Syamsu: Koordinator Sistem Bioetik

Syamsu KOORDINATOR SISTEM BIOETIK FAKULTAS KEDOKTERAN UNHAS

Human Rights and Health What is the Human Right to Health? Every woman, man, youth and child has the human right to the highest attainable standard of physical and mental health, without discrimination of any kind Enjoyment of the human right to health is vital to all aspects of a person's life and well-being, and is crucial to the realization of many other fundamental human rights and freedoms.

PENYIKSAAN

PERBUDAKAN

MELINDUNGI KEKERASAN TERHADAP WANITA DAN ANAK2

KEBIASAAN YANG BERBAHAYA

PELANGGARAN HAM BERDAMPAK PD KESEHATAN HAK UTK BERPARTISIPASI KEBEBASAN DARI DISKRIMINASI

HAK UNTUK SEHAT HAK UNTUK PENDIDIKAN

HAK UNTUK MAKANAN DAN MINUMAN

PENURUNAN KERENTANAN UNTUK SAKIT DENGAN MEMENUHI HAM

KESEHATAN DAN HAM

PROMOSI HAM MELALUI PENGEMBANGAN KESEHATAN

KEBEBASAN DARI DISKRIMINASI

MEMENUHI

HAK UNTUK MENDAPAT INFORMASI

HAK UNTUK KEBEBASAN PRIBADI

MENGHORMATI CONTOH-CONTOH HUBUNGAN HAM DAN KESEHATAN

HAK-HAK MENURUT UU 39 TH 1999 : 1. Hak untuk hidup 2. Hak berkeluarga dan melanjutkan turunan 3. Hak mengembangkan diri 4. Hak memperoleh keadilan 5. Hak atas kebebasan pribadi 6. Hak atas rasa aman 7. Hak atas kesejahteraan 8. Hak hak turut serta dalam pemerintahan 9. Hak wanita 10.Hak anak

Hak-hak Sipil dan Politik (Generasi I) Hak-hak bidang Sipil : 1. Hak untuk menentukan nasib sendiri 2. Hak untuk hidup 3. Hak untuk tidak dihukum mati 4. Hak untuk tidak disiksa 5. Hak untuk tidak ditahan sewenang-wenang 6. Hak atas peradilan yang adil Hak-hak bidang Politik 1. Hak untuk menyampaikan pendapat 2. Hak untuk berkumpul dan berserikat 3. Hak untuk mendapat perlakuan yg sama di depan hukum 4. Hak untuk memilih dan dipilih

Hak-hak Sosial, Ekonomi dean Budaya (Generasi II) Hak-hak bidang Sosial Ekonomi 1. Hak untuk bekerja 2. Hak untuk mendapat upah yang sama 3. Hak untulk tidak dipaksa bekerja 4. Hak untuk cuti 5. Hak atas makanan 6. Hak atas perumahan 7. Hak atas kesehatan 8. Hak atas pendidikan Hak-hak bidang budaya 1. Hak untuk berpartisipasi dalam kegiatan budaya 2. Hak untuk menikmati kemajuan ilmu pengetahuan 3. Hak untuk mempereroleh perlindungan hak cipta

Hak-hak Pembangunan (Generasi III) Hak-hak bidang pembangunan 1. Hak untuk memperoleh lingkungan hidup yg sehat 2. Hak untuk memperoleh perumahan yang layak 3. Hak untuk memperoleh layanan kesehatan yang memadai

TANGGUNG JAWAB NEGARA 1. Menghormati Hak Atas Kesehatan 2. Melindungi Hak Atas Kesehatan 3. Memenuhi Hak Atas Kesehatan

Elemen2 Hak atas Kesehatan 1. Ketersediaan 2. Keterjangkauan : - tidak ada diskriminasi - terjangkau fisik - terjangkau ekonomi - terjangkau informasinya 3. Penerimaan 4. Kualitas memenuhi

Pencapaian Indikator Utama Pembangunan Kesehatan Indikator utama

Target MDG’s 20151)

