THE CONTROL OF RABIES WITH DESA PAKRAMAN APPROACH IN BALI-INDONESIA

By : Sang Gede Purnama

Control efforts of rabies not government responsibility but all the community. The involvement of the village pakraman in this case really was needed where the traditional agency could participate directly in eliminating the dog, VAR giving and the production awig-awig quite supportive the success of this program.

The development of the rabies illness increasingly the day was increasingly worrying his situation. The number of his casualties continued to improve and his spreading territory also continued to spread. What was done by us evidently still could not bring about the Balinese province freest from rabies. Beforehand we were known as the free region rabies but with passing of time evidently our region has visited the animal of the bearer of the rabies virus.

The rabies virus in fact could be brought by the dog, the cat, and the monkey. Where the biggest potential was at this time spread by the dog. His spread through the bite the animal of the bearer of the rabies virus and including zoonosis (the animal diseases that could spread to humankind). The rabies illness could cause the death so as to need the serious handling towards this illness.

Precisely that distinguished the Balinese Province from the other area was ownership of this dog. His population's dog a large number of in the Balinese Province was compared the other area, this Dog was often set free by his owner, the Owner of the dog did not have data collected on it and rarely the dog that was given the vaccine. Nearby that the dog for the Balinese community as the guard of the house so as almost each house contained the dog. Estimated only was needed by a dog in the incubation period to spread rabies in Bali. The high dog population (500,000-600,000 tails) in Bali was the media that was effective as the spreading of rabies.

As the area of world tourism that most of his communities depended on the sector of tourism. Bali could also experience the big loss if the plague of rabies happening. The tourism industry is generally sensitive to the problem that happened especially the problem of the health of the community. During 2004, Bali the arrival almost 1.5 million foreign tourists. According to survey the Service of tourism Bali, these foreign tourists in general remained for 11 days with the issuing per tourists per the day of Rp 550,000.00. This means that during 2004, the amount of money that entered from the foreign tourists who went on holiday in Bali it was estimated as big as Rp9.075 trillion (Rp550.000,00 multiplied 11 days, multiplied 1.5 million people). That meaning that the impact indirectly that was caused to be big enough where being felt also by the perpetrators of tourism where being gotten by the hotel business, the agency of the tour trip, the transport, the restaurant, the tourist attraction, the handicraft or souvenir, and the perpetrators of the business.

The social condition for the community's culture that liked to maintain the dog also must be accompanied by his maintenance. The problem precisely emerged because of many deliberate kept dogs left wild by his owner without having the maintenance and the vaccination. This could become the supporting factor of the spreading of rabies was increasingly fast because of congestion of the dog population in Bali. Moreover if eventually had the monkey in Sangeh or the Alas Kedaton was affected by rabies then his situation will be increasingly just serious. That could cause the tour region only remained at the name because all the monkeys must be eliminated from the place.

How control efforts of rabies until now?. Officially Livestock breeding and the health Service mutually coordination in an effort to handle this problem. Eliminate the dog continued to be carried out but indeed still was more ineffective especially regional area that it was known had the positive dog rabies because still was the opposition from the community nearby not all the dogs could be eliminated. Several casualties with the story of the dog bite and positive rabies has also been died since last year up to now. Giving of the vaccine anti rabies (VAR) to the dog was still limited was carried out with various reasons. Rabies apparently became the time bomb for our community then the support and the community's participation that was needed in the handling of this problem.

The supervision of the animal transmitted rabies enters Bali currently began to be tightened. Nevertheless the potential for the entry of the animal transmitted rabies could happened. Besides having the dog that the bearer of the rabies virus roamed about in this province. This dog could already positive but not yet the showed sign of rabies so as to be able to enter the Balinese Province and to spread his virus.

His problem became so complex because of efforts eliminated that still was limited, VAR to the dog also not continued was carried out, many dogs that did not have data collected on it in each one the territory, The Number Of wild dog populations and was not yet applied by him the system that was comprehensive in the handling of this problem. Therefore must have steps that were serious and continuous in the handling of this problem.

The control rabies by Desa Pakraman approach in Bali, Province

The control system of based rabies the village pakraman was one of the options that it was considered was effective enough because in accordance with the social-culture condition the Balinese community. Handling efforts of an diseases with the social-culture approach were very important. Participation of all the sides towards the handling of this problem was needed. While this that happened was the government officially livestock breeding and the health that more often worked. With the number of powers and their limited budget the difficulty of carrying out the program in the Bali territory that was wide with various condition sorts.

