Trauma Stabilisation as a Sole Treatment Intervention for Post-Traumatic Stress Disorder in Southeast Asia.

Southeast Asia contains high numbers of traumatised populations arising from either natural disasters or interpersonal violence. Consequently, the need for empirically based trauma treatments, compromised by insufficiency in appropriately trained clinicians and mental health workers, makes the situation more challenging in addressing traumatic sequelae in local populations. In response, the humanitarian/ trauma capacity building organisation, Trauma Aid Germany, trained 37 therapists in psycho-traumatology, based on EMDR Therapy, which included trauma stabilisation techniques. This research analyses the impact of Trauma Stabilisation as a sole treatment intervention for Post-Traumatic Stress Disorder (PTSD) in adults. Each client was screened for PTSD utilising the Harvard Trauma Questionnaire - pre- and post-treatment. Analysis of the data considered only those interventions focussed on trauma stabilisation, including psychoeducation. Participants receiving trauma confrontation interventions were excluded from the data. Trauma stabilisation - as a sole treatment intervention, was highly effective in alleviating PTSD diagnoses. Results demonstrate PTSD symptoms were reduced in both clinical and sub-clinical trauma groups. The data set suggests trauma stabilisation, as a sole treatment intervention, was safe, effective, efficient and sufficient treatment intervention for PTSD. Furthermore, trauma stabilisation interventions have the advantage of being safe, flexible, and adaptable to the cultural and spiritual context in which they were are applied. The research findings also have implications regarding teaching and learning and the potential utilisation of paraprofessionals, and other allied health professionals in addressing the global burden of psychological trauma.

IJEPA: Gray Area for Health Policy and International Nurse Migration.

Indonesia is recognized as a nurse exporting country, with policies that encourage nursing professionals to emigrate abroad. This includes the country's adoption of international principles attempting to protect Indonesian nurses that emigrate as well as the country's own participation in a bilateral trade and investment agreement, known as the Indonesia-Japan Economic Partnership Agreement that facilitates Indonesian nurse migration to Japan. Despite the potential trade and employment benefits from sending nurses abroad under the Indonesia-Japan Economic Partnership Agreement, Indonesia itself is suffering from a crisis in nursing capacity and ensuring adequate healthcare access for its own populations. This represents a distinct challenge for Indonesia in appropriately balancing domestic health workforce needs, employment, and training opportunities for Indonesian nurses, and the need to acknowledge the rights of nurses to freely migrate abroad. Hence, this article reviews the complex operational and ethical issues associated with Indonesian health worker migration under the Indonesia-Japan Economic Partnership Agreement. It also introduces a policy proposal to improve performance of the Indonesia-Japan Economic Partnership Agreement and better align it with international principles focused on equitable health worker migration.

Cultural considerations in the treatment of mental illness among sexually abused children and adolescents: the case of Bali, Indonesia.

Childhood and adolescence sexual abuse can have long-lasting and devastating effects on personal and interpersonal growth and development. Sexually abused children tend to exhibit higher rates of poor school performance, aggressive behavior, PTSD (posttraumatic stress disorder), or depressive symptomatology, as well as social and relational deficits (e.g., age-inappropriate sexual behaviors). The trauma following such abuse can further affect neurodevelopment and physiology, aggravating mental or physical problems in adulthood. Early symptom recognition and appropriate interventional applications are important factors in successfully treating or even preventing the development of mental disorders in such cohorts. A central element of effective treatment is the selection of treatment targets. Cultural considerations are rarely or peripherally considered in sexual abuse treatment strategies. Western-trained psychiatrists and clinical psychologists tend to overlook or underestimate such factors in cross-cultural settings, resulting in interventional efforts that may interfere with traditional approaches to healing, and potentially contributing to a transgenerational cycle of trauma. By using Bali (Indonesia) as a focal culture, in this article we discuss the effects of cultural elements and showcase their potential contribution and systematic implementation into a holistic and sensitive interventional model for the treatment of mental illness in childhood and adolescence sexual traumatization.

Can Development Programs Shape Cooperation? : Results from a Framed Field Experiment in Indonesia.

Empirical studies among small-scale societies show that participation in national development programs impact traditional norms of community cooperation. We explore the extent to which varying levels of village and individual involvement in development policies relate to voluntary cooperation within community settings. We used a field experiment conducted in seven villages (208 participants) from an indigenous society in Indonesia known for their strong traditional cooperative norms, the Punan Tubu. We framed the experiment in terms of an ongoing government house-building program. The results indicate that there were synergistic and antagonistic interactions between existing cooperative norms and government development policies. Participants' cooperation in the experimental setting was low, probably because the Punan Tubu are used to cooperating and sharing both under demand and in a context in which uncooperative behavior is largely unpunished. Variation in experimental behavior was related to both village- and individual-level variables, with participants living in resettlement villages and participants living in a house constructed under the government program displaying more cooperative behavior. The cooperation evident in resettled villages may indicate that people in these villages are more comfortable interacting in anonymous settings and less committed to the demand-sharing norms still prevalent in the upstream villages. The more cooperative behavior among villagers who have previously received a house might indicate that they recognize that they are now better off than others and feel more obliged to cooperate. Policies aiming to capitalize on existing cooperative behavior to stimulate community collective action should consider the specific conditions under which cooperation occurs in real settings since traditional norms that regulate cooperative behavior might not translate well to cooperation in government-led programs.

