KESEHATANTHE HEALTH MAGAZINE FOR INDONESIAN HEALTH WORKERS PUBLISHED BY AIDE MDICALE INTERNATIONALE MAJALAH KESEHATAN UNTUK PEKERJA KESEHATAN INDONESIA DIPUBLIKASIKAN OLEH AIDE MDICALE INTERNATIONALEADOLESCENTS HEALTHISSUE 5 / JANUARY 2007 EDISI 5 / JANUARI 2007KESEHATAN REMAJATIDAK DIPERJUALBELIKAN / NOT FOR SALECONTENTS AND EDITORIALEDITORIALHealth providers are key actors in adolescents healthy development I I am not an adult, and I am not a child. I am in theContentsADOLEsCENTS HEALTHmiddle (1). No longer a child, not yet an adult, here are adolescents! Even if more than half of the worlds population is below 25, with four out of five young people living in developing countries, issues linked with adolescence are often overlooked. In Indonesia, one fifth of Indonesians population are adolescents (13-19 years old) who are engaged in risky behaviors without being aware of the long-term consequences of their actions.

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In Aceh province, several data show that a lot of adolescents health problems find their roots in tobacco and other substances abuse, interpersonal vio lence, accidents, and unprotected sexual intercourses that lead to sexually transmitted diseases including HIV/AIDS. Moreover, not all young people are equally vulnerable.

In Aceh, young people are still suffering from psychological distress due to years of armed conflicts and the tsunami disaster. Then gender considerations should not be neglected.

Young girls are likely to be engaged in unprotected sexual activity and exposed to risky early childbirth. Adolescence is a very complex transition to body self-integrity and autonomy that every young adult should know. But young Achenese people have actually a very little understanding of their own maturation and changes. Despite the above described situation described and the associated huge needs, adolescents health problems are not very differently handled from those of adults or younger children. The underlying cause is a lack of specific medical care and psychological support. And even if existing, privacy during consultations is not always respected. As a result, adolescents have a low access to health services.

They are not well-prepared to cope with problems, whatever they may be, from first menstruation to peers pressure in using hemp. The need of available specific adolescent health services no longer requires justifications. These friendly services, which are starting now to be developed in the country and in Aceh, should be strengthened and health providers appropriately trained. Through this issue dedicated to adolescents health, Health Messenger team wish to improve health providers skills by giving them basic, practical and updated information that could respond to the following questions: what is adolescence in Indonesia? What are the stages of physical and emotional maturation? How to prevent risky behaviors? How to interact with adolescents?

What is the role of the community? What about national, local policies and other initiatives? We hope that this issue will be a useful instrument for health workers to give appropriate counseling and care to adolescents, which is, after all, the most important thing. Lastly, its necessary to create a safe and supportive environment to ensure that adolescents will be respected and listened to. Adolescents can go through their vulnerability as long as they have benefits of an adequate guidance from adults. Parents, teachers, community members, health workers, public authorities, international agencies, local and national NGOs, all of them are key players who should not only work together to meet young peoples multiple needs, but systematically involve adolescents in implementing and assessing programs. Adolescents are tomorrows adult population: their health and well-being are crucial!

Several partners joined us for this edition. We would like to deeply thank YAKITA, BKKBN, ASHO, Aceh Partnership in Health (APiH), UNICEF, CARE International, SAMARITANS PURSE International Relief, World Health Organization (WHO) and the Provincial Health Office (PHO, Dinas Kesehatan Propinsi) for their useful contributions. As usual, all readers are most welcome to send any questions or suggestions to enrich the magazine. Enjoy your reading! Florence Colas, HMs publication manager(1) No Home without Foundation: A Portrait of Child-headed Households in Rwanda, Cohen, C.

And Hendler, New York: Womens Commission for Refugee Women and Children, 1997.Source: Samaritans PurseIN OUR COUNTRY 02 What are adolescence and puberty? Adolescents health in Indonesia A case study:What are the available services for adolescents in puskesmas? PUBLIC Health 08 A better access to services: the concept of Adolescent Friendly Health Services (AFHS) GENERAL Health 14 How does the adolescents body develop? How does the adolescents personal identity develop? What does an adolescents life look like in Aceh? Monitoring adolescents risky behaviors in Aceh WELL-BEING 34 From the field: a stimulating place for positive and useful psychosocial activities in Panga sub-district (Aceh Jaya district) REPRODUCTIVE HEALTH 40 At-risk early pregnancies Why we should focus on mothers-girls education A well-balanced diet for early pregnancies To go deeper 52 The consultation: how to communicate with a young person?

Health Education 56 Reducing adolescents vulnerability: advices for health workers Glossary Useful contacts society 60 How the society can addres adolescents psychosocial needs? LETTERS TO THE EDITOR questionnaire 64HEALTH MESSENGER N 05ADOLESCENTS HEALTHDAFTAR ISI DAN EDITORIALDaftar isiKESEHATAN REMAJA 03 DI TANAH AIR KITA Apakah pengertian remaja dan pubertas?

