SampelaHealthProgram2007(C.Crawford,J.Wallace,R.Watson,C.Young)

Introduction

Whentheearthissickandpolluted,humanhealthisimpossible....Tohealourselveswemusthealourplanet,

Andtohealourplanetwemusthealourselves.BobbyMcLeod(Kooriactivist,aboriginal)

Environmentalhealthcomprisesthoseaspectsofhumanhealthanddiseasethataredeterminedbyfactorsintheenvironment.Italsoreferstothetheoryandpracticeofassessingandcontrollingfactorsintheenvironmentthatcanpotentiallyaffecthealth.Inrecentyears,mystudiesinanthropologyhavemademequestionnotonlytheroleoftheenvironmentinhumanaffaires,butalsotheimpactofhumanactivityontheenvironment.Withinthedevelopingworld,themajorityofinfectiousdiseasesaredirectlyrelatedtopeopleslifestylepracticesinthecontextoftheirsurroundingenvironment.Forexample,leavingstagnantwateruncovered,whichthenbecomesavitalbreedingsiteformosquitolarvaeandapossiblehostfordiseasessuchasMalariaorDengueFever.Theprevalenceofdiseaseincreasesamongstmorerural,impoverishedanduneducatedsocieties.Thusthereisaneedtoinvestigateandunderstandthesecommunitieswithinthecontextofboththeircultureandtheirenvironmenttoensurebetterhealthcaremethodsandapproaches.

Inthisaspect,IinvestigatedthemedicalbeliefsoftheBajau(arural,seafaring)societyinSoutheastSulawesi,IndonesiaandthenanalyzedtheBajauperceptionsoftheirsurroundingenvironmentspurposeandimportancetotheirhealthandwellbeing.Themajoraimsofmyprojectincludedthefollowing:

Fromahealthperspective

TounderstandperceptionsofhealthandcausationofillnessintheBajaucommunity. TounderstandtheBajaucommunitiesknowledgeofmodernmedicine. TostudythecontributionofculturalbeliefsinthechoiceofamedicalremedybymembersoftheBajau

community.

Fromanenvironmentalperspective

Toexplorecurrentattitudes,environmentalknowledgeandperceptionsheldbytheBajauonecosystemstructuresandfunctionsandhowtheyperceivetheirplacewithinthatenvironmentalsystem.

Fromanenvironmentalhealthperspective

Focus1:Toevaluatewater/wastewaterimpacts

Whatistherelationbetweendailylifestylepracticesbasedonthecontextoftheirsurroundingenvironmentandtheincidenceofwaterbornedisease(Ex.AretheBajauusinglatrines?Whereisthefreshwatersupply?Dotheyusecyanideinfishharvesting?Howmighttheprevalenceofdiseasedifferbetweenlandandseabasedcommunities?)

Focus2:Toinvestigatelocalusesofmarineresourcesforhealthrelatedpurposes

Towhatextentmightlocalmedicinalpracticesbeaffectingtheresourceabundanceordecline?(Ex.AretheBajauharvestingaresourcewhichmightdisrupttheecosystemfortheirhealthneeds?HowmightthisaffectBajaulivelihoodneedsoffoodsecurityinthefuture?)

TheprojectwasconductedthroughOperationWallaceawhichhasbeenworkinginaremotecornerofSoutheastSulawesiinIndonesiasince1995todevelopresearchcentersintheLambusangoforestinSouthButonIslandandonHogaIslandintheWakatobiMarineNationalPark.WithintheWakatobiregion,IlivedintheBajauVillageofSampelafordurationofsixweekswhilecompletingmyresearch.Sincemytimeinthevillagewaslimited,onlyFocus1ofmyabovepreresearchproposalwasinvestigated.ItwouldbestronglyrecommendedthatiftheSampelaHealthProgramweretocontinueinthefollowingyear,thatresearchersalsolookintoFocus2.Interviewquestionnairesaswellasrawdatahavebeenincludedwithinthisreporttoaidfutureefforts.Pleasefeelfreetocontactmeifyouhaveanyquestionsorconcerns.

Whileconductingresearchwithinthevillage,IwasalsosimultaneouslycreatingastudentorganizedgroupbetweenanthropologystudentsandmedicalelectivesatthesitetoanalyzeanddiscussprimaryhealthissuesinSampelaandKaledupa.Inthefinalweeksbeforemydeparture,theSampelaHealthProgramwascreatedasaresponsetothelackofformalizedknowledgebetweenlocalgovernment,communityleaders,andresearchers.

CamiaCrawfordBrownUniversity,RI,USAAnthropology08

Aimsandobjectives

TheaimsandobjectivesoftheHealthIssuesinSampelaandKaledupa(HISK)aspectoftheSampelaHealthProgram(SHP)aretoinvestigatetheprevalenceofhygieneandwaterqualityrelatedhealthissuesonKaledupaandSampela,aswellasthemostimportanthealthissuestotheSampelacommunity,withrespecttowaterborneillnessesandriskassociatedwithdailyactivities.Theaimofthesefollowingstudiesistoenableanunderstandingofthegapsinthecommunitysknowledgeofhealthybehavior,inordertocreateanddeliveraneducation/informationprogramtoreducetheprevalenceofwaterbornediseases.Inadditiontothis,theSampelaHealthProgramaimstocontinueannualcollectionsofhealthandwaterqualitydatabystudentsofOperationWallacea.Eventuallytheprogramwillaimtoincorporatecommunitymembersandtrainthemintheprocessofdatacollectionandfurtheradvanceindependentcommunitymonitoring.

