Bauzi women in a health class for new and expectant mothers Bobby Anderson
The political space of Papua and the space where Papuans live is not the same. This is especially evident in the rural and coastal lowlands, which hardly even rate a mention in the political debates about Papua that so often simplify the territory’s development issues. In many areas of the lowlands, Papuans are having their first interactions with the state. In the meantime, Indonesian NGOs and others are bridging the services gap left by the weakness of the state.
A new district
Other than the mountains on its southern border, Papua’s Mamberamo Raya District is a vast lowland expanse of jungle and swamp. Located on the northern coast of the province about 300 kilometres to the west of the provincial capital, Jayapura, it is still 90 per cent forested. The district’s primary geographic features, besides the vast Lake Rombebai, are the Tariku (née Rouffaer) and Taritatu (née Idenberg) Rivers, which begin in the highlands on Mamberamo Raya’s southern border with Tolikara; the Tariku runs from west to east, and the Taritatu runs from east to west. The headwaters of both rivers run narrow and clear, and each runs through and drains the forested Lakustrin plain before they merge together to form the 670 kilometre Mamberamo River, which grows wider and slower with each passing kilometre as the river dissolves into a massive delta of mangrove swamp where it meets the Pacific Ocean.
This lowland terrain is even more forbidding than the mountains to Mamberamo Raya’s south: the district’s rivers remain the primary mode of travel, and once one moves away from the trails between settlements along the rivers, one encounters an impenetrable landscape, much of which is traditionally viewed by indigenous peoples as an existential threat, with warnings posted in the form of spiritual beliefs. Dangerous areas are lands of ghosts.
This barely-tread forest conceals undiscovered flora and fauna: a new kangaroo species and a long-nosed frog were discovered as recently as 2008, and vast areas of the district have never been penetrated by humans. Settlements and sustenance are found within earshot of the rivers. Such an environment as Memberamo Raya’s is incapable of supporting large populations, or even large social groupings. As we shall see, an unseen epidemiological topography exists as well, and wreaks havoc on the inhabitants. This combination of environmental threats has traditionally kept human populations both miniscule and isolated.
In addition to being one of the newest districts in Indonesia, Memberamo Raya may be one of the most sparsely populated. The district population, according to 2010 government figures, is 18,365: 0.59 persons per square kilometre. The provincial average is eight persons per km2, while the country’s population density is 124 persons per km2. The greater Jakarta metropolitan area had a population density of 15,342 persons per km2 in 2011; if Jakarta had the same population density as Mamberamo Raya, it would have a population of 437.
Much of the district’s population are subsistence hunters, gatherers, and occasional farmers who dwell in small family groups, although many only wander seasonally, remaining near to one of the roughly 56 settlements that groups return to in the rainy season, to live in birchbark houses built on short stilts. The locals hunt cassowary, cuscus and wild pig; they use dogs in these endeavours. They also fish and plant sago.
Mamberamo Raya was created only in 2007, when it was separated from Sarmi and Waropen. The district capital, Kasonaweja, was created at Mamberamo Raya’s birth — built from scratch around a missionary airstrip near the river that was hacked out of the jungle with hand tools. Now it is paved and fenced, with dozens of blue-roofed, one-story concrete buildings and a skeleton population of bureaucrats administering barely-functioning structures.
The forgotten lowlands
While Papua’s highlands receive an undue amount of political attention, its lowlands are forgotten. The experience of highlanders with the church, and through that entity, the state, began in earnest in the 1950s. But in Mamberamo Raya, most of the population did not have first contact — that often terrifying and volatile encounter that uncontacted tribes have with outsiders — until the 1980s. Missionaries created the first airstrips there, and were the only outsiders with whom the indigenous peoples regularly interacted until the decentralisation policies of recent years. What has only recently started to occur in much of Mamberamo Raya, then, is the first regular interaction between a state and its citizenry.
The experience of Mamberamo Raya’s Bauzi people is emblematic of this interaction. The Bauzi number roughly 2,000; they generally live along the banks of the Mamberamo River near the semi-permanent settlement of Noiadi, one and half hour’s flight from Sentani. The settlement consists of roughly 50 houses, a church that doubles as a school, and a grass airstrip.
