Local contractors are building new polindes ? midwife clinics ? so that village midwives can live and work at the heart of their communities. Dozens of midwife clinics were washed away or badly damaged by the tsunami. Many of those that remain are run down, and some are poorly located, either on damp ground or away from the daily buzz of village life. The European Commission and the IRC are building 23 new polindes, each with its own well and septic tank. “A polindes takes three months to build, plus another month to furnish,” says IRC health construction manager Mutia. “We hope to have the first midwives moved into their new homes by January.”

The Provincial Training Center for Midwives in Banda Aceh was severely flooded during the tsunami. Its buildings were badly damaged, vital documents were lost, and medical equipment was destroyed. Training was brought to a complete standstill at a time when it has never been needed more ? estimates suggest hundreds of Acehnese midwives died during the tragedy. The IRC and the European Commission helped to rehabilitate the center, and seminars are once more underway for 30 midwife trainers. The midwives are refreshing their knowledge on reproductive health. But more importantly, they are learning how to train another 120 of their colleagues from Aceh Besar, Aceh Jaya, Aceh Utara and Nagan Raya ? the four districts in which IRC operates.

A circle of pregnant women sit and listen attentively to midwife Cut Nursanti talk about labor contractions. Clearly relishing their attention, Cut enjoys her job in the village of Lambaro Sukon. But she admits a new polindes will make her life much easier. “For now, I have to go to a patient’s house when she is ready to give birth. This is difficult at night, as I have to rely on her family to transport me and I have my own small children to look after.” A culture of home deliveries has emerged, which means Cut can’t monitor her patients properly. But she believes change will come with the new polindes. “The women know they will get to give birth in a safe environment. Some have already told me they’re going to use it. I won’t have to persuade them to come. They know it’s right.”

Minutes before the waves came and destroyed the village of Punge Blang Cut, Nurafa ran for her life. She escaped, but her home was destroyed and she now lives in the Neuhun temporary living center, Aceh Besar. “People are living in very crowded conditions here,’ says Nurafa. “And health is a problem.” When she was approached by teams from the IRC looking for community health workers, Nurafa jumped at the chance. “We received training and I’ve learnt a lot. Today, I’m showing how to make oral rehydration salts for people suffering from diarrhea.” Community health workers visit households to raise awareness about health and to distribute hygiene items like soap and detergent. With European Commission funding, the IRC has trained 174 community health workers in more than 60 sites.

It’s a humid day outside, but Nurhayati is impeccably dressed in her blue and white community health worker’s uniform. She’s busy questioning residents at Lapang temporary living center and writing their answers down on her official checklist. “I’m collecting data on any health problems,” explains Nurhayati. “My job is to ask people living here is anyone has diseases like malaria or dengue fever, and then give the data to our health center.” Nurhayati’s findings act as an ‘early warning system’. Medical staff can plan what information, drugs or equipment to take along with them on their monthly outreach visits to treat patients and prevent wider outbreaks of disease.

Clean water is crucial for people’s well-being, whether they are staying in a temporary living center or a home full to bursting point with displaced relatives. The risks of outbreaks of infectious diseases, such as diarrhea and scabies, are high. Trucking water to tanks, water bladders and tap stands meets the immediate needs of tsunami-affected communities, but the IRC is also supporting more long-term solutions, such as drilling new boreholes and digging wells. We are also channeling water from natural springs, and erecting water treatment systems that can last up to five years if well-maintained.

Five-year old Wah-yuna hums to herself as she bathes in the brightly-colored MCK. An MCK is a combined bathing, washing and toilet area, so once she’s finished, Wah-yuna moves over to help her grandmother Ajibah with the family’s washing. The IRC and the European Commission have built almost 450 latrines, of which roughly a third are MCKs. But it’s not just a case of ‘build it, and then leave’. Staff are actively promoting good hygiene practices, for example by holding talks with community members and organizing more structured sessions with local elementary school children. Each new latrine also gets a brightly-colored poster promoting good hygiene habits.

Today is a typical morning at the clinic for Dr Kemata Sari. Her first patient, six-year old Ikhsan sticks out his tongue and says ‘aaaah’. Her second-patient, the six-months pregnant Nilwati, sits patiently so the doctor can monitor her vital statistics. Dr Sari works at the local health center in Tanah Pasir, where she sees a variety of complaints ? from throat infections to malaria. The good news however is these complaints are on the decrease, according to IRC health adviser Dr Atilio Rivera. “The situation is getting much better because people are taking care of their own health,” he says. “Our community health workers are showing them how to prevent common diseases and people are listening.”

Health center staff in the IRC’s four supported districts take care of an average of almost 30,000 newborn babies a year. Each new baby needs to be monitored before birth, to check that things are going smoothly, ready for a safe delivery. Mothers must then bring their newborns to the health center to be measured, weighed and vaccinated. “Thanks to the European Commission, the IRC has been able to give equipment like scales, stethoscopes and measuring charts to help with these activities,” says IRC’s reproductive health manager Dr Tira Aswitama. “We’ve also donated several motorbikes, so that staff can go out from the health center and do community visits.”

“The tsunami left many medical staff feeling overwhelmed and frustrated,” says one of the IRC’s senior field monitors Regina Sadica. “They have the skills to help injured people, but their clinics had been badly damaged and they had no drugs or supplies.” The IRC and the European Commission rehabilitated and re-equipped local health centers, and provided medical equipment and renewable supplies. They also assisted district-level staff to provide training in the latest techniques for accurate diagnosis and treatment. “We wanted a situation where Ministry of Health staff in these centers have the power and the ability to respond independently,” says Regina.

(Dec 2005) In the devastating tsunami of December 26th 2004, the Acehenese health sector suffered not only from damage to clinics, hospitals and vital roads, but also through loss of services and human resources, as hundreds of heath staff perished.

The International Rescue Committee (IRC) is rehabilitating ten local health centers and dozens of midwife posts to make it easier for tsunami-affected communities to access day-to-day health care. We are also working with the Ministry of Health to train medical staff across Aceh, especially in the field of reproductive health.

Dr Atilio Rivera, IRC Aceh’s health adviser says: “Thanks to the European Commission, we are assisting almost 65,000 people with health services and water and sanitation initiatives.”

“Our work has made a real difference in the day-to-day health care being offered to the Acehnese people,” adds Dr Rivera. “Now no-one should live more than five kilometers from their nearest center, or have to walk more than an hour to reach it.”

The European Commission and the IRC are currently holding a photography exhibition at the Provincial Health Office in Banda Aceh, Indonesia.

Here is a selection of photographs from the show.

For more information about the exhibition, email: info@theIRC.org.