Target RPJMN 2009

Umur Harapan Hidup 73 70,6 (Tahun) DAFTAR TILIK EMPAT ELEMEN HAK

Angka Kematian bayi (per 1000 KLH)

19 26 I. KETERSEDIAAN

Kondisi saat ini Nas (2007) 69,2

ATAS KESEHATAN 342)

Angka Kematian Maternal (per 100 ribu KLH)

110

226

2282)

Prevalensi Gizi Kurang (%)

18

20

23

Lets Speak Out for MDGs: Achieving the Millennium Development Goals in Indonesia. Bappenas, 2008 SDKI 2007 (preliminary report) 3). Depkes, 2006 (Berdasarkan SUSENAS 2005) 1).

2).

The Human Rights at Issue Human Rights relating to health are set out in basic human rights treaties and include: The human right to the highest attainable standard of physical and mental health, including reproductive and sexual health. The human right to equal access to adequate health care and health-related services, regardless of sex, race, or other status.

The human right to equitable distribution of food. The human right to access to safe drinking water and sanitation. The human right to an adequate standard of living and adequate housing. The human right to a safe and healthy environment. The human right to a safe and healthy workplace, and to adequate protection for pregnant women in work proven to be harmful to them

The human right to freedom from discrimination and discriminatory social practices, including female genital mutilation, prenatal gender selection, and female infanticide. The human right to education and access to information relating to health, including reproductive health and family planning to enable couples and individuals to decide freely and responsibly all matters of reproduction and sexuality. The human right of the child to an environment appropriate for physical and mental development. Semua manusia lahir merdeka dan sama haknya dalam Hak dan Martabat

"Everyone has the right to a standard of living adequate for ... health and well-being of himself and his family, including food, clothing, housing, medical care and the right to security in the event of ... sickness, disability.... Motherhood and childhood are entitled to special care and assistance...." --Universal Declaration of Human Rights, Article 25

"The States Parties ... recognize the right of everyone to ... just and favourable conditions of work which ensure ... safe and healthy working conditions....; ... the right to ... an adequate standard of living ...; the enjoyment of the highest attainable standard of physical and mental health. The steps to be taken ... to achieve the full realization of this right shall include those necessary for: ... the reduction of ... infant mortality and for the healthy development of the child; the improvement of all aspects of environmental and industrial hygiene; the prevention, treatment and control of epidemic, endemic, occupational and other diseases; the creation of conditions which would assure to all medical service and medical attention in the event of sickness." --International Covenant on Economic, Social and Cultural Rights, Articles 7, 11, and 12

"States Parties shall ... ensure to [women] ... access to specific educational information to help to ensure the health and well-being of families, including information and advice on family planning.... States Parties shall ... eliminate discrimination against women in ... health care ... to ensure, on a basis of equality of men and women, access to health care services, including those related to family planning....; ensure ... appropriate services in connection with pregnancy.... States Parties shall ... ensure ... that [women in rural areas] ... have access to adequate health care facilities, including information counselling and services in family planning...." --Convention on the Elimination of All Forms of Discrimination Against Women, Articles 10, 12, and 14

States Parties undertake to ... eliminate racial discrimination ... and to guarantee the right of everyone, without distinction as to race, colour, or national or ethnic origin, to equality before the law, ... the right to public health, medical care, social security and social services...." --Convention on the Elimination of All Forms of Racial Discrimination, Article 5

"States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health...." --Convention on the Rights of the Child, Article 24

"Health and development are intimately interconnected. Both insufficient development leading to poverty and inappropriate development ... can result in severe environmental health problems.... The primary health needs of the world's population ... are integral to the achievement of the goals of sustainable development and primary environmental care.... Major goals ... By the year 2000 ... eliminate guinea worm disease...; eradicate polio;... By 1995 ... reduce measles deaths by 95 per cent...; ensure universal access to safe drinking water and ... sanitary measures of excreta disposal...; By the year 2000 [reduce] the number of deaths from childhood diarrhoea ... by 50 to 70 per cent..." -- Agenda 21,Chapter 6, paras. 1 and 12

