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    Een demografisch mozaiek, Indonesie 1880 - 1942

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    This study concerns regional diversity in demographic developments regarding the indigenous population of the Indonesian archipelago during the heyday of colonial rule, i.e. from 1880 to 1942. The central question of the study is: Have demographic developments been more or less uniform in the various parts of the archipelago?This concentration on demographic uniformity or diversity is inspired by recent findings concerning demographic developments in Europe in the nineteenth and twentieth century. Research into the decline of fertility in Europe, carried out by Princeton University, yielded the conclusion that regional variation in fertility decline could not be explained by socio-economic variables only. Cultural diversity and peculiarities of the various regions played their part as well. A similar conclusion was found in various studies regarding the determinants of spatial variation in mortality. This means that research into regional demographic diversity has an interest in its own right. By situating this kind of research in a colonial setting an extra dimension is added. It is not only interesting to know to what extent socio-economic or cultural phenomena have determined demographic developments, but also whether colonial or indigenous socio-economic and/or cultural determinants were decisive for demographic behaviour in Indonesia.One can speculate on the impact of colonial rule on demographic diversity in Indonesia. On the one hand, it seems plausible that around 1900, when colonial rule had penetrated into the very outskirts of the archipelago, a certain uniformity in living conditions of the indigenous population emerged which enhanced uniformity in demographic developments. On the other hand, colonial exploitation in agriculture and mining could have brought about an entirely new spatial pattern of economic activities and spatial inequalities in development, resulting in new patterns of demographic diversity. Along similar lines, one might conjecture whether colonial rule has diminished or enlarged cultural diversity. The introduction of western education and the rise of Indonesian nationalism as a reaction to colonial rule may have enhanced cultural integration and thereby lessened diversity. An equally valid speculation is, however, that colonial rule brought about the migration of certain ethnic groups, creating new patterns of cultural diversity. Furthermore, it seems plausible that -quite apart from colonial rule- developments in the indigenous society were decisive for demographic behaviour. Hoping to bring speculations on firmer ground, the first chapter of the study concludes with an inventory of recent literature on the demographic history of Indonesia.The literature on population growth in nineteenth and early twentieth century Java is reviewed. With respect to the nineteenth century, two views emerge. According to Breman, Wander, and Boomgaard, on the one hand, the growth during the first half of the nineteenth century must have been somewhat more than 1.0% per year. Breman's and - following him- Wander's guess amounts to 1.4%, while Boomgaard, who uses more reliable benchmark years, conjectures 1.25%. The same authors agree that population growth in the second half of the nineteenth century accelerated to more than 1.5 % per year. This speeding up was caused by mortality decline and, according to Wander, by a rise in fertility. The mortality decline was attributed to the success of the vaccination programme against smallpox and to improvements in the transport network. Peper, Widjojo Nitisastro, and McDonald, on the other hand, are of a different opinion. Peper has put forward that a growth of more than 1.0% per year during the first half of the century is very unlikely because the smallpox vaccination had not yet been organized efficiently, since the government had no time or money to spare, involved as it was in the Java war. Widjojo thinks that any acceleration of growth in the nineteenth century is improbable, since living conditions were very poor and health care was hardly provided for. McDonald agrees with them in general, but is slightly more optimistic, putting forward that there must have been a slow but rather steady growth. This contrasts favourably with the varying periods of decline and growth in former centuries. According to his guess, population growth amounted to 1.2 % per year on average during the entire nineteenth century.Turning the attention to the early twentieth century, a stronger consensus about demographic developments is seen, but the picture is somewhat vague. All authors (Breman, Wander, Widjojo, and McDonald) agree that the growth rate slowed down in the years 1900-1920, and accelerated again in the twenties and thirties. Breman conjectures that the slowing down was caused by a deterioration in living conditions. Wander is less sure about this, putting forward that there were also economic crises during the nineteenth century, without perceptibly slowing down population growth. The acceleration in growth after 1920 is attributed to improvements in health care. The growth rates mentioned by the various authors amount to 1.0 % per year for the years 1900-1920, 1.5 to 1.6 % in the twenties, and 1.5% in the thirties. A closer examination of these rates show them not to be very well founded. For one thing, the results of the so-called 'Bevolkingsopnamen' (Population Counts) of 1900 and 1905 are not very reliable. Censuses were held in 1920 and 1930. Evidently, the 1930 census was the more reliable one. It seems anybody's guess, however, how much better the