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Papua Tidak Boleh Sakit, Kita Bergerak Itu Sakti

PAPUA, kisah pilumu tergambar dalam lima hari headline Kompas. Saya teringat akan pengalaman pribadi saat menjadi peneliti lapangan di Survey Indikator Kesehatan Nasional 2016 di Wamena, Lembah Baliem, Pegunungan Tengah. Daerah ini bisa ditempuh dengan sekitar 3 jam. Pertama dari Jayapura menggunakan pesawat ke Puncak Jayawijaya. Lalu, menempuh jalan darat sekitar 2 jam.

Saat kaki menginjak tanah surga yang pernah dilukiskan oleh Franky Sahilatua itu, membuat saya spontan ingin bernarsis ria. Sayang sinyal tidak mendukung. Gagal sudah update Instagram dan Facebook.

Di luar itu, saya mendapati masyarakat masih tinggal di dalam rumah jerami yang disebut Honai. Di dalamnya dia tinggal bersama ternaknya. Mereka memasak dengan kayu bakar di mana asapnya mengepul dan mengepung di dalam rumah. Bayangkan dia hidup bersama hewan ternak bersama asap. Di rumah itu turut pula anak dan sanak famili mereka.

Keterkejutan saya selanjutnya saat saya berbicara dengan warga soal ante natal care, pemeriksaan kehamilan. Selama hamil hingga bersalin, kebanyakan penduduk asli, hanya dibantu oleh orang tua atau orang yang dianggap pintar.

Padahal Puskesmas dari Desa Ilokama itu bisa ditempuh selama 40 menit. Dan di sana sudah ada dokter dan fasilitas medis yang menanti. Ya, lagi-lagi ini soal budaya dan perspektif mereka dalam memandang kesehatan.

Banyak dari mereka memang tidak percaya dengan pendekatan kesehatan modern. Proses kehamilan dan persalinan di rumah menjadi budaya, dan sulit bagi mereka untuk mempercayai pengobatan medis modern.

Saya teringat kisah seorang rekan di tempat kerja saya, Bappenas, Arifi sekitar tahun 2015. Dia datang ke kawasan mutiara hitam untuk memantau pelaksanaan program kesehatan di pedalaman Papua. Di sana dia ditugaskan dari Merauke menelusuri sungai dengan 8 jam melewati Boven Digul menuju Kabupaten Mappi, tempat bermukim suku pesisir, Auyu.

Di sana Arifi melakukan pelayanan kesehatan dengan masyarakat yang dominan masih hidup di pohon-pohon dan jauh dari Instagram, Spotify, dan Facebook. Ah jangankan piranti-piranti penting milenial itu, listrik saja mereka tak punya.

Di tengah jalan dia harus menepi beberapa jam untuk terhindar dari fenomena alam yang disebut “kepala arus”, fenomena ini adalah tabrakan antara aliran hulu dan muara, bisa memecah kapal yang melintas di atasnya. Sudah pasti ini adalah momok dalam urusan transportasi.

Kesulitan lainnya, dia menceritakan saat pelaksanaan program kesehatan itu adanya gap antar budaya. Seperti misalnya, program kesehatan seringkali mengalami resistensi. Salah satunya penduduk lokal lebih memilih untuk mendengar kepala suku dan orang luar yang sudah bermukim lama di sana.

Kedua pengalaman itu kemudian memberikan saya sebuah insight, berbicara soal kesehatan di Papua memang kompleks. Salah satunya adalah soal budaya, pendekatan etnografi masih jarang digunakan oleh para pelaku medis di tanah Cendrawasih ini.

***

Lima hari ini saya membaca headline Kompas (dari 10-15 Januari 2018) tentang kondisi kesehatan anak-anak di Papua. Kompas mengulas anak-anak Papua kini didera gizi buruk dan terserang penyakit (utamanya campak). Mereka tidak tersentuh oleh imunisasi dan PMT (pemberian makanan tambahan).

Kendala geografis, sulitnya transportasi dan komunikasi, terbatasnya infrastruktur dasar, langkanya tenaga kesehatan, gizi buruk dan wabah penyakit adalah penyebab yang telah memicu tragedi kemanusiaan meninggalnya 61 anak di Asmat dan di distrik lainnya yang belum terhitung.

Anak-anak gizi buruk terlambat ditangani karena ketiadaan Posyandu dan petugas kesehatan yang tidak selalu ada. Permasalahan akses yang sulit juga dialami warga suku Asmat yang harus menyewa perahu motor atau di Wamena yang membutuhkan pesawat atau helikopter. Harga? Pastinya mahal dengan jarak tempuh yang jauh disertai tantangan alam.