"Everyone has the right to the enjoyment of the highest attainable standard of physical and mental health. States should take all appropriate measures to ensure, on a basis of equality of men and women, universal access to health-care services, including those related to reproductive health care.... The role of women as primary custodians of family health should be recognized and supported. Access to basic health care, expanded health education, the availability of simple cost-effective remedies ... should be provided...." --Cairo Programme of Action, Principle 8 and para. 8.6

"We commit ourselves to promoting and attaining the goals of universal and equitable access to ... the highest attainable standard of physical and mental health, and the access of all to primary health care, making particular efforts to rectify inequalities relating to social conditions and without distinction as to race, national origin, gender, age or disability...." --Copenhagen Declaration, Commitment 6 "The explicit recognition ... of the right of all women to control all aspects of their health, in particular their own fertility, is basic to their empowerment.... We are determined to ... ensure equal access to and equal treatment of women and men in ... health care and enhance women's sexual and reproductive health as well as Health." --Beijing Declaration, paras. 17 and 30

"Women have the right to the enjoyment of the highest attainable standard of physical and mental health. The enjoyment of this right is vital to their life and well-being and their ability to participate in all areas of public and private life.... Women's health involves their emotional, social and physical well-being and is determined by the social, political and economic context of their lives, as well as by biology.... To attain optimal health, ... equality, including the sharing of family responsibilities, development and peace are necessary conditions." --Beijing Platform for Action, para. 89

"Strategic objective ... Increase women's access throughout the life cycles to appropriate, affordable and quality health care, information and related services.... Actions to be taken: ... Reaffirm the right to the enjoyment of the highest attainable standards of physical and mental health, protect and promote the attainment of this right for women and girls and incorporate it in national legislation...; Provide more accessible, available and affordable primary health care services of high quality, including sexual and reproductive health care...; Strengthen and reorient health services, particularly primary health care, in order to ensure universal access to health services...; reduce maternal mortality by at least 50 per cent of the 1990 levels by the year 2000 and a further one half by the year 2015;... make reproductive health care accessible ... to all ... no later than ... 2015...; take specific measures for closing the gender gaps in morbidity and mortality where girls are disadvantaged, while achieving ... by the year 2000, the reduction of mortality rates of infants and children under five ... by one third of the 1990 level...; by the year 2015 an infant morality rate below 35 per 1,000 live births.... Ensure the availability of and universal access to safe drinking water and sanitation...." --Beijing Platform for Action, para. 106

UNIVERSAL DECLARATION OF HUMAN RIGHT Article 1. All human beings are born free and equal in dignity and rights.They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood. ^ Top Article 2. Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. Furthermore, no distinction shall be made on the basis of the political, jurisdictional or international status of the country or territory to which a person belongs, whether it be independent, trust, non-self-governing or under any other limitation of sovereignty. ^ Top

Article 3. Everyone has the right to life, liberty and security of person. Article 4. No one shall be held in slavery or servitude; slavery and the slave trade shall be prohibited in all their forms. Article 5. No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. Article 6. Everyone has the right to recognition everywhere as a person before the law. Article 7. All are equal before the law and are entitled without any discrimination to equal protection of the law. All are entitled to equal protection against any discrimination in violation of this Declaration and against any incitement to such discrimination.

Article 8. Everyone has the right to an effective remedy by the competent national tribunals for acts violating the fundamental rights granted him by the constitution or by law. Article 9. No one shall be subjected to arbitrary arrest, detention or exile. Article 10. Everyone is entitled in full equality to a fair and public hearing by an independent and impartial tribunal, in the determination of his rights and obligations and of any criminal charge against him.

Article 11. (1)Everyone charged with a penal offence has the right to be presumed innocent until proved guilty according to law in a public trial at which he has had all the guarantees necessary for his defence. (2) No one shall be held guilty of any penal offence on account of any act or omission which did not constitute a penal offence, under national or international law, at the time when it was committed. Nor shall a heavier penalty be imposed than the one that was applicable at the time the penal offence was committed. Article 12. No one shall be subjected to arbitrary interference with his privacy, family, home or correspondence, nor to attacks upon his honour and reputation. Everyone has the right to the protection of the law against such interference or attacks.