Since the 1980s, the Bauzi have tended to settle for part of the year in places like Noiadi, but they maintain their mobility. The Bauzi do not speak Indonesian. The first outsiders to live among them were an American missionary couple who both learned the Bauzi language and spent much of the next 30 years in Noiadi. The Indonesian organisation they work for, Yayasan Misi Penginjilan Pemuridan Papua (YMP3, Evangelisation and Discipleship Ministries for Papua), is solely responsible for the health services accessible to the Bauzi. YMP3 runs maternal and child health services (Pos Pelayanan Terpadu or Posyandu) with traditional midwives who they have additionally trained in hygiene, nutrition, and other health concerns.
Another long-term volunteer has developed Indonesian language literacy programs for Bauzi adults. The outside world is encroaching, and in it, literacy and numeracy in Indonesian and English are forms of self defence. This new knowledge of languages cannot be disentangled from health knowledge and practice. YMP3 is integrating this knowledge, teaching about health and hygiene in a simplified alphabet they created for the Bauzi language, and teaching Indonesian simultaneously.
Some lowland areas are being transformed by their contact with the modern economy. In Keerom, to the east of Jayapura District on the border with Papua New Guinea, a primordial forest is rapidly being transformed into a circuitboarded landscape of palm oil plantations, leaving the local population of hunters and gatherers ill-equipped to function, and often leading to their departure from their traditional lands. Only a few of the relatively successful groups have adapted to gold-panning.
Bauzi men preparing to go down the river to fell a few trees, and hunt a few animals Bobby Anderson
The struggle for health
Unlike in Keerom, the necessity for literacy and numeracy in Bauzi areas remains theoretical. Modernity and its physical transformation of the land have yet to arrive, and the Bauzi live as they always have. A USAID-funded project, Indonesia Forest and Climate Support (IFACS), is working with indigenous peoples to try to preserve a minimum of 70 per cent forest cover in the coming decades, but the success or failure of this and other endeavours remain to be seen. Should the district remain in its primordial state, without major plantations or other modern economic activities, then literacy and numeracy would remain important, but not desperately so. Health knowledge, on the other hand, is a much more pressing need.
The author’s recent visit to Noiadi amply illustrated Bauzi health needs: the area is rife with malaria, elephantiasis, and tuberculosis. Deaths from diarrhea, anemia, pneumonia and neonatal sepsis are common. And HIV looms just over the horizon, kept at bay because Bauzi men do not yet work as seasonal labourers in Papua’s cities.
YMP3 is countering these health issues through equal parts knowledge and practice, with much of the progress being made among young mothers who attend weekly health and hygiene classes taught by YMP3 volunteers, from Sulawesi, West Timor, and further afield. These women are learning about the importance of exclusive breastfeeding up to six months (most Papuan women begin to feed their children sago mash in the weeks after birth, an inherently harmful practice; ironically because poorer women cannot afford to do this, their babies are the healthiest), supplemental feeding for children up to two years, and knowledge of healthy locally available foods. The Bauzi diet consists of hardly any vegetables other than sago, which has little nutritional value. Bauzi women are now using YMP3-imported mosquito nets for their infants — an import that had the benefit of keeping numerous large spiders from dropping on the author as he slept in Noiadi.
The Bauzi population is about 60 per cent Christian, but that belief co-mingles with earlier beliefs: that the Memberamo river’s crocodiles are inhabited by the spirits of the ancestors, for example (interestingly, this doesn’t prevent Bauzi from eating crocodiles). Some of these beliefs are an impediment to health, because they prevent understanding of germ theory, instead ascribing disease solely to the realm of spiritual machinations.
One of the most horrifying local beliefs concerns twins: the Bauzi people believe that only one is real, and the other in an evil copy. The twin that is born last is buried alive. The last twin burial was roughly half a year before the author’s visit. Such things still happen in Bauzi areas distant from Noiadi. On the author’s visit, a Bauzi man believed that he saw the signs of an aggressive and malign spirit in his home: he ran about, screaming challenges and waking the settlement at three in the morning, and a babel of screams and challenges to those same spirits from neighbouring men and women rippled across the settlement like a wave.
