The Key To Successful Smallpox Vaccination In The Dutch Period Is In The Hands Of The Health Minister

JAKARTA - The archipelago had a deficit of health workers when the smallpox epidemic hit during the Dutch era. The Company quickly turned its brains. The idea of holding a crash training to print health paramedics for bumiputra emerged. In the future, they will be the key to the success of the epidemic prevention program by becoming the medical vanguard who carries out vaccinations.

According to history, smallpox entered the archipelago during the Hindu-Buddhist kingdom. At that time, smallpox entered the trade traffic that was busy.

However, smallpox was not yet considered deadly. The people of the archipelago actually believe it to be a curse and at the same time consider variola (smallpox) to be spread by spirits. Hoax popping up.

To find out more fully, we have reviewed how the first outbreak of smallpox in the archipelago in an article entitled "Long before the Coronavirus, there was a smallpox epidemic that was feared by mankind."

Then, smallpox became a disease that was rampant to various regions. Quoted from Baha'udin in his journal "From Mantri to Javanese Doctors" (2006), smallpox has only been detected as a disease since the 17th century.

The impact of smallpox itself is enormous. In 1781 it is estimated that out of 100 Javanese people who contracted smallpox, 10 of them died. Meanwhile, in the early 19th century, of the 1,019 babies born in Java, 102 of them died from smallpox.

Gradually smallpox began to spread to Aceh, Bali, Batavia and Sulawasi. At first, the Dutch had not taken the eradication of the plague so seriously. The proof, the six periods of eradicating smallpox since the Governor General of the Dutch East Indies Pieter Gerardus van Overstraten (1796-1801), to Godert Alexander Gerard Philip baron van der Capellen (1819-1826) were not optimal.

In fact, the Dutch had already employed doctors to treat smallpox. However, the native people seemed to doubt their efforts. As a result, many natives go to a shaman. Then die. Besides that, the negligence of the Dutch doctor who often gave smallpox medicine without paying attention to the expiration date became another woe.

Efforts to fight smallpox seriously did not appear until October 1847. This was initiated directly by the Head of Miliataire Geneeskundige Dienst (Military Medical Service), Dr. William Bosch. The doctor proposed to the Governor General of the Dutch East Indies Jan Jacob Rochussen (1845-1841), to provide Western medical education for the native people.

For this reason, the Javanese Doctor School (STOVIA) was founded in Weltevreden. The study period is two years. After graduating, students will receive a title as a Javanese Doctor. However, they are not really doctors, but European doctor assistants (hulo geneesher). Most of the graduates were given the job of providing smallpox orderlies.

The mantri for smallpox then went down to the villages to help European doctors to make efforts to prevent smallpox, namely the smallpox vaccination. Or what is better known by the term Pencacaran.

Smallpox vaccination then became the oldest effort ever made to prevent a disease in Indonesia. In fact, until 1900, there was no other effort by the Dutch government for health care other than treating smallpox through vaccination.

Moreover, the colonial government understood that if Doctor Djawa had stepped down, it was this cultural reason and emotional closeness that made the native people want to participate in the vaccinations. Indirectly, this process then becomes the transfer of knowledge about health to the community, especially those living in rural areas. Therefore, the models and patterns of colonial government policies in dealing with smallpox were applied to treat other diseases, such as cholera and malaria.

"Even though there is no compulsory vaccination program in the Dutch East Indies, the Medical Service has tried as much as possible to do it in a careful and systematic manner. Each village is visited once every 7 years by a competent vaccine expert. The population is gathered with the help of civil servants, then vaccinated en masse, over a span of several days. The same special inspection trip is carried out for infant vaccination, ”explained Dr. J. Stroomberg in the book Dutch East Indies 1930 (2018).

This method is considered effective. Smallpox, which used to appear frequently and ravaged many villages, has now become a thing of the past. This is because in 1928 in Java and Madura, no more than 11 people died from smallpox. In contrast to 1871 which could reach tens of thousands of deaths, even then in Bali alone.

Although the presence of smallpox mantri is at the forefront of breaking the chain of smallpox, their salary is relatively small. In a book published by the Directorate General of Indonesian Culture entitled The History of the Regional National Awakening of East Java (1978), states that there is a huge difference between the salaries of STOVIA students (Javanese Doctor School) and OSVIA (Pangreh Praja candidate schools).

This difference is also supported by differences in background between STOVIA and OSVIA. The OSVIA students usually come from the sons of the upper prijaji class. Meanwhile, most STOVIA students come from lowly priyai groups, such as teachers, police inspectors, poor aristocrats, and village heads.

"By the upper level priyayi class, STOVIA graduates are seen as 'Mantri-Cacar' and belong to the lower priyayi group. They only receive a salary of 70 guilders a month, which is half the salary of an OSVIA graduate," the book reads.

Even more sad, for orderlies who have to travel long distances, there is no special treatment for them. "And if they travel by train at the expense of the state they are only allowed to use class III (not class II); thus they are equated with coolies and prisoners," he wrote.