Article 13. (1) Everyone has the right to freedom of movement and residence within the borders of each state. (2) Everyone has the right to leave any country, including his own, and to return to his country. Article 14. (1) Everyone has the right to seek and to enjoy in other countries asylum from persecution. (2) This right may not be invoked in the case of prosecutions genuinely arising from non-political crimes or from acts contrary to the purposes and principles of the United Nations.

Article 15. (1) Everyone has the right to a nationality. (2) No one shall be arbitrarily deprived of his nationality nor denied the right to change his nationality. Article 16. (1) Men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family. They are entitled to equal rights as to marriage, during marriage and at its dissolution. (2) Marriage shall be entered into only with the free and full consent of the intending spouses. (3) The family is the natural and fundamental group unit of society and is entitled to protection by society and the State

Article 17. (1) Everyone has the right to own property alone as well as in association with others. (2) No one shall be arbitrarily deprived of his property.

Article 18. Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance.

Article 19. Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regardless of frontiers. Article 20. (1) Everyone has the right to freedom of peaceful assembly and association. (2) No one may be compelled to belong to an association.

Article 21. (1)Everyone has the right to take part in the government of his country, directly or through freely chosen representatives. (2) Everyone has the right of equal access to public service in his country. (3) The will of the people shall be the basis of the authority of government; this will shall be expressed in periodic and genuine elections which shall be by universal and equal suffrage and shall be held by secret vote or by equivalent free voting procedures.

Everyone, as a member of society, has the right to social security and is entitled to realization, through national effort and international co-operation and in accordance with the organization and resources of each State, of the economic, social and cultural rights indispensable for his dignity and the free development of his personality. Article 23. (1) Everyone has the right to work, to free choice of employment, to just and favourable conditions of work and to protection against unemployment. (2) Everyone, without any discrimination, has the right to equal pay for equal work. (3) Everyone who works has the right to just and favourable remuneration ensuring for himself and his family an existence worthy of human dignity, and supplemented, if necessary, by other means of social protection. (4) Everyone has the right to form and to join trade unions for the protection of his interests.

Article 24. Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay. Article 25. (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. (2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection

Article 26. (1) Everyone has the right to education. Education shall be free, at least in the elementary and fundamental stages. Elementary education shall be compulsory. Technical and professional education shall be made generally available and higher education shall be equally accessible to all on the basis of merit. (2) Education shall be directed to the full development of the human personality and to the strengthening of respect for human rights and fundamental freedoms. It shall promote understanding, tolerance and friendship among all nations, racial or religious groups, and shall further the activities of the United Nations for the maintenance of peace. (3) Parents have a prior right to choose the kind of education that shall be given to their children.

Article 27. (1) Everyone has the right freely to participate in the cultural life of the community, to enjoy the arts and to share in scientific advancement and its benefits. (2) Everyone has the right to the protection of the moral and material interests resulting from any scientific, literary or artistic production of which he is the author. Article 28. Everyone is entitled to a social and international order in which the rights and freedoms set forth in this Declaration can be fully realized

Article 29. (1) Everyone has duties to the community in which alone the free and full development of his personality is possible. (2) In the exercise of his rights and freedoms, everyone shall be subject only to such limitations as are determined by law solely for the purpose of securing due recognition and respect for the rights and freedoms of others and of meeting the just requirements of morality, public order and the general welfare in a democratic society. (3) These rights and freedoms may in no case be exercised contrary to the purposes and principles of the United Nations. Article 30. Nothing in this Declaration may be interpreted as implying for any State, group or person any right to engage in any activity or to perform any act aimed at the destruction of any of the rights and freedoms set forth herein.

