Health and Hygiene: A Cultural Interpretation

After subjecting my friend to a mini-rant/lecture on this topic, I figured I'd spare her and unleash instead on my blog about my observations on health and hygiene in Indonesia. One of the first things a Westerner will notice about Indonesia on arrival is the stark difference in what is considered healthy and hygienic here as compared to back home. These differences cross a very broad range of areas, so let's break them down into subsections. I love subsections, and using underline and bold. I've been in uni FAR too long. Anyway, let's begin with:

The Streets

After years of brainwashing in primary school combined with a genuine concern with the environment, I was and still am appalled at the way people simply drop rubbish on the ground here. Everywhere. People habitually drop plastic packaging on the ground the second they're done with it, and almost everywhere you go, you see rubbish. I'm often upset by this, because the natural beauty of this country is almost always marred by the ever present carelessly discarded trash. Even when I hiked for hours through mud to get to a very isolated lake in the middle of an island, there was STILL rubbish everywhere. And although it may make it look cleaner, the heavy rains are constantly washing rubbish away from the streets and into rivers and oceans.

Back home, a combination of playschool, government-sponsored anti-littering campaigns and hefty littering fines have all served to severely discourage littering. Rubbish bins are in abundance. Littering, generally, is minimal. People make a moderate effort to recycle. Generally, it looks cleaner back in Australia (though, we have 1/10 of the people, and a lot more space), and it's socially bad form to litter.

However, one other thing must be mentioned. In Indonesia, people from the lower classes DO go along the streets and popular rubbish dumping spots, collecting and sorting rubbish for a pittance. While arguably yes, this creates jobs (extremely low-paying however) and helps keep the streets clean, it does very little to act as a deterrence to littering, or as encouragement to keep your environment clean and beautiful.

The Kitchen

As many people who have visited here, and have experienced food-related sickness first-hand, can testify, Indonesia is not a shining example of food handling and kitchen cleanliness. There are several reasons for this.

First of all, good refrigeration is rare. Many meats and vegetables are left at room temperature until they are used, and lots of styles of food, for example Padang cooking, involve meals being cooked in the morning, and servings dolled out during the day until the dish is finished. This can mean that the gorengan (fried food) you just ate has been sitting there for 12 hours or more. For those of the more sensitive stomachs, the quick growth of bacteria in the warm, humid weather can be devastating.

Secondly, dishes here tend to be washed in cold, tap water. After discussing this with a few Indonesians, there seems to be a national presumption that water = clean. If you wash something with water, and it looks clean, it automatically is clean. What many of these people forget though, is that in fact their tap water is not clean. It is not clean enough to drink. So the germs that they avoid when they avoid drinking tap water, they ingest anyway because their plates and cutlery are covered in them once washed. A typical Indonesian sink will have a small bowl filled with detergent and water, and a sponge sitting soggily in it. This water and this sponge will rarely be changed, warms up during the hot days, and probably provides an ideal home for all sorts of bacterial colonies. This sponge is then applied to dish after dish, washed under running cold water (or in a bucket if it's a

little street stall) never washed, and replaced back into its detergenty little swamp. Hot water is very rare in this country, and people don't seem to know that boiling water kills germs. Most accept what they see on TV, detergent makes things clean, and don't realise that while detergent emulsifies and removes grease, it is not antibacterial, and doesn't kill germs. Looking clean is as good as being clean most of the time.

The Bathroom

One of the biggest surprises I've had since living in Indonesia is finding out that Indonesians believe that white people are dirty. One of the main reasons for this is that many feel we do not bathe enough. When presented with this statement, from time to time I retort with "I don't need to bathe as much, because I get it right the first time". Living here probably hasn't been great for my cultural sensitivity. Anyway, in this previous post I described the process of mandi as it is done in Indonesia. In short, ladling cold water on yourself to wash yourself. Now for me, I must admit, I have never really felt completely clean after a mandi. Back home, I have long scalding showers, and always feel completely cleansed afterwards. Whereas back home, it would be almost unthinkable to have a house without hot water, here it is very rare to find a house with hot water. My friend told me the other day, he always thought that white people had hot showers simply because we are spoiled. There's something, however, about cold water for me which simply doesn't feel like it cleans me as much, and something about ladling water onto you which feels like you're never compl

etely doused and washed. Also, inevitably, after a mandi, the floor is covered in water, and it is typical to wear shoes into the bathroom while bathing. I think an important part of being clean for me is also being dry, and in Indonesia, you are almost never dry. Anyway, I usually have at least one mandi a day, adding more depending on how hot it has been or how much physical activity I've had. Apparently though, I'm still a dirty Bule.