Global HIV Interventions and Technocratic Racism in a West Papuan NGO.

In the era of scale up, global donor-driven HIV activities are transforming NGO work by demanding administrative, technical, and data-oriented activities. Drawing on interviews and participant observation in an NGO in the West Papuan city of Manokwari between 2011 and 2014, I attempt to understand why Indigenous Papuan NGO employees were steadily replaced by non-Indigenous migrant settlers, mainly of Javanese heritage, to deliver HIV services. I show that new rivalries, technical roles, performance targets and efficiency rhetoric intersected with existing racialization to produce a preference for Javanese employees, who were assumed to be more compliant and professional than their Papuan counterparts and to operate more easily within the technocratic regime imposed by donor expectations. I use the term technocratic racism to describe the way that global HIV rationalities intersect with ethnic stereotypes and gendered racial ideas to make possible certain HIV workers and not others. I contribute to anthropological literature on the delivery of HIV services by showing how a technocratic approach to HIV/AIDS intervention intersects with a settler-colonial context to gradually exclude Indigenous employees. Approaches that allow for relational, independent and flexible services would assist to decolonize HIV responses in West Papua.

Outbreak investigation in cargo ship in times of COVID-19 crisis, Port of Santos, Brazil.

In February 2020, a Chinese cargo ship docked at the Port of Santos with reports of crew members with a feverish and respiratory condition. A team was gathered to verify the existence of suspected cases of COVID-19 inside the vessel and define its clearance. All 25 crew members were interviewed, and no suspected cases were found. The vessel was then cleared for port activities. The investigation resulted from the implementation of the contingency plan to face a public health emergency of international importance and several surveillance entities cooperated.

Recurrent ascending cholangitis with acute pancreatitis and pancreatic atrophy caused by a juxtapapillary duodenal diverticulum: A case report and literature review.

RATIONALE: Intermittent combined pancreaticobiliary obstruction may lead to multiple episodes of ascending cholangitis and pancreatitis, usually due to choledocholithiasis or periampullary mass. However, one of the rare causes is periampullary or juxtapapillary duodenal diverticulum. Although duodenal diverticula are relatively common in the general population, the overwhelming majority are asymptomatic. Duodenal diverticula can cause combined pancreaticobiliary obstruction through multiple mechanisms such as stasis-induced primary choledocholithiasis, stasis-induced intradiverticular enterolith, or longstanding diverticulitis, causing stenosing fibrosing papillitis or a combination of more than one of these mechanisms. Herein, I report a case of Lemmel syndrome due to a combination of multiple mechanisms and review the available literature on the epidemiology, pathogenesis, clinical presentation, diagnostic work-up, and management of juxtapapillary duodenal diverticulum. PATIENT CONCERNS: Multiple episodes of abdominal pain, jaundice, anorexia, fever, and significant unintentional weight loss. DIAGNOSES AND INTERVENTIONS: Primary choledocholithiasis, recurrent ascending cholangitis, recurrent acute pancreatitis, and pancreatic atrophy due to giant juxtapapillary duodenal diverticulum, with unsuccessful endoscopic retrograde cholangiopancreatography that was completely resolved after open transduodenal sphincteroplasty and septoplasty, transampullary and transcystic common bile duct exploration and stone extraction, and duodenal diverticular inversion. OUTCOME: Complete resolution of combined pancreaticobiliary obstruction without recurrence for 2 years after surgery. LESSONS: Surgeons should be aware of such rare syndromes to avoid misdiagnosis and delayed or inappropriate management. Furthermore, they should understand the different available operative options for cases that are refractory to endoscopic approach.

Right to Health: A Buzzword in Health Policy in Indonesia.

The "right to health" operates as a buzzword in Indonesia to frame health policies as beneficial to citizens. Right to health is equated with access to Western biomedical services. Within the policy on partnership between biomedical and traditional midwives, only the biomedical midwife can fulfill the right to health. The "traditional" midwife is reframed as her assistant. Right to health language hides underlying tensions in relationships between these two categories of midwives by presenting the policy as mutually beneficial. Right to health language is effective in the post-Suharto era as it aligns with other incontestable values, including democracy and modernity.

Migrant workers in Sabah, East Malaysia: The importance of legislation and policy to uphold equity on sexual and reproductive health and rights.