Background

SamaBahari(otherwisereferredtoasSampela)isavillagebuiltupfromacoralreefflatofapproximately1300inhabitantslyingtothenortheastofKaledupaIsland,intheWakatobiregionofSouthEastSulawesi,Indonesia.ItispopulatedbytheBajaupeople,whoareknownastheseagypsiessincebeforeagovernmentsettlementinitiativeinthe1950stheylivedonhouseboatsandroamedtheopenseasaroundtheWakatobiregion.TheirreligionismostlyMuslim,howeverthereisastrongbeliefinseaandlandspiritswhichtakealargeroleinmanyhouseholdscentralbeliefs.

SamaBaharihas286householdssplitintothreesubdusuns(communities)withanaverageoffourchildrenperhousehold.Themajorityofthevillagepopulationisfemaleorunder20duetothemigrantworkernatureoftheBajaumen.Thevillageisgovernedlocallybyaheadman,theKepalaDesa,andhisfamilywithaclosenetworkof

influentialmothersandtraditionalhealers,theSandro/Sanjo.However,onamoreregionallevelthereisalocalCamat(pronouncedchamat),equivalenttoacouncil,whichreportstovariousgovernmentofficialsontheislandandregion.(putinsquarefootageorkilometerstoestimatepopulationdensity,somemoreondemographics,numberofchildren,numberofpeopleperhousehold).

Thestructureofthevillageanditsbuildingsaremostlybuiltatopcoralplatforms,hackedfromthereefitself,oronstiltsthatrise8feetabovethelowtide.Walkwaysspanacrossthecommonpathsbutindividualhousesarelinkedbyplanksofwoodorbamboopoles.Howeveratlowtideonecanwitnesslocalchildrenplayinginamongstthecoralplatforms.Theworryingfeatureofthisbuildingstrategyisthatthetoiletsandwashingfacilitiesperchprecariouslyabovechannelsflowingbetweenhouses,whichmeansthatduetotheflowsystemsandtidesonecanregularlyseehumanwastecollectinginbottlenecksorevenfloatingouttosea.

TheseagypsynatureoftheBajaupeoplemeanstheirmainfoodandincomesourceistheseaandreefitself,andinordertoutilizethisvastcommoditytheyfishbyboatusingnets,fences,gleaningatlowtideandattimesbombfishing.Anothergoodsourceofincomeisagarfishingtoselltomultinationalcorporationsforbiochemicaluse,aswellasparticipatingasinformantsinresearchthroughtheOperationWallaceaprogram.

Itshouldalsobenotedthatthereisnofreshwatersupplytothevillage,thereforelocalsmustcollectitfromawellorspringonKaledupaforasmallprice.Althoughfreshcleanwaterisnotarelativelyexpensivecommodity,itmustbetransportedfromthemainlandtothevillageoffshore.Thedifficultyintransportationresultsinlimiteduseofcleanwaterforthingsotherthandrinking/cookingsuchaswashingplates/utensilsorbathing.

ThefollowingsectionsofthepaperwilllookatthethreemajorsourcesofdatacollectedbymyselfandothersinvolvedintheHISKstudy.ItbeginsfirstwithananalysisifdatacollectedfromtheKaledupaMedicalCenter,followedbyresponsesfromcommunityinformantinterviews,andfinallywaterqualitydatacomprisedwithinspatialmapping.

HISKstudy1)KaledupaMedicalCenterreportsDatafromtheKaledupaMedicalCentersrecords,inatownhalfamilefromSamaBahari,wasenteredintoanexceldocument,bymonthlypresentationsofeachillnessbyagegroups,whichwere04,514,1544and4559yearsofage.FromMay2006untilJune2007thereportedillnesseswere

Diarrhea Dysentery Tuberculosis Malaria Worms Respiratoryinfection Diabetes Anemia

Hypertension TukakLambung(?) Accidentalinjuries Skininfection SkinAllergy Bronchitis Asthma Eyeinfections

Thisdatawasanalyzedby;

Annualdistributionofallillnesses Annualdistributionbyagegroup,ofillnessesrelatedtowaterandhygiene

Diarrhea Dysentery Malaria

Worms Skininfection Skinallergy

Annualdistributionofthemostprevalentwaterandhygienerelatedillnesses

Analysis

Graph1.Agerangecomparisonofthetotalnumberofpresentationsperillness,totheKaledupamedicalcentrefromMay2006untilJune2007.

Thisgraphshowsthatthehighestnumberofpresentationswasforrespiratoryinfectionsacrossallagegroups,withthe1544agegrouphavingthehighestnumberofpresentations.ThesecondhighestnumberofpresentationswasforskinallergyacrossallagegroupsbutwasforTukakLambungfortheoldesttwoagegroups.Chronicdiseasesuchasdiabetes,anemiaandasthmawerehighestamongsttheoldestagegroup.