Like the areas profiled in my earlier articles in Inside Indonesia, ‘Living without a state’ and ‘The middle of nowhere’, there has never been a military or police presence in Noiadi. Unlike those highland areas, however, Noiadi has a government teacher who is actually present and teaching. And the provincial government’s strategic village development project (Rencana Strategis Pembangunan Kampung or RESPEK) has had positive results. Unlike in the highlands, where RESPEK projects are often co-opted by the patronage needs of local elites, the program’s two grants to Noiadi have benefitted the people.
In the first year that a RESPEK facilitator arrived, the heads of every family got together and voted on needs: electricity won, and so the grant went to two generators, wiring, and light bulbs. Every hut in the area was connected and the generator runs for a few hours every night, with regular tithes for fuel collected from every household. In the second year, the heads of families decided on rainwater catchment systems for every household. Plastic tanks and piping were duly purchased and transported by boat, and during the author’s visit, most families were constructing wooden one-story towers next to their huts for the tanks. While RESPEK is intended to capture every community voice in project selection, this does not occur in Noiadi. But it is still providing benefits, and the women voted through their husbands for the water systems.
One of the reasons for such a positive outcome may have to do with the weakness of traditional leaders among the Bauzi. Each male head of family leads his family, and each head of household is more or less equal to the other. The area has never been subject to the ‘big man’ form of leadership that is prevalent in the highlands, and in Papuan politics. This is likely due to a topography that simply prevents large social groups from functioning effectively. A leader’s constituency does not go far beyond his immediate kin group.
However, as the lowland landscape transforms, so will the viable styles of leadership. While dense lowland forest may have prevented strong leaders from rising, bureaucracies have a different natural law. The big man culture will become entrenched as aspirant leaders emerge and utilise the same systems of patronage and money politics that big men in the cities and in the highlands use. The encroachment of this style of leadership is already found in the hiring of civil servants: more on this will be discussed below.
The experience of Boven Digoel
On the other side of the highlands lies Boven Digoel, a landlocked lowland district to the immediate southeast of the highlands that Mamberamo lies to the north-northwest of. This district borders Merauke to the south and Papua New Guinea to its east. The PNG border in the district is officially closed, but many of the locals move across it at will. To the north, the district’s flatlands grow into the hills that eventually turn into the Pegunungan Bintang (Star Mountain) range, while to the west lies Mappi, a vast flatland of swamp that stretches to the sea. The district is defined by the Digul (nee Digoel) River. The Digul’s headwater is located in the mountains to the north. It flows 525 kilometres south and west through a landscape of mostly uninhabited swampland before it empties into the Arafura Sea.
Boven Digoel has great similarities to Mamberamo Raya, although its experience with the state goes back nearly a century. The district served as a place of isolation for Indonesian political prisoners during the Dutch colonial area, with a penal colony, Tanah Merah (which grew into the district capital) constructed there after the failed communist uprisings in Java and Sumatra in 1926. A second penal colony, Tanah Tinggi, was constructed for those already-exiled nationalists who were regarded as ‘problematic’ by the authorities.
Despite Boven Digoel’s long experience with the state, it is mostly empty of the evidence of human habitation outside of Tanah Merah and the multiplying palm and other plantations to the district’s south, on the border with Merauke District. The road from Tanah Merah to Merauke is nearly ruined: outside of the capital, the roads are dirt tracks in the dry season and nearly impassible mud in the rainy season. Entrepreneurial drivers in custom-built 4x4s for rent do a brisk business in the district. Other than the tenuous and seasonal road link to Merauke, transport to other areas of Papua is entirely by plane or by boat down the Digul.
Unlike Mamberamo Raya, Boven Digoel has a large migrant population, but the migrants are concentrated in the capital. The indigenous peoples of the area maintain lifestyles like their brethren to the north, hunting the same animals and cultivating the same staple foods. There is also a marked absence of the ‘big man’ style of leadership in the virgin swampy landscapes of the district, where such social structures are not viable. Locals live in small settlements on the district’s many dirt tracks, and many still maintain a semi-nomadic lifestyle.
