“This has been a smoke for decades.”

As the smoke rises in Sumatra with hundreds of hotspots mostly in South Sumatra, it also fires our attention about how it affects our society’s daily activities. The smoke decreasing Pekanbaru’s visibility to only around 50 meters, preventing the inhabitants to see further and moreover, deteriorates the air quality. The smoke also interferes public transportation in the city, including flight from and to Riau.

From 29th June to 27th September 2015, the victims of smoke reached 44,871 people, said Andra Sjafril, Chief of Riau Health Office, when interviewed by Republika on 28th September 2015.

The victims sufferered from quite vast array of diseases; acute upper respiratory tract infection, pneumonia, asthma, eyes irritation, or skin diseases. They act as a prominent evidence that smoke, as a disaster, jeopardize our health.

Just like the smoke, questions also rises. Questions concerning how the government will react to tackle this haze, questions how we as a society will act to alleviate the pain and how the affected society holding on.

More importantly but often forgotten, questions about how we as a nation, will mitigate and adapt to such catastrophe.

The sense of urgency must be heartfelt by our whole country; promoting societal movement from under the flag of humanity. While the smoke has clear associations with health and welfare of the citizens, the issue will consistently blown up in media until it is taken care of.

And when the nurse changed the TV channel to something more entertaining to be watched by the kids, I walk down the isle while the children helplessly laying down on their bed, “This has been a smoke for decades.”, I thought. No, not that kind of smoke we watched on TV. This kind of smoke is invisible, disguised itself as a number in statistic report, silently massacred Indonesian children.

If you’re wondering what is the smoke that killed our children, this is the disguised form: In 2012, UNICEF estimated 152.000 children in Indonesia died because of diarrhea and pneumonia. Though the numbers have plummeted from 385.000 deaths in 1990, these two diseases still claimed lives over 3 times compared to Sumatra smoke’s victims.

WHO’s final report, The State of The World’s Children 2014, ranked Indonesia 72 out of 194 countries based on the value of Under-5 Mortality Rate (U5MR) in 2012, a critical indicator of the well-being of children. Phillipines are slightly above us, sitting on rank 75 while Malaysia skyrocketed above us, sitting on rank 141. It means we only do better than 71 countries (out of 194 countries) in terms of protecting our children, including other developing countries like South Africa, Nepal, India, and Afghanistan.

It haunts me every day as a future healthworker, to write and ask why no one hit the emergency button, no sense of urgency? I think it wasn’t because the smoke didn’t soar up from my place, nor because we didn’t know our country still struggling with infectious diseases. I think this has been a calm storm because we didn’t know that these deaths, just like the smoke, promoted by multiple hotspots too.

The smoke that killed Indonesian children also flared up by multiple hotspots, varied from individual to national level. Countless researches have shown that maternal education, contaminated food, water supply and sanitation, socioeconomic status, accessibility and availability of healthcare facilities are the social determinants of health contributing to the outcome of the patient with diarrhea.

Those with socioeconomic disadvantage live in communities that are at a higher risk of environmental contamination and are least likely to have access to good medical care. With this level of social disparities, the disease only blanketed the poor and marginalized, killing the selected communities with contaminated food, poor sanitation and poor water supply.

Rudolf Virchow, once said “Do we not always find the diseases of the populace traceable to defects in society?” Correlating to the welfare of citizens, in 1988, Beauchamp stated that good health is fundamental to a good society.

To cure and rehabilitate is not enough, we must prevent and promote in order to create a good society.

Comparing diarrhea with the smoke using the same analogy, then socieconomic status, sanitation, contaminated food, and water supply are the hotspots.

As the smoke threatened our life through respiratory tract, we also need to grasp that diarrhea also threatened our children’s life through digestive tract.

As we thought providing masks for smoke victims is helpful, we also need to provide clean water for everyone regardless the geographical obstacles.

As we work to decrease the fire hotspots while urging the government to do something, we also need to secure water, uncontaminated food, hygiene and sanitation, while we also advocate for better housing and health facilities.

We need to shift our perspective from individual to population-based approach, to learn to see health in a global perspective. A perspective that health is a multifaceted field which crosses intersectoral borders, need to be holistically addressed, and solved not only by healthworkers but by all actors who must be involved.

We have learned the importance of comprehensive and collaborative action from government, nongovernmental organizations, public figures, and societal movement in healing the destruction caused by the smoke in Sumatra, we also need to adopt the same perspective in dealing with other health problems.

And when we finally decide to reimagine health problems, investing in population-based promotions and disease prevention, with the attention already focused on personal health care, the healing will be in harmony as we raise once again under the flag of humanity, to fight another smokes, together as a nation.

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