Graph2.Annualdistributionofhygiene

Thisgraphshowsthatthemostsignificant

thereis

Graph3.Annualdistributionofhygiene

Bycontrasttograph2,theillnesswiththe

n

are

ehighestnumber ).

relatedillnesspresentationsinthe04agegroup.

illnessinthisagegroupisdiarrheawithapeaknumberofpresentationsinNovember(12).Atthesametimeacorrespondingincreaseinthesecondmostprevalentillness;skininfections,whichhavethreeannualpeaksinJune,NovemberandthemostsignificantpeakinFebruary(5).OverallthetrendisforasteadyincreaseincasesofdiarrheafromJulytoNovemberandthenadeclineuntilFebruary.

relatedillnesspresentationsinthe514agegroup.

mostpresentationsisskininfection,howeverwithasimilartimecourseasdiarrheaingraph2.Therearethreepeaks,thefirstinJuneandJuly,andtheanincreasetothehighestnumberofpresentationsinNovember(10)whichverysimilarinbothtimeandnumbertodiarrheacasesingraph2.Comparativelydiarrheahasfewcaseswithth

ofpresentationinDecember(3

Graph4.Annualdistributionofhygienerelatedillnesspresentationsinthe1544agegroup.

infectionthroughouttheyear;howeverthereweremorecasesof

r

.

raph5.Annualdistributionofhygienerelatedillnesspresentationsinthe4559

owsthattheillnesswiththehighestnumberofpresentationsisagain

d4

ofdiarrheapresentationsacrossallagegroups

youngestagegroup(04years)andhasapeaknumberof

mber

Thisgraphshowsthatthemostprevalentillnessisskin

eyeinfectioninmay(4casescomparedto3).Similarlytograph3therearethreepeaksofskininfectionpresentations,thefirstinSeptember(5cases)thesecondhasasimilarbutlongertimecoursetograph3fromNovemberuntilJanuary(5cases).Howeverthehighestnumberofcaseswasatthesametimeasapeakingraph3duringApril,howeverthenumbeofcaseswas8comparedto5ingraph3

G

agegroup.

Thisgraphsh

skininfection.Similarlytograph4,thereisahighnumberofeyeinfectionsinMay(7)cases,andtherearethreeannualpeaksofskininfectionpresentations.Eachpeakoccursatverysimilartimesofyeartothoseingraphs3and4,thehighesthoweverisatadifferenttime,occurringinSeptember(15cases)followedbyasecondinDecember(9cases).Withthelastpeakearlierthaningraphs3anoccurringinMarch(7cases).

Graph6.Annualdistributionofthenumber

Graph6showsthatdiarrheaisthemostprevalentinthe

presentationsinNovember(12).TheotheragegroupshaveapeakonemonthlaterinDecember,howeverthenuofpresentationsismuchless(1,2andthreecasesinincreasingagegroups)

Graph7.Annualdistributionofthenumberofskininfectionpresentations

skininfectionhasvaryingratesofpresentationamongstthe

f

andin

late

showsthatthetwomostsignificantwaterandhygienerelatedillnessesarediarrheaandskininfection.Italsoshowsthattheprevalenceofeachdiffersbetweenagegroups,withdiarrheacasesbeinghigherinthe04agegroupand

groups,withpeaknumbersofpresentationsoccurringbetweenSeptembertoDecemberandFebruarytoApril,formostwaterandhygienerelatedillnesses,butmore

rsbetweenagegroups,butonecanassumethattheyoungestagegrouparemoresusceptibletopoorwaterqualityandrelyonothersfortheirpersonalhygiene,thereforethe

eand

avelimitations,astheKaledupamedicalcentreonlyhasasmallpercentageofpatientsfromSamaBahari,andthereisalsomassiveunderreportingofillnessesamongsttheBajaupeople,notonlytotheKepalaDesabutalsoto

ealthrelateddatafromtheregionandisthereforeusefulinidentifyingmajordiseasesandtheireffectonhealthbyagegroupandseason,andowingtothecloseproximityandinteractionsbetweenSamaBahari

acrossallagegroups

Thisgraphshowsthat

agegroupsaswellasatdifferenttimesotheyear.ThehighestnumberofpresentationsisinSeptember,DecemberandMarchintheeldestagegroupNovemberandAprilbythetwomiddleagegroups.Surprisinglytheyoungestagegroupdoesnothaveashighnumbersofpresentationsasotheragegroups.Thearetworoughpeaksduringtheyear,betweenSeptemberandDecember,andfromMarchtoMay.Thesecouldcorrewithchangesinseason,waterflowand

Conclusions

winddirectionalteringthetypeofpathogen/routeoftransmission.

Thedatacollected

skininfectionshavingsimilarnumbersofcasesintheotherthreeagegroups.

Thereisalsoapatternintheannualdistributionofillnessesthroughoutallage

specificallyfordiarrheaandskininfectionsacrossallagegroups.

Thereisnodefinitereasonwhythenumberofpresentationsdiffe

prevalenceofdiarrheaishigherbutskininfectionsislower.Converselyolderagegroupsaremoreselfreliantonhygienareabletoobtaincleanerwater,thereforereducingthenumberofdiarrheapresentations.Howevertheyhaveamoreactivelifestyleleadingtoahigherriskofinjurywithacomplicatingskininfection,givingahighernumberofskininfectionsintheoldestthreeagegroups.

Limitations

Thisstudydoesh

governmentandhealthcareofficials.

Howeveritisthelargestcollectionofh

andAmbewa(wherethemedicalcentreislocated)wecanassumethatthesameseasons,tidesandreefstructureaffecteachvillagesimilarly.

