Malaria in the Dutch East Indies: A Study on Indigenous Health

During Colonial Times

Dahlena Sari Marbun and Umar Zein

Universitas Islam Sumatera Utara, Medan, Indonesia

Keywords: Malaria, Medicine, Colonialism, Discrimination, Indonesia.

Abstract: Malaria prevention is basically one of the parts that is inseparable from the efforts of the colonial

government to form a Jawatan / Rakyat Kesehatan Service in 1925. In addition there are also efforts to

establish an initial health service through an army hospital. This health service is basically a continuation of

the Army Health Service (Militair Geneeskundige Dienst) in 1808 which was established during the

administration of Governor General H.W. Daendels. At that time there were three large Army Hospitals: in

Batavia (Jakarta), Semarang and Surabaya. Civil health efforts began in 1809, and the Government

Regulation on Civil Health Services was issued in 1820. In 1827 the two departments were combined and

only in 1911 was there a real separation between the two departments (Health Promotion Team, 2006: 6).

Indonesian malaria in the Dutch colonial era. Malaria is endemic in Indonesia due to colonial government

policies and environmental factors and human behavior. This epidemic then spreads to various blood

through human activities and the environment. The government and indigenous people are trying to

eradicate the outbreak. They did the effort but there was discrimination and difference in treatment. This

study discusses the case of Indonesian malaria in the Dutch colonial era.

1 INTRODUCTION

In the history of human civilization, malaria is a

tropical infectious disease that has caused suffering

and death until now. Since this disease is considered

mysterious until now, molecular research has

continued to develop and malaria cases are still a

health problem for people in the world including

Indonesia.

Each year Indonesia’s 230 million people

collectively suffer at least several million cases of

malaria caused by all four known species of human

Plasmodium. Despite a long history of pioneering

work in malaria prevention, treatment and control

reaching back to the early 1900s, no systematic

review of malaria in Indonesia has yet been

undertaken.

1.1 Human population

The Republic of Indonesia in Southeast Asia making

up the Indonesian archipelago straddles the equator

and stretches 5200 km from west Malaysia to Papua

New Guinea. The country consists of 17,504 islands

(only 6000 of which are inhabited), covering a land

area of 1.9 million km. The archipelago comprises

seven main islands: Sumatra, Java, Kalimantan,

Sulawesi, Maluku, Lesser Sundas and Papua.Sixty

percent of Indonesians live on Java and Bali,

representing only 7% of the land area of Indonesia.

More people live in rural (57%) than in urban areas

(43%). The ratio of male to female is 1:1. The age

distribution of the population is 30% young (0–14

years old), 65% productive age (15–64 years old)

and 5% old age (≥65 years old).)

1.2 Healthcare Delivery Systems

Healthcare services are made up of primary health

centres, public hospitals, private and semi-private

pharmaceutical industries and private sector

healthcare facilities. Primary health centres are

mainly located in sub-districts and provide maternal

and infant care, family planning and in-patient and

out-patient services to the community, as well as

communicable disease control services. In 2007,

there were 8234 primary health centres, with a

centre serving, on average, about 27,400 people. The

number of primary health centres increases at a rate

Marbun, D. and Zein, U.

Malaria in the Dutch East Indies: A Study on Indigenous Health During Colonial Times.

DOI: 10.5220/0008882901230127

In Proceedings of the 7th International Conference on Multidisciplinary Research (ICMR 2018) - , pages 123-127

ISBN: 978-989-758-437-4

123

of about 2.7% per year. The service coverage by

province ranged from 8000 to 52,000 people per

health centre. Seven provinces failed to meet the

standard target of a maximum of 30,000 people per

health centre. These were Riau, Banten, West Java,

Central Java, East Java, Bali and West Nusa

Tenggara. The area coverage per centre was 192 km

on average; however, in sparsely populated Papua,

Central Kalimantan and East Kalimantan area,

coverage was greater than 1000 km

The number of hospitals was 1319 in 2007,

which provided a total of 142,707 hospital beds.

