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  • Title: Primary health care among the Iban of Sarawak.
    Author: Chen PC, Tan YK.
    Journal: Trop Geogr Med; 1981 Dec; 33(4):403-9. PubMed ID: 7342391.
    Abstract:
    A pilot project was established in the Entabai area of the 6th Division of Sarawak, Malaysia to test the value of village aides and self-care in the provision of primary heath care for the underserved areas of Sarawak. The predominant ethnic group in Sarawak is Iban. The pilot project covers a 700 square kilometer area with a population of 5000 Ibans located in 48 longhouses. Each longhouse has 8-40 households and is led by a headman. In the center of this pilot area is a community clinic, manned by a hospital assistant, a junior hospital assistant, a sanitarian, and 2 community nurse midwives supported by a boatman and 2 attendants. The community clinic provides comprehensive primary health care services including simple curative medicine, maternal and child health care services, environmental services, and nutritional advice, but because of the lack of roads, the facility serves only 9 of the 48 longhouses i.e., those located within hour's traveling distance of the community clinic. From the community clinic a mobile health team visits the surrounding 39 longhouses about once every 2 months. From the underserved longhouses, 15 village aides were selected by the people and trained. Each was given intensive full-time training for 2 weeks and will continue to receive additional inservice training once a month. Each month the village aides return to the community clinic to be retrained and to replenish their stocks of medicines. 2 years after the pilot project was initiated, the hospital assistant reported that the people have come to accept many aspects of modern medicine and to cooperate with measures aimed at health promotion and disease prevention. Village aides see that serious illnesses are referred earlier; consequently the number of seriously ill patients has dropped. There has been a 44% reduction in the number requiring admission into the inpatient facilities in the community clinic as well as a 46% fall in the number of emergencies referred to the backup divisional hospitals. the number of clean water supply systems installed in the pilot project area from 1971 to 1981 showed that the largest number of such water supply systems were installed in the 24-month period after the village aides were introduced. Simple but essential health care is being provided to every longhouse by village aides backed up by the staff of the community clinic who in turn are backed up by the doctors at the hospital. Simple primary health care is now available within 30 minutes of every longhouse in the pilot project area.
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