The Toilet

This issue was also the source of an argument between my friend and I the other day. The vast majority of Indonesian toilets are squat toilets. This, or at least how I understand it, is how Indonesians use them. First they squat over the toilet and complete their business, next they use either a hose or a gayung (small ladel) to wet their left ha

nd (and underneath themselves) and physically wash themselves with direct contact between their hands and their bottoms. This is usually quite a messy business, and water will inevitably get all over the floor of the bathroom. They then wash their hands (hopefully usually with soap) and go along their merry way.

Again, I was shocked to hear in light of all this that Indonesians think white people are dirty because we use toilet paper. The reasoning behind that presumption is this: using toilet paper does not adequately clean your behind. This again drawing back to the belief that water cleans everything. I responded with the assertion that using toilet paper means we don't have to touch anything at all, and our hands are protected from both being dirty and being covered in germs. Indonesians try avoid any potential contamination by re

serving their left hand for toilet associated activities, and their right hand for picking up things, taking things from people, and so forth. It wasn't really until this conversation that I understood the impact culture can have on ideas of cleanliness.

First Aid and Health

Indonesia is still very much a belief-based culture. I've had several experiences with Indonesian "first-aid", but my most memorable ones so far are probably the two times I burnt my leg on the muffler of a motorbike. The first time, my friend insisted I put toothpaste on the burn. "When in Rome," I thought, and gave it a go. One day and a pretty filthy, oozing infection in my leg later, I boiled water and thoroughly washed the thing in dettol. I was sitting on the kitchen floor busily attending my festering leg, when my Ibu Kos (owner of my a

ccommodation) walked in and asked what I was doing. After explaining I'd burnt my leg and had an infection, she paused before informing me I should have used toothpaste. Facepalm.

The second time I had burnt my leg on the trip to Batu, a mountain range near Malang. When we arrived, I went to try to find some ice, however, all the Indonesians (including the warung owner I was trying to buy it from) in the vicinity started protesting my clearly unlearned ways and offering loudly several other treatments including the tried and tested toothpaste, and my personal favourite, butter. This is one of the few times I've really lost my cool here, and I ended up screaming at everyone to shut up, none of them knew what they were talking about, there was no way in hell I was putting filthy butter on my leg, and to give me ice immediately. Which was probably not very sensitive of me, but Indonesians, wh

o almost always mean well and try to help, are very insistent in that sense of helpfulness, and will often help you even if you don't want or need their idea of help. And like I said, there was no way in hell I was putting butter on a burn.

Before I finish, I'll make a couple of other observations about Indoesian health. Like I said above, health here is still riddled with hearsay and superstition. One traditional remedy, which I don't believe in, but have tried a couple of times anyway, is called kerokan. This remedy is a "cure" to an affliction called masuk angin (roughly translated to mean that a bad wind is inside your body). Masuk angin is pretty much used to describe any type of malaise, but particularly things such as colds. Kerokan involves rubbing the skin of the back in tiger balm (or the like) and then running the edge of a coin along in curved lines. The idea is to

let the wind out by increasing blood flow. Now, I don't think that this really will cure anything, and it looks frankly horrific afterwards, but it does feel like a nice massage.

Here's a picture:

Finally, I'll briefly mention Indonesian hospitals. To be honest, I was seriously impressed by them. When I went to go get my x-ray after my adventures here, in just two hours for for AU$20, I managed to get a consultation, an x-ray, the results of my x-ray, a follow up consultation with a prescription and the prescription filled. I never actually followed that blog up with the humorous story of actually getting the x-ray. Suffice to say, I think I gave the little radiologist girl the embarrassment as well as the story of her life when she had to ask me to take out my nipple piercing, and then had to mime what she meant after I misunderstood and started taking out my earrings. When I couldn't, so was provided instead with a lovely souvenir x-ray where I have a bolt of steel through my chest.

Alrighty, on reflection this has turned into a bit of an essay, and I'm sure people will be complaining about how long it is, so I'll wrap it up. Health and hygiene are very different things here in Indonesia to back home, with people taking very different routes in order to achieve the same result. I think I've pretty much adjusted now to how health is handled here in Indonesia, painful sometimes as that may be, but I honestly cannot wait until I have hot water available at the turn of a tap again.

Thanks for tuning in!!