Ownership of these hospitals was 49% private and

51% public and government operated. The overall

ratio of population to each hospital bed was 1581:1.

The Indonesian Ministry of Health (MoH) declared

the ideal ratio to be 1000 people per bed. The annual

increase in hospital beds is typically 1.1%. The total

number of people seeking hospital treatment was

about 30 million in 2005, with ~7.8% of them being

referred from lower levels of healthcare delivery,

including primary health centres.

The activities of the pharmaceutical industry

ensure the availability, accessibility and distribution

of drugs to the community. By 2005, according to

the Drug and Food Control Agency, there were 465

standard pharmaceutical companies and 1634 small,

traditional drug companies in the production sector.

According to the Indonesian MoH in 2007 there

was about half a million health personnel employed

in Indonesia. Nurses and midwives made up 54%

and 14%, respectively, of that number. Typically, for

every 100,000 people, there were 138 nurses and 35

midwives. Eight percent of these half a million

health personnel were licensed physicians, yielding a

service ratio of about 19 physicians per 100,000

people. Health personnel specializing in public

health made up two percent of this half a million,

with a service ratio of approximately four per

100,000 people. The distribution of health personnel

was 257,555 (45%) at hospitals and 184,445 (32%)

at healthcare Centre.

2 RESULT AND DISCUSSION

Research on malaria in HindiBelandawas first

carried out by Allard van der Scheer in 1891. Van

der Scheer ended his tenure in 1899, however, it was

not long. Re-malaria-related research was conducted

a year later. A German doctor named Robert Koch

visited the HindiaBelandaion September `889 to

make series of research expeditions on malaria in the

tropics. His research report entitled "Professor

Koch's Investigations on Malaria" can be read in The

British Medical Journal (Vol. 1, No. 2041, 1900).

Political Ethics has its intended good effect as

the reciprocity from the Dutch to the Indonesian

people but it turned into a misery. There were three

policies of the ethical politics: education,

immigration and irrigation. But, The irrigation

programs were not maintained well so the malaria

outbreak became a serious problem in Java island.

The Cultivation system policy in Indonesia brought

enormous wealth and prosperity of the Netherlands.

The Dutch colonial system in Indonesia from 1870

to 1900 brought suffering to the local population.

The land law in 1870 gained the foreign investors

grabbing land from the kingdom. The Sugar Law, as

well as polices from the kingdom which encouraged

the growth of the Dutch East Indies economy, made

the Europeans and Chinese people richer and the

indigenous people poorer. As Furnivall said

(1983:326): “…under the Chinese liberalism who

benefited greatly from the freedom of the company,

and if the profits plummeted, the Europeans felt

more about the excess opportunity of their

competitors.”

The situation caused the criticisms of the

colonialism in the Netherlands and in the Dutch East

Indies colonies that only brought benefits to the

Dutch, while the local population lived in poverty.

(Robert Van Niel, 1984:19)

Besides in Batavia, Dr. Koch also conducted

research in Ambarawa. This region was chosen

because there were military hospitals with complete

facilities and had characteristics as malaria endemic

areas. The Ambarawa landscape with its rice field

and swamping area is very conducive to the

development of malaria.

In Ambarawa, Dr. Koch collected and examined

blood samples of hundreds of children in three

villages close to rice fields and swamps. As a

result,he concluded that children, especially

toddlers, were more susceptible to malaria.

However, immunity to malaria will increase with

age.

The Ethical Politics was supposed to be a

reciprocation but turned into disaster. Irrigation is

mismanaged, malaria brought disaster on the island

of Java.

The Section I and II infrastructure projects were

successfully constructed in the mid-1895. At that

time, the Governor-General of the Dutch East Indies

had turned to Carel Herman Aart van der Wijck. The

Department of Public Works continued to develop

the Section III project which included the primary

canal on the bank to the right of the Ciranjang river.

