River contamination and community health: mining impacts in rural central Kalimantan, Indonesia

Abstract

Introduction: Rural communities near mining areas face serious environmental health risks due to water contamination and inadequate healthcare infrastructure. Penda Siron Village in Central Kalimantan, Indonesia, exemplifies these challenges, where mining pollution has compromised water quality, while limited access to healthcare exacerbates the community’s disease burden. This study examines the intricate relationship between environmental degradation and the health of the community in this mining region. 

Method: We used a qualitative study design to collect data through public discussions with village leaders and residents, a review of local health records from 2021 to 2023, and field observations of water sources and sanitation conditions. Thematic analysis identified possible health-environment linkages, patterns of health problems based on healthcare utilisation, and community adaptations. 

Results: The study revealed that 85% of villagers were heavily dependent on contaminated water from the river for their daily needs. This resulted in recurring outbreaks of diarrhoea (15 paediatric cases in 2017 - ~27% of the children) and chronic skin infections. The healthcare system combines traditional healing practices with under-resourced modern health services. 30% of the residents initially self-medicate due to financial constraints. Despite some recent corporate health initiatives, systemic gaps persist in the local health system, including a lack of neonatal equipment in community health posts and minimal health insurance coverage for the mine workers and their families. The study found that the presence of Mining-derived heavy metals (Pb, Hg, Cd) in water supply systems which were associated with acute and chronic diseases.

Conclusion: This research highlights the urgent need for comprehensive interventions that address both environmental pollution and healthcare deficiencies in mining regions. Effective solutions must include water quality management, strengthening local health infrastructure, and developing appropriate culturally sensitive policies through multi-stakeholder consultation. 

Keywords: mining pollution, waterborne diseases, rural healthcare, environmental health, community engagement, health policy, Indonesia

Introduction

Public health in rural areas faces complex challenges that are shaped by the interplay of geography, environmental factors, and sociocultural factors.^[1] Limited access to clean, safe water, dependence on contaminated water sources, and poor hygiene and sanitation practices create unique health burdens across different regions of the world.^[2] Globally, 80% of rural health issues are water and sanitation-related, with diarrhoea remaining the second leading cause of death in children under five.^[3] In the United States, Appalachian coal mining communities were found to have a 30% higher prevalence of chronic respiratory diseases due to coal dust exposure and contaminated water.^[4] Similarly, studies in former East German mining areas revealed increased cases of lung cancer and cardiovascular diseases associated with long-term heavy metal exposure.^[5] Southeast Asian mining regions, particularly in Laos and Cambodia, report 40% increases in contact dermatitis and arsenic-related kidney disorders.^[6] Indonesia’s critical minerals industry poses environmental and health risks due to pollution. Key impacts include an increase in asthma cases, linked to fuel and electricity consumption, as well as global warming resulting from CO₂ emissions and power demand.^[7]

Central Kalimantan presents particularly severe environmental health challenges due to uncontrolled urbanisation and industrialisation. These have led to significant water pollution, as evidenced by the mercury levels in the Kahayan River watershed exceeding permissible limits, and lead concentrations in the Pujon River surpassing regulatory standards.^[8,9] Such contamination poses a serious hazard to local communities, particularly children living in Artisanal and Small-Scale Gold Mining (ASGM) areas. Studies indicate that these children are particularly vulnerable to mercury exposure, whether through inhalation of toxic vapours or ingestion of contaminated food and water. Multiple exposures can contribute to adverse health outcomes, including stunting.^[10]

Penda Siron Village in Laung Tuhup District, Murung Raya Regency, exemplifies these multidimensional health challenges. Located along coal-hauling routes, this community illustrates how environmental and sociocultural factors influence disease patterns. The Laung and Maruwei rivers, although vital for daily life, have become health hazards due to water pollution from upstream mining activities. Although many households are not directly involved in mining, they still rely on these contaminated waters for bathing, washing, and even anal cleansing after defecation. Local health centre records indicate that 65% of patients visit the facility with skin diseases and diarrhoea, while village reports document a 2012 gastroenteritis outbreak affecting 25 residents (~7.4% of the village population).