Avicenna(980-1037 A.D.) and the Canon of Medicine

EMAS background – EU Environmental Policy Objective of sustainable development Framework of 6th Environment Action Programme 02-12

General policies: • Air • Water • Waste • Biodiversity • Etc

Information Regulation Economic instruments

Industry

Voluntary measures ETAP

Example of mix regulatory – voluntary: Production processes: integrated permits (IPPC) & voluntary scheme Products: environmental improvements (IPP) & Eco-labelling ( EU Ecolabel) EMAS : Eco Management and Audit Scheme is an European Commission Regulation

MAIN AREAS OF HEALTH DEVELOPMENT Technological Environment

Economic Environment

GLOBALI SASI

Moral Foundation

Demographic, Social Environment

Health Promotion Human, Financial and Physical Resources

Health Status Research and Development Health Services Personal Health Care Public Health Function

Health and Environment

Health Management

(Health Protection)

Socioeconomic Development Physical, Biological Environment FAM, 29 Oktober 2007

DESENTR ALISASI

Planning, Organizing, Cooperating, Evaluating

Political Environment

Paradigma Sehat Sehat adalah HAM

Pembangunan berwawasan kesehatan (A) Kesehatan Keluarga (Individu) Sistem, Model Praktik Kedokteran ---------------------------“Dokter Keluarga”

Pembiayaan/ Pendanaan “Kooperai” JPKM

(B) Kesehatan Masyarakat (Kawasan Sehat) Sistem, Model Kesehatan Masyarakat (Lintas Sektor) --------------------------------“Kawasan Sehat”

Pembiayaan/ Pendanaan Pemerintah

FAM, 29 Oktober 2007

Peran, Fungsi dan Tanggung Jawab Pemerintah Pusat dan Daerah

Health Resources EDUCATION

Stakeholders Harus membuat

POLA, SISTEM dan STANDAR

Health Financing INSURANCE

Personal Health Care And Medical Service

Service Management STRUCTURE

Pemerintah Harus membuat

REGULASI

FAM, 29 Oktober 2007

SOS International Global Health

PEMERINTAH,

MASY & SWASTA

UKP LANDASAN HUKUM ARAH KEBIJAKAN PEMBANGUNAN KESEHATAN

PEMBIAYAAN KESEHATAN (PRIORITAS)

UKKD

TERSEDIA, MUTU, AMAN, TERJANGKAU DAN MERATA

UKM

PEMBERDAYAAN MASY

SDM KES SARANA OBAT ALKES

PENINGKATAN DERAJAT KESEHATAN MASY. JATIM

ARAH KEBIJAKAN

LANDASAN HUKUM

SARANA PENUNJANG

INSTITUSI SUB SISTEM UPAYA KESEHATAN SUMBER DAYA MANUSIA

PEMBIAYAAN MANAJEMEN

DAFTAR TILIK EMPAT ELEMEN HAK ATAS KESEHATAN I. KETERSEDIAAN No

Kriteria

1

Tersedia pelayanan antenatal care.

2

Tersedia pelayanan Keluarga Berencana.

3

Tersedia pelayanan imunisasi.

4

Tersedia pelayanan dokter umum. C

5

Tersedia fasilitas pertolongan pertama pada kegawatan dan kedaruratan.

6

Tersedia obatan-obatan pokok (essential drugs).

7

Tersedia pendidikan untuk menangani masalah kesehatan.

8

Tersedia promosi penyediaan makanan dan nutrisi yang seimbang.

9

Tersedia fasilitas air bersih dan sanitasi dasar

ada

Tidak

Daftar tilik empat elemen hak atas kesehatan A. Ketersediaan No

Kriteria

1

Tersedia pelayanan antenatal care.

2

Tersedia pelayanan Keluarga Berencana.

3

Tersedia pelayanan imunisasi.

4

Tersedia pelayanan dokter umum.

5

Tersedia fasilitas pertolongan pertama pada kegawatan dan kedaruratan.

6

Tersedia obatan-obatan pokok (essential drugs).

7

Tersedia pendidikan untuk menangani masalah kesehatan.

8

Tersedia promosi penyediaan makanan dan nutrisi yang seimbang.

9

Tersedia fasilitas air bersih dan sanitasi dasar

ada

Tidak

2. Keterjangkauan No

Kriteria

1

Pelayanan kesehatan dapat dimanfaatkan oleh setiap lapisan masyarakat.