HISKstudy2)CommunityInterviews

ThesecondpartoftheHISKstudywasonaonetoonebasisinthecommunity.Itwasintheformofaninterviewandquestionnairewiththeheadofahousehold(usuallythewife/mother)usingseveralinterpreters.Indepthinterviewswereconductedwith39peoplethroughoutthevillageandtookapproximatelyonehourlong.Thestructureoftheinterviewsandquestionnaireswereto:

1. Introduceourselvestothecommunity

2. Discussandrecordhealthbeliefsandbehavior

3. Identifydifferencesorunconventionalviewsonhealth,hygieneandrisktakingbehavior

Thequestionnaireincludedsectionsandquestionson Waterandsanitation

Wheretheygetwaterfrom

Dotheyboilit,andwhy?

Sicknessanddisease Recentillnessesbyseason

Whatcausesillness

Recentfamilydeaths

Medicaltreatment Rankingwhatservicestheyuseby

illness

Governmenthealthprogram Whattheyknowaboutit

Iftheyuseit,whyso/not

Attheendofthequestionnairewasariskassessmentofvariousdailyactivities,whicheachintervieweewasaskedtorankashigh,medium,lowornoriskatall.Threesetsofintervieweesweresoughtoutforthissectionincludingnormalmembersofthecommunity,localexpertsbyprofessionandforeignexpertsbyeducationallevel(Opwallvolunteers/staff).Theareasassessedwere;

Collectingfirewoodinthemangroves

Fallingfromabridge Nightgleaning Bombfishing Walking/swimmingat

hightide

Gettingavaccine

Walking/swimmingatlowtide

Drinkingunboiledwater

Drinkingcoffee Drinkingalcohol Smoking Eatingsweets

Eatingrawfish Cookingameal Disposingofwaste

aroundthehouse

Gettingmalaria Havingdiarrhea Socializingwithpeople

withdiarrhea

Results

WaterandSanitation

Graph8.Percentagedistributionofintervieweeswaterrelatedbehaviors

Therearetwosignificantthingstoobserveinthisgraph.1.)Althoughthemajorityofindividualsclaimtoalwaysboiltheirwater,manyofthemareonlyboilingtheirwateruntiltheyseebubbles(andnotfortherecommended5minutesbyWHO).Additionally,whileindividualsacknowledgeboilingwaterpreventsthemfromgettinggenerallysick,onlyafewwereabletospecificallylistcommowaterborneillnesses.

that

n

Sicknessanddisease

Graph9.Reporteddryseasonillnesses

Duringthedryseason,amajorityof

Graph10.Reportedwetseason

IncontrasttoGraph9,majorillnesses

y

individualsclaimedthatheadacheandfluwerethemostcommonillnesses.Thismayduetooverexhaustionanddehydrationfromdiarrhea.IncreaseinFlucouldbeduetoevenlesssanitaryconditions.

illnesses

ofthewetseasonwerediarrheaandmalariathussuggestingthattheremabeacorrelationbetweenprevalenceofspecificillnessesandtypeofseason.

Graph11.Reportedfrequencyofdiarrheaperintervieweeandtheirfamily

Duetoalackofinconsistencyinanswersandthepossiblesensitiveorembarrassingnatureofthequestion,therearenoconclusionsthatcanbeconcretelymade.

Graph12.Variouscausesgivenbyintervieweesfordiarrhea

Thetoptworeasonsforcausesofdiarrheagivenbyindividualswereassociatedwitheatinginvertebratesorthewetseason.Interestingly,iffecalmatterisbeingdisposedintothesurroundingreefflatwhereBajauvillagerscollectinvertebratespeciesfrom,adirectlinkcanbeidentifiedbetweenpeopleswasteandeatingpatternsinrelationtodiarrhea.

Graph13.Percentageoftotaldeatperagegroup,andthemaincausesofdeath.

hs

Althoughthestudyfocuseddeeplyonwateranddiarrhealpatterns,duringinterviewsitwasdiscoveredthatyellowsicknesswhichwaslinkedwithblackmagichadsymptomswhichcloselyrelatedHepatitisB(perhapsanevengraverdangerandpublichealthconcernforthevillage).

Firsttreatmentchoiceperillness

0102030405060708090

Malaria

Diarrhoea

Skinrashes

Earinfections

Stomachache

Eyeinfections

FeverP

ercentageof

interviewee

s

doctor/hospital

traditional healer

selfremedy

MedicalTreatment

GraphW.FirstTreatmentChoiceperIllness

Thefollowinggraphdemonstratesahighpreferenceforselfremedyforthemajorityofcommonillnessesrelatedtopoorwaterquality.Whilepreferencefortraditionalhealersanddoctorsvarydependingonillness,theyaresoughtalmostequallyincasesofdiarrhea.Apublichealthprogramtargetedwilltherebyneedtoincludebothpracticesforittobeeffective.

GraphX.CombinedriskassessmentscoreofdailyacbytheSampelacommunit

tivitiesy

WhileDiarrheaiseasilyidentified

vities

l,

Thus

t

GraphY.Combinedrisk

Interestinglythisillustrateshow

asahighriskamongstthecommunity,behavioralactiwhichmaycausediarrhea(i.e.Walkinglowtide,wastedisposarawfish,interactingwithpeoplewhohavediarrhea)arenotacknowledgeasmajorrisks.thelinkbetweendiseaseandrelatedcausalbehaviorarenoidentifiedinthepopulation.

assessmentscore

cultureandeducationcaninfluenceperceivedrisk.Asshown,localandwesternexpertsnotedwastedisposalandwalkinginlowtidefarmoredangerousthanthelocalnonexpert.

