be reached by foot.
“Sometimes when someone is really sick, we have to carry them and walk all the way to the Puskesmas,” Agustinus says.
Like many other remote villages throughout East Nusa Tenggara, South Oenenu is also grappling with an acute shortage of clean water. Although geographically close to the district capital, the villagers still have to walk up to 1.5 kilometers to fetch drinking water.
“It’s only enough for cooking and drinking, definitely not enough for washing or bathing,” Agustinus says. “What’s even worse is that the spring is also used by our cattle, which leaves the water polluted. That’s why there are so many cases of diarrhea and skin disease.”
Numerous requests have been made to the district authorities to provide clean water to the village, but the village chief says his efforts have gone unanswered.
“We don’t have a grand dream. All we ask for is a dependable water supply. It will change our lives,” he says.
“The climate and soil condition of course play a part in causing the health problems here in North Timor Tengah, but the main problem is low awareness when it comes to health and nutrition,” says Joseph Budianto, the area development program manager for East Nusa Tenggara at Wahana Visi Indonesia, the local branch of World Vision International, a Christian development organization.
Wahana Visi Indonesia has been working closely with locals to tackle poverty, health and economic issues.
“What’s really sad is sometimes the locals manage to grow vegetables but then they sell the vegetables to the market and use the money to buy instant noodles or sodium-loaded snacks,” Joseph says.
A nationwide health survey carried out by the Health Ministry in 2010 found that 29.4 percent of children aged under five in East Nusa Tenggara were undernourished and 58.4 percent suffered from stunting due to poor nutrition experienced by mothers during pregnancy. The figures were the worst in Indonesia.
A separate study conducted by WVI in 2009 found that 44.2 percent of children in North Timor Tengah were undernourished and 57 percent were stunted.
Dogels Maradesa, the maternal child health and nutrition coordinator at WVI’s North Timor Tengah office, says access to proper nutrition has always been a serious problem in the region.
“Much of the land is dry, while the soil is rocky and contains limestone,” he says.
With their land yielding poor harvests, villagers have turn to slash-and-burn forest clearing to open up new land, in the process damaging the ground’s ability to retain water and thus aggravating the chronic water crisis in the region.
“There have been a lot of initiatives here, but what we need is an integrated approach, because nongovernmental organizations and the government have been working separately on programs that often overlap one another,” Dogels says.
In South Oenenu, the lack of knowledge about nutrition has led to mothers often feeding their babies and toddlers only rice porridge and salt.
“Many mothers in South Oeneno don’t realize that their children are undernourished because they don’t appear to be sick,” says Fridliukonas, the WVI facilitator in South Oenenu. “But actually more than 30 percent of children under five years old in this village are undernourished.”
Changing bad habits in the village was a tall order, he says, because the villagers preferred to spend money buying processed foods and snacks rather than nutritious food for their children.
“Mothers are busy helping their husbands working in the fields, no they have time to tend their children’s needs. It took us a very long time to achieve a positive change,” he said.
Assisted by WVI, posyandu volunteers dedicate their time to teach the mothers how to prepare healthy meals by themselves, using nutritious food they can grow in their own backyards.
“Of course the environment is tough, but it’s not impossible to grown some vegetables and get some sources of protein,” Fridliukonas says. “The more pressing problem is their lack of knowledge about nutrition and how to prepare the food.”
Maria Imelda Noe, the village midwife, says she treats children on a daily basis suffering from upper respiratory tract infections and skin rashes, caused mostly by poor hygiene and a lack of water.
“There are also a lot cases of diarrhea and stunted development because of the bad diet,” she says. “The kids aren’t being fed properly.
Given the lack of health facilities in the area, the mothers have turned to posyandu to monitor their children’s development.
Esni, who volunteers at the South Oenenu posyandu, says she dedicates her time and effort to teach the villagers about health issues because she is deeply concerned about the children’s health.
“I noticed there were so many underweight children in my village. I felt I had to do something to help out,” she says.
Assisted by WVI, Esni underwent training to be a posyandu volunteer.
She was taught basic information about nutrition and health so she could teach the villagers how to make the most of their dry and barren environment to provide decent food for the family.
In neighboring Oenino village, a few kilometers away, villagers have begun integrating the lessons gleaned from their own posyandu with gardening activities, in a scheme called “Kebun Gizi” or “Nutrition Garden.” As part of the program, they are finding ways to make the ground more fertile so they can grow vegetable such as spinach, string beans and carrots.
“Our ultimate goal is to bring women back home so they don’t have to walk so far, leaving their children at home, to work on their land,” Sri Wulandari, the maternal child health and nutrition specialist for the East Nusa Tenggara administration, tells the Globe. “Before we started the garden, mothers had to leave their children for a long time and they didn’t have the opportunity to pay attention to their health.”
Amanda Tnomel, one of the volunteers at the Oenino posyandu, says that even though the village has better access to clean water than South Oenenu, there are still many undernourished children.
Spurred by what they learned at the posyandu, the Oenino women began growing vegetables in their own backyard.
“We began harvesting spinach and string beans a while go,” Amanda says. “The children like their porridge better now that we put some vegetables in it.”
Most of the health and nutrition problems in North Timor Tengah are associated with the lack of clean water.
In Oenino, lives changed for the better when the government, under its National Program for Community Empowerment (PNPM Mandiri), provided water containers, and WVI set up a pipe bringing water from Mount Mantis.
“We always had skin diseases and diarrhea problems before, but now our life is so much better with the clean water,” says Daniel Afu, the Oenino village chief.
With 90 percent of the villagers reliant on farming for their livelihood, having access to a reliable source of water changed everything. All of a sudden they were able to grow and harvest more corn, cassavas and bananas. They even managed to grow leafy vegetables.
Minarto, the Health Ministry’s director of health and nutrition, says overcoming nutrition problems in regions like East Nusa Tenggara calls for a special approach.
“We have prepared a very specific intervention to tackle the nutrition problems in East Nusa Tenggara. The strategy is very different from efforts to tackle nutrition problems elsewhere, because the problem is very complex,” he says.
Minarto says that the province, along with 10 others where the prevalence of malnutrition and stunting remain high, will be a model for implement the government’s long-term initiative on the issue, which includes public empowerment, framing reformation and funding disbursement to create more capable health volunteers who can provide proper counseling for mothers.
“However, we also provide a direct intervention for a province like East Nusa Tenggara,” Minarto says. “We give the children medicines, vitamins and additional food, especially for those who are already undernourished.”
East and West Nusa Tengara have the highest rates of malnutrition nationwide. Undernourishment is also still a very common problem in Gorontalo, West Kalimantan, East Java and West Java.
Minarto says the government also plans to revitalize all posyandu by providing incentives for the volunteers and giving funding to support posyandu activities.
According to the Health Ministry’s 2010 Basic Health Survey, 17.9 percent of children under five are underweight nationwide, marking a decrease from 31 percent in 1989.
Fifteen percent is the widely recognized indication of a nutrition emergency.
A UN report released last week noted that while the government had made great strides toward ending malnutrition among children under five, the pace of progress was slowing and there was a danger that Indonesia could miss the target of slashing the rate by two-thirds by 2015, set out under the Millennium Development Goals.