Pemerintah di sana bukannya berpangku tangan saja. Sudah ada layanan kesehatan antar distrik (istilah setempat untuk dusun), namanya ‘Layanan Kaki Telanjang’. Layanan dimana petugas Puskesmas berkeliling dari satu distrik ke distrik lainnya untuk menjajakan kesehatan.

Kesulitan mencari tenaga kesehatan turut juga dialami di sana. Wajarlah, akses komunikasi dan transportasi yang demikan sulit, tentu para petugas kesehatan ragu akan masa depan mereka. Okelah, kalau untuk jangka pendek. Tapi kalau untuk jangka panjang tentu mereka akan berpikir berkali-kali.

Jujur saya sangat sedih tapi sekaligus tertantang.  Apa yg bisa kita lakukan untuk mereka? Saya yakin ada banyak hal yang bisa dilakukan.

Potensi daerah mesti diprioritaskan, Papua membutuhkan orang asli yang lebih mengerti dan memahami. Selain itu, dia dekat dan bisa tinggal lama di sana. Yang disekolahkan untuk menjadi tenaga kesehatan. Putra daerah.

Pendekatan dialog, kolaborasi dan pelibatan orang lokal dan orang luar yang sudah lama tinggal di wilayah tersebut untuk memberikan pemahaman melalui pendidikan kesehatan.  Pastinya pendekatan tersebut baiknya berbasis budaya setempat, wilayah adat dan fokus pada orang asli Papua.

Selain itu program magang dokter dan nusantara sehat juga perlu mendarat di Papua. Opsi lainnya adalah telemedicine, tapi dengan syarat jaringan sudah terpasang dan sinyal kuat, selain itu moda transportasi yang layak untuk rujukan.

Saya kira masih banyak solusi yang ada di kepala. Krisis kemanusiaan di Papua berada amat dekat dengan kita, bahkan di ‘rumah’ kita sendiri.

***

Seorang teman volunteer dari MSF (Dokter Lintas Batas), sebuah organisasi nirlaba yang bergerak di bidang kemanusiaan, menghubungi saya via Facebook. Dia mengutarakan bahwa organisasinya berniat membantu masyarakat Papua. Namun, niat itu harus diurungkan karena Kementerian Kesehatan berucap bahwa pemerintah setempat masih bisa menanganinya.

Waduh. Saya kira permasalahan ini bukan lagi soal wewenang siapa dan siapa. Permasalahan ini adalah soal kemanusiaan. Nah, kenapa itu tidak bisa? Seharusnya pemerintah menyambut semua pihak yang berada pada gelombang dan frekuensi yang sama untuk menuntaskan masalah kesehatan Papua ini. Kalau Anda bukan bagian dari solusi, Anda adalah bagian dari persoalan.

Bahkan di level Indonesia, kita punya Humanitarian Forum Indonesia dan Indonesia Humanitarian Alliance yang saya kira akan sangat siap membantu. Masalah luar negeri saja mereka repot, masak dalam negeri mereka tidak terpanggil.

Ayo bergerak dengan tindakan nyata untuk Papua, mari bergandengan tangan, bahu membahu, kita berbuat sesuatu untuk Papua.  Papua punya dana otonomi khusus (Otsus). Juga sudah ada instruksi presiden untuk percepatan pembangunan Papua, dan kabarnya sedang disusun rencana aksi nasional dan petunjuk teknis untuk pelaksanaannya.

Sebetulnya kita tidak kurang aturan, nasehat dan petunjuk. Teringat kata senior saya Teguh Dartanto dari LPEM (Lembaga Penelitian Ekonomi dan Masyarakat) UI, hak asasi manusia tiada artinya tanpa kewajiban asasi manusia.

Saatnya kita menyapa Papua yang sedang susah karena mereka adalah bagian dari kita. Kita tidak perlu menunggu surga untuk hidup bahagia. Tetapi bagaimana menciptakan surga-surga nyata dalam kehidupan bersama, sekarang dan di sini.

Abdul Halik Malik

Dokter umum, peneliti kesmas, tenaga ahli kesehatan dan gizi masyarakat Bappenas 2016-2017.

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Abdul Halik Malik

Dokter umum, peneliti kesmas, tenaga ahli kesehatan dan gizi masyarakat Bappenas 2016-2017.

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