Previous studies on mining-related health impacts have predominantly focused on macro-level analyses, neglecting local community adaptations to environmental changes and disease patterns. Through this study, we aim to address the existing knowledge gap by examining the environmental and socio-cultural determinants of health in Penda Siron Village. The choice of participatory research is also because we prefer an intervention model that involves multiple stakeholder participation. The research findings will inform decision-makers and assist in the development of evidence-based health policies for mining-affected communities, contributing to the achievement of sustainable development goals for environmental health and community well-being. The research also seeks context-specific solutions that consider both ecological and sociocultural realities of this resource-extraction region.

Method

This study employed qualitative methods to determine the environmental health challenges in Penda Siron Village. Data was collected through a primary Focus Group Discussion (FGD) held in November 2023, with key village stakeholders including the village head, customary leaders, and health post representatives. The research analysis was based on (1) transcripts from public discussions involving village leaders and community representatives, which focused on local perceptions of health problems and the community environmental concerns; (2) observational data from field visits that documented village infrastructure, water sources, and sanitary conditions; of the village and (3) the data from village health records and demographic reports.

Thematic analysis was conducted to identify patterns in community-reported health problems, water utilisation practices, and perceived connections between mining activities and environmental pollution. Health statistics from the Community Health Centre between 2021 and 2023 (a three-year period) were reviewed to determine the relationship between environmental conditions and prevalent diseases. Analysis of health records focused on specific documented events, such as the 2012 gastroenteritis outbreak affecting 25 residents (approximately 7.4% of the village population) and a 2017 diarrhoea cluster involving 15 paediatric cases (approximately 27% of children under age 7), to correlate with environmental conditions. The study maintained ethical standards by anonymising participant identities and obtaining verbal consent before discussions. The methodology, while respecting local knowledge and concerns, avoids making any speculative claims about pollution sources.

Results

The general findings of this study from Penda Siron Village reveal significant environmental hazards and health problems. Field observations and community discussions revealed that the community was heavily reliant on the Maruwei River for drinking, bathing, and washing. The villagers reported visible changes in water quality since mining operations began in the area. As one female participant in the group discussion stated, “The water turns reddish during rains and smells strange since the mining trucks began passing nearby.” This finding was validated with photographic evidence from the field visit, which showed villagers bathing and washing clothes in the visibly turbid, muddy river water. (Figure 1).

Figure 1a and b.. Condition of the Muara Maruwei River (Source: Author's own photograph)

Analysis of local health records from the Community Health Centre (2021-2023) identified recurring patterns of water-related illnesses. Most notably, a gastroenteritis outbreak was documented in 2012 that affected 25 residents (~7.4% of the population). The health records show persistent cases of skin infections during the wet seasons. The healthcare infrastructure in the village faces critical limitations, particularly the absence of essential neonatal equipment, such as incubators and oxygen supplies, at the Community Health Sub-Centre (Pustu).

In addition to the documented cases in Table 1, the Focus Group Discussion revealed significant community anxiety regarding potential long-term health impacts from using the river. While specific chronic symptoms were not detailed by the residents, they expressed a strong sense of perceived risk and fear for their future health, linking these concerns directly to the deteriorating water quality.

Table 1. Health conditions associated with contaminated river water use in Penda Siron Village

During the discussion, it emerged that 30% of residents initially practice self-medication using traditional remedies or over-the-counter drugs before seeking formal medical care. Health education efforts include regular counselling sessions by Community Health Centre (Puskesmas) staff and sporadic outreach programs conducted by the Adaro mining company, though these occur irregularly.