response was in 1930. To complicate matters further, population figures with regard to the thirties are very scarce, and the census which had been planned for 1940 was cancelled due to the outbreak of the Second World War in Europe.Reliable birth and death rates are very scanty as well. The authors agree that the registration of births and deaths -as far as it has been performed and the results have been published- was very unreliable. Various estimates of fertility and mortality have been made which do not inspire much confidence either. Widjojo's well-founded estimate of the infant mortality rate is an exception. Only this estimate is based on data concerning western Java in the thirties, and can therefore neither be generalized to other parts of Java nor to other time periods.Much less is known about population growth, fertility, and mortality in the Outer Islands (i.e. all islands outside Java). Wander and McDonald both suppose that, in the Outer Islands, population growth was faster than in Java in the early twentieth century. Moreover, Wander conjectures that regional diversity in mortality must have been considerable. She expected the lowest rates to be found in accessible areas where the colonial administration was firmly settled, while the remoter areas had the higher rates. These opinions are very speculative however, since the authors do not mention any reliable demographic data. Only in a few areas does demographic history seem to have been better documented. Widjojo mentions Sumatra's east coast in this respect, where registrations were kept at the agricultural estates, while Jones analyses demographic data from Minahasa (north Celebes), where most of the population was christianized in the nineteenth century.Some literature exists about migration regarding Java, as well as the Outer Islands. This pertains to the so-called transmigration, resettlement schemes of the colonial government, and the labour migration between Java and the agricultural and mining estates in the Outer Islands. Furthermore, various authors (Wander, Widjojo, and Hugo) have analyzed the lifetime migration data that were collected in the 1930 census. Widjojo gives a brief description of the most significant migration streams, and Wander tries to characterize the various streams according to distance and destination (rural/urban). Wander and especially Hugo stress that most migration in the period 1880-1930 occurred in consequence of colonial rule.The review of literature on the demographic history of Indonesia has revealed that there are many lacunae in the knowledge concerning the period 1880-1942. Most authors suggest or state explicitly that colonial rule had an impact on demographic developments. Since they do not pay much attention to regional diversity, it is far from clear whether colonial rule did enhance or diminish diversity. In order to be able to fill some of the gaps in the knowledge about Indonesia's demographic history, it seems necessary to initially scrutinize the sources of demographic data thoroughly. The results of this endeavour are described in Chapter II.During colonial times, most demographic data were collected by civil servants. Consequently, these data were arranged according to the administrative division in force. Part of the Netherlands Indies was governed under a system of indirect colonial rule. Here, the imprint of colonial rule was still of very little consequence during the last decades of the nineteenth century. Attempts of the colonial government to strengthen its hold caused some bloody wars, the one in Aceh lasting thirty years being the most well known. The endeavours to limit the extent of the indirectly ruled areas by force or by peaceful means continuously caused administrative revision of the territory. This is a source of discontinuity in demographic statistics. After about 1910, indirect rule was not confined much further. Ibis did not mean, however, that administrative redivision came to an end. On the one hand, the government needed various revisions of the administrative division in the process of gradually claiming more power in all areas (directly and indirectly ruled). On the other, it had to administer the colony with as few civil servants as possible. Changes in the distribution of the population or in the infrastructure could therefore prompt a redivision. With regard to Java, most administrative redivisions are comparatively well documented. Concerning the Outer Islands however --and especially the indirectly ruled areasinformation is often lacking about the number of inhabitants or the size of the area involved in the redivision. This is a serious impediment to the reconstruction of demographic trends.The administrative entities which are used most frequently in this study are the residence (residentie) and the subdivision (afdeling). The residences were the entities on the highest level in the administrative territorial hierarchy. Each residence was divided into several subdivisions, while these in turn were divided into still smaller units.The various sources of demographic data and their shortcomings are discussed only briefly here, since a detailed account in English is given in volume XI in the series "Changing Economy in Indonesia" (P. Boomgaard & A.J. Gooszen, 'Population Trends 1795-1942').Figures about population size can be derived from the afore-mentioned Population Counts, which have been taken every five years from 1880 to 1905 inclusive. Most parts of the Outer Islands were not included in these Counts. The first census was organized in 1920. It was of a rather simple design and could not be taken in many areas outside Java. The 1930 census was much more elaborate, and had been carefully prepared and well organized. From