2

Pelayanan kesehatan dapat dimanfaatkan oleh kelompok dengan kondisi ekonomi terendah di daerah tersebut.

3

Letak pelayanan kesehatan relatif dekat dengan masyarakat.

4

Masyarakat relatif mudah mendapatkan informasi mengenai kesehatan dan pelayanan kesehatan.

5

Setiap ibu hamil bisa mendapatkan perawatan kesehatan sebelum, pada saat, dan setelah melahirkan.

6

Setiap anak bisa mendapatkan pelayanan imunisasi pokok.

7

Masyarakat bisa mendapatkan obat-obatan untuk sepuluh penyakit terbanyak di daerah tersebut dengan mudah.

8

Masyarakat kelompok ekonomi terendah bisa memperoleh obatobatan pokok (essential drugs).

9

Masyarakat kelompok ekonomi terendah dapat memperoleh fasilitas air bersih dan sanitasi dasar.

10

Masyarakat kelompok ekonomi terendah memperoleh pengetahuan mengenai masalah kesehatan.

11

Masyarakat kelompok ekonomi terendah memperoleh pengetahuan

ada

Tidak

3. Penerimaan

No

Kriteria

1

Menghormati nilai-nilai sosial budaya masyarakat.

2

Pelayanan kesehatan tidak bertentangan dengan etika medis.

3

Menghormati kaum minoritas.

4

Menghormati nilai-nilai individu

ya

Tidak

4. Kualitas No

Kriteria

1

Pelayanan kesehatan sesuai dengan standar minimal.

2

Petugas kesehatan teruji kompetensinya.

3

Fasilitas pelayanan kesehatan mampu menangani wanita yang sedang dalam keadaan hamil, melahirkan, dan menyusui.

4

Fasilitas kesehatan mampu memberikan pelayanan imunisasi.

5

Fasilitas pelayanan kesehatan mampu menangani sepuluh penyakit terbanyak di daerah tersebut.

6

Fasilitas pelayanan kesehatan mampu menangani kondisi kegawatan dan kedaruratan yang mengancam jiwa.

7

Peralatan dalam fasilitas pelayanan kesehatan berfungsi dengan baik.

8

Obat-obatan pokok (essential drugs) tidak kadaluarsa.

9

Air minum aman dan bersih.

10

Sanitasi memadai.

ya

Tidak

Kasus riil yang mengandung 4 elemen HAM dalam hak atas kesehatan. Derita Supriono, Duka Indonesia[1]; Supriono, seorang pemulung, membawa mayat anaknya menyusuri jalan-jalan di Jakarta karena tidak mampu membiayai penguburannya. Ironis, di tengah masyarakat Ibu Kota yang gemerlap SRI Suwarni, warga Manggarai jakarta Selatan, terkejut bukan kepalang. Kakinya gemetar: Supriono, pria yang pernah mengontrak rumah petaknya, bertandang secara tiba-tiba dengan cara aneh: menggendong mayat anaknya. Tamu yang sehari-hari berprofesi sebagai pemulung itu mengaku kebingungan mencari tempat untuk mengubur anaknya. “Bude, saya mau minta tolong,” kata Supriono kepada Sri, pada sebuah maghrib hari Minggu, 5 Juni lalu. Awalnya, Sri mengira anak dalam gendongan Supriono itu tidur lelap. Apalagi Supriono, pria asal Muntilan, Jawa Tengah, itu menggendong anaknya, seolah sedang meninabobokan. “Saya pikir dia mau jalan-jalan dan butuh ongkos,” kata Sri kepada Tempo, Jumat pekan lalu. Sri jadi lemas ketika dijelaskan bahwa anak dalam gendongan itu telah menjadi mayat. Pertemuan Supriono dengan Sri itu merupakan ending drama memilukan yang dialami pemulung kardus dan botol plastik bekas itu. Sekaligus menjadi akhir kisah sedih Supriono sepanjang hari, menyusuri jalan-jalan Jakarta dengan menggendong anaknya yang telah tiada. Tanpa diminta, Supriono pun bercerita kepada Sri Suwarni [1]

