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Are floating public services the answer - A story from Sarawak
2008-06-16
In an effort to counteract poor access to health services in Sarawak, Malaysia, students and community leaders are being trained in basic first aid CPR and emergency response. This campaign is part of the Sarawak Inland Waterway Transport System Study.
A SMALL crowd was gathered around the girl, whose shoulder-length hair hid her face as she bent over the body lying on the floor. Her frail arms began pumping the victim's heart, counting softly up to 30. This wasn't a real accident, but 7-year-old Rachel Sebastian earned kudos from all her schoolmates and teachers of Sekolah Kebangsaan Ng (pronounced Nangah in Iban) Kain that evening.
And it wasn't just the fact that she had bravely volunteered to demonstrate the cardiopulmonary resuscitation (CPR) procedure in front of the whole school. "Rachel's father died three months ago," her class teacher said.There had been an accident at the logging camp along Sungai Rejang where he had worked to feed his family of six. With the nearest clinic about three hours away by boat and inaccessible after nightfall, there was no way to get him the medical attention needed to save his life.
In a blink of an eye, the Sebastian family lost its sole provider.
For people who live in the Klang Valley, Penang or any other major city, 24-hour hospitals and clinics, armed with competent doctors, are just a short drive or bus ride away.
This is not the case for rural villages or schools in Sarawak that are accessible only by river transport or logging trails, and are sometimes cut off from health and other economic and social services.
Given Sarawak's rugged geographical terrain and poor connectivity between urban and rural areas, accessibility to even the most rudimentary health services continues to be a challenge.
Getting medical supplies and personnel to the longhouses that dot the banks of the state's 55 navigable rivers poses a logistical nightmare, often taking about a day's journey by boat. The problem is compounded by the sparse and unevenly distributed population in the context of Sarawak's very large size, which drives up the cost of healthcare delivery.
This is why it is critical that we build up the resilience of rural communities to deal with emergencies. Poverty in Sarawak is largely a rural phenomenon, where rural households account for 70 per cent and 98 per cent of the state's poor and hardcore poor respectively.
For these predominantly agricultural communities who bear the brunt of severe weather events such as floods and droughts, learning how to respond effectively is not an option but an imperative.
For the past year, a small team led by the Sarawak Rivers Board has been training students and community leaders in remote locations across Sarawak in emergency first response, CPR and basic first aid skills.
The campaign is part of the Sarawak Inland Waterway Transport System Study, which seeks to develop rivers as a main mode of transportation.
The logic behind the initiative is simple - if Sarawak encourages the use of the rivers for transport, it is critical to promote a culture of safety among river users and improve safety standards, especially in light of the fact that there is still no mechanism to regulate community water transport upon which the rural poor are wholly dependent.
Special sessions on basic food hygiene and prevention of water-borne diseases are conducted by the Federation of Private Medical Practitioners' Associations of Malaysia Citizen's Action In Response to Emergencies programme, whose own objective gels with the campaign - that is, to raise a critical mass of "citizen responders" within Malaysian society who are able to effectively manage emergency scenarios. The doctors also conduct free medical screening for students.
The headmaster of SK Ng Kain said that when the floods arrived, the water level rose over 10 metres, submerging the first floor and cutting off the school's main water supply. He said they were lucky it happened when the school was closed for the year-end holidays.
The school did not have a first aid kit. Aid never arrived.
As the saying goes, much of life is timing. Nowhere is this truer than in an emergency, be it a natural disaster, a disease outbreak or violence.
In all these cases, rapid humanitarian response is critical for saving lives. However, our current infrastructure and aid financing and deployment to manage floods are neither speedy nor transparent.
Clearly, there is much room for us to re-examine our current approach to emergency preparedness and disaster mitigation. At the policy level, shouldn't they be made part of the evolving development agenda in the country since management of these disaster risks is a long-term effort and not a one-time affair?
At the ground level, more holistic efforts should be made, including adequate funding and co-ordination between agencies and organisations, to create awareness about emergency preparedness and response within communities.
In the case of Sarawak, perhaps a good starting place would be the "floating" community centres that ply the waterways and contain clinics, banking and libraries. These multipurpose boats would arguably be more efficient and cost-effective in the long run than rigid structures located in gateway towns, as is the case now.
There is much scope for public-private partnerships in delivering crucial development services to the doorsteps of rural folk, currently an untapped market.
With capital from the private sector and with government providing the impetus, access and basic infrastructure, these community centres could also double up as ambulances in times of emergencies.
For the most part, we already know what needs to be done to save lives. The great Asian tsunami taught us that Mother Nature shows no mercy to the unprepared.
The time to act is now - not in the devastating aftermath of the next great flood or tragedy.Extract from original article by Lilei Chow, UNDP, May 2008.
Original article: http://www.nst.com.my/Current_News/NST/
Sunday/Columns/2249151/Article/index_html