Sabah, located in Southeast Asia, hosts the highest number of non-Malaysian citizens (27.7%), predominantly the Indonesian and Filipino migrants in comparison to other states in Malaysia. Sabah has inadequate data on migrants' sexual and reproductive health and rights (SRHRs). Various migrant-related policies and laws are present, but they do not offer full protection and rights to legal migrants in terms of their SRHRs. The aim of the laws and policies appears to be controlling the migrants from having any negative impact on the locals, rather than protecting migrants' health and rights. This affected their rights to marriage, having children, increase their vulnerabilities to labour trafficking and sexual abuse and access to health-care services. Female migrant workers and undocumented migrants form the most vulnerable subgroups of migrants. This narrative review highlights the status of SRHRs of migrants in Sabah and the migrant-related Malaysian laws and policies affecting their SRHRs.

Outbreak investigation in cargo ship in times of COVID-19 crisis, Port of Santos, Brazil / Investigação de surto em navio de carga em tempo de COVID-19, Porto de Santos, Brasil

ABSTRACT In February 2020, a Chinese cargo ship docked at the Port of Santos with reports of crew members with a feverish and respiratory condition. A team was gathered to verify the existence of suspected cases of COVID-19 inside the vessel and define its clearance. All 25 crew members were interviewed, and no suspected cases were found. The vessel was then cleared for port activities. The investigation resulted from the implementation of the contingency plan to face a public health emergency of international importance and several surveillance entities cooperated.

RESUMO Em fevereiro de 2020, um navio de carga vindo da China atracou no Porto de Santos com relato de tripulantes com quadro febril e respiratório. Uma equipe foi mobilizada para verificar a existência de casos suspeitos de COVID-19 dentro da embarcação e definir a liberação da embarcação no porto. Todos os 25 tripulantes foram entrevistados e não foram encontrados casos suspeitos. Então a embarcação foi liberada para atividades no porto. A investigação resultou da aplicação do plano de contingência diante de uma emergência de saúde pública de importância internacional e houve a colaboração de diversas entidades de vigilância.

[Four cases of pulmonary tuberculosis among deep-sea fishermen].

Pulmonary tuberculosis among deep-sea fishermen was reported. Four pulmonary tuberculosis cases among fishing boat members engaged in deep-sea fishing were registered at the Kesennuma Health Center during three years period from 2000 to 2002. Crew engaging in deep-sea fishing live together in a narrow cabin with inadequate airconditioning for a long period of time, about 1 year. It is difficult to consult with a medical institution in an open sea. If a tuberculosis patient breaks out in a boat, the risk of transmission of tuberculosis to other members is high. In boats of all four cases in this report, about 30 to 70 percent of crew were Indonesian. Indonesia is one of the high burden countries of tuberculosis in the world. The Japanese fishing boat members have received the medical checkup every year. Indonesians have also received the pre-employment medical checkup, however, the improvement in the quality of this medical checkup is required.

[Community care for a foreign bride who had attempted suicide].

Cultural maladjustment of foreign brides is an important social problem. In order to elucidate effective community nursing intervention, a 27 year-old Indonesian bride who had attempted suicide was adopted as a subject presented. In four months of community nursing care, the client's cooperation was won the client's and family's knowledge of suicide was improved, the client's coping skills were improved, communication between the couple was improved and the client's social interaction was improved, and religious tension with the family was moderated. The client's attitude was changed from rejecting to accepting. There was no suicide attempt in the subsequent 6 months and the client's ability to use social resources was significantly improved.

Cleansing the world of the germ of laziness: hygiene, sanitation, and the Javanese population in Suriname.

In 1915 the Rockefeller Foundation took its hookworm eradication campaign to Suriname, but was soon disappointed because of opposition from its main target group: the Javanese. Moreover, authorities and planters objected to the construction of latrines because of the costs and their belief that the Javanese were "unhygienic". In describing the labor migration from Java to Suriname, I show that this "lack of hygiene" was closely related to the system's organization. I argue that uncleanliness was the consequence of harmful socio-economic and ecological conditions. Secondly I suggest that even though the Foundation did not manage to cleanse Suriname of hookworm, its educational efforts, its emphasis on prevention, and its training of local health workers probably had more impact than Rockefeller officials thought.

Indigenous round houses versus 'healthy houses': health, place and identity among the Dawan of West Timor, Indonesia.

Qualitative research was undertaken among Dawan people living in Fatumnasi, West Timor, to investigate the reasons for the Dawan's retention of traditional houses, ume kbubu, in the face of a national development campaign to introduce modern, "healthy" homes (rumah sehat). Indoor smoke pollution from internal fires and poor ventilation is believed to contribute to poor respiratory health among this population. The study explored Dawan cultural constructions of health to find that ume kbubu are fundamental to the Dawan's sense of psychosocial well-being and ethnic identity. While rumah sehat are associated with prosperity, public image and social status they do not provide the warmth, security and emotional nurturance that the Dawan perceive as necessary for optimum health and to protect them from disease.

