Sunday, 9 December 2012

MALNUTRITION: Indonesia: The Face of Childhood Nutrition in Eastern Indonesia

Brooke Nolan | December 09, 2012
Children eating snacks in Southeast Sulawesi. Here, traditional food sources are affected by industry and importing healthy food is costly. (JG Photo/Brooke Nolan)Children eating snacks in Southeast Sulawesi. Here, traditional food sources are affected by industry and importing healthy food is costly. (JG Photo/Brooke Nolan)
Recently, I read yet another article in the Indonesian press about child malnutrition. Or rather, it was less an article about malnutrition per se and more a presentation of the standard format: a study, statistics and a solution. 

The study: a respectable report by Unicef, the United Nations Children’s Fund. The statistics: 40 percent of Indonesian children suffer from malnutrition. The solution: funding from the European Union and Unicef for programs in East Nusa Tenggara, Central Java and Papua. 

Any regular reader of Indonesian newspapers is familiar with articles such as this one. What these articles miss is precisely what they purport to present: an evaluation of child malnutrition. 

Pivotal questions are left unanswered: What does child malnutrition actually mean in Indonesia today? Why are children in this resource-rich country malnourished? And why does Indonesia seek to rely on programs run by international organizations whose effectiveness is questionable? 

None of these questions are easy to answer but they must be asked if child malnutrition is to be addressed in any meaningful way. Furthermore, these questions need to be discussed in the media to give a realistic picture of how child malnutrition afflicts Indonesians today. 

One problem with the study-statistics-solution formula is that it distances the reader by presenting child malnutrition as an abstract problem that can be neatly encapsulated by statistics (the reliability of which is never questioned) and conveniently solved by other people, that is, the “experts” with big budgets who are usually flown in from outside Indonesia. 

This fails the test for responsible journalism on at least three accounts. Firstly, it is uncritical. Secondly, it distances, rather than engages, the reader. And finally, it is misleading at best and dishonest at worst. The well-educated, middle-class urban reader sits in a comfortable lounge in an air-conditioned room reading these articles, reassured by the knowledge that the “experts” will “fix” the “problem,” a grave issue in which they are not implicated that therefore requires no more thought on their behalf than the two minutes it takes to read the article. Articles like these provoke two reactions: pity for the victims and relief that saviors are at hand. 

This is precisely where the illusory nature of these stories is most blatant. Child malnutrition in Indonesia and elsewhere will never be “solved” by a heroic team of “experts,” regardless of how solid their claims to expertise or how hefty their budgets. Everyone in Indonesia, including non-Indonesians, has an impact on problems of development such as child malnutrition. 

It’s not simply a matter of giving to charity. It’s a question of where money is spent every day: in malls or markets? It’s a question of travel: to thriving hotels belonging to millionaire businessmen in Bali or to more remote places, where income from tourism affects the living standards and prosperity of the local population more directly? And it’s a question of awareness: who knows if their driver or domestic helper is able to feed their children well? 

Put bluntly, child malnutrition is not merely a question of how Indonesia’s most impoverished citizens eke out a living; it is a question of how we all live. 

Instead of the study-statistics-solution articles we are all weary of reading, journalism that is both critical and engaging would take as its starting point questions such as what malnutrition means in a day-to-day sense. 

Child malnutrition is experienced in vastly different ways throughout the archipelago. A malnourished child in a Jakarta slum has different needs to a malnourished child in a village in the highlands of Papua, or a fishing village in Kalimantan. Different needs require different responses. 

This is what malnutrition looks like in rural parts of Eastern Indonesia: adults unable to put anything but poor-quality, government-subsidized rice on the table, sending their children to relatives’ houses to ask for leftover beans or fish; old women advising other old women that drinking tea in the morning will keep them full enough so they won’t need to eat lunch; school children staring vacantly at their teachers because they haven’t eaten anything all day. 

In the Southeast Sulawesi village where I work, almost all the residents are farmers. Many children here are malnourished. Not only are they dangerously thin, but their hair is a yellowish brown rather than black — a sign of malnutrition known as hypochromotrichia, produced by a lack of nutrients causing reduced melanin in hair follicles. The local people all say the discoloration is from playing in the sun too long. 

Here, children typically arrive at school without having eaten breakfast. Before they’ve even entered the classroom, their ability to learn is inhibited. Any snacks they eat at school have little to no nutritional value. A typical lunch consists of rice and beans. 

Most of the men do not own fishing boats. Those who do spend a few hours in the afternoon fishing. But as in many parts of Indonesia, decades of overfishing, poison bombs and the (not necessarily legal) entry of huge trawlers has meant a steep decline in the amount and variety of seafood available. So fishermen here often come home empty-handed. If they make a catch, it is often not enough to feed their whole family.

There is no market and there are no warungs (streetside stalls) in this village. Instead of selling nutritious food, the small shops out the front of one-roomed houses are stocked with cheap snacks full of excessive sugar, artificial flavors and preservatives. 

Basic nutritional education is required to tackle malnutrition. The local puskesmas (community health center) closes at midday. Nurses and other health workers could spend a few hours in the afternoon educating local people, including shop owners, about basic nutrition. 

Not only is such education in the interests of local people themselves, it is also in the interests of the government and the country as a whole. Healthy people make better workers, cost the healthcare system less money, live longer lives and are less of a burden to society as a whole. 

Here, people have to take a four-hour boat trip to Kendari if they want to buy fruit, vegetables and other food. The return trip costs Rp 70,000 ($7.30). Most people here earn Rp 300,000 to Rp 500,000 per month and cannot afford the trip. 

Geographical isolation does not affect those employed at the puskesmas as harshly as the local people. Nurses and other civil servants earn approximately 10 times as much as local farmers. They make regular trips to Kendari, returning with food, drink and other supplies for themselves that they cannot obtain locally. Villagers here say that for every week the public servants employed in remote communities in Sulawesi stay there, they spend a month in Kendari. 

Most of these public servants come from cities far away and have little attachment to the communities they’re employed in. For many public servants, from the time they arrive in the community, they are counting down the days until they leave. Local people, those they are supposed to be serving, are commonly treated with indifference and disdain. 

Children should be taught basic lessons in nutrition and hygiene at school, but teachers are so frequently absent in these communities that the sight of high-school students marching down the dusty roads protesting their teachers’ absence is common. Public servants know they will receive their salaries regardless of whether they work with dedication or do the bare minimum. 

But an intervention by a foreign organization is not what these communities need. International bodies and NGOs remain while there is money, and once the funds run out, the programs finish and the communities usually return to where they were before the aid workers turned up. 

What is needed in Eastern Indonesia and elsewhere in the country is the realization that with some basic knowledge about health and widespread availability of nutritious foods, local people themselves will bring about the sorely needed changes required to eradicate cases of malnutrition and allow communities to thrive. 

Brooke Nolan is a PhD student at the University of Western Australia. She is currently conducting research into women’s health during childbirth in rural Southeast Sulawesi.

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