Kesehatan remaja di Indonesia Kasus yang dipelajari: Pelayanan apa saja yang tersedia bagi remaja di puskesmas? 09 KESEHATAN PUBLIK Akses yang lebih baik untuk memperoleh pelayanan: merupakan konsep Pelayanan Kesehatan Ramah Remaja (PKRR) 15 KESEHATAN UMUM Bagaimana tubuh remaja berkembang? Bagaimana kepribadian remaja berkembang?

Seperti apa kehidupan remaja di Aceh? Mengamati prilaku beresiko remaja di Aceh 35 KESEJAHTERAAN Dari lapangan: tempat yang mendukung untuk pelaksanaan kegiatan psikososial yang positif dan berguna di Kec. Aceh Jaya) 41 KESEHATAN REPRODUKSI Kehamilan dini yang beresiko Mengapa kita harus berfokus kepada pendidikan ibu-gadis Diet seimbang untuk kehamilan dini 53 LEBIH MENDALAM Konsultasi: bagaimana berkomunikasi dengan anak muda? 57 Pendidikan Kesehatan Menurunkan kerentanan remaja: Saran untuk petugas kesehatan Kosa kata Kontak yang bisa dihubungi 61 masyarakat Bagaimana masyarakat bisa memenuhi kebutuhan psikososial remaja?

SURAT UNTUK EDITOR 64 KuesionerEDITORIALPenyedia layanan kesehatan merupakan pemeran utama untuk perkembangan remaja yang sehatAku bukan orang dewasa, dan bukan anak-anak. Tapi aku berada diantara keduanya (1). Bukan anak-anak lagi, namun belum bisa dikatakan orang dewasa, itulah remaja!

Meskipun lebih dari setengah jumlah penduduk dunia berumur di bawah 25 tahun, 4 diantara 5 anak muda ini tinggal di negara berkembang, masalah mengenai remaja sering sekali diabaikan. Di Indonesia, 1/5 dari jumlah penduduk adalah remaja (13-19 tahun) yang berpeluang berprilaku beresiko tanpa mewaspadai akibat jangka panjang dari prilaku tersebut. Di propinsi Aceh, beberapa data menunjukkan bahwa banyak masalah kesehatan remaja berakar dari kebiasaan merokok dan penyalahgunaan narkoba, kekerasan interpersonal, kecelakaan, serta hubungan seksual yang tidak aman yang bisa mengakibatkan penyakit menular seksual termasuk HIV/ AIDS.

Di samping itu, tidak semua remaja bisa dianggap rentan. Di Aceh misalnya, anak muda masih menderita tekanan psikologis dikarenakan konflik bersenjata selama bertahuntahun dan juga karena bencana tsunami. Kemudian perbedaan jenis kelamin seharusnya tidaklah diabaikan. Remaja perempuan lebih cenderung terlibat dan dihadapkan kepada masalah seksual yang tidak aman dan persalinan usia muda beresiko. Remaja adalah masa transisi integritas-diri dan kemandirian yang sangat kompleks yang harus difahami oleh orang dewasa.

Akan tetapi anak muda di Aceh mempunyai pemahaman yang sangat kurang tentang kedewasaan dan perubahan mereka. Meskipun dari gambaran situasi yang dijelaskan di atas dan hubungannya dengan kebutuhan kolosal, masalah kesehatan remaja tidak ditangani secara khusus.

Penyebab utamanya adalah kurangnya penanganan khusus secara medis dan dukungan psikologis. Dan meskipun ada, ke-privacy-an selama konsultasi tidak selalu dijamin.

Akibatnya, para remaja akan memiliki akses yang rendah ke pelayanan kesehatan. Mereka tidak dipersiapkan dengan matang untuk mengatasi berbagai masalah; se perti masalah menstruasi pertama sampai kepada masalah dorongan teman sebaya untuk penggunaan ganja. Kebutuhan yang tersedia untuk pelayanan masalah kesehatan remaja tidak perlu ditanyakan lagi. Pelayanan ramah, yang sekarang sedang mulai dikembangkan di Indonesia dan Aceh, haruslah diperkuat lagi dan petugas kesehatan harus betul-betul terlatih. Melalui edisi yang membahas masalah kesehatan remaja ini, tim P2K berniat untuk meningkatkan keahlian petugas kesehatan dengan memberikan informasi dasar yang praktis dan terkini yang diharapkan bisa merespon persoalan seperti: bagaimana keadaan remaja Indonesia?

Apa saja tahapan perubahan fisik dan emosi? Bagaimana mencegah prilaku beresiko? Bagaimana berinteraksi dengan remaja? Apa peranan masyarakat?

