VZCZCXRO8105
RR RUEHCHI RUEHCN RUEHDT RUEHHM
DE RUEHJS #0109/01 2661022
ZNR UUUUU ZZH
R 221022Z SEP 08
FM AMCONSUL SURABAYA
TO RUEHC/SECSTATE WASHDC 0294
INFO RUEHDT/AMEMBASSY DILI 0017
RUEHJA/AMEMBASSY JAKARTA 0280
RUEHBY/AMEMBASSY CANBERRA 0149
RUEHZS/ASSOCIATION OF SOUTHEAST ASIAN NATIONS
RHHMUNA/HQ USPACOM HONOLULU HI
RUEHJS/AMCONSUL SURABAYA 0299

UNCLAS SECTION 01 OF 02 SURABAYA 000109 
 
SENSITIVE 
SIPDIS 
 
DEPT FOR EAP, EAP/MTS, IRN/EAP, DRL/PHD, INL 
 
E.O. 12958: N/A 
TAGS: TT PGOV PHUM ID PREF EAGR
SUBJECT: EAST NUSA TENGGARA: WHERE CHILDREN STARVE, A FAMINE OF 
SOLUTIONS TOO 
 
REF: 07 SURABAYA 55 (WEST TIMOR'S PERFECT STORM) 
 
SURABAYA 00000109  001.2 OF 002 
 
 
This message is sensitive but unclassified.  Please protect 
accordingly. 
 
 
 
¶1.  (SBU) Summary: East Nusa Tenggara Province (NTT), at the 
extreme southeastern edge of Indonesia's archipelago, has long 
lacked food security and chronic malnutrition persists.  While a 
flurry of spring 2008 media reports gave the impression that 
hunger is more acute than in previous years, local government, 
NGO and health sources agree that food insecurity and 
malnutrition is endemic.  The province's weak, isolated economy 
is yoked to an arid and increasingly unpredictable climate. 
Making matters worse, NTT's traditional culture resists certain 
nutritious foods and eating habits that might mitigate the 
problem.  Local sources say that insecure local food production 
and imbalanced food intake are proximate causes while tradition 
and the weak economy complicate long-term solutions.  End 
Summary. 
 
 
 
26 Children Dead, Thousands At Risk 
 
--------------------------------------------- ---- 
 
 
 
¶2. (SBU) During Surabaya PolEcon Officer's September 15-18 visit 
to Kupang, the provincial capital of NTT, local government, 
health, and NGO officials described the province's battles to 
combat endemic malnutrition and improve food security.  Dr. 
Stefanus Briaseran, Head of NTT's Health Service expressed 
pessimism about near term improvement in NTT's malnutrition 
efforts.  Dr. Brianseran said that the health department is 
targeting food aid to children under five years old since their 
developing bodies are most at risk.  According to NTT Health 
Service statistics, as of September 2008 among the 512,639 
children under five living in the province, some 82,327 were 
diagnosed as undernourished.  Of these, 69,770 were seriously 
malnourished but did not suffer additional clinical symptoms; 
while 12,452 suffered from additional clinical symptoms.  Of 
these, 90 suffered from marasmus (severe protein energy 
deficiency) and 13 from kwashiorkor (protein deficiency, usually 
marked with a distended belly), while 2 children suffered both 
diseases.  26 children died as a result of malnutrition. 
 
 
 
¶3. (SBU) Dr. Stefanus Brianseran stressed that the risk of 
infectious diseases remains acute due to the weakened health of 
the population.  Infectious diseases such as malaria, dengue, 
tuberculosis and diarrhea-related diseases can be exacerbated by 
immune systems weakened by malnutrition.  Without access to 
clean water, hand-washing campaigns can have little impact. 
This is particularly true on arid West Timor, home to over half 
of NTT's population and those displaced during neighboring Timor 
Leste's fight for independence.  Dr. Brianseran noted that US 
assistance in Malaria research and assessment in NTT would be 
welcome. 
 
