Changes in the Environment, Epidemic, and Politics in Health: Public Health in the Residency of Cirebon in the Colonial Era Imas Emalia [email protected] Mohammad Iskandar (Department of History University of Indonesia) [email protected] Abstract This paper aims to present the theme of history of health. The focus of this research is the change in the environment in Cirebon in the times of the Dutch colonial when there was an epidemic which influenced the politics in health. At the time when Cirebon and the surrounding area was deemed vital for the development of the economy of the Dutch colonial government, which led to a decision of turning Cirebon a gemeente or colonial town in 1906. Cirebon was turned from a traditional town (kingdom) into a modern town and since then the number of population rose which gave rise to slums and kampongs . It was the conditions of the kampongs that caused epidemic which spread to various regions in Cirebon. Since then, the state of health of the people of Cirebon deteriorated until the beginning of the 20 th century and the number of mortality rose. Boomgaard’s research on health explained the contributing factor which caused the state of public health was the unfair government policy. While according to Hesselink the condition was caused by the fact that the people opted to traditional treatment and rejected the modern treatments introduced by Europe. These two factors do not explain the influence of the environmental changes which actually triggered the epidemic. The history method with the social cultural approach by William H. Sewell will be used to explain this matter. Health as part of the real life is strongly sustained by the condition of the environment besides various rules. Keywords: History on health, changes in the environment, Epidemic, Health Policies. 1 Introduction Geographically, Cirebon has the characteristic of inland and coastal area and historically it was also known as the center of the spread of Islam in West Java. Since the 16 th century, Cirebon had already been known by people outside Cirebon as a bustling coastal area. This was because Cirebon became the center for the collection of trading goods either from local residents or external traders. Meanwhile, the hinterland became the supplier of various agricultural and plantation products such as vegetables, rice, coffee, wood and other goods. The economical life and activities of the Cirebonese were adjusted to the geographical conditions. They were maritime people living around Port of Cirebon and hinterland people who worked as farmers on their rice fields. The maritime people can also be found around the rivers that crossed their residences such as Cimanuk River, Pekik River, Kasunanan River and Losari River. The rivers became an important route which can be sailed by ‘jung (ships)’ to connect to the remote areas. The Cirebonese had been used to the maritime, farming and trading world for the interest of economic, politics and religion. More and more migrants came to Cirebon to sail or to do trading. In line with the rising popularity, more Europeans travelled more often to Cirebon, up to the point in 1681 when the Sultanate of Cirebon was conquered by the Dutch traders or the VOC ( Vereenigde Oost-Indische Compagnie ). The sultan did not have any authorities in the control of politics and economy anymore. Even up to the end of the colonial rule (VOC) (1799), the power of the Cirebon Sultanate was not acknowledged at all and did not function anymore. Meanwhile, The Dutch colonial government believed that the role of this region was essential due to the fact that this region was the transit place for export and import commodities to the remote areas and the surrounding areas. To support its economic activities both in the coast and hinterland, the Dutch colonial government carried out construction of social facilities. Since 1859, the improvement of the environment of Cirebon was continuously done. Cirebon increasingly became the attraction for outsiders for the development of the economy (Sulistityono; 1994; 146). Since 1870s, Cirebon had experienced modernization and industrialization period, but the problem was that it was after this period that epidemics of many diseases spread in the society. The 2 infectious diseases that became widespread were malaria, small pox, cholera and plague. Since the changes occurred in the environment of Cirebon, the natives who urbanized often suffered the diseases. The state of health of the natives deteriorated up to the mid of the 20 th century. Since then Cirebon became one of the regions which had the highest mortality rate caused by the outbreak of diseases. This was the factor that influenced the policy of the government on health in Cirebon. Some of the policies were the decentralization on the budget for the cost of health up to the establishment of special health office for the eradication of plague. Thus, the question which is raised in this discussion is why was the state of public health in Cirebon became one of the worst in Java after the changes in the environment in the colonial times and how were the political policies on health at that time? Boomgaard, who researched the history of health in the Dutch East Indies, explained that among the factors which caused the poor public health condition of the natives was the Dutch East Indies government unfair political policy in health. The health services were especially provided by the government to military personnel of the Dutch Army, citizen from Europe and China, while the natives were not provided with the same portions of health services. The health services were expensive for them and they were placed based on social status (Boomgaard; 1996). Sciortino is also of the opinion that the health services in the colonial period were owned by the military (Sciortino; 2007). In contrast with the opinions of Boomgard and Sciortino, Hesselink believes that the public health of the natives was terrible due to their own health behavior which preferred getting traditional treatments and not approving modern treatment system. This traditional culture was the cause of the epidemic among themselves to become more widespread (Hesselink; 2011). But, in the case of the epidemic in Cirebon, based on the government report in the Binnendlansch Bestuur 1893, it was explained that since the beginning of the 19 th century, the outbreak of disease which spread from Cirebon to Indramayu, Galuh, and Majalengka was malaria (Binnendlansch Bestuur; 1940-1942). The disease escalated especially after the construction of various infrastructures. The construction of main roads oftentimes caused malaria to occur and attacked the workers due to the lengthy construction process which caused puddles of water in the 3 site. Thus, the disease spread to other society. Besides malaria, influenza plagued the natives especially laborers like laborers in the train industry, port factories or plantations. After the environment of the city changed its function, almost all of the Residency of Cirebon became an area of epidemic starting from malaria, cholera to influenza (Paulus; 1917). Theoretical Framework To answer the problems aforementioned, the theory used in this discussion is structural theory from William H. Sewell who used the social-cultural approach (Spiegel; 2005). This theory will make it possible to understand the living practices of certain society of Cirebon in their new environment after the changes in the environment due to the formation of gemeente or colonial town by the Dutch East Indies government. The establishment of gemeente brought about certain consequences on the Cirebonese who were forced to abide by the rules of institutions or government in order to realize or to grasp the meaning of modernization. The ability of Cirebon people to adapt to new cultures or ideas influenced many different practices in life including on health. Methods In this discussion, the method used is the method of history. The first step is heuristic in the form of finding primary and secondary sources. This stage prioritized more on archive research. The second step is history critics. The acquired sources are then verified, that is to choose then analyze based on the theme of research. The third step is to interpret that is to explain facts in line with the data found which is then arranged chronologically. The last step is to reconstruct events in history in the form of the work of history of historiography. Preliminary Study The study on the history of health in Java in the Dutch East Indies era had been discussed in a book Health Care in Java: Past and Present edited by Peter Boomgaard. In the introductory, it is mentioned that since the 19 th century, health services had belonged to the Dutch military personnel. 4 While the civil society especially the natives couldn’t access the services as easily as the military. Government’s injustice in providing health care became the factor why the state of health was in bad condition at that time (Boomgaard; 1996. 1993; 77-93). Similar studies conducted by Heselink explained that health policies implemented through various health educational institutions in the end of the 19 th century like the establishment of Sekolah Dokter Djawa (Djawa School of Medicine) and Sekolah Bidan (School of Midwifery) were aimed to improve the state of health of the natives. But due to the fact that the society still do traditional treatments, their state of health was still bad at that time (Hesselink; 2011). The two works on history has the same tendency in explaining the health dynamics in the time of the Dutch East Indies. Both revealed the dominancy of the government policy in determining the state of health of the people at the time.