Sudirman H Nasir , Victoria | Opinion
The death of 35-year-old Daeng Basse and her five-year-old son Bahir in Makassar last week was widely reported by the media and discussed by many people.
Her death and the subsequent reaction reveals the devastating impact of chronic poverty among many people in urban poor areas.
Daeng was seven months pregnant and the controversy surrounding her death indicates the culture of denial and finger-pointing among many state officials in this country.
As reported by the media, many officials in Makassar, including the mayor, Ilham Arief Sirajuddin, have said neither hunger nor malnutrition caused the deaths.
Rather, they said acute diarrhea resulted in the woman and child's death.
They also said the family had not accessed health facilities on time.
The debate around the cause of death however is highly unproductive. Hunger or under-nutrition and infectious diseases such as diarrhea are two sides of the same coin.
Diarrhea can be the cause or consequence of prolonged under-nutrition.
Moreover, it was widely reported Daeng Basse and her family stayed in a poor house in a slum area in Makassar, without adequate access to clean water, hygiene or sanitation.
The combination of prolonged under-nutrition and poor housing is fertile ground for many kinds of infectious diseases, including but not limited to diarrhea.
Blaming Daeng Basse and her family for not accessing health facilities is also morally incorrect.
Though the city mayor claimed health facilities such as Posyandu (integrated services for pregnant mother and children that provide antenatal care) and Puskesmas (community health centers) are free, it does not guarantee poor people like Daeng Basse know about or are able to access those facilities.
Studies on health access among the urban poor have shown there are still many constraints for the poor to access health facilities even if those facilities are free.
Such constraints -- ignorance toward basic knowledge of health and toward the procedures to access health facilities as well as the absence of transport fees -- are some examples.
The ignorance of poor people can be viewed as proof of the weaknesses of government's health promotion programs.
In addition, Daeng Basse's family came from a poor village in Bantaeng regency (about 100 kilometers from Makassar) and this reveals the intricate relation of structural poverty and health problems.
Daeng's husband, Basri, decide to migrate to Makassar due to the hard life in the village. As with so many others, the family dreamed of a better life in Makassar.
However, Basri's limited education and skills forced him to confront the even harsher realities of the daily lives in the city.
Basri, a becak (tricycle) driver who can only earn about Rp. 10,000 (US$1.09) per day, struggles to make ends meet.
His family's condition is affected further because he frequently spends about half of his daily earnings on cigarette and ballo (local palm wine, a cheap alcohol drink in Makassar).
With their limited funds, Daeng Basse and her children mostly consumed bubur (rice porridge) with salt.
It was also reported she was a victim of domestic violence.
The fact that Daeng Basse was seven months pregnant and had one son hospitalized, who was one year younger than Bahir, indicates a lack of access to contraception, family planning and reproductive health.
These circumstances clearly show the vulnerability of women and children in urban poor settings.
If we are to prevent these tragic deaths and improve the lives of the poor, structural interventions to enhance life skills through better access to basic facilities such as education and health facilities as well as access to decent employment should be realized.
And structural and cultural constraints for poor people to access those basic facilities should be minimized.
The responsibility of all levels of government (central and local) as well as support from business and civil societies to design and implement various structural interventions such as alleviating poverty and unemployment by creating more jobs and increasing access to basic facilities (education and health facilities) are crucial.
Those programs can only be materialized if government officials are willing to alleviate the culture of denial and blame within their institutions.
The writer, an alumnus of Hasanuddin University, Makassar, is currently pursuing a PhD at the Key Centre for Women's Health and Nossal Institute for Global Health at the University of Melbourne, Australia.
