Published: 30/07/2008

Case Study in the Kelurahan of Cempedak, Kotabumi subdistrict, North Lampung

This article is a summary of a case study of an issue in reproductive health services and childbearing mothers. This case study is taken from one of seven Districts in Indramayu, Surakarta, Lampung Utara district, West Sumba district, East Lombok district, Jembrana district, and Lebak district. It is describing the life story of Nurwati who lives in Cempedak District, Kotabumi subdistrict, North Lampung.


Nurwati came from Serang but grew up in North Lampung. She was born in 1967 which means that she is now 40. Nurwati is the eighth child of ten siblings. She once went to elementary school but ended up in the second grade and totally terminated her education because of the economic limitations of her parents. Soon after her first menstruation, Nurwati got married at the age of 16 to Suherman, one year older than her. Getting married in such a young age is not something strange for the local people who practice the custom. When a girl has experienced her first menstruation, she has got a signal of being mature enough to marry. By marrying off their daughter, they have reduced their pressing economic burden.


One year later Nurwati gave birth to her first child when she was still 17. To fulfill their economic needs, Nurwati offers to do whatever she can do to her neighbors like doing the laundry, cutting the grass, cleaning the house and so on. So does her husband who does any work he can do such as digging a well, cutting trees, and so on. Their monthly income is not steady. Sometimes they could get Rp 200,000 when there were people who used their service, some other times they got nothing since there was no one to use their service.


Now Nurwati has 9 children, 5 girls and 4 boys. She revealed that from her 9 children, three of them were attended by a traditional birth attendant during their births, once by a midwife, and the rest did not get any medical help other than from her husband and herself. Only after the child had been born did they call a traditional birth attendant or a midwife to cut the umbilical cord and bathe their newborn. This was done to save childbirth cost. The normal cost for a traditional birth attendant is Rp. 150,000, and around Rp. 350,000 for a midwife. By bearing the child herself, Nurwati and her husband only spent Rp. 100,000 for the midwife for having taken care of their newborn, giving the injection and providing the medicines. If it was a traditional birth attendant that came to help them then they just spent Rp. 50,000.


Honestly Nurwati admitted that if she had to choose between a traditional birth attendant and a midwife to help the childbirth, she would prefer to use a midwife if she had enough money to pay her service. She felt that a midwife was more safety-giving because she provided injections and medicines when she underwent some pains during the childbearing or after it. A traditional birth attendant, on the other hand, just gave “holy water” to drink before the process of childbearing in order to drive away evil spirits that hung around so that the child could be easily born.


Nurwati said that so far she and her family very rarely sought for health facilities in a Puskesmas or visited a midwife because of economic difficulties. Other than that using the Askeskin card for health services was not that convenient. She felt being looked dwon upon, did not receive due appreciation and did not get the service. Had she got the service, the health officers did not give it wholeheartedly, as could be seen by their less hospitable expressions to Askeskin card holders.


Nurwati and her hunband acknowledged that for the time being they have not felt the benefit of the Askeskin card issued by the government. According to their experience so far there has not been any free health service although they used the Askeskin card, “Without money you cannot get any health service”. They admitted that only after they had money did they dare to look for health services. If there was no money, better for us to do a self-help by buying medicines in the stalls.


Nurwati’s youngest child is always brought to the Puskesmas to get immunizations. In this case she complained over the fact the health services are not really free. She had to pay at least Rp. 1,000 for an immunization, needless to mention the biscuits that she has a right to get as additional food, but was not given to her under the reason that her child was no longer a baby, despite the fact that her baby is still below 5 (3 years old). According to Nurwati if she was not able to pay immunization cost, the officers would not be willing to give immunization to her child.


Other disappointing experiences undergone by Nurwati’s family was the fact that she could not use the Askeskin card to obtain a medical treatment for her child, Arsandi, who suffered from severe talasemia and finally died because there was no comprehensive treatment. Arsandi’s death was a big blow for the couple, since they had time and again brought Arsandi to have a medical treatment in the hospital. But free facilities given to Askeskin card holders are only room, doctor’s service and medicines – if those are available in the hospital, while the need formedical treatment for talasemia does not cover only provision of medicines but also recurrent blood transfusion in a sufficient supply. This was a really hard situation for Nurwati and her husband.


Nurwati disclosed that for blood transfusion for her child she had to buy blood from Indonesian Red Cross for Rp. 60,000 per bag. This blood price was felt expensice dan pressing because every time of transfusion Arsandi needed 4 bags of blood. So, for each time of blood transfusion Syarifah had to prepare fund as much as Rp. 240,000. For each medical treatment when the talasemia flared up again, they had to have at least two days medical treatment in the hospital and 4 bags of blood. The disease suffered by ther child was already severe so that in one month they had to go to the hospital twice or three times to get the medical treatment and blood transfusion. The condition would be worse if the blood supply at Indonesian Red Cross was little and Nurwati had to buy for Rp. 100,000 per bag.


The Askeskin facilites were limited only to roomrent and payment for the doctor, while the medicines and blood must be bought. The last time before Arsandi died he had been under medical treatment for around one month where the total cost was worth Rp. 1.5 million. This does not count the transportation cost and meals for the family when they took turns to take care of Arsandi in the hospital. Nurwati and her husband expected that there will be a government policy that really alleviate poor people’s burden. ***