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In her book, “Etika yang Berkeping-Keping: Lima

Telaah Kajian Aliran Etis dalam Politik Kolonial

1877–1942”, the historian, Elsabeth Locher-

Scholten, wrote that it invited the concerns of the

ethics who encouraged the implementation of 100

million guilders loan to the Dutch government in

order to fund the projects in the Indies.

After the irrigation infrastructure was completed

in 1904, other problems followed. The government

disregarded for the environmental conditions in

Cihea, especially the land conditions. Furthermore,

the government did not consider that farmers in

Cihea were backward and not accustomed to using

irrigation flows which in that era were fairly

modern. The water that flew through the rice fields

turned out to be stagnant and never receded. Water

puddles also spread, inundating land other than rice

fields. As a result, Cihea became a malaria epidemic

area.

Eight years since the irrigation had been

operated, Cihea was declared as a malaria endemic

area. From the report compiled by W. van Gorkom

regarding malaria endemic area in Cihea, it can be

seen that there was a high mortality rate of people

due to malaria. From around 22 villages in the Cihea

region, the death rate of the population reached an

average of 50 percent. The irrigation infrastructure

within an ethical spirit turned out to disaster. Over

the next few years, at least until 1930, the victims

fell on the side of the population.

After irrigation was operated, the government

allowed the establishment of a private Dutch paper

mill. The government wanted to make a big deal

from the irrigation. Meanwhile, the farmers were

taxed from the investment interest invested by the

colonial government. The badness of the colonial

government could also be seen from the way they

handle the malaria epidemic slowly, so the problem

was dragged on while the suffering of the population

never ended. This is an example of how the face of

colonial ethics is covered on hypocritical mask.

Owing to mismanagement of irrigation malaria

came back to attack and bring disaster on the island

of Java showingliberal political policy towards

indigenous people. The progress of the country's

trade gained from the sale of forced crops carried out

in Indonesia produced wealth and prosperity to the

Netherlands.

One more factor that arose along with the

advancement of agriculture and industry in the

liberal era was the increase in the number of people

who were mostly migrants. The situation gets worse

if the unemployed city residents invade the area

outside the city to find work. The breadwinner for

the Indonesian population is left behind because

positions that require proficiency are characterized

for Christians.

One impression of industrial development in the

Liberal era was the increasing population growth.

After 1870 the number of Europeans on Java began

to increase. This change was a result of the speedy

citizens who entered the area that was previously

reserved for government employees. This new

European group worked for the company or in the

private sector that started to grow and developed.

They began to hold associations to foster a sense of

brotherhood that was different from the European

community who arrived early to work as employees

of the royal court. Local people only worked as

laborers.

At the end of the liberal era, it became clear that

the predictions and expectations of the liberal group

through a liberal economic system would bring

greater prosperity to Indonesians who could not be

tested before when they had confirmed a planting

system that only helped destitution and misery in

Indonesia. Such circumstances caused the local

population to become dissatisfied (Ledge, 1972:

101).

By 1990 the situation had reached the height of

the upheaval, resulting in the banquet of Van Kol, a

deputy who was the representative of the socialist

party (Ledge, 1972: 101). Before this, Van Deventer

had also stated in his idea regarding debt:

"........... there is no need to be sure that the

Netherlands has extorted wealth from the East Indies

at the time of the plant and because it involves

muruah, women who are paid because they receive

assistance; the Dutch has extorted wealth from the

East Indies at the time of the plant and because they

keep the money, it is worth paying the debt by

obtaining assistance from the Dutch treasury to help

with the financial condition of the colonies and seek

Indonesian virtues "(Ledge, 1972 : 101).

The new European community who lived in Java

began to see the development of the lives of the

local people which were declining. They began to

want a more open and modern political change.