Conclusions

inthisaspectoftheHISKstudyrevealseveralimportantfindings.Mostimportantlywediscoveredthatdiarrheawasmostprevalentduringthewetseasonandthatthereislittleunderstandingamongst

rease

finitivesourceoftreatmentsoughtwhenpeopleexperiencedsignsofdiarrhea.Sincethemajorityofwaterborneillnesssymptomswerereportedlytreatedbyselfremedy,itcouldmeanan

.

allimitationswithinthisstudythataredifficulttoknowthedepthsof,butshouldsurelybeacknowledged.Likeanyinterviewitischallengingtoknowwhethertheintervieweeisbeingcompletelyhonest

atea

ygivena

ulturewillinherentlyplacedifferentriskvaluesondifferentthingsbasedupontheirfamiliaritywiththething/experienceor

rrhea,

h

eachofthethreesubdusunsthroughoutthevillageaskingwhethertheyhadexperiencedMalaria,HepatitisB,Cholera,Flu,orDiarrheawithinthelastsix

ttoh

Thedatacollected

thecommunitybetweendiarrheaandotherwaterbornerelatedillnessesandthebehaviorswhichmayincrisksuchas,walkingthroughthechannelsatlowtidewhenfeceshaveyettobeflushed,notboilingwaterforalongenoughperiodoftimeornotatall,andeatingrawinvertebratespecieswhichmaybecontaminatedwithhumanfecesintheenvironment.

Inadditiontothis,therewasnode

underreportingintheincidenceofdisease.Additionally,sincebothtraditionalhealersandKaledupandoctorsaresoughtbydependinguponafamilyswealthorculturalpreference,therecanbenoclearwayforapublichealthapproachwithinthevillage.Tellingpeopletochangecertainbehaviorswillnotbetheanswer,sincetheBajau,anomadicpeople,haveneverlistenedtoanyoutsidebodyotherthanthespiritswhichtheyfeelakinto

Limitations

Thereweresever

regardingsensitiveandpersonalquestions.Althougheveryeffortwasmadetoensureconfidentialityandcrespacewhereintervieweestofeelcomfortable,nonetheless,ourmostinaccuracywasregardingthenumberoftimesanindividualexperiencessymptomsofdiarrheainthemonth.Itshouldalsobeacknowledged,thatalthoughasensitivequestiontobeaskedbyaforeignstranger,theBajaupeopledonotquantifyexperiencesbdaysortimesasweinthewesternworlddo.Insteadtheymightclassifythingsintermsofhappeningmorecertainseasonandhappeninglessinadifferentseason(asseeninthewet/dryseasongraphs).

Finally,theconceptofriskisdifficulttdescribeandalsotomeasurecrossculturallysinceeachc

theireducationalknowledgeofit.Forexample,theBajaumaynotcitemangroveharvestingasparticularlydangerousbecausetheyarewellskilledintheartofusingaknifetochopdowntrees,whereasaforeignermightfindthistaskincrediblydangerous.Similarly,theBajaumightacknowledgemalariaasagreaterriskthandiabecauseifanindividualcontractsmalariaevenjustonce,theymaydie.Yet,anindividualcancontractdiarrheanumeroustimesthroughouttheirlifetimeandnotdieduetoit.Childmortality,commonandoftencausedbydiarrheaiswidelyacceptedamongstthecommunityandtherebyoftentobeexpectedamongonetoseveralofawomansbirths.Theriskassessmenttherebyaidsusinunderstandingthesesocialandculturaldifferenceswhicmaydictatetheneedformultifacetedpublichealthapproaches.

*Note:Abasicquestionnairewasdistributedtoeachhouseholdin

months.ThiswasdoneunderinsistenceoftheKepalaDesa.Whileourteamattemptedtomaketheroundsamongthevillage,theKepalaDesainsistedtoorganizetheeventhimselfandgivemetheresults.WhenIwencollecttheresult,allformswerefilledoutthesame,withalarminglyhighreportsofcholeraandmalaria,whicwouldassumeeveryoneinthevillagehadcholeraandshouldthereforebedeadorincrediblyill.ThedocumentswerefalsifiedforwhatreasonIamunaware.Mostlikely,Ibelieve,itwasaclaimofstrongdesireformoremedicalattentiontobebroughttothecommunity.Wedidnotusethisdatainourfinalsummaries.

HISKstudy3)WaterQualityandSpatialMapping

ThethirdaspectoftheHISKstudyisquantitativeincomparisontotheothercomponentsbutaidsinspatiallydiagnosingenvironmentalhealthhazardswithinthelandscapeofthecommunity.Fortheperiodofmystay,therewereseveralmainfactorsthatwerebeingmeasuredormonitoredonaregularbasis.Theywerethefollowing:

Recording%DissolvedOxygenonbothahighandlowtide Mappingbridgesandmajorpathwaysthroughoutthecommunity Newhouseswhichhaveyettoberecordedinthelasttwoyears Areasoflargedebrisorbuildup Surroundinglandscapearoundthevillage(deepchannel,reefflat) Weatherpatternsindifferentseasons

Thecompilationofallofthesefactorsallowedustocreateaseriesofspatialmapswhichallowustocorrelateincreasingpopulationwithanalreadystrainedecosystemandthehealthconsequenceswhichariseduetotheseimpacts.

Map1.SamaBahariVillage

Hereonecanseetheexistingvillageinbeige,majorroadsandpathsingray,smallerpathsinnavyaswellasnewhousesinnavy.Thepredominantexpansionofhousesnowreachesfurtheroutontothereefflatinthenortheasternandsoutheasterndirections.(nottoscale,approximatelength)

Map2.TransectGrid

ThismapclearlydefinesthegridamongstwhichtheDOtransectstookplace.BothredandbluespotscorrelatetositesofDOmeasurement.