the point of view of the demographer, it is a pity, however, that no data were gathered on the age structure of the indigenous population. A division was only made between adults, older children, and young children who could not walk yet, the latter category presumably between 0 and 1Β½ years old. This census was the first one to be executed nearly everywhere in the archipelago. For many areas it yielded the first and also the last reliable population figures the colonial government ever obtained. This does not mean that no insight whatsoever existed on the population size of these areas. Local tribal chiefs or rulers of more complex societies certainly kept a fairly good account of the number of their subjects who owned them taxes and services. However, only fragments of this knowledge actually reached the Dutch functionaries. The native rulers had their reasons not to reveal too much to them. On the other hand, Dutch civil servants were possibly not too keen on knowing more than strictly necessary to carry out their limited administrative tasks.With regard to Java, another source of data on population size is available, which has not been used by other authors. It concerns the population figures published annually by the Public Health Service from 1912 to 1933. These figures are not reliable enough to reflect the actual population sizes at the time, but -except for the first few years- they are of a fairly constant quality and are therefore useful to compute growth rates.As has been stated by other authors, the registration of births and deaths was very deficient. In the thirties, a system of birth and death certificates was introduced in many Javanese residences, especially in Central Java. At that time, it was felt that this system would improve registration considerably. However, later research revealed that this optimism was misplaced. In the 1970s, when the same system was used, births and deaths were still registered very incompletely. At the same time, registration quality showed considerable regional variation. Birth and death rates can be traced in another way, i.e. in various reports from civil servants, mostly about medical or epidemiological research. Part of this material has not yet been used in the literature on the demographic history of Indonesia. The reports concern small groups and areas in various parts of the archipelago.With regard to migration, new material can be found in the extensive reports about the research conducted in the first years of the twentieth century into the deteriorating economic situation of the indigenous population of Java (the so-called 'Mindere Welvaarts Onderzoek').The search for demographic data has brought to light that a reconstruction of regional diversity in demographic developments during the last sixty years of colonial rule can only be fragmentary, especially for the years 1880-1900 and 1930-1942. Considering this limitation, it was decided to selectively answer the question about the impact of colonial rule on demographic developments by investigating a few strictly-defined themes. With regard to fertility, two case studies have been carried out, one about the fertility of Javanese estate labourers on Sumatra's east coast, the other on marriage and divorce among the christianized population of the Minahasa (northern Celebes). As far as mortality is concerned, the discussion is turned to western health care and its possible contribution to mortality decline. With respect to migration, Hugo's study is taken as a starting point, and the question is raised whether migration took place without being influenced by colonial rule.The reconstruction of regional diversity in demographic developments starts with the two demographic processes which are relatively well documented, i.e. population growth and migration. These processes are described from a bird's-eye view in Chapter III.In precolonial and early colonial times, there must have been a considerable amount of migration between the large islands, Java, Sumatra, Borneo, and Celebes, and the rest of the archipelago (henceforward denoted as 'the eastern archipelago'). Some migration streams were curtailed or diverted to other destinations when the Netherlands' East India Company (VOC), and later the colonial government, disturbed and destroyed power and trade relations. Besides this indirect impact on migration, the colonial government tried to control migration and mobility directly by requiring travel passes. This measure turned out to be quite ineffective and was abolished gradually, till most travel and migration was free by the beginning of the twentieth century. Attempts were also made to control outmigration to neighbouring countries, most of them colonized as well at that time. Labour recruitment for agricultural and mining estates in these colonies was effectively restricted. However, the government of the Netherlands Indies did not succeed in prohibiting its subjects to migrate on their own account to Malaya, where they could enlist at the British labour recruitment offices.In the early twentieth century, the number of spontaneous and recruited labour migrants to other colonies (including Surinam, one of the Dutch colonies in the West Indies) was greatly surpassed by the number of outmigrants from Java to the agricultural and ruining estates on the Outer Islands, especially Sumatra. Estate agriculture and mining, financed with private western capital, had developed in Java as well as in the Outer Islands since 1870. After 1900, however, the estates really flourished when the demand for rubber rose sharply and petroleum mining became profitable. Local labour not being sufficient in the Outer Islands, the estate owners turned first to China (mostly via