They demanded from the government and wanted a

power of autonomy to take care of financial matters

that were freer than the government. The liberal base

is a system designed for European private investors

and they have succeeded in accumulating wealth

from the colonies. The liberal basis provides limited

opposition to the forced cultivation system. The

liberal basis is the basis for wanting to implement

human rights, namely religious freedom, freedom of

expression and freedom in education. In 1860 the

Malaria in the Dutch East Indies: A Study on Indigenous Health During Colonial Times

125

liberal mind was actively developing in Europe and

gave birth to people who were free and humane.

The liberal group always insisted on the

government so that the element would pass the

giving of things to the promised autonomy of

government in the Indies - Dutch colonies. Under

the government of the Liberal Foundation the Indies

colony - the Netherlands had turned into a tool for

the production of the world economy protected by

the government. Local residents began to be

introduced to the system of low-wage workers.

Residents began leaving the rice fields because they

were attracted by the system of wages and the value

of money. To facilitate the delivery of merchandise

from the results of cultivation to the European East

Indies government regulating shipping associations

they carried out monopolies that diverted shipping

and shipping operations to local residents.

Various criticisms made by Dr. Abraham

Kuyper, as an expert in winning the Netherlands,

finally brought a downfall to the liberal party.

Kuyper wrote an editorial plan on our progress or

our progres. He wrote about his moral responsibility

in supporting the virtues of the Indonesian

population. The intended debt other than the

proceeds of the forced planting wealth (1830-1870)

also resulted in gains during the liberal period

obtained in the Netherlands.

2.1 Period 1959-1968 (Malaria

Extermination Period)

Malaria control in Indonesia began in 1959 with the

existence of KOPEM (Malaria Eradication

Command) at the center and in the area of the

establish of the Malaria Eradication Service which

was an integration of the Malaria Institute, as well as

training for the establishment of the Malaria

Training Center in Ciloto and 4 field training centers

outside Java.

During this period malaria control was called the

eradication period, where the focus of eradication

was carried out on the islands of Java, Bali and

Lampung. The main activities carried out were

spraying insecticides, treatment with Chloroquine

and prophylaxis. It was not until 1961-1964 that

insecticide spraying was carried out outside Java and

Bali. This effort was quite successful in the Java and

Bali regions with a decrease in parasite rate.

In 1966, efforts to eradicate malaria faced

various obstacles, caused by funding decreasing both

from the government and from outside assistance,

the spread of Anopheles aconitus resistance to DDT

and Dieldrin in Central and East Java, the resistance

of Plasmodium falciparum and Plasmodium

malariae to Pirimetamin and Proguanil and increased

tolerance of Plasmodium falciparum to Primakuin in

Irian Jaya.

Then in 1968, KOPEM was integrated into the

Directorate General of P4M (Prevention of

Eradication and Eradication of Communicable

Diseases), so that it no longer used the term

eradication but eradication.

2.2 Period 1969 - 2000 (Malaria

Eradication)

With the integration of malaria control efforts with

the health care system, malaria activities are carried

out by Puskesmas, hospitals and other health care

facilities. Along with ecological changes, in 1973 it

was reported that the existence of resistance to

Plasmodium falciparum in Yogyakarta, even in 1975

in all provinces in Indonesia, accompanied by a case

of Plasmodium resistance to Sulfadoxin-

Pirimethamin (SP) in several places in Indonesia.

In 1973 import patients were found from East

Kalimantan in Yogyakarta. In 1991 there were

reported cases of resistance to Plasmodium vivax

against Chloroquine on Nias Island, North Sumatra

Province.

3 CONCLUSION

Political Ethics has its intended good effect as the

reciprocity from the Dutch to the Indonesian people

but it turned into a misery. There were three policies

of the ethical politics: education, immigration and

irrigation. But, The irrigation programs were not

maintained well so the malaria outbreak became a

serious problem in Java island.

The Dutch colonial system in Indonesia from

1870 to 1900 brought suffering to the local

population. The land law in 1870 gained the foreign

investors grabbing land from the kingdom.

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