Four-year-old Ayu Santika, who suffers from malnutrition, is pictured with her grandmother in a low-cost apartment in North Jakarta while her mother works as a neighborhood cleaning lady to make ends meet. (Photo by Konradus Epa)
At the age of four, Ayu Santika should be in pre-school like other children her age. But unlike them she is thin, weak and pale — telltale signs of malnutrition.
A woefully inadequate diet is a fact of life for millions of children in Indonesia, a sprawling archipelago nation where access to basic medical treatment is also an issue for families living on or under the poverty line.
Cases of mass child deaths as a result of malnutrition may sound like a horror movie but sadly are not.
At least 65 children died in Papua province earlier this year due to a poor diet. Instead of addressing the situation, the military responded by ordering a female BBC reporter to leave for tweeting about the health emergency.
But such reports are not limited to remote Indonesian regions.
Ayu lives with her parents in a low-cost apartment building unit in Muara Baru in North Jakarta. She has been diagnosed as undernourished since 2016.
Weighing in at just 10kg, the family doctor describes her as being "severely underweight," according to her mother, 21-year-old Adika.
And at just 80cm, Ayu's growth has already been stunted, the premature legacy of a life without nutritious food that was always destined to be beyond the scope of her parents' meager budget.
Ayu was born when her mother was just 17. Adika now works as a part-time cleaner earning a paltry US$38 a month. However this is $38 more than her husband, who is unable to find employment.
"I'm very busy with my work so I have to leave Ayu with my mom," Adika told ucanews.com.
Each month she takes Ayu to a government-run pediatric clinic near their apartment but there have been no tangible results so far suggesting her condition has not improved.
Adika said she regrets not being able to send her daughter to pre-school education but the annual fee is equivalent to one month's pay, making it a bridge too far.
A Papuan child suffering from malnutrition lies in a hospital bed for treatment in Agats, the capital of Asmat district in Indonesia's easternmost Papua province, on Jan. 26. Some 800 children have been sickened in the area with as many as 100 others, mostly toddlers, feared to have died in what a military official called an "extraordinary" outbreak that was first made public this month. (Photo by Bay Ismoyo/AFP)
Rent gobbles up nearly a third of her salary, then there are all the other costs to take into account: food, transport, clothes, medicine — the list goes on. Sometimes it seems endless, she says. And $38 can only stretch so far.
In 2016 the family moved to a cheaper apartment subsidized by the Jakarta government and built during the term of former Jakarta governor Basuki Tjahaja Purnama. It was originally meant as a refuge for slum-dwellers.
However, rather than being restricted to the slums and shanties, Ayu's story is one that is shared by toddlers and young children in pockets across the capital.
Hesti, 5, is another young victim of malnutrition. She lives with her mother Aniah in the same district as Adika and Ayu. Two years without decent meals have left her weighing just 11kg. She is 90cm tall.
Her mother is a domestic worker and her father a construction laborer. Between them, they earn about US$5 a day — nearly four times what Adika's family get by on but still not enough in this bustling, fast-paced capital.
"I can only afford to give her rice and tofu every day. I seldom give her eggs, milk or meat," Aniah told ucanews.com.
She said she often had to fast while pregnant as funds would run low, which she sees as a primary cause of her daughter's stunted growth. Since delivering the baby she has never had a medical check-up.
Fahrul Putra, 4, is in a similar position to the two girls. He lives in a small house with his parents in Cilincing, another district in North Jakarta, and weighs just 8kg.
His mother, Nurlita, said he relies heavily on milk supplied for free by a local clinic because. If not for that, she said, milk wouldn't be a part of his diet as it is unaffordable.
"I can just about scrape together enough money to buy rice and eggs," said Nurlita, who peels shells with her husband to pull in about $4 a day — barely enough to take care of even the most frugal family of five.
These three children are all considered to be living on a "red line" by the World Health Organization (WHO), which classifies them as being severely underweight.
Health workers take a blood sample from a Papuan child at a temporary hospital in Papua on Jan. 25. (Photo by Bay Ismoyo/AFP)
Santika and Hesti are now under the care of Child Welfare Bureau of Jakarta Archdiocese, which provides them with green bean porridge, milk, bread, vitamins and biscuits.
Bureau coordinator Herman Yoseph Marsudi said the office has helped many children in Jakarta since 2000.
"We always advise their parents, particularly mothers, so prioritize milk and nutritional food," he said.
He said each year they help feed hundreds of children in parts of the capital.
Muhayati works as the coordinator of a childcare center in Muara Baru known locally as Posyandu. She said the center takes care of 12 malnourished children from poor families in the area.
Part of the problem, she said, is that many mothers only attended elementary school, meaning they were never taught about how to raise a healthy child.
"We cooperate with the Child Welfare Bureau of Jakarta Archdiocese to try and raise awareness of a good diet," she said.
Diah Mulyawati Utari, a nutritional expert from the University of Indonesia, said infections and disease are also a major concern for underprivileged families.
"Malnutrition is also related to poor sanitation facilities, a lack of clean water, education and transportation costs, which are expensive," she told ucanews.com.
The government has been assigning more of its health budget to help grassroots projects like the Posyandu service but more needs to be done, she added.
Posyandu only opens one day a month and yet it plays an important role in charting the growth of at-risk children. If it detects any cases of malnutrition it immediately refers the child to a local hospital for further care.
Utari said that based on WHO classifications, which have been applied in Indonesia since 2005, the weight and height of children in the country indicates that millions are malnourished.
The number hit 6.5 million last year, leading Indonesia to rank as the fifth worst country in the world in terms of poor nutrition for its young.
According to Indonesian Health Minister Nila Moeloek, nine million kids are now experiencing stunted growth as a result of their diet. He said they mostly live in Sumatra, Sulawesi, Papua, Nusa Tenggara and Java.
The minister said that in order to overcome this problem the ministry is pushing to educate people on the importance of living a healthy life.
It also provides food supplements and clean water for children in need as well as immunization and sanitation programs, he added.
This year the government has allocated a budget of US$74 billion to address these issues, a move applauded by rights groups.