The adults gather at the little mosque in the early morning hours, grandmothers and mothers with children bundled up in protective arms. They sit in neat semi-circles around nurse Andina and nurse Roy, who take their names and pulses. Then IRC doctor Jon White arrives to take a look at what’s wrong.
The cases come in one by one. An old man arrives smoking a cigarette with a machete wound and a big toothless smile. A little boy comes in with his mother – he has two weeks of fever and five-day headache. And then there are the other children, the ones who are healthy now but might develop measles without intervention.
The mobile clinic is part of an initiative by the IRC and the Indonesian Ministry of Health designed to ensure that both the clinical and public health needs of rural communities are satisfied. “We have two goals,” says White. “We want to care for the acutely ill who might otherwise not be treated and we want to prevent future illness through vaccination, education and training of local health staff.”
A young couple brings in their 10-month-old girl. Maulidar is small for her age, weighing only about 14 pounds. There is a skin rash on her chest and arms. “It’s a red flag for malnutrition,” says the doctor. “She needs a measles shot. Her mother needs to be supplemented with Vitamin A.”
The vitamins will filter through the mother’s breast milk and into the child to fortify her immune system. And the inoculation will reduce 10-to-20 fold her likelihood of dying from measles infection. Later, midwives and community health workers trained by the IRC will teach the mother how to improve her child’s nutrition through better breast feeding techniques and the management of common illness.
At first the child, dressed in a pink dress and hair bow, is curious about the doctor. His hands are almost the size of her arms and when he rubs her with alcohol she is mesmerized. It is only when the needle is removed that she begins to cry. “Cry now,” jokes White. “Survive longer.”
About 15 minutes later, 4-year-old Suitan arrives with his mother and father. The fevers have gone on for too long and the boy seems continually in pain. The doctors are puzzled. The symptoms look like malaria but a rapid test provided by another aid organization was negative for the deadly Falciparum malaria.
The child is brought to a nearby puskesmas (community health center) that was recently refurbished by the IRC. White and the local physician take more blood and examine thick and thin smears under a microscope only to determine that another less deadly strain of malaria called Vivax is the culprit. “This child has probably had malaria for the past two months,” White says. “We’ll treat him with Chloroquine and follow his progress closely.”
But treatment is only the last resort. White knows that other IRC environmental health specialists will be distributing more than 5,000 mosquito nets and training local health workers to teach community members how and why to use the nets.
“The important thing here is that people understand the value of public as well as clinical health,” White says. “Treating one patient is one thing but preventing hundreds of infections is the real goal.”
The clinic has performed well, especially for a day in which many are harvesting rice. As villagers gather in the mosque for prayers, the staff departs quietly.