Unlike in Memberamo Raya, the population of Boven Digoel benefitted from health and education services until the end of the New Order. There is a long-standing security presence, and there were once insurgents there too, in the form of a ‘chapter’ of the Free Papua Movement (it has since become inactive). Health and education services, outside of Tanah Merah, disintegrated after Suharto’s fall, and the decentralisation trend which created numerous new districts, subdistricts and villages in the area has done exactly the opposite of what decentralisation was supposed to notionally provide. Rather than bringing better services, services have declined.
Creating new provinces and districts
Indeed, as services wither with every new administrative invention, the solution only seems to become more decentralisation. The latest initiative is the proposed creation of a new Southern Papua province, including Boven Digoel and several other districts. Unlike many other campaigns to create new provinces, however, the idea of a Southern Papua province cannot be dismissed out of hand: the area has long been neglected, bureaucratically and otherwise, and the Catholics south of the Pegunungan Tengah have felt distinctly apart from the Protestant north and centre of Papua. Public support for such a province exists.
But those who imagine a new province will be a panacea for the region’s development ills have not learned from the formation of the many new districts throughout Papua. It’s not only that the record of new districts suggests a new province will not make a difference in the lives of people at the grassroots, especially those being denied health and education services. Another problem is that the power to provide those services is found at the district level, and it is their responsibility to run the services that impact most directly on the daily lives of ordinary people.
Such simple solutions as new districts or subdistricts misrepresent the problems that people face in Papua. There are exceptions to this: Memberamo Raya’s services are improving after the creation of that district, although just barely. In most cases, however, the creation of new districts is motivated by local elites seeking to directly access funding from the national-level government, via the ministry of home affairs: funds per district are set by the national government based on the district population, and this sometimes leads to an inflation of the population far beyond what the real population of a district is.
In some cases, such as Memberamo Raya, this population inflation does not occur. In others, such as Yahukimo, the district population reported might be more than double what the actual population is: the district authorities there report a population of nearly a quarter of a million, but the churches (the GDI church in particular), who record local births and deaths, have the only accurate figures. Like all knowledge, population figures are closely guarded secrets in Yahukimo, but the actual district population is likely between 60,000 and 100,000. Any population figures for the province as a whole must be regarded skeptically.
The flawed logic whereby new administrative structures are created to better serve populations, but services actually worsen, results in a blame game among civil servants that the author was again witness to in Boven Digoel among health bureaucrats, and which can result in patients being refused care. A puskesmans in an existing subdistrict will often direct people to use their new subdistrict’s puskesmas — especially if they try to use insurance — even if that puskesmas has not yet been constructed. Or, it has been constructed, but is still closed, because no head has been appointed. Or the head has been appointed, but no accommodation has been constructed. Or the accommodation has been constructed, but it is sub-standard. Or the puskesmas has been constructed and the head has been relocated, but there is no equipment and/or none of the other staff have arrived at the duty station. Or the healthcare staff refuse to relocate because there is no functioning school nearby for their children. And since they get paid only in the district capital, they have to travel there often and are not on hand to provide services to patients.
Such excuses made by health care workers (and similar ones are made by education officials, teachers, and other civil servants), continue ad nauseum, to the point where people start suggesting the provision of laptops and DVD players for people with more remote postings in order to entice them to take these jobs and stay there. While some of these excuses are valid, too many are not, and district governments possess the resources they would need to act upon such complaints and needs. But they do not. For example, even though banking services are non-existent in much of Papua, districts could pay Puskesmas staff on site in the majority of locations. Across the highlands, local governments once utilised small air transport companies such as Mission Aviation Fellowship to transport payroll.
The creation of these new health centres and other government offices, and the awarding of positions to fill them, is motivated by the need to award jobs to supporters and clan members. These are no-show jobs similar to those found on construction sites in New York that a mafia capo can then award to his crew. That’s the basic problem: district proliferation and the creation of new government offices often have nothing to do with the provision of services.
Other actors enter the gap
The failures of government means that other actors step in to provide the services that local people so desperately need. The activities of these actors often do not fit easily into the political and development discourses that exist about Papua. For example, on the Boven Digoel border with Papua New Guinea, it is the Indonesian military that provides free health and education services for locals. The military is attempting to formalise this arrangement by training their officers to be primary school teachers in Makassar.