Malaya) and, after the turn of the century, more and more to Java to recruit labour. The resulting labour migration got the aspect of forced migration since the labourers, who often had been lured to the estates under false pretences, were severely punished if they did not comply with the very strict rules of their contracts. They were housed on the estates and hardly received any opportunity to mingle with the local population.Migration to the estates was by no means the only migration between the large islands during the first decades of the twentieth century. Smallholders' commercial agriculture induced much labour migration as well. These migration streams are not as well documented as the migration to the estates. It is clear, however, that a lot of seasonal migration took place from Banten (western Java) to south Sumatra due to the pepper cultivation in the latter area. Besides, in central Sumatra, smallholder rubber cultivation attracted migrants from Borneo, Java, and Celebes. Just like the estate labourers, these migrants were not integrated in the local population.Migrationto Sumatra contributed to sustaining and presumably accelerating population growth on this island. The exact growth rate, however, is difficult to ascertain. Before 1920, growth rates can only be estimated for the south Sumatran residences Lampung, Bangka, and Bengkulu, and for the residence Sumatra's west coast. Elsewhere, population figures are too unreliable and/or computations are hampered by administrative redivision without the required documentation. During the last decades of the nineteenth century, population growth varied from 0.2% per year in Bengkulu to 1.5% per year in Bangka. It seems plausible, therefore, that the growth rate for this area as a whole was not much different from the one in Java at the same time, where it is estimated to have been 1.1 % at the least and not more than 1.5 % per year. After the turn of the century, the growth rate in Java declined to 1.0% in the period 1900-1920, and remained the same during the twenties. In the south Sumatran residences Lampung and Bengkulu, the rate of population growth accelerated during those decades, while the population of Bangka followed the Javanese trend.With regard to the other islands, Borneo, Celebes, and the eastern archipelago, up to 1920, population growth can only be computed for two areas, i.e. Minahasa (northern Celebes) and the small island of Amboina, together with the still smaller neighbouring islands of Saparua and Haruku in the eastern archipelago. For the years 1880-1900, both areas showed growth rates which again resembled those on Java, amounting to 1.4% for Minahasa and 1. 5 % per year for Amboina. In the first two decades of the twentieth century, this growth slowed down to 1.3 and 0.6% per year, respectively. During the twenties, an acceleration followed to 1.6% in Minahasa and 1.2% in Amboina.Although it is impossible to compute population growth for the population of Sumatra, Borneo, and Celebes as a whole during the twenties (estimates varying from 0.7 to 2.7% per year for Sumatra, 1.4 to 2.8% per year for Borneo, and 1.8 to 3.3% per year for Celebes), one can safely conclude that at least on Borneo and Celebes, population growth must have been faster than on Java at that time.Concerning the thirties, population figures are very fragmentary. With regard to Java, a growth rate of more than 1.0 %, but 1.5 % per year at most, can be estimated. This means an acceleration of growth compared to the twenties. On the contrary, available data on the Outer Islands (i.e. West Borneo, Palembang on Sumatra, Minahasa and the Sangir and Talaud isles north of Celebes, and the island of Bali in the eastern archipelago) seem to indicate a decline in growth in the thirties compared to the twenties.At the end of Chapter III, attention is paid to one aspect of population distribution, i.e. urbanization. In the various counts and censuses, the criteria for considering a settlement as urban are often vague. Moreover, they are obviously not always the same. Therefore, one criterion is used here, being the number of indigenous inhabitants. Only settlements with 20,000 or more indigenous inhabitants are considered as towns.In 1890, only 2.0% of the indigenous population of Java lived in towns of which there were a total of nine at that time. Thirty years later the number of towns had risen to 29. The degree of urbanization

    Transforming operating rooms: factors for successful implementations of new medical equipment

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    Operating Rooms (OR’s) are complex, high tech environments with extensive use of medical equipment and information technology. The implementation of new medical equipment with the aim to increase safety, improve patient outcomes or to improve efficiency may initially cause disruptions in the OR, which influence its success. Between and within hospitals the implementation of medical equipment varies and a generic implementation model omits. The aim of this study is to identify factors for successful implementations according to surgical supportive staff. Results are compared with findings from other published studies. In total 90 out of 235 surveys were returned (38%). Respondents, scrub nurses and circulating nurses, indicate that implementation and integration of new medical equipment in current activities and ICT systems remain a challenge. In this study we identified the following factors: a coherent and holistic implementation approach; integration of medical equipment in processes, systems and organization; knowledge and skill development and effective communication during the implementation process
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