 
 
Health Service is Cash Starved 
 
--------------------------------------- 
 
 
 
¶4. (SBU) Despite the fact that the Health Ministry first 
declared a malnutrition emergency in NTT in 2005, the problem 
remains intractable.  Dr. Brianseran described a continuing low 
level of financial support from the national and provincial 
authorities to fight malnutrition.  Brianseran explained that 75 
percent of the Rp. 65.5 billion Rupiah (USD 7 million) 
provincial health budget is spent on operating expenses for the 
provincial hospital in Kupang.  This leaves roughly USD 1.75 
million to address the annual health needs of nearly 5 million 
NTT citizens.  NTT's Health Department calculates that it will 
take Rp. 15,000 per day (USD 1.60) to supplement the diets of 
each of the 69,770 malnourished children under five years old in 
NTT.  This notional daily expenditure of USD 111,632 (USD 3.35 
million per month) is untenable given current provincial health 
budget allocations.  Dr. Brianseran stressed that families with 
 
SURABAYA 00000109  002.2 OF 002 
 
 
malnourished children generally also have malnourished parents 
--supplements for the family are needed too.  Some families are 
reluctant to bring children for hospital treatment even when 
available because of the stress of travel and finding food away 
from home.  Brianseran said that an augmented daily budget of 
Rp. 20,000 per family per day (roughly USD 2) would cover both a 
single family caregiver and malnourished child in treatment. 
 
 
 
Geographic, Economic and Cultural Factors 
 
--------------------------------------------- ----------- 
 
 
 
¶5.  (SBU)  Paradoxically, rates of malnutrition in the 
provincial capital Kupang are roughly equivalent to the poorest 
regions of the province, including those housing former refugees 
from Timor Leste.  This is linked to several factors.  First, 
the difference between living standards in the city and the 
interior among the at-risk population is not great.  Job seekers 
from the interior of West Timor and other NTT islands come to 
Kupang.  Those migrants who find work overseas often leave 
children behind with caregivers, who might not have resources to 
spare to care for the child.  Remittances are typically brought 
back by the worker on an annual basis, leaving the family at 
risk.  Attention of the provincial, national and international 
donor community has focused on the regencies nearest Timor 
Leste, traditionally the hardest hit by food insecurity:  Timor 
Tengah Utara (TTU), Timor Tengah Selatan TTS and Belu. 
However, the rates of malnutrition in the regency and 
municipality of Kupang are statistically identical to these 
remote regencies. 
 
 
 
Agriculture and Water Management 
 
--------------------------------------------- -- 
 
 
 
¶6.  (SBU) Agriculture is linked to the problem of malnutrition 
and traditional farming methods along with poor soil mean that 
slight delays in seasonal rains can push communities closer to 
the edge of crisis in a matter of weeks (reftel).  Farmers have 
noticed a delay in the arrival of the monsoonal rains by nearly 
a month in recent years.  However, most damaging is the uneven 
pattern of rainfall once the rains come.  According to a 
Catholic Relief Services worker familiar with local agriculture, 
farmers might plant with the first days of rain, assuming the 
beginning of typical rainy season.  However, days of rain might 
be followed by days or weeks of clear skies and hot sun, killing 
crops.  Porous volcanic rock underlies most of Timor, so the 
rainy season also means flooding and landslides. Since the rocky 
porous ground cannot hold water, precious topsoil is easily 
washed away. Building catchments to hold the run-off and 
cisterns in West Timor is a government priority, according to 
the Vice Governor, Esthon Foenay. 
 
 
 
Local Culture is Key 
 
-------------------------- 
 
 
 
¶7.  (SBU) Health Department and NGO sources agree that other 
cultural biases unique to NTT exacerbate malnutrition.  Many are 
reluctant to eat plentiful pumpkins and beans since they are 
commonly used as cattle fodder and thought unsuited to humans. 
Parents are reportedly reluctant to feed fish to children for 
fear that worms and bugs eaten by the fish might harm the 
children's health.  One NGO worker familiar with NTT diet and 
custom said that such notions might go unchallenged during times 
of plenty, but put their children in danger of malnourishment 
when food supplies dwindle.  The World Food Program provides 
biscuits to communities in West Timor near the border with Timor 
Leste.  However, because the imported biscuits are intended as a 
stop gap measure, they can never become part of a sustainable 
daily diet.  NGO workers fear that reliance on the biscuits will 
delay solutions to the complex underlying causes of malnutrition 
in NTT. 
MCCLELLAND