OGAN ILIR, SOUTH SUMATRA — Ayu Widianti (29), a midwife from Banyuasin Regency, South Sumatra, is carrying out her mandate in Tanjung Mas Village, Rantau Alai District, Ogan Ilir Regency. It has been a year since 2022, Midwife Ayu has migrated there to carry out her dedication in a Dompet Dhuafa program called Bidan Untuk Negeri (BUN) through the South Sumatra Free Health Service (LKC) in Tanjung Mas Village until the end of 2024.
She has been working as a midwife since 2015. Previously, Ayu studied D3 Midwifery in Palembang, then continued D4 in East Java with an interest in clinical education and investigators. After graduating, Ayu immediately served as a Village Midwife at a health center and clinic in a village in Palembang, the area is also far from the residence, but not settled.
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“Yes, I have been in Tanjung Mas Village for two years. It’s not the first time I’ve been to the countryside, but this time I stayed, and the situation is different in each village. It’s far, about a hundred kilometers, through three districts from home (Banyuasin) to here (Ogan Ilir). Because if midwifery there is something that must carry out exams and experience for practice, “said Midwife Ayu to the Dompet Dhuafa Team.
The livelihoods of the people in Tanjung Mas Village are generally farm laborers, while a small proportion are fishermen. The stilt houses are mostly inhabited by 2 or even 4 family cards (KK) in 1 house. In addition to stunting, the elderly, and the poor, most pregnant women in Tanjung Mas Village are still <25 years old and are very unfamiliar with obstetric health education.
Wanting to be a soldier
Previously, Midwife Ayu was interested in becoming a soldier. She had no interest in the health field, nor did she think she would become a midwife. But at one point, a relative of her parents inspired Ayu to choose a university and an academy major to pursue. Although she didn’t immediately say yes, Ayu delved deeper into midwifery.
“After going through and having come this far, I got a lot of things and it’s not just knowledge, but also experience and learning. Meeting new environments with different problems. Whereas before, I was not a person who often socialized. Now I have to meet many people in different regions with different characteristics and environments. I became aware of the adjustments and maturation of each of them, there are approaches that I must do with people in the interior who may be unfamiliar with education or health programs,” said Bidan Ayu.
Instead of diving in, one day midwife Ayu saw a friend taking some tests for the Bidan Desa program. She was encouraged to start looking for similar tests. After several unsuccessful attempts, she saw an information flyer for Dompet Dhuafa’s Midwife for the Country Program on social media to fill service needs in South Sumatra. The region she was hoping for.
“When looking for the Village Midwife program, I mostly saw information for placement outside South Sumatra. Some are Aceh, Java Island, and others. Meanwhile, my parents still want me in the South Sumatra region. Qadarullah, there is a Dompet Dhuafa Midwife for the Country in South Sumatra. I took the test and thank God I am now living it, “admitted Midwife Ayu.
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Health Care = Maturation and Empowerment
At the beginning of her placement in Tanjung Mas Village, Bidan Ayu felt worried and scared to be in a new place, working alone in a rural area. She was still a little wary of her previous placement experience. She had experienced social conflict and was prone to robbery. However, her mentality and maturity began to be trained to be more courageous and adaptive.
“Here, thank God, it’s safe, not as bad as we think. It’s just that because we are new here, we have to remain friendly and adjust. After a year, I realized that the people of Tanjung Mas Village support each other. They often help pack and cook in the kitchen when there are activities like today’s service, and they do it voluntarily. Initially, there might be a mindset about money, but over time we know that it’s about providing education and services,” she said.
The Bidan Untuk Negeri program itself is not just a service, but also an empowerment. There is education to increase knowledge, especially for pregnant women. Because previously those who were unfamiliar with health services, for example pregnancy checks, were still difficult to do. An example of a case experienced by Bidan Ayu, there are those who only check pregnancy when the womb is six months old. Likewise, when it comes to treatment, those who are unfamiliar with treatment do it when it is already severe, not while it can be prevented.
“For example, here, from the beginning the community was only given medicine when there was a recitation, now health services are centralized in the house or this BUN Healthy Service Post. At first, it was not easy to get them to come. I approached the cadres here, went door-to-door and word of mouth. From only 10 people benefiting from the service, I added 15 people, now thank God 30 people can come every time there is a service. The rest are residents whom I visit house to house,” she explained.