As for the control system of based rabies this community where the role of the government agency and the social agency the community co-operated with each other. The service Livestock breeding officially coordination with the health office where the Community Health Centre and Puskeswan co-operated directly with the community's agency like the Pakraman Village. The Pakraman village furthermore communicated with the Banjar Adat (traditional organization in Bali). The role of this traditional series as the tip of the implementation spear of the program. Where eliminating the wild dog was done by Pecalang (The official security in Bali). Afterwards Kasinoman (The official who gave information to the community's other member), carried out the monitoring and the supervision of the dog that was owned by the resident including the unclear new dog emergence his ownership was in the village environment carried out by data collection. The cadre of the Health that was trained to be asked for as the promotion power of the health and if being needed could be trained to become the power that gave the Anti Rabies Vaccine (VAR) to the dog and the dog that met VAR was given the sign. The youth group also could play an active role as the promotion of the health worker towards the control of rabies.

The role of public figures as the agent of change also was needed. They that it was hoped could give good and true information afterwards Make full use of the community undertook the program that was agreed to. So as the control program of rabies could go well.

In several areas was that applied awig-awig (the traditional regulation that was agreed to together) where the community that had the deliberate dog in for wild and bit casualties then the owner was asked to replace the medical treatment cost in fact until the death ceremony and will be given the fine in accordance with the rule that was agreed to. This had a purpose so that this community guards his dog well and did not release just like that without the maintenance. The owner of the dog had an obligation to give the vaccine to his dog and treated him. If having the unclear wild dog his ownership was best to eliminated.

The implementation of the traditional regulation (awig-awig) that was agreed together to by the community was it was considered more effective as efforts to carry out the supervision of the wild dog and the control of rabies. In several areas of the production awig-awig this was carried out. The community's member who had the dog that earlier was left wild and was not maintained well currently began to carry out the supervision and the maintenance.

In fact many potentials for the organisation of the community that could in asked the co-operation in supporting this program like IAKMI, PHDI, LSM, Universities, and other. This the form of the community's participation towards the control of rabies. The problem of rabies was the problem all of us so already appropriately all of us participated in his control.

HIV/AIDS condition in Bali Province, Indonesia

The incident HIV+/the AIDS in Bali more often was encountered in the level of the household. The cumulative data of Health office Bali Province (2008a) up to November 2009 showed as many as 0.6 % case of the HIV were the baby and 1.35% age 1-4 years. Results sero the survey of the co-infection of TB-HIV in Bali in 2008 also showed 2.7% the housewife (IRT) that suffered TB also suffered the HIV (Muliawan, 2008).

The invention of some HIV sufferers around the patient TB was through the unit of the health service (UPK) the community health centre. Several community health centres in certain territories in fact showed the proportion of the infection findings HIV+ that was same or higher was compared by the findings through hospital UPK

Up to December 2009, the number of the total case of the HIV and the AIDS in Bali that it was reported by the Health Office Bali Province was 3238 cases totally the death totalling 298 cases. This data also showed that the spread through heterosexual higher was compared by the spread through the needle (68%:23%). The proportion of the case that claimed transmited through sexual relations increased by 17% in the period for the last 4 years whereas that claimed transmited through the needle only increased of 5%, in fact beforehand the highest case always resulting from the use of illegal drugs injection.

All the regencies and the city in Bali had cases of the HIV and the AIDS, where 3 big was occupied by Denpasar, Buleleng and Badung. Because of that then many of his control efforts were directed to 3 areas. Whereas the other regency, although the proportion of his case was still low but the potential for the spreading of the HIV and the AIDS were very big, especially with the expansion cafe and karaoke until the area of rural areas. Gianyar regency had many places that were visited by tourists so as to the interaction between the local inhabitants happen to tourists really tight.

Until this of most of the community's members did not yet often know the incident of the HIV infection with the infection oportunistik (IO) that was with him, so as often they did not realise himself was infected by the HIV and careless to take medicine. This condition caused the number of the community's members to come to the hospital in the serious situation or in the continued phase. This matter was supported by the VCT data in several of RS in Bali (that tended to be waiting for the client), where 21-32% ODHA that came had finally died.

Still many treatments stigmatisation and discrimination against the sufferer HIV+, caused the fear to be known by the status of HIV. This caused many of the community's members to be reluctant to acknowledge the connection or his risk against HIV. Results of the study also showed many stigmas and discrimination happened at the time of them was faced with the official of the health or when coming to look for the health service