Kangean island is the largest island of the islands located in the Sumenep District. This island could be pursued for 12 hours using a vessel from Port Kalianget, Sumenep. If an express vessel is used, the travel time could be reduced to 3 – 4 hours. The Subdistrict of Arjasa was one of three sub-districts in this island. It takes approximately 30-40 minutes to reach Arjasa by car, due to the potholes and rain. In Arjasa specifically, the Arjasa health centre has only 3 general practitioners, namely 2 fixed/permanent doctors and one temporary doctor. The health centre has to bear 21 villages existing in the Arjasa Subdistrict. The population living with a lump struma or hernia ranges from children to adult, and they are not a small part of the population. Most of them do not go to Sumenep or Surabaya because the fees are expensive and the travel time is very long. There are many stories where pregnant women experienced labor complications that eventually led them to give birth on board while they are being referred, and a fair number of those women (as well as their babies) died on the way.