Bagaimana dengan kebijakan nasional dan lokal serta berbagai inisiatif lain? Kami mengharapkan edisi ini akan menjadi alat bantu yang berguna bagi petugas kesehatan untuk memberikan konseling dan penanganan yang tepat kepada remaja, yang merupakan hal yang paling penting diantara semuanya. Akhirnya, sangatlah penting untuk menciptakan lingkungan yang aman dan mendukung remaja. Orangtua, guru, anggota masyarakat, petugas kesehatan, pemerintah publik, organisasi internasional, NGO lokal dan internasional, adalah merupakan pemeran utama yang tidak hanya bekerjasama memenuhi kebutuhan-kebutuhan anak muda yang beragam, tapi secara sistematis melibatkan remaja dalam pelaksanaan dan evaluasi program. Beberapa partner bergabung untuk penyelesaian edisi ini.

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Kami mengucapkan terima kasih yang sebesar-besarnya kepada YAKITA, BKKBN, ASHO, Aceh Partnership in Health (APiH), UNICEF, CARE International, SAMARITANS PURSE International Relief, World Health Organization (WHO) dan Dinas Kesehatan Propinsi, atas kontribusi yang telah diberikan. Seperti biasa, semua pembaca dipersilahkan mengirimkan pertanyaan atau saran-saran untuk meningkatkan mutu majalah ini. Selamat membaca! Florence Colas, manager publikasi P2K(1) Tidak ada Rumah tanpa Fondasi: Gambaran Prilaku-anak dalam Rumah tangga di Ruanda,Cohen, C, dan Hendler, New York: Komisi Perempuan untuk Pengungsi Wanita dan Anak-anak, 1997.KESEHATAN REMAJAPEMBAWA PESAN KESEHATAN N 05IN OUR COUNTRY / ADOLESCENTS HEALTH IN OUR COUNTRYAdolescents health in IndonesiaBy Provincial Health Office (PHO) Family Health and Nutrition sub-department, Rika Setiawati (AMI) and Health Messenger team What are adolescence and puberty? Adolescents are individuals, either man or woman, who are in the middle of a transition period between childhood and adult. According to the World Health Organization (WHO) classification, the age of this group is between 10 to 19 years old, whereas the United Nations Childrens Fund (UNICEF) says that youth is between 15 and 24 (the term of young people refers itself to the composite age group of 10-24 years). Compared to other stages of the life cycle, adolescence is the most complex period for individuals as it is the period of psychological transition between childhood and adulthood.

Adolescence boundaries are less well-defined than puberty ones as it refers more to the whole psychosocial adolescents development. Adolescents health in Indonesia In Indonesia, adolescents represent 20% of the Indonesian population, which is a substantial rate. In the early 90s, adolescents abuse of Napza (narcotics, psychotropics and other addictions) and HIV/AIDS infections were quite unusual. In the meantime, adolescents knowledge of risky behaviors and their impacts on health (reproductive health in particular) is still limited in Nanggroe Aceh Darussalam (NAD) province.

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This situation is mainly due to the lack of communication and information from parents, health workers and the community, as well as limited initiatives from the government. Why do adolescents need care and support? Most of the time, adolescents refuse to be called children, but they also can not be considered as adults as they are going through a transition period. It also means that adolescents may no longer benefit from the attention and care that usually goes to children, but they may not get the protections associated with being an adult either. As adolescents remain fragile and need care, counseling from health care providers as well as a safe and supportive environment are necessary, in order for them to grow and develop. In order for this support to be effective, health workers should have a thorough knowledge of this particular stage of life.

There is also an urgent need of a spontaneous and integrated public management of adolescents health care and adolescents reproductive health in particular. LAdolescents represent 20% of the Indonesian population.GOOD TO REMEMBERChanges during adolescence are normal and will be experienced by every human being!GOOD TO REMEMBERPuberty itself could be defined as the process of physical changes and sexual maturation by which a childs body becomes an adult body capable of reproduction. Besides these enormous physical changes, adolescents also experience emotional/psychological changes that clearly appear in their attitudes and behaviors.Things have now changed. Adolescents are currently more and more involved in risky behaviors, due to several underlying causes like poverty of families (some adolescents can not attend school and have to work), rapid social changes or media influence. This complicated - and competitive - situation makes them struggle for life.

At the same time, we should not forget that adolescence period is fragile and that young people are vulnerable, especially young girls. Moreover, influen ces (positive or negative) outside the family ones become increasingly important. All these reasons are the leading causes of adolescents risky behaviors, which mainly are: risky sexual behaviors which consequences are sexual transmitted diseases or early/at-risk pregnancies, drugs abuse (tobacco and other substances), accidents, injuries, violence.Adolescents should be informed of their physical and emotional changes, and well-monitored.

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Thus, health workers should have a thorough knowledge of the puberty stage.GOOD TO REMEMBERHEALTH MESSENGER N 05ADOLESCENTS HEA.