Map3.PhysicalSightings

Thismapclearlyindicatesthelocationsofheavydebrisbuildupwithincertainchannelsasindicatedbypinklines.Largepresencesofupsidedownjellyfishoftrashbuilduparemarkedbysmallpinkdotsandindicatestagnantpoolsofwater.Additionallylistedarethecommonswimmingareasforchildrenandthepresentwinddirectionduringthewetandwindyseason.

Map4.DOResults

EachDOtestingsite(indicatedbythebluedot)showsbothlowtideandhightidetestingresults.Thedarkestshadesofblueindicateahealthy/normalDOreadingwhilethelightestshadesofblueindicatetheworstareas.Whatcanbeinferredfromthisdataarethelocationswhereareasofthevillageareflushingonahightideorduetowind,butwheretoothercentralareasarnot(1.quadrantsquadrantsA6A7)

e

C7C82.

DOmonitorreading:

suboptimal 9.0ppm

Map5.FinalCompilation

Thisfinallapoverlaysthes

wind

to

blem

transectpoints,withdebrisightings,winddirection,andhighandlowtideDOaveragedresults.VisaVistheoverlay,wecandemonstratethatthedirectionandchannellocationonthewesternborderofthevillagehelpflushitsoutermostsections.Additionally,thereisadirectcorrelationbetweendebrisbuildupandtheworstDOresults,helpingustounderstandwhereproareasexistwithinthevillage.

Limitations

thisresearcharemostlyinregardtothevaluationoferrorinthedissolvedoxygenmeteranditsabilitytomakeinferencesaboutthequalityofthewateralone.Typically,atraditionalanalysisofwaterquality

ing

indingsandRecommendations

nsmadeduringmybrieftimeinSampela,thereareseveralrecommendationsIwouldliketomaketoboththecommunityandregionalgovernmentaswellastheOperation

databasewhichmoreaccuratelydocumentshealthincidentswithinthecommunity

This l aswellasbuildadatabaseofmedicalhistory,whichthecommunitycanthenusewhenadvocatingforgovernmentaid.Ifthe

erspart

ta

communityhealthworkerswhoareeducatedinbasicpublichealthtraining

Dur t mmunityhealthbutalsoahighinfantmortalityrate.Bytalkingtolocalofficialsandtraditionalhealersinconjunctionwithour

lBajau

astraditionalhealersinSampela

Pres l fromoneanothertheKaledupaHealthOffice,theGovernmentSanitationworker,thetraditionalhealersofSampela.

ly

Thelimitationsof

regardinghealthissueswouldincorporateDOmonitoring,Nitrogenmonitoringaswellasfecalcoliformtesting.ThedatafromtheDOmeter,althoughincomplete,stillallowsustoidentifyareasofwaterwithinthechannelsthatareaeratedmorefrequentlyorlessfrequently.Withlessaerationwecanassume,thatwasteproductsarenotflushingcompletelyfromthevillageandarepresent.OnseveraloccasionsInotedfecalsightingswhilepurstheDOmonitoringaroundthevillage.Additionally,whilewindanddebrisfactorsareidentifiedthroughobservationonlytheyhelptopaintthelargerscenarioandareimportantfactorsinunderstandingwaterqualityinSampela.

F

Baseduponthedatacollectedandobservatio

WallaceaProgram.

1. Creatinga

wil allowmedicalelectiveswiththeOperationWallaceaprogramtoincreasedatacollectionsskills

communitycannotshowevidenceofaneedformoremonetarysupportormedicalsupplies,thegovernmentdoesnotsponsorthemwithadetailedmedicaldatabase,thecommunitywillhavethetoolsnecessarytoadvocateforaid.OverallKaledupamedicalrecordsexist,butcomparablerecordsdonotexistforSampela.Ourteamsrecommendationsincludethemonitoringofchild/infantmortalitydata,aswellastheincidenceofMalaria,HepatitisBandDiarrhea.Opwallstudents/researchersshouldworkcollaborativelywithcommunitymembwhovolunteertobehealthadvocatorstocollectthisdata.Itwouldbebestifcommunitymembersalsotookinthecomparativedataanalysissothattheytoobegintounderstandtheimportanceandsignificanceofthisdaandhowtouseit.

2. Establishing

ing hecourseofthisstudywenoticedadistincteffectofwaterqualityanduseonnotonlyco

shortseasoninIndonesia,wefeelthatthemostproductivewaytoattempttoaddressthehighprevalenceofwaterbornediseasesistosetupacommunityeducationprogramthatisnotonlycommunityrunbutselfsustaining.Thusestablishingacommunityhealthcorpsisvital.Basichealthlessonsmightincludetraininginboiltimeaswellasbasichandandfoodsituation.Thosedesigningtheseprogramsshouldberespectfuloflocacultureandnotonlysuggestwesterneducationaltechniques.

3. CoordinatewiththelocalhealthclinicinKaledupaaswell

ent y,allthreefactionsofthehealthandsanitationworkinKaledupa/Sampelaremainseparate

WhileallthreesectorsprovideservicetothepeopleofSampela,theirworkisnotoneofcollaboration.Byestablishingaframeworkbywhichallthreesectorscancoordinateandcollaboratewithoneanotherwillgreatincreaseefficiency,localmedicalknowledgeandaccesstoresources.