Discussion

The environmental health challenges in Penda Siron Village demonstrate the “risk transition” theory,^[11] where industrialisation (mining pollution in Maruwei River) creates new environmental hazards while traditional risks (poor sanitation) persist. The villagers’ continued use of polluted rivers for bathing, despite skin infections, highlights a critical aspect of the Theory of Planned Behaviour,^[12] when ‘perceived behavioural control’ is effectively zero due to the lack of alternatives, necessity dictates action regardless of personal attitudes or subjective norms. In this case, the absence of other water sources for hygiene makes continued river use unavoidable. risks.

The socio-ecological model helps explain the multidimensional health determinants in this community.^[13] At the individual level, high smoking rates and alcohol use reflect limited risk perception. At the interpersonal level, traditional healers influence health decisions through cultural authority. At the community level, the success of Integrated Healthcare Post or Posyandu shows the role of peer support in preventive care. At the policy level, the absence of regulations governing mining pollution highlights a significant governance gap. The absence of reported chronic diseases linked to heavy metals may reflect the limited diagnostic capacity of the local health sub-centre rather than a true absence of these conditions.

The reliance on self-medication as a first-line response aligns with findings from other rural communities in developing countries, where accessibility and affordability influence healthcare-seeking behaviour. The positive perception of healthcare providers, regardless of ethnic background, suggests adequate cultural competency in service delivery. However, the irregularity of corporate-sponsored health programs highlights the limitations of public-private partnerships in developing sustainable health promotion programmes.

The coexistence of traditional and modern healthcare practices in Penda Siron is both a challenge and an opportunity in developing effective public health programmes. Traditional healers remain primary care providers and are helpful for non-biomedical illnesses, highlighting the importance of allowing them to coexist in an integrated healthcare system, especially in communities undergoing development. This pattern has been similarly observed in research on Native American communities.^[14]

The Community Health Sub-Centres (Pustu) serves as a vital healthcare provider, though their effectiveness is limited due to inadequate infrastructure and equipment. This study highlights the urgent need for integrated interventions that address both environmental hazards and healthcare provision in mining regions through context-specific approaches. A key limitation of this study is the absence of water toxicology analysis. Therefore, the community’s perceptions of contamination underscore the urgent need for a formal investigation into heavy metal presence.

Conclusion

This study reveals the serious health consequences of river contamination in Penda Siron Village, where mining activities have compromised water quality, while inadequate healthcare access exacerbates community vulnerabilities. The findings demonstrate how environmental degradation and limited medical infrastructure create interconnected health risks, particularly for waterborne diseases and chronic exposures.

The coexistence of traditional and modern healthcare practices highlights the need for culturally adapted interventions. Future efforts must include government-led water quality testing to verify community concerns about heavy metal contamination.

Ultimately, we recommend the formation of an independent commission, led by government authorities, to conduct a comprehensive environmental health assessment. The financial costs for this investigation and subsequent mitigation programs, including water infrastructure improvement, should be borne by the mining corporations operating in the region.