Majalah Tempo, 19 Juni 2005

Awal Juni lalu adalah awal dari kegundahan Supriono. Anak bungsunya, Nur Khaerunisa, sedang sakit muntaber, sementara biaya berobat tidak ada. “Saya hanya membawanya sekali ke puskesmas, dokter menyuruh rawat inap, tapi saya tidak punya uang,” kata Supriono. Apa boleh buat, tubuh kecil tidak berdaya itu meringkuk di gerobak berukuran sekitar 2 meter persegi, berbaur dengan kardus dan botol plastik bekas. Dalam kondisi seperti itu, khaerunisa masih dibawa ayahnya bekerja memungut barang-barang bekas. Sebenarnya, dokter di puskesmas Setiabudi, Jakarta Pusat meminta Supriono membawa kembali anaknya untuk berobat. Kemelaratan yang mendera keluarga pemulung itu membuat sang ayah menolak anjuran dokter. Sekali berobat ke puskesmas, dia harus membayar Rp. 4.000. meski biaya berobat itu sama dengan ongkos parkir mobil di Jakarta Kota, Supriono tidak sanggup membayarnya karena ia hanya seorang pemulung. Sebagai pemulung, penghasilannya sekitar Rp 10 ribu setiap hari. Uang itu harus cukup untuk biaya makan dia dan dua anaknya, Muriski Saleh dan Nur Khaerunisa. Bagaimana bisa mengobati anak, apalagi sampai menungguinya di puskesmas? Pekerjaan pemulung harus tetap dijalani. Khaerunisa yang lemas kesakitan terpaksa pula dibawa dalam gerobak, sesekali dicandai oleh kakaknya, Muriski Saleh.

Tuhan rupanya turun tangan menyelamatkan gadis cilik tanpa dosa ini. Setelah empat hari meringkuk dalam gerobak, Khaerunisa dipanggil menghadap ke haribaan-Nya. Pukul 07.00 pagi di hari Minggu, bocah berumur 3 tahun itu menghembuskan nafas terakhirnya di peraduan Tuhan, sebuah gerobak tua yang berada di sebuah “rumah” yang lapang tanpa atap dan dinding, di bawah kereta layang di kawasan Cikini. Supriono berkabung, Muriski tidak tahu adinya meninggal, dan orangorang sibuk lalu lalang Supriono merogoh saku bajunya. Ada sedikit uang tersisa, tapi tak sampai Rp. 10.000. “Jangankan menguburkan anak, untuk membeli kain kafan saja saya tidak mampu,” katanya. Kemelaratan membuat Supriono nekat ingin membawa mayat si bungsu ke Kampung Kramat, Bogor menggunakan kereta rel listrik (KRL) Jabotabek. Di sana, sebuah lokasi tempat kaumnya para pemulung bermukim, dia berharap mendapat bantuan penguburan. Jakarta tak memungkinkan hal itu. Begitu terlintas dalam pikiran Supriono. Mayat si bungsu pun dibawa menggunakan gerobak, alat kerja sekaligus tempat tidur kedua anaknya setiap hari. Dia menyusuri Jalan Cikini, Manggarai, menuju Stasiun Tebet. Mendekati stasiun, Khaerunisa dibopong menggunakan kain sarung layaknya menggendong anak yang masih hidup. Agar tidak terlihat sudah meninggal, wajah gadis mungil itu

