Peter Van Eeuwijk

Old-age vulnerability, ill-health and care support in urban areas of Indonesia

The epidemiological health transition in Indonesia has lead to a substantial ageing of its population and a rapid increase in the prevalence of chronic progressive illnesses in advanced age that, in most cases, require some sort of care. This shift from ‘cure’ to ‘care’ necessitates new paradigms in both health-care delivery and research on older people in less-developed countries. Care involves both attitudes and practice, and is a dynamic interaction between giver and recipient. The vulnerability of frail older people is strongly related to the resources, capability and willingness of kin and non-kin to act as care-givers for extended periods. Normative filial piety and kinship obligations are no longer undisputed. This paper reports a study of the care and support received by chronically ill older people in urban areas of North Sulawesi, Indonesia. The majority rely on close family members, most often a wife or a daughter (or both), to provide treatment, care and support. The main care activities are support with ‘activities of daily living’ and therapies for specific illnesses. Care-givers experience manifold burdens when providing care for frail older people, and tend to reduce their support as the severity and duration of their relatives illness increases. It is shown that an older persons vulnerability to inadequate care provision, or its withdrawal, is associated with marital status and gender (unmarried women and widows being most at risk), poverty, weak support networks, and having care-givers who are themselves vulnerable.

Health anthropology and urban health research

We live in a rapidly urbanising world. According to the 2001 statistics of the United Nations,a the proportion of urban dwellers rose from 30% in 1950 to 47% in 2000 and will probably attain 60% in 2030. Almost 70% of these urban dwellers live in cities of developing regions. At the current rates of urbanisation, the number of city dwellers in the world will equal that of their rural counterparts by 2007. In the late 1980s, researchers became increasingly concerned about the combined impact of rapid urban growth and economic recession on the health of a majority of people in African and Asian cities. Several books established urban health research with a focus on developing countries as a multidisciplinary field of inquiry (Harpham et al., 1988; Salem &Jeannée, 1989). It is now widely recognised that urbanisation per se is not necessarily bad for health, but it becomes so if urban governments fail to establish and support necessary infrastructure and services to protect citizens from environmental hazards and from social, economic and political insecurity.

Urban elderly with chronic illness: local understandings and emerging discrepancies in North Sulawesi, Indonesia.

Old-age research in developing countries is at its beginning in the social sciences and particularly in anthropology, which has focused on other vulnerable groups, but has not sufficiently addressed emerging health issues of elderly urban dwellers in developing countries. This study investigates the health status of aged people living in cities (i.e. the ‘burden of disease’), and how urban elderly experience and give meaning to chronic illnesses in context (i.e. the ‘burden of illness’). It correlates the conceptual framework of ‘health transition’ with prevailing theoretical concepts and models of medical anthropology. The research project was carried out in three cities of North Sulawesi Province; it encompasses elderly people (≥ 60 years) suffering from one or more chronic illnesses. Elderly people experience chronic illnesses in three qualitative ways: illnesses that (1) disturb, (2) threaten, or (3) cause worry. The harsh urban setting reinforces these afflictions, and may lead to economic hardships ...Old-age research in developing countries is at its beginning in the social sciences and particularly in anthropology, which has focused on other vulnerable groups, but has not sufficiently addressed emerging health issues of elderly urban dwellers in developing countries. This study investigates the health status of aged people living in cities (i.e. the ‘burden of disease’), and how urban elderly experience and give meaning to chronic illnesses in context (i.e. the ‘burden of illness’). It correlates the conceptual framework of ‘health transition’ with prevailing theoretical concepts and models of medical anthropology. The research project was carried out in three cities of North Sulawesi Province; it encompasses elderly people (≥ 60 years) suffering from one or more chronic illnesses. Elderly people experience chronic illnesses in three qualitative ways: illnesses that (1) disturb, (2) threaten, or (3) cause worry. The harsh urban setting reinforces these afflictions, and may lead to economic hardships and social destitution. The meaning of chronic illness of elderly varies distinctly from that of biomedicine and results in divergent health priorities. This article examines patterns of meaning developed by urban elderly with chronic illnesses, and explores how these emic classifications mirror afflictions of city life for these elderly in daily practice.

Perceived illness drives participation in mass deworming campaigns in Laos

Multiple helminth infections are very common in communities of southern Laos. Preventive chemotherapy in combination with health education is the mainstay of control. We assessed the knowledge, perceptions and practices of rural communities related to endemic helminthiasis and their control during a mass drug administration (MDA) campaign. Short interviews with household heads (n=192), direct observations and discussions with attendees of MDAs, and in-depth interviews with local opinion leaders (n=21) were carried out. Quantitative and qualitative data analysis was performed. Results showed that opinion leaders and villagers were well aware of the importance of attending MDA. Leaders perceived the effectiveness of MDA against severe schistosomiasis and appreciated that it was provided for free and in their village. They encouraged villagers to attend it. Anticipated adverse events of praziquantel was a barrier for participation. A majority of leaders purchased deworming tablet (mebendazole, albendazole) in a local pharmacy for deworming when MDA is absent in their villages (19/21). Most leaders (20/21) had a good knowledge on severe schistosomiasis though only a few of them (5/21) described its cause correctly. They knew little about the disease consequences of liver fluke (3/21) and soil-transmitted helminth (4/21) infections but more about their causes. A high risk for worm infection was observed: consumption of raw or insufficiently cooked fish (100%), frequent physical contacts with Mekong River water (76.0%) and low number of latrines (14.5%). In conclusion, MDA is widely accepted in affected communities. Avoiding severe schistosomiasis was the main motivation to comply. Participation rates increased significantly with drugs provided free of charge in the villages. Better knowledge on the consequences of worm infections and on its modes of transmission will foster the distribution and acceptance of appropriate preventive treatment and other measures in helminth-endemic communities. Where multiple infections require several drugs for MDA, preceding health education and information about MDA and its benefits are a prior condition.