The aim of this project is to set up a women's healthcare pilot project as an example for other rural communities, using the village of Pemuteran, North Bali, as an example. Specifically, the goals are to improve knowledge, attitudes and practices (KAP) of the rural women who reside in Pemuteran and by default, their male partners with regard to their health, including reduction of risk for STDs and cancer, in addition to improving their reproductive health status and knowledge about their bodies. This is being done through counseling by the village midwives, who are being trained by volunteer medical staff from two hospitals (Sanglah and Prima Medika) in Denpasar.

In addition, two village midwives have been trained to help detect breast and cervical cancer and all forms of STDs (Sexually Transmitted Diseases). These midwives have been provided with all the equipment necessary to take pap smears and blood samples from patients. These slides are then sent to Denpasar for laboratory testing. Aside from the testing, the women and their partners are educated about issues around women's cancer by teaching them how to look for signs of breast cancer themselves and to have regular check-ups and pap smears by the midwives.

It is critical that this type of training be done because by the time many breast and cervical cancer patients from rural areas are referred to doctors and hospitals for proper treatment, it is often too late, causing heavy financial burdens for their families.

To assess just how bad the situation had become, oncologist Dr. Tjakra Wibawa Manuaba and a team of doctors from Sanglah hospital, supported by the Yayasan Kanker Indonesia (YKI) and Johnson and Johnson, came to Pemuteran to take pap smears from 30 test patients (the staff of Puri Ganesha villas, as an example to the rest of the village) just after the bomb in November 2002. Of the 30 women tested, 19 were diagnosed with vaginal infections and provided with bethadine douches, 4 patients were treated for STDs and 1 patient was diagnosed with cervical cancer.

In August of 2004, Dr. Tjakra and a team of doctors and midwives from Prima Medika Hospital in Denpasar went to Pemuteran to begin the training of the midwives. Dr Agus from the Puskesmas (Community Health Clinic) in Gerogkak was also on hand in the newly renovated & equipped surgery belonging to Desa Pemuteran.

The two midwives were given new gynecological beds and all the equipment they need to run a women's village clinic. The doctors and midwives from Denpasar showed the two village midwives how to take pap smears from 17 test patients; the slides were brought back to Denpasar for analysis. The midwives receive Rp 10.000 for each patient tested. It is hoped that evenutally between them, the two midwives will be able to test 100 patients each month, so that the assessment of women's health in Pemuteran can be done properly.

These women have no hygiene education and have no money to go to a doctor. They give birth at home and not one of them has ever had a gynecological examination. Breast cancer usually remains undetected until it is too late and then the families have no way of paying for expensive treatments. The aim of this project is to educate village women to realize just how important sexual hygiene is and that they should come to the clinic immediately if anything seems to be wrong. This means that they can receive treatment before costs for the families become astronomically high and impossible to pay for.

A computer has been installed in the Puri Ganesha Hotel where an administrative staff person has been trained to set up a data base with the medical history of all the women in the village so that they can be examined and tested regularly. This will also assist in building a statistical data base which can be used to analyze the health situation of women in very rural areas. This is being done with the back-up of the local village authorities.

Eventually, if funding and human resources permit, ELISA testing for HIV/AIDS shall be done at the two midwives' clinics.

Since the clinics opened in August 2004, 123 women have been treated.

THE TEAM

The project manager is Diana von Cranach, a volunteer from YKIP. Her staff from Puri Ganesha were the original volunteers to be tested for cancer and STDs.

The team leader for the medical staff is Dr Tjakra Wibawa Manuaba, a member of YKIP's advisory board. Other doctors on the team are Dr Wayan Sudarsa, an oncologist from Sanglah hospital and Dr Anak Agung Wiraguna, specialist in skin and venereal diseases.