See the original post (with photos) on USAID Indonesia’s Exposure account.

It’s midnight in Indonesia. Abdul Murin and his family are fast asleep in their home in the Melawi district. There’s a knock at the door.

Murin was expecting this. Local health workers and the village chief had told Murin’s community that teams from the Ministry of Health were conducting a survey.

“We didn’t feel disturbed,” Murin said. “It was actually good that they visited us tonight.”

This was no ordinary survey. The teams were there to draw blood from Murin and his family as they surveyed the area for the presence of lymphatic filariasis (LF), a neglected tropical disease (NTD) spread by mosquitoes. Left unchecked, it can lead to extreme swelling of the legs and other body parts — a condition known as elephantiasis.

A midwife sits in a red and green longboat holding an umbrella to protect her and a young child in her lap from rain. The midwife is on her way to a community (Nanga Ora village) to participate in a survey to determine if there are still cases of a disabling neglected tropical disease called lymphatic filariasis. Behind her is the water and houses built on stilts appear before a tropical hillside covered in trees.

A midwife travels to join a lymphatic filiariasis survey in Nanga Ora village. Photo: RTI International / Oscar Siagian

LF is endemic in Melawi and 236 other districts in Indonesia, the world’s largest island nation and fourth most populous country.

USAID has been supporting the Government of Indonesia to eliminate the disease since 2011.

Indonesia relies on night blood surveys — collections of blood between 10:00 p.m. and 2:00 a.m., when the worms that cause LF are most active in the blood — to monitor the disease and plan treatment campaigns.

That’s why health officials often go door to door in the dark for these surveys to detect the presence of LF in an area.

Technicians travel by car, boat, motorbike, and on foot to reach remote communities at night.

But you can’t just show up at someone’s house in the middle of night asking to take their blood. You have to let them know you are coming. That’s why advance collaboration across multiple levels of the health system, along with local governments and communities, is critical.

“The key was coordination with village officials. We also involved sub-district officials, the police, and military. We involved all stakeholders to help in educating people.” – Dwi Sarodo Limbaputra, the head of a community health center in Melawi.

“Not everyone understands that filariasis is a communicable disease. We try to make them understand that if people are infected, it may cause a permanent disability.” – Ibu Endang Susilawati, the head of disease prevention and control at the Melawi District Health Office.

With USAID support, Indonesia’s Ministry of Health trains survey team members and their supervisors in survey methodology and management.

Lab technicians also receive training at the University of Indonesia in night blood collection, including safely drawing blood samples and preparing slides, to ensure the standards needed for accurate readings under a microscope are met.

USAID has helped Indonesia train more than 450 health officials and 130 lab technicians to manage these complex, often challenging, surveys. Local officials, health workers, and lab technicians are critical to the long-term success of disease elimination efforts.

“The Ministry of Health greatly appreciates the strong support we have received from USAID over the years to help strengthen the capacity of our staff and expand program implementation. With strong partners like USAID, we are confident we will be able to reach our goal of elimination of LF by 2030.” – Regina Tiolina Sidjabat, head of the NTD Working Group in Indonesia’s Ministry of Health

“I hope there will be no more cases… so no more people will have to live with disability, especially future generations. People say that we should never pass down disease to the next generation. Instead, we should pass down good things.” – Prabudi Hartono, a survey team member in Melawi

By building local and regional capacity, Indonesia is ensuring the country can achieve elimination of this disease so that families like Abdul Murin’s in Melawi can stay LF free.

Story by: USAID Act to End NTDs | East Program (Act | East) USAID Act | East is helping Indonesia improve survey implementation, strengthen its laboratories, and plan for a future without LF. Today, nearly 65 million people across 117 districts are no longer at risk for LF. Indonesia’s Ministry of Health leads all aspects of treatment and surveillance, with the goal of eliminating LF as a health problem by 2030. As the country nears this goal, the program is helping Indonesia adapt and innovate to ensure LF is eliminated for all Indonesians, even if it means working at night and reaching some of the most remote island communities.
West Kalimantan, Indonesia
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