OCT 3 — There has been much talk in Singapore about the need to recapture the “gotong royong” spirit of the past — the spirit of volunteerism, selflessness and working together for the good of the community.
Across the Causeway, several villages in Malacca are showing how that spirit can be harnessed in innovative ways to tackle chronic ills which also plague Singapore, such as obesity and smoking.
It all began at a state-wide meeting of village leaders in 2010 when Dr Nor Aryana Hassan, Head of Malacca’s Non-Communicable Disease Unit, threw down the gauntlet.
Explaining the state’s worsening health situation — Malacca had the second-highest rates of obesity and diabetes in the country — and appealing to state pride in the “Melaka Maju” dream (of achieving fully-developed status by 2010), she offered state assistance and challenged village leaders to make a difference in their own communities.
On tap was RM4,000 (S$1,550) per village to print materials; training for volunteers in health knowledge, nutrition and exercise; and lots of encouragement.
From 102kg to role model
Three years on, Dr Aryana’s programmes are in full swing in a number of villages. In Kampung Bukit Senggeh in Selandar, perhaps the most rural part of Malacca, influential community leader Mohamad Bazit heads the village’s 1 Stop Centre for Health (1SC). A core of 80 or so villagers participates in its activities, which include group exercises to popular Korean, Arab and Malay music. The centre monitors blood sugar levels and pressure, inculcates in villagers the habit of counting calories and teaches them how to cook healthily.
Mr Bazit himself is a living example of what healthy living can do. Trim and energetic, it is hard to believe that a few years ago he was a hefty 102kg. In the programme’s lingo, he is an ikon (icon), a local role model selected to helm the programme, inspiring by example and enthusiasm.
He modestly credits the kader (cadres) or village volunteers for being “very involved and proactive” — such as preparing the reception of home-made food for our visit, complete with labels displaying the caloric count of each dish.
We were amazed to see the kader using blood glucometers to measure high-risk fellow villagers’ blood sugar levels and giving counsel on appropriate lifestyle changes. They are held in high regard by the local community and, after three years of service, each is personally awarded a certificate of appreciation by the Malacca Chief Minister.
No-smoking homes
Over in Kampung Sungai Jerneh, Lubok China, Mr Jaafar Atan leads their Komuniti Bebas Asap Rokok (KBAR) or Smoke-free Village initiative. As could be expected, when the programme began in 2010, it was met with suspicion and even anger from the community’s smokers.
Said Mr Jaafar: “We explained that we were not forcing them to stop (smoking). We were just trying to protect others in the family and community from passive smoking.” Framed in this way, the programme became more acceptable to the villagers.
Now, through their own initiative, “No smoking” signs are displayed prominently in all common areas and designated smoking “corners” have been set up away from crowds. At community events such as weddings and family days, announcements are made declaring them “smoke-free events”.
Many villagers have even put up in their own homes a large green sign declaring “This is a smoke-free home”.
As owner of the only provision shop in the village, Mr Jaafar personally took the momentous step of stopping the sale of cigarettes.
He explained: “I was most uncomfortable with the selling of illegal cigarettes, especially to young people. They were a very good source of income. But in Islam, smoking is haram (sinful). I stopped selling cigarettes at my shop for this reason.”
Just like in Kampung Bukit Senggeh, sense of ownership, community empowerment and an infectious spirit of volunteerism were all in abundance. Both had leaders who believed in the message and demonstrated its importance through their own actions.
Scaling efforts countrywide
How did these successes come about? Dr Aryana explained the happy confluence of need, opportunity and leaders who rose to the challenge.
She was prompted to action by Malacca’s dismal health standings in 2006. “It had the second-highest rates of obesity and diabetes in Malaysia. Smoking was also a major challenge. When we analysed the data, we found that most deaths are from chronic diseases,” she said.
Dr Aryana realised that chronic diseases could only be tackled successfully in the community as a bottom-up, grassroots driven initiative. Not top-down edicts from the government, not magic pills or quick fixes. The people had to take ownership.
There was so little awareness of chronic diseases, let alone knowledge about the need for diet and lifestyle changes. Thankfully, the timing was opportune. The Malaysian government had mooted a national Non-Communicable Disease Prevention 1Malaysia (NCDP1M) programme with funding for state-level efforts. Tapping on federal funding, the Malaccan health department launched its deceptively simple but ultimately effective 1SC and KBAR initiatives.
Thanks to successes in Malacca, Dr Aryana has been posted to Putrajaya, the federal administrative centre of Malaysia, where she is now making plans to scale these concepts across Malaysia.
To her, the secret is in plain sight: “You must empower the community. Equip the locals with skills and knowledge, appoint them as leaders and then trust them to deliver.” — Today
* Fatimah Zahrah Alsagoff and Adib Zalkapli are from the Secretariat of the ASEAN Non-Communicable Diseases (NCD) Network, an informal grouping of healthcare experts with a shared passion and commitment to improving care for NCDs in South-east Asia.
** This is part of a series on healthcare innovations in ASEAN.
*** This is the personal opinion of the writers and does not necessarily represent the views of The Malay Mail Online.
