It was the last day of a week-long summer camp at Roshan Learning Center. Inside the red brick building, children were still listening to the dentist’s explanation of the tooth decay process. Outside, teenagers were discussing their tooth problems with a health professional. Many of them hadn’t seen a dentist for a while—or ever.

After his turn to get examined on a portable dental unit, teenager Mujaba (not his real name) learned that the main cause of his tooth problem had to do with tooth brushing technique. He seemed to have an aha-moment, realizing that brushing one’s teeth properly has a lot of benefits, not only to his oral hygiene but also to general health and well-being. He now pays more attention to self-care, knowing that a little oral hygiene awareness can go a long way.

To raise awareness about health and well-being, local doctors Evan Regar and Melissa Lenardi and dentists Eddy Giarso, Hedwin Kadrianto, Rachel Emteta volunteered their time and used their expertise to support refugees at Roshan Learning Center on July 11. They conducted screenings, vital sign checks, vision tests, physical examinations, dental check-ups, and basic dental treatments. They also provided a terrific learning opportunity; clinic organizers required that would-be patients attend a seminar to learn about teeth cleaning and its benefits.

Having a health clinic day provided a useful channel for personal contact and communication between the patients and professionals, which is especially valuable among people who become used to relying information they can find online or through hearsay. Community members at the clinic were able to express their needs and health professionals were able to respond in a personalized way despite the time constraints that afternoon.

The Challenges of City Living

Awareness of urban public health issues is now more important than ever. The world is undergoing a significant growth of urban populations—more than half of the world’s population lives in cities, and even more will soon—and a growing number of them are refugees. The United Nations Humans Settlements Programme (UN-Habitat) estimates that there are 8.64 million refugees living in urban areas this year. Because of the difficulties cities have in providing clean water, adequate sanitary conditions, timely trash removal, and so forth, urban areas are more likely to provide fodder for illness, especially among the poor and otherwise vulnerable residents such as refugees. Lack of available and affordable health services only exacerbate the problems.

Many refugees in Indonesia choose to live in Jakarta, one of the world’s most populated cities, in part because of the presumed opportunities to access amenities available in the city. However, they quickly realize that services here are not as available as they had imagined. Healthcare providers often see refugees and asylum seekers as temporary visitors to a host country and regarded as separate from the host community. Furthermore, because they cannot work, they have limited opportunities to earn the wages that would allow them to pay for healthcare.

Accessing Local Health Services

The 1951 Refugee Convention protects refugees to have access to healthcare similar to that of the host population. In Indonesia, the most affordable health service can be accessed at puskesmas, government-run community health clinics, which provide basic care services, immunizations, prenatal care, and dental services. Though not top-tier in terms of quality in many cases, puskesmas may be the most accessible basic health service provider for both the locals and refugees. Health status of refugees can vary depending on the context surrounding their flight, lack of immunity to the diseases in their new environment, and the stress factors caused by migration, displacement, and an uncertain future. Typically, these factors converge to cause refugees to need greater-than-average medical attention.

So why are refugees not going to puskesmas when they have bronchitis, a toothache, or dengue fever? One critical barrier is language. Farsi and other language-speaking refugees face issues of communication when health professionals can’t understand the problem or explain information. This situation may result in possible misdiagnosis, patients’ noncompliance, and other medical errors. A great deal of confusion and unreliability of the public health system only leaves them vulnerable to exclusion from healthcare as well. Refugees often don’t have all the facts about what services they are allowed to receive and by whom; and providers also don’t have all the facts about refugees. Every refugee population consists of individuals with diverse backgrounds—it is rarely homogenous—and health providers need to take the time to gather the relevant information from a given refugee patient.

Next Steps

To our delight, it was not only refugees who benefited from the health clinic day. In the spirit of lifelong learning that we promote at Roshan Learning Center, our visitors also had a few things to learn from the refugees. The health professionals learned about different health conditions refugees tend to experience at high rates, such as psychological issues, weakened immune system, and nutritional deficiencies. They said they found it helpful to learn more about refugees’ living conditions and health challenges, which are compounded by general health challenges in Jakarta such as respiratory infections, waterborne diseases, dengue fever, and road traffic accidents; so they can tailor future clinic days to Jakarta refugees’ common health issues.

This is good news for Mujaba. He claims that not only will he brush his teeth properly every day, but also he will enthusiastically come if we offer another health clinic. How many teenagers look forward to a dentist’s appointment? Many thanks to the volunteer doctors and dentists who shared their expertise with us to such good end.