Grassroots development and upwards accountabilities: tensions in the reconstruction of Aceh's fishing industry.

This article explores the tensions between aid funding and grassroots development goals in the context of post-disaster fisheries reconstruction in Aceh, Indonesia. We argue that both short- and long-term grassroots goals are distorted by upward accountability requirements which lead to unsatisfactory aid outcomes. Our analysis employs the concept of aid webs and draws on fifty-one formal interviews with stakeholders in Aceh in 2007/2008. The findings initially concentrate on the impacts of upward accountability on project cycles, with a particular focus on the problematic incorporation of private boat-building contractors and commercial values during the implementation phase. We then discuss the more subtle, long-term impacts of upward accountability on the professionalization of community institutions ­ in this case, the Panglima Laot Lhok. We conclude with a few observations about the hybrid institutions ­ combining elements of local and development cultures ­ that are produced within the current political economy of aid.

El Habano and the world it has shaped: Cuba, Connecticut, and Indonesia.

In the half century since the 1959 Cuban Revolution, El Habano remains the premium cigar the world over; but both before and since 1959, the seed, agricultural and industrial know-how, and human capital have been transplanted to replicate that cigar in a process accentuated by upheavals and out-migration. The focus here is on a little-known facet of the interconnected island and offshore Havana cigar history, linking Cuba with Connecticut and Indonesia: from when tobacco was taken from the Americas to Indonesia and gave rise to the famed Sumatra cigar wrapper leaf; through the rise and demise of its sister shade wrapper in Connecticut, with Cuban and Sumatra seed, ultimately overshadowed by Indonesia; and the resulting challenges facing Cuba today. The article highlights the role of Dutch, U.S., British, and Swedish capital to explain why in 2009 the two major global cigar corporations, British Imperial Tobacco and Swedish Match, were lobbying Washington, respectively, for and against the embargo on Cuba. As the antismoking, antitobacco lobby gains ground internationally, the intriguing final question is whether the future lies with El Habano or smokeless Swedish snus.

Community-based targeting and initial local conditions: evidence from Indonesia's IDT Program.

Community­based selection of social program recipients has the potential to benefit from local knowledge about individuals in need. However, this information advantage might be offset by local elite capture and administrative incompetency. Using data from Indonesia's antipoverty program, Inpres Desa Terttingal (IDT), this article investigates which preprogram conditions are associated with community-based targeting outcomes. Results show that wealthier and more unequal villages constantly target better. The findings for inequality suggest that, under certain political and program contexts, any possible influence of local elites might be overwhelmed by the ease of identification of the poor. Evidence is also found that villages with young, educated heads initially exhibit better targeting. However, they lose this advantage as the program design limits the continued monitoring of benefit allocations by the village heads.

Bicultural identity formation of second-generation Indo-Canadians.

This article examines the bicultural identity formation and cultural experiences internalized by second-generation Indo-Canadians in their efforts to accommodate the "best of both worlds" into their lifestyle. The objectives of this article are to educate the reader to become cognizant of the bicultural issues encountered by second-generation Indo-Canadians; to demonstrate interventions suitable for the second-generation Indo-Canadian populations; and to increase the readers' understanding of bicultural identity formation. What becomes evident is that intergenerational dialogue has a profound impact on the bicultural identity formation of this population. It will serve to guide these individuals to find a third space (Bhabha 2004) or zone of proximal development (ZPD) to encourage evolvement of their bicultural identity (Cummins 1996; Gutiérrez et al. 1999).

Primary health care for Indo-Chinese children in Australia.

This study reports the detailed analysis of 61 consecutive presentations by recent immigrants from Indo-China to the Casualty Department of a modern Australian Children's Hospital. The parents/guardians were interviewed either in the Casualty Department or in their homes. Indo-Chinese children coming to a Casualty Department manifested the same age distribution and spectrum of illnesses that is seen in the general Australian paediatric population. However, significantly fewer presentations to hospital occurred due to accidents/trauma when the group was compared with the general population attending the Casualty Department. Only 21% of the Vietnamese and Cambodian families can communicate satisfactorily with hospital staff without interpreter help. Fifty-one per cent of parents reported that they did not have enough English for a medical interview without an interpreter. Twenty-eight per cent did not have enough English to communicate at all. Parents of Vietnamese children reported that on occasions they had not sought medical care for their children because of language difficulties. Many families do not know that an Interpreter Service is available, and many believe that access to such a service is available only through a doctor. Many of these children also use traditional Chinese remedies in the context of their contemporary Australian lives. We have found no evidence that this practice causes late presentation with deleterious effects, or any evidence that it compromises modern 'Western' treatment.