The mountain paths wind away into the rough terrain. In the difficult conditions of the rainy season, we must trek along rocky roads and mud, across flooded rivers and valleys, and up steep hills prone to dangerous mudslides.

This may be extreme for me, but for my hardy Timorese friend, Aplonia, it’s just another day’s walk. She is taking me to a remote part of one of the already distant villages of Boti in the district of South Central Timor (TTS) in Indonesia. Far from the King’s Palace, or Sonaf, and far from the core of the village.

We finally reach the home of Mesriana, a woman who gave birth to her third child a month ago. Mesriana tells us the story of the birth. Waking up on 2 February she had no sense that the baby was on its way. Only around 2pm, after making lunch for her family, did she begin to feel sharp pains. With no transportation options, Mesriana and her husband, Mikael, had no choice but to begin walking to the village health clinic: ‘We had to walk far to get to the village health clinic. We had to climb many mountains,’ she says.

Throughout the mountainous two-hour, six-kilometre journey she could hardly walk. Luckily, the worst of the exhaustion and pain only came as she reached the health clinic. Mesriana was able to give birth safely, to a healthy baby weighing 3.5 kilograms.

Mesriana’s story is a reminder of the vulnerability and risk faced by rural and remote communities, far from health facilities and medical practitioners. Indonesia has one of the highest rates of maternal mortality in South-East Asia. Approximately 228 women die for every 100,000 live births. In disadvantaged provinces in eastern Indonesia, the rates are worse. In the district of South Central Timor the maternal mortality has reached nearly 290 per 100,000 births. Neonatal mortality in the wider province of Nusa Tenggara Timur (NTT) is one of the highest in the country at 31 deaths per 1,000 births. One influential factor in these development gaps has been the difficulty for the communities in eastern Indonesia to access roads and transportation needed to reach health services.



Lanan Mafatu Documentary

Mathias, who is the head of Sopo village, speaks of the lack of availability of vehicles to transport mothers to adequate health facilities to give birth. The midwife co-ordinator, Delda, refers to the environmental obstacles in accessing these villages.

These conditions are often worsened by extreme weather. Strong winds bring down trees onto the roads; heavy rain leads to flooding and mudslides. Health workers and communities then have to find other ways to get the pregnant women to medical facilities – even if that means making a stretcher from bamboo and carrying them over flooded rivers, mud and broken roads.

Such remoteness and environmental obstacles prevent health practitioners from delivering optimal service, says Dr Suryo in Lilana, one of the villages surrounded by wide rivers without bridges. On one occasion Suryo and villagers were forced to wait until the rains stopped before they could help a pregnant woman in a critical condition cross the river. The long delay resulted in complications: ‘We tried the best we could but we could not save both of them… by the time we arrived the baby had passed away. But thanks to god we were able to save the mother.’

In Nakfunu village the conditions are just as unforgiving. This is a serious concern for expectant mother Anita. But she manages to find an alternative solution. Local government and the health department, working alongside other programmes such as the Australia Indonesia Partnership for Maternal and Neonatal Health, have established a number of ‘waiting houses’, strategically located near Subdistrict health clinics. They provide a safe and comfortable living space for expectant mothers like Anita towards the end of their pregnancies, thus eliminating the risk of having to make a long journey while in labour.

‘Travelling such a long distance is very concerning for me,’ says Anita.‘What if during the middle of the journey the baby wants to come out? This is what makes me choose the waiting house.’

The waiting houses form one element within a wider ‘Revolution for Maternal and Child Health’, part of the global effort to reduce maternal and neonatal mortality as part of the Millennium Development Goals.

Yet more work is needed in disadvantaged peripheral parts of developing countries. Prolonged dry seasons have led to shortages of drinking and washing water for environmental health. Shorter periods of more intense rainfall have created various environmental obstacles limiting access to health services. As we approach the era of the Sustainable Development Goals (SDGs) these experiences also serve as a timely reminder of the increasingly interlinked spheres of health and environment.

This article was written as a background to the short documentary Lanan Mafatu (above). The documentary was made by Egen Bunga of Rumah Desain Media and Nicholas Metherall – Australia Indonesia Partnership for Maternal and Neonatal Health (AIPMNH).

The background and story behind Lanan Mafatu can be found at lananmafatu.wordpress.com

Watch a longer version of the film here

Nicholas Metherall is currently conducting field work with AIPMNH in rural and remote parts of Eastern Indonesia and Melanesia. He was also a previous Global Voices delegate to the First United Nations Environment Assembly (UNEA) held in Nairobi in 2014. Follow Nicholas on Twitter: @NMetherall