Wied Trisnadi and Paramitha Hapsari
For most street children, the notion of good general health is hardly a subject of primary concern. Only when sufficiently ill to be unable to undertake activity of any kind, as when experiencing severe illnesses such as dysentery or typhoid, or when in unbearable pain, do they regard themselves as sick. Street children have no access to the public health institutions. Nor do they have reliable sources of information about health.
Public health centres and the polyclinics of public hospitals regularly refuse treatment to street children because they do not have identity cards. Indeed, street children without an identity card cannot access any public service of any kind, including enrolment in school. Nor can they rectify this easily. To obtain an identity card, a child needs to be able to provide proof of birth and have some legitimate basis to claim residence in a particular neighbourhood. He or she also needs significant sums of money to process such a matter. For the homeless, this is an impossible task.
Street children themselves raised the issue of their lack of access to health care facilities during a camping retreat. In response, YLPS Humana and Yayasan Indriyanati worked with members of a local community organisation called KKY (Kerabat Kota Yogyakarta) to address the children’s basic health needs. They eventually established a permanent clinic, the Klinik Kerabat Kota Yogya (Klinik KKY), under the auspices of Humana and KKY, just off Malioboro in downtown Yogyakarta.
The clinic gradually took shape over several years of trial and error. In 1997 a mobile clinic would visit places where street children congregate once a month. But changes in the way children had to seek their living made mobile clinics difficult to operate.
In late 1999 and early 2000, a fixed clinic operated from a drop-in centre where a volunteer doctor was on duty for a few hours every Friday afternoon to provide basic medicines for headaches, skin infections, fever, wounds and toothache, as well as for STDs and more serious infectious diseases. But the loss of the right to use that house put an end to this initiative.
In mid-2001, Humana was able to get sufficient funds to contract a building in downtown Yogyakarta. This provided a permanent venue where more complete health care facilities could be made available each day. The fixed location also meant that other people in the area who could not otherwise access public health care could have the advantage of consultation with a doctor at low cost.
On average the clinic treats between 150 and 300 patients each month. Street children as well as others who cannot pay for service now can receive free medical treatment including medicines. Residents of nearby kampung have access to the clinic as well as people who wish to come from other parts of the city. Members of the local community who can afford it are asked to pay a nominal amount for medicines, although the consultation is still free.
Raising health awareness
One of the chief functions of the clinic is to raise the health awareness of the children. A major problem for the clinic’s staff is the misuse of medicines. The children often take medications without attention to suitability of dosage or other directions. They are often aware of only one form of treatment and think that it pertains to all sicknesses.
Developing visual modes of education about the difference between various diseases and their appropriate treatment including proper use of drugs is especially effective. Having the children make their own drawings, and the use of pictures showing the process of treatment and healing, also helps in the healing process.
It is not surprising that the form of medical care in this clinic is unusual. It places great emphasis on inter-personal communication, freedom of expression for the patients, and flexibility of treatment regimes, rather than just handing out medications.
A shaky future
Although the problem of finding a way to provide medical care has been overcome, the chief problem now is how to maintain the existence of the clinic in the future. With poverty and its associated increasing burden of disease brought by the economic crisis, coupled with a decline in both local and international sources of support, the problem of continued financing of the clinic and its activities is a serious one.
There remains widespread discrimination regarding the dissemination of health services, as well as a rollback in many public services. Until discrimination has been removed, and more services can be made widely available, clinics such as this one will perform a crucial service both in terms of health care, health maintenance, and health education. That is, if they themselves can survive.
Wied Trisnadi and Paramitha Hapsari are on the staff of YLPS Humana. They can be contacted at firstname.lastname@example.org