4. Supportanddevelophealthinfrastructureandgrowthwithinthecommunityaspartofthemedicalelectivesprogram

WithOperationWallaceasvastwealthofresources,thisseemsliketheperfectopportunitytohaveafullyengagingmedicalelectiveprogramwithalocalcommunityaswellasanopportunitytoreturnvitalservicestothecommunitywheretheextractmuchoftheirresearchfrom.Itcouldbeginwithmedicalelectives,documentingdata,providingemergencyservice,andcommunityawareness.

5. Inviteteamofenvironmentalengineerstoconductresearchinflowinchannelsandmakepossiblerecommendations/changestoexistingchannelsystem

Theissueofdebrisbuildupisonenottobeansweredbysocialscientistsofmedicalelectives.Instead,professionalsareneededtoevaluateconsequentialrisksthatunblockingthechannelsmightduetotheadjacentreefflataswelldesignamethodforincreasingwaterflowthroughthechannelsandpreventingdebrisbuildup.Thismayposeasanattractivehandsonopportunitytofacultyandateamofstudentsatanengineeringuniversity.

6. DiscusshousingexpansionwithKepalaDesaanddevelopaplantodealwithincreasingpopulation

Therapidincreaseinpopulationinsuchadenselypackedareaisundoubtedlycausingdetrimentalaffectsonthepeopleshealththatlivewithintheareaaswellasthefunctioningofthenearbyecosystem.ItwouldbewisetostartplanningforalternativestocopewiththepressureofanincreasingpopulationwiththeKepalaDesaonemightaskifanotherBajauvillagecouldbebuiltnearbyorperhapsabettersystemofcreatingchannelsbetweenhousestoensurewaterflowthroughoutthevillage.

7. BuildfreshwatertapviachannelfromKaledupatoSampelaorstandingreserveincommunity

LimitedaccesstofreshwaterisoneofthemainreasonsthatthepeopleofSampeladonotusefreshwatertocleandirtydishes.Insteadtheyopttocleanthedishesinthesamesaltwaterthatfecesaredisposedintherebyincreasingchancesoffecalcoliformcontaminationwheneating.Afreshwatertaporbarrelreservemighthelptoreducethisrisk.

8. Conducttestingofinvertebratesforconsumptionofhumanfecalmatter

Notingthatmanypeopleinthecommunityidentifiedeatinginvertebratesasasourceofdiarrheaitwouldbewiseandofgoodpurposetoconducttestingoftheinvertebratestheyareeating.Iftheytestpositiveforcoliform,thecommunityshouldbenotifiedandadvisedofotherlocationstogleanorperhapscookinvertebratesthoroughlybeforeeating.

9. Createcompostingtoiletsbeneathstilthouses

Therehavebeenmanytacticsforcreatingcompostingtoiletstoensurebettersanitationwithinavillage.Ifpossible,onemightwanttolookintothepossibilityofdevelopingcompostingtoiletsbeneathhousesthathaveacoralreefplatformbuiltbeneaththem.Usingthecoralrockasamethodoffiltrationandcomposting,theamountofopenfecalsubstancesintotheenvironmentcanbedecreased.

10. Developreefplatformwherewastedisposalcanbeburned

Presently,themethodofdisposingoftrashandgarbageistodirectlythrowitintothesurroundingocean,posingamajorthreattosurroundinganimalsandplantsintheecosystem.Althoughburningtrashisoftenpreventedduetoitsoffsetofcarbonemissions,burningthetrashwithinthevillagewillhavesmalleffectsincomparisontodirectlydisposingofitintotheocean.Itwouldberecommendedthatfiresarewellcontrolledandtheplatformisinadirectionthatwillnotbegreatlyaffectedbywinddirectionnorcauserisktoburningofneighboringhomes.

Appendixannotatedquestionnaire.

Survey Questionnaire (English) Questionnaire No.______ Village:_________________ Interviewer:____________________ Number of Household Residents;__________ Socio-Economic Status Roof Nipa (thatched palm)_____ Tin____ Other_____ Walls Wood_____ Cement___ Other_____ Floor Dirt____ Wood____ Cement_____ Other_____ Presence or absence of the following items in the House: Electricity Y N Radio Y N TV Y N CD/DVD Player Y N Water and Sanitation 5.) Do you have a toilet Yes No

If yes: Indoor____ out house___ Water seal____ Pit latrine_____ 6.) Where do you get water for bathing/washing from?

Well__ Pipe__ Spring__ Other___________(specify) Must you buy it or pay a fee for water service Yes No If yes, how much?_________ Rupiah (gallon/liter/jug) per specify water unit ______

7.) How far is the source from your home? ____ Kilometers 8.) Where do you get drinking water from?

Well Pipe Spring Other Must you buy it or pay a fee for water service Yes No If yes, how much?_________ Rupiah (gallon/liter/jug) per specify water unit ______

9.) How far is the source from your home? ____ Kilometers 10.) Do you boil your drinking water? Yes No 11.) Why?_____________________________________________________________________ 12.) Do you believe that boiling water keeps you from getting sick?

Agree __ Disagree__ Dont Know__ 13.) How long do you boil water for? ____ minutes Where/How do you dispose of your garbage/trash_____________________________________ ______________________________________________________________________________

Sickness and Disease 14.) How often do you get intestinal diarrhea sickness in one month?

Frequently Often Seldom Never (you may want to ask this differently and next question as well : How often do you get intestinal diarrhea sickness

at least once a week at least once a month less than once a month never 15.) How frequently do members of your family get intestinal diarrhea sickness in one month?