Melihat pria menggendong anak dengan muka tertutup, seorang pedagang minuman iseng bertanya. “Saya jawab anak saya sudah mati dan akan dibawa ke Bogor,” kata Supriono berterus terang. Keterusterangan ini membawa celaka, calon penumpang lain yang mendengar jawaban itu sontak geger. Hari gini gendong mayat naik KRL? Supriono pun digelandang bak pesakitan ke kantor polisi Tebet. Supriono lalu diperiksa di Polsek Tebet. Lebih dari empat jam duda cerai dengan Sariyem itu diinterogasi aparat. Kesimpulannya, polisi tetap curiga, lalu memutuskan mengirim mayat Khaerunisa ke Rumah Sakit Mangunkusumo untuk diotopsi. Supriono tunduk dan menyerah. Tetapi di kamar mayat RSCM, dia menolak tegas anaknya diotopsi. Masalahnya, ia tidak punya uang untuk biaya otopsi itu, selain dia kasihan melihat mayat putrinya yang sudah tenang dibedah. Tubuh kaku Khaerunisa akhirnya tidak jadi dibedah, namun Supriono meneken surat pernyataan penolakan otopsi. Aneh bin ajaib (atau karena Supriono seorang pemulung?), mayat kecil itu diperbolehkan dibawa keluar rumah sakit dengan cara digendong. Kemana sang anak itu harus dikuburkan? Pertanyaan itu menghujani pikiran Supriono. Dalam keadaan bingung, ia membopong mayat anaknya ke jalanan. Sejumlah sopir ambulans sempat menawarkan jasa untuk mengangkut mayat itu. Jasa? Ya, jasa di jakarta berarti uang. Sopir ambulans mengurungkan jasa itu begitu mendengar Supriono tidak

Orang kecil seperti ditakdirkan berteman dengan orang kecil. Para pedagang sekitar RSCM beberapa orang lagi yang kebetulan ada di trotoar, mulai urunan memberi uang sekedarnyauntuk supriono.merasa cukup punya uang dari sedekah, supriono memanggil sopir bajaj.ia tiba-tiba teringat Sri Suwarni, pemilik rumah petak yang pernah disewanya beberapa tahun lalu. Bajaj pun meluncur ke jalan Manggarai Utara VI, Jakarta Selatan, rumah petak Ibu Sri. Sri meneteskan air mata. Perempuan mana yang tidak menangis mendengar kisah sedih di hari Minggu itu? Tubuh mungil dalam balutan kain warna merah kekuningan itu lantas direngkuh dari dekapan Supriono. Mayat itu dibaringkan di atas kasur tipis yang berada di ruang tamu rumahnya. Wanita berusia 40 tahun itu lalu meminta bantuan tetangganya. Warga setempat akhirnya dengan tulus urunan membantu mengurus jenazah, ada yang membeli kain kafan, ada yang memasang bendera kuning di sudut-sudut gang, ada yang berdoa dan memandikan. Keesokan harinya, putri bungsu Supriono dimakamkan di Blok A6 No.3 Taman Pemakaman Umum (TPU) Menteng Pulo. Bunga surga itu pun akhirnya bisa beristirahat dengan tenang, diantar orang-orang miskin yang kaya amal

Siapa sebenarnya Supriono? “Saya mengenal keluarga Supriono hanya sebentar. Tahun 2003 lalu mereka mengontrak rumah petak saya,” kata Sri Suwarni. Ketika itu, Supriono mengontrak sebuah kamar berukuran 6 meter persegi. Sewa rumah panggung dengan dinding papan tripleks dan seng bekas itu per bulan Rp. 140 ribu. Saat tinggal di rumah kontrakan, kata Sri, Supriono bersama istrinya Sariyem membawa banyak perabotan seperti televisi 20 inci dan kipas angin. Sri tak mengikuti perkembangan Supriono sejak keluarga itu tidak lagi mengontrak rumahnya. Terakhir kabar yang diterima Sri adalah Supriono bercerai dengan istrinya, yang memilih pulang kampung. Sejak pisah dengan istrinya, Supriono hidup menggelandang dengan dua anaknya menyusuri jalan-jalan di Jakarta. Dia sengaja membuat gerobak kayunya tertutup di bagian tengahnya untuk tidur dan berlindung dua anaknya. Di bagian depan gerobak dibuat kotak yang digunakan untuk menyimpan baju dan keperluan anaknya. “Saya mangkal di halte depan Gereja (Isa Almasih) Cikini. Kalau lagi hujan, gerobak saya bawa ke halte, biar anakanak tidak kehujanan,” tutur Supriono tentang “domisilinya” itu. Tuan-tuan pejabat di DKI, kalau domisili Supriono seperti itu, kemana dia harus meminta surat keterangan tidak mampu?