As for health care provision in this part of Boven Digoel, this mostly takes the form of army medics taking action to address whatever needs they witness in the field. For those who would say these services are just a propaganda exercise for the Indonesian military, those providing health services never advertised their acts externally. Instead, it was journalists working with the Jayapura branch of the Independent Journalist’s Alliance (Aliansi Journalis Independen or AJI), a group led by the iconoclastic journalist-activist Victor Mambor, that discovered this.
A road in Boven Digoel Bobby Anderson
In the villages to the north of Tanah Merah, an Indonesian NGO, Talenta Asia, is attempting to reinvigorate integrated maternal and child health services (posyandu) so that they can provide a bare minimum of services for expectant and new mothers and their babies, including by checking the health of pregnant women and infants on a monthly basis, providing vaccinations, information regarding nutrition, and so on. The group works in the subdistricts of Arimop and Iriyandit, where no health services exist, and they are re-starting posyandu services in the villages of Bukit, Ginggimop, Maju, Patriot, Ujung Autriop, Langguan, Ogenatan, Tetop, and Waritop.
While puskesmas services are theoretically provided only in the subdistrict capitals (but not in Arimop or Iriyandit), posyandu services are theoretically provided in every village on a fixed time schedule. In Boven Digoel, while the infrastructure providing these services fell apart, the human infrastructure — the midwives and others — remained, with some continuing to attempt to provide services even though they were no longer drawing a salary for it.
It was this infrastructure that Talenta Asia tapped into, providing the midwives with equipment, training and some incentives to work. Although the intervention is not sustainable in the sense that funding is of a limited duration, at the very least the Indonesian health staff of Talenta are providing equipment that will remain behind after they leave, and they are providing knowledge to mothers. They are also intensively lobbying the local government to pick up on their lead and take over from Talenta and expand what they are doing. As an alternate, they are seeking funding to sustain their own work.
Talenta Asia is witnessing small successes in the communities where they are working: rising baby weights, reductions in supplemental feeding for children under six months, and more nutritional diets for babies as they move onto solid foods. Despite this, however, the freshly dug graves of newborns that the author saw in Ginggimop testify to the work that is left to be done.
The best and the worst
In Memberamo Raya, services that were never offered are now beginning. In Boven Digoel, services once offered have ended. In both districts we witness the best and the worst. In Boven Digoel, as in many areas of the highlands, bureaucracies are so inefficient that they actually cause harm through their neglect. It remains to be seen whether such services will ever reach across Mamberamo Raya.
But it is churches, NGOs, and — in a few communities on the PNG border — the Indonesian military that are attempting to fill the chasm that separates what is needed from what is there. There is a great element of simple heroism to all this, in the Papuan midwives in Boven Digoel who never stopped working when the health system ground to a halt, the TNI medics who decided to take care of sick and injured people in the villages near their posts, the YMP3 volunteers from as near as Sentani and as far away as Kupang who work with the Bauzi, and the young Bataks and Betawis from Talenta working with Papuan midwives and mothers. Despite all the bad news about Papua, and all the problems in the Papua-Indonesia relationship, there are many people who are bringing their conviction and their expertise together in the service of their own. And many Indonesians from across the archipelago are helping their Papuan sisters and brothers.
The lowlanders, and their highland brethren, are a people too often rendered childlike and simple by the press and development actors. Papuans were perfectly adapted to survive in a world that has not just recently ended but that is still ending, in fits and starts. For many of the Papuans living in remote areas, a painful transition is underway: old skills are less needed, and new skills in literacy, mathematics and health practice grow in importance as the global economy makes inroads into places that were untouched by it just decades ago. But those new skills are not being delivered: many local governments pay lip service to such responsibilities while essentially functioning as nothing but distribution systems for cash, favours, and no-show jobs.
The Papuans in places like Serui, Biak and Jayapura have benefitted from functioning education and health services for generations, and this is the reason they dominate the provincial bureaucracy. Highland Papuans who benefitted from church educations in the first mission stations such as Ninia, Wamena and Pyramid have status and power far above that of their uneducated brethren. In today’s Papua — highlands and lowlands — education and health are and will remain the determinants of success. And for Papuans to truly realise their potential, they need a functioning state to deliver such services.
Bobby Anderson (firstname.lastname@example.org) works on health, education, and governance projects in Eastern Indonesia, and he travels frequently in Papua province.