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Night labor in the river during forest and land fires
Bidan Ayu said that pregnant women in rural areas are still accustomed to giving birth on their own, only calling a health worker or midwife in an emergency. She had heard of a woman checking her pregnancy. There was no opening yet, but when checked again it turned out that the umbilical cord had come out or fell and crossed.
“What is worrying is that although the community is crowded, they don’t really know whether this is an emergency condition and must be referred or not. Because there is no ambulance here. At that time the mother survived, but the fetus did not. So I’m improving the class for pregnant women here,” said Bidan Ayu, as a lesson for herself.
“Once, in the middle of the night, it was raining, there was an emergency. Like it or not, we had to refer them to Palembang. It was far away, and the closest route was by river. There was also a time when there were forest and land fires, and the thick haze was severe, when we had to take the river route, until finally someone gave birth in a narrow boat with only a small light. The pregnant woman’s posture was large, and only her husband accompanied her, so it was difficult to evacuate her at the port. Yes, this is the challenge in rural areas. This is what I remember the most,” said Midwife Ayu.
Bidan Ayu admitted that when such a situation arises, she doesn’t feel like a hero at all. Instead, she thinks that the patient must be saved at all costs. She is well aware that situations in the field, challenges during emergencies, and patient conditions vary. There is only one principle, and that is to be wholehearted.
“The main thing is to survive first, not thinking about anything else. I don’t care whether I’m pushed, whether I’ve eaten or not, whether I’m wearing flip-flops, the important thing is that I help first, hehe. But from there we realize that every situation is different, so just do your best, wholeheartedly,” said Bidan Ayu.
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One of the factors for the BUN Program to be present in Tanjung Mas Village is that this village is also a high stunting location. The results of Bidan Ayu’s analysis, in Tanjung Mas Village there are around 20 stunted children with one child with indications of Down syndrome.
“Children with Down syndrome and stunting get sick easily. We cannot overcome it with food, it must be treated, referred to the puskesmas, then to the hospital. I take them to the hospital because if I don’t take them, sometimes they don’t want to seek treatment. This is because the family’s economic condition is also lacking. Well, we (LKC) also have a Nutrition Post Service that has been running here for a year. Alhamdulillah, now stunting has decreased from 20 children to only 5 children. Behavioral education to change this mindset is the most important thing,” explained Midwife Ayu.
Improving Health Access to Delivery Services in Remote Areas
One of the indicators of community welfare in a country is the maternal and infant mortality rate. Therefore, efforts to improve maternal and child health need special attention. Not to mention that UNICEF has named Indonesia as the country with the fourth highest stunting cases in the world.b Midwives spearhead the development of the first thousand days of child birth. Midwives are also women’s partners who oversee women’s health throughout the life cycle. The lack of access to maternity services in remote areas is a concern for the sustainability of the quality of the next generation.
In order to assist the government in improving access to public health in the process of delivery services to remote areas of the country, Dompet Dhuafa has launched the Midwives for the Country Program which has been spread across several points in Indonesia since June 2021. Currently, BUN is present in South Sumatra, Banten, North Sulawesi and Papua.
Dompet Dhuafa’s General Manager of Health, Dr. Yeni Purnamasari, said that the main task of the midwives in this program is to provide services while carrying out community health empowerment programs. The midwives must also be able to coordinate with the puskesmas and local government to strengthen their programs.
“Dompet Dhuafa provided 6 midwives with various training for 3 weeks. This training is very useful as a provision for midwives who will occupy remote areas, where people may still be unfamiliar with knowledge about pregnancy, as well as maternal and child health. In addition, life in remote areas is certainly very different from life in urban areas,” said Dr. Yeni.
Before implementing the BUN Program, the midwives conducted a three-week training with LKC Dompet Dhuafa. The briefing on the BUN Program is not just about village midwife services, but also about social empowerment. Not only childbirth, BUN also has briefings related to stunting reduction empowerment. The BUN program runs for two years. So does the midwife. After that, the BUN Program will develop into a healthy area.
“I call BUN ‘Ngaji Layanan’, so our work with social empowerment and humanitarian affairs is very close. The sense of humanity must still be there. Hopefully, if I can open my own practice later, it won’t just be a business, but also have a social side. Because as I have experienced and seen firsthand, there are still many who live in the interior with the challenges of the area and the poor community as well, “concluded Bidan Ayu, optimistically. (Dompet Dhuafa)
Text and Photo: Dhika Prabowo
Editors: Dedi Fadlil, Ronna