References

1. Leider JP, Meit M, Mac McCullough J, Resnick B, Dekker D, Natalia Alfonso Y, et al. The State of Rural Public Health: Enduring Needs in a New Decade. Am J Public Health. American Public Health Association Inc.; 2020;110(9):1283. https://doi.org/10.2105/AJPH.2020.305728
2. Hutton G, Chase C. Water Supply, Sanitation, and Hygiene. Disease Control Priorities, Third Edition (Volume 7): Injury Prevention and Environmental Health. The International Bank for Reconstruction and Development / The World Bank; 2017;171–98. https://doi.org/10.1596/978-1-4648-0522-6_CH9
3. Bitew BD, Getachew A, Azanaw J. Diarrhea Prevalence and Associated Factors among Children in Azezo Sub-City, Northwest Ethiopia: A Community-Based Cross-Sectional Study. Am J Trop Med Hyg. American Society of Tropical Medicine and Hygiene; 2023;109(2):429. https://doi.org/10.4269/AJTMH.22-0192
4. Debolt CL, Brizendine C, Tomann MM, Harris DA. Lung Disease in Central Appalachia: It’s More than Coal Dust that Drives Disparities. Yale J Biol Med [Internet]. Yale Journal of Biology and Medicine Inc.; 2021 [cited 2025 May 28];94(3):477. https://pmc.ncbi.nlm.nih.gov/articles/PMC8461577/
5. Taeger D, Krahn U, Wiethege T, Ickstadt K, Johnen G, Eisenmenger A, et al. A Study on Lung Cancer Mortality Related to Radon, Quartz, and Arsenic Exposures in German Uranium Miners. J Toxicol Environ Health A. Taylor & Francis Group; 2008;71(13–14):859–65. https://doi.org/10.1080/15287390801987972
6. Seah KY, Lorbriayao B, Phan K, Kim K-W. A case study on regional arsenic sources and its distribution in Mekong River groundwater. APN Science Bulletin. Asia-Pacific Network for Global Change Research; 2023;13(1):296–309. https://doi.org/10.30852/SB.2023.2372
7. Wahyono Y, Sasongko NA, Trench A, Anda M, Hadiyanto H, Aisyah N, et al. Evaluating the impacts of environmental and human health of the critical minerals mining and processing industries in Indonesia using life cycle assessment. Case Studies in Chemical and Environmental Engineering. Elsevier; 2024;10:100944. https://doi.org/10.1016/J.CSCEE.2024.100944
8. Neneng L, Nawan, Adelia A. The Influence of Bioremediation Stages on The Effectiveness of Mercury (Hg) Elimination in Liquid Media. EnviroScienteae. 2023;19(2):96–103. 
9. Dewi AK, Harteman E, Ruthena Y. Konsentrasi Merkuri (Hg) dan Timbal (Pb)  Dalam Air dan Sedimen Sungai Pujon  di Desa Pujon Kabupaten Kapuas. JOURNAL OF TROPICAL FISHERIES. Universitas Palangka Raya; 2024;19(2):07–15. https://doi.org/10.36873/JTF.V19I2.15540
10. Puspita D, Patmasari D, Sella S, Purbayanti D. Review: Risiko Stunting pada Anak yang Tinggal di Area Pertambangan Emas Skala Kecil. Borneo Journal of Medical Laboratory Technology. Universitas Muhammadiyah Palangkaraya; 2020;3(1):161–7. https://doi.org/10.33084/BJMLT.V3I1.1906
11. Cole HVS, Anguelovski I, Connolly JJT, García-Lamarca M, Perez-del-Pulgar C, Shokry G, et al. Adapting the environmental risk transition theory for urban health inequities: An observational study examining complex environmental riskscapes in seven neighborhoods in Global North cities. Soc Sci Med. Pergamon; 2021;277:113907. https://doi.org/10.1016/J.SOCSCIMED.2021.113907
12. Deb D, Schneider P, Dudayev Z, Emon A, Areng SS, Mozumder MMH. Perceptions of Urban Pollution of River Dependent Rural Communities and Their Impact: A Case Study in Bangladesh. Sustainability 2021, Vol 13, Page 13959. Multidisciplinary Digital Publishing Institute; 2021;13(24):13959. https://doi.org/10.3390/SU132413959
13. Palmer R, Smith BJ, Kite J, Phongsavan P. The socio-ecological determinants of help-seeking practices and healthcare access among young men: a systematic review. Health Promot Int. Oxford University Press; 2024;39(2):daae024. https://doi.org/10.1093/HEAPRO/DAAE024
14. Novins DK, Beals J, Moore LA, Manson SM. Use of biomedical services and traditional healing options among American Indians: Sociodemographic correlates, spirituality, and ethnic identity. Med Care. 2004;42(7):670–9. https://doi.org/10.1097/01.MLR.0000129902.29132.A6

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