Frequently Often Seldom Never 16.) In your opinion, what causes this sickness? ____________________________________________________________________________________________________________________________________________________________ Medical Treatment 17.) Who do you see for treatment when you get sick? Health worker Traditional Healer Family Member Doctor Other _______ Nobody 18.) Do you take any medicines when sick? Yes No 19.) If yes, what kinds? First response_______________________________________________

Second response_____________________________________________ Third response______________________________________________

Do you ever use traditional or herbal remedies instead of drugs from the pharmacy? Yes No Why?__________________________________________________________________ 20.) Do you harvest any creatures from the ocean for medicinal purposes? Yes No

If yes, What kind/names of creatures?_____________________________________ 21.) Why?__________________________________________________________________ Optional/Additional Qs: 22.) Do you cover your food after cooking? Yes No Why?__________________________________________________ 23.) How long do you leave your food out before you throw it away as spoiled? __________hrs Personal information 1.) Age _____ years 2.) Gender Male Female 3.) Ethnicity _______________________ (self identified) 4.) Educational level ____yrs formal schooling)

Survey Questionnaire (Bahasa Indonesia)

NO kuisioner :______ Desa:_________________ Pewawancara:____________________ Jumlah anggota keluarga:__________ Status social dan ekonomi Atap rumah Nipah_____ Seng/Genteng____ Lainnya_____ Dinding rumah Kayu_____ Semen___ Lainnya_____ Lantai rumah Kayu_____ Semen___ Lainnya_____ Ada atau tidak hal-hal dibawah ini di dalam rumah: Listrik Y N Radio Y N TV Y N CD/DVD Player Y N Air dan Kesehatan Apakah Anda mempunyai toilet (WC)? Ya Tidak

Jika Ya: Di dalam rumah ____ di luar rumah___ Jenis:

Hilang dengan disiram air______ jumbleng (lubang tanah , ditutup setelah dipakai dan kotoran dibiarkan )_____ lubang tanah_____

Dimana Anda memperoleh air untuk mandi dan mencuci?

sumur__ pipa ledeng__ air sumber __ lainnya___________(jelaskan)

Apakah Anda harus membeli air atau membayar iuran untuk layanan air? Ya Tidak Jika ya, berapa harganya?_________ Rupiah (gallon /liter /kubic ) tiap satuan unit air

Seberapa jauh tempat mengambil/membeli air dari rumah anda? ____ Kilometer Dari mana asal air minum yang Anda dapatkan?

pipa ledeng sumur air sumber lainnya___________(jelaskan)

Apakah Anda harus membeli air atau membayar iuran untuk layanan air? Ya Tidak Jika ya, berapa harganya?_________ Rupiah (gallon /liter /kubic ) tiap satuan unit air

Seberapa jauh tempat mengambil/membeli air dari rumahmu? ____ Kilometer Apakah Anda memasak air yang akan diminum? Ya Tidak Mengapa?_________________________________________________________________

Apakah Anda percaya bahwa merebus air minum akan mencegah Anda dari sakit perut?

Setuju __ Tidak setuju__ Tidak Tau__

Berapa lama Anda mererbus air ? ____ menit Dimana dan bagaimana Anda membuah sampah ? _____________________________________ ______________________________________________________________________________ Sakit dan Penyakit Seberapa sering anda mengalami diare perut dalam satu bulan?

Sangat sering ___ Sering___ Jarang____ Tidak pernah_____

Seberapa sering anggota keluarga Anda terkena penyakir diare perut dalam satu bulan?

Sangat sering ___ Sering___ Jarang____ Tidak pernah_____ Menurut Anda, apa sebab-sebab penyakit sakit perut (diare)? ____________________________________________________________________________________________________________________________________________________________ Perawatan Medis Bila Anda sakit, anda pergi ke siapa/kemana? Pegawai kesehatan Dukun Anggota keluarga Dokter Lainnya Tidak kemana-mana Apakah Anda meminum obat bila sakit? Ya tidak Jika iya, obat apa ? Tindakan pertama ____________________________________________

Tindakan kedua _____________________________________________ Tindakan ketiga _____________________________________________

Apakah Anda pernah menggunakan obat traditional atau obat dari tumbuh-tumbuhan dan hal tersebut lebih Anda Sukai daripada obat dari apotik?

Ya Tidak Mengapa?__________________________________________________________________ Apakah Anda menggunakan jenis hewan/tumbuhan dari laut untuk obat (misal rumput laut)?

Ya Tidak JIka iya, Jenis /Apa nama hewan/tumbuhan tersebut _____________________________

Mengapa?__________________________________________________________________ Pertanyaan tambahan (tidak wajib) Apakah Anda menutupi masakan anda setelah selesai memasak? Ya Tidak

Mengapa?__________________________________________________ Seberapa lama Anda membiarkan makanan Anda diluar sebelum Anda buang di tempat sampah (basi)?

__________jam Informasi pribadi

Umur _____ tahun Jenis Kelamin Laki-laki_____ Perempuan______ Suku _______________________ (self identified) Tingkat pendidikan _______tahun sekolah formal ( misal : tamat SD=6 tahun, SMP= 9 tahun, SMA = 12 tahun, Perguruan tinggi=16 tahun)

HISK study 1) Kaledupa Medical Center reportsHISK study 2) Community InterviewsHISK study 3) Water Quality and Spatial Mapping