Health care in Sarawak for rural people

Rural Health Centres

• Sarawak has 194 rural health clinics that function as "one-stop" family health centres
  
• provide an integrated service comprising
  
  • maternal & child care
    
  • general outpatient care
    
  • environmental sanitation
    
• All clinics have rest beds and birthing facilities to encourage safe delivery among rural mothers.
  
• Community clinics are smaller versions of health centres and serve between 1,500 - 3,000 people.
  
• Except for a few larger clinics with medical officers, all rural health facilities are managed by allied health personnel.
  

Mobile Health Services

• to serve people in less accessible areas.
  
• These teams either travel by road, river, on foot or by helicopter, depending on the accessibility of the areas they serve.
  
• In rural areas, Village Health Teams are based in rural health centres, while those serving peri-urban areas, are based at the Divisional or District Health Offices.
  

Flying Doctor Service

• introduced in 1973 to provide basic health services to people living in remote areas
  
• The service operates 3 helicopters that are rented under a contract with a private company
  
• The helicopters are based in Kuching, Sibu and Miri
  
• cover 175 locations throughout the State with a population of about 70,000
  
• comprises
  
  • a medical officer
    
  • a medical assistant
    
  • two community nurses
    
• Visit the locations once a month or once in two months.
  

Village Health Promoter Programme

As the mobile health teams can only visit remote villages once a month, Sarawak Health Department introduced a village health volunteer programme to provide basic health care to these communities on a more continual basis.

• Started in 1981
  
• two volunteers from each participating village are given three weeks' training on a fairly wide-range of health-related topics
  
• Upon returning to their respective villages, these volunteers
  
  • give first aid
    
  • do health promotion
    
  • make blood slides for detection of malaria parasites
    
  • make sputum slides for detection of tuberculosis
    
• The volunteers give regular feedback on their activities
  
• Regularly supervised by staff from the Sarawak Health Department
  

Issues

• Iban people's belief
  
  • Life and health are dependent upon the condition of the soul (samengat). Some illnesses are attributed to the wandering of one of an Iban's seven souls, and the shaman undertakes a magical flight to retrieve and return the patient's soul.
    
  • Iban strive to maintain good life and health by adherence to customary laws, avoidance of taboos, and the presentation of offerings and animal sacrifices.
    

When they seek medication, they try the old ways through consultation with the old folk and the local healer, and you will be treated with folk medicine made from herbs and roots. Then, they try to sleep off the sickness.

For people who have serious illnesses like cancer and or difficult child birth, the likely scenario is that they lie down and rest, and wait to die.

Imagine people living in the headwaters of the great Baram or Rejang Rivers a few hundred KM away from any modern medical centres in Miri or Sibu. The nearest medical assistant is probably a minimal local clinic with a dresser or a nurse in charge, who can be reached by many hours of walking through the jungle and a boat ride in the treacherous water of the rapids.

For serious cases that require sophisticated and prolonged medical care, the rural patients will be in big trouble.

To get a helicopter to fly down the river to the big city is like hitting the jackpot in the Big Sweep draw. An alternative will be to travel many hours in a motor boat of some kind. Not many rural dwellers in upper Baram or Ulu Rejang have that kind of cash to pay for the fare.

In the event that the rural patient is finally brought to the urban hospital somehow, his or her trouble has just begun.

The patient may not have an identity card, which is quite common among remote rural dwellers. When they give birth in their jungle abode, who is going to report to a registration department many KM and many expensive Ringgits away.

The hospital might refuse to admit the patient without an IC, or refuse to grant him or her the kind of financial and other assistance that can be given to them by the social welfare department.

It has become a custom in Sarawak, for various relatives or family members to accompany the patient to the hospital, and there take turn to look after the patient 24/7, even on small matters like fetching a glass of drinking water or bringing the bed-pan.

But being from the remote mountainous region upriver, where are the relatives going to sleep and eat in the big city? By the roadside? We certainly cannot expect them to check into the Holiday Inn, can we?