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  • Title: Notes on health care and traditional birth attendants in the region of Yogyakarta, Indonesia.
    Author: Cobb AK.
    Journal: Kans Nurse; 1983; 58(8):17-8, 28. PubMed ID: 6558256.
    Abstract:
    A major in health care services in Indonesia since the 1950s is the development of a national health system with emphasis on service to rural communities. To achieve this a network of 5000 public health centers, or PUSKEMAS, was built throughout the country. Staffing depends upon a nationally legislated requirement that medical school graduates complete 3-5 years of mandatory service in a rural area before they can apply for training in a clinical specialty or go into private practice. The health care system is organized into a hierrachy of resort, with the local health centers screening high-risk cases of all types, which then are referred to regional hospitals and, if necessary, to the university hospital which maintain a full array of health care specialists. Philosophically, there is a strong emphasis on service and coummunity health and a deemphasis on premature adoption of sophisticated technologies. The values of community orientation, service, and sensitivity to cultural differences are trangibly expressed in an interdisciplinary rural community health project now being carried out at Gadjah Mada University (GMU), with funding from the government of the Netherlands. Students make weekly visits to a rural village where they have a simple program foccusing on the weighing of babies. During this process, health screening, health education in proper nutrition, child development, and continuation of breadt feeding are done. Another grassroots coumunity health project is a research project in which members of women's clubs in the rural villages volunteer to do rudimentary screening for high risk pregnancy. The women were trained to check on a monthly basis blood pressure, height, and weight, and to report any significant changes to health professionals at the nearest PUSKEMAS. A shift from simply providing health services to a strong emphasis on health education is advocated. Near Yogyakarta, the midwife holds a respected position within her coummunity and provides supportive assistance in the home during the delivery and for 35 days thereafter, during which time daily massage is given to both mother and baby. The women do not recognize the need for prenatal care and usually seek help only at the time of delivery. The traditional birth attendant, because of her integration and high status within her community, traditional birth attendant, because of her integration and high status within her community, can be an effective allay in the effort to reduce infant and maternal morbidity and mortality.
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