'I do my nursing from a rubbish tip'

Nani (left) earns just enough daily for her bus fare

Jane Elliott BBC News Online Health Staff

Nani has a very unusual clinic - in the middle of a municipal rubbish tip in Makassar, Indonesia.

Each day the 24-year-old nurse braves the rotting smell of refuse to see her patients.

Cramped living conditions, a lack of clean water, poor diet and unsanitary conditions mean high sickness levels among the rubbish camp dwellers.

It is very difficult for the rubbish-pickers to keep clean

Nani

Infectious disease is rife, especially diarrhoea and acute respiratory infections among the younger children.

Malaria and typhoid are also a problem caused by the unsanitary conditions of living on the dump.

Workload

The nearest hospital is about half-an-hour away by car, but in emergencies patients have found themselves being rushed to hospital in a rubbish truck.

As well as being the local nurse to the community Nani is also the midwife delivering and caring for the new babies and the school nurse.

She sees about a dozen patients every day at the clinic, but regularly also makes about three home visits a day.

Her journey from her home takes about an hour-and-a-half by bus with a final half-a-mile on foot along a muddy track and at the end of the day she has usually earned just enough to cover her bus fare.

But despite all the hard work Nani admits that she loves her job and has forged close links with the rubbish dwellers.

"Yes, I do enjoy working here, especially with the children.

"They usually stop by on their way home from school to visit me.

"Before this centre was built, the children were isolated.

"But in the past two years that has changed.

"Now the neighbours of this community also send their children here."

Prevention

Part of Nani's work is prevention and she gives regular advice on sexual health to the young women.

She also gives check-ups at the local school and educates the youngsters about keeping clean in their unsanitary conditions.

"It is very difficult for the rubbish-pickers to keep clean.

"There is one well close to the garbage dump; the water is OK, but not for drinking.

"I treat many babies who are coughing and feverish."

There is no charge to attend Nani's clinic, but patients do pay a voluntary donation of 4,000 Rupiahs (about 25 pence) if they can afford it.

All the funds are then used to buy medicines.

Nani's work is funded through Plan, which through western sponsorship builds and equips health centres as well as training and sponsoring nurses in local communities.