“Healthcare condition in Indonesian remote places”

I never imagined before that I would work in a remote island called Saketa in south Halmahera, North Maluku province. I worked as a medical doctor there upon graduation from medical school three years ago. I was on the island as part of the government’s program for young doctor in the province.

Saketa was totally different from big cities such as Jakarta, where I used to live. Cell phone reception, electricity, fresh water and petroleum were precious things on the island. The South Halmahera district covers 17 islands with a population of around 9,000.

I was the only doctor for the district at the time. In the health center I worked at, I could check up to 46 patients with various illnesses in one day. The health center was very crowded with patient and their families, not only in the clinic, but also in the ward.

As a doctor, I met many patients and also many problems. For instance, there were no simple health facilities such as blood-test and radiology equipment, at the health center. Most times, people did not have a health insurance system fully covered by the local government.

There was one incident that I am still not happy with. One night I was called to a house of a 30-year-old man, located 100-meter away from the health center. He complained of pain with distended abdomen. When I arrived, I saw him almost in a delirious state. His Abdomen was swollen his respiratory rate was abnormal at 30 times a minute, his body temperature was high and his radial pulse was weak. He surely needed an operation.

But to take patient to the district hospital was not easy as normally it takes two hours by boat from Saketa. I then took him to the health center where I inserted an infuse set and a modified nasogastric tube from his nose through his stomach to decompensate his distended belly as emergency treatment before I decided to take him to the district hospital.

With 5-meter wave and rain that night, I managed to get the patient to the district hospital one hour longer than the normal journey. But, the long and risky journey was useless as the hospital surgeon was having time off to visit his children in java. The man died in hospital without further medical care. I was in a complete shock and could not believe what had happened.

Yet, the problem is not only in the health facility, but also the health system. The health system in Indonesia is not built to handle new emerging degenerative diseases such as cardiovascular disease, cancer and diabetes. It only works for infectious diseases.

Furthermore, the Indonesia health budget only constitutes 4 percent of the total national budget, which is too small to cover expenditures for all infectious diseases, let alone degenerative diseases. Moreover, life expectancy of Indonesians is more than 65 years nowadays. As a consequence, the number of patient with degenerative diseases is staggering.

Another problem is in the quantity of health workers. In the district hospital that I mentioned above, there is no permanent surgeon, pediatrician and internist, while the entire wards and emergency rooms are only covered by one general physician and two nurses.

The problem is apparently not specific to Saketa, but nationwide, as the overall number of doctors in Indonesia is not compatible with the population.

There is no formal data from the government or other source of the number of doctor in Indonesia, but former chairman of the Indonesian Doctor Association (IDI) Fahmi Idris once said there were 70,000 doctor -50,000 are general physicians and the remaining 20,000 are specialist. That number is definitely not enough to cover a healthcare program in Indonesia.

According to Fahmi, the right ratio should have more than 90,000 doctors.

These are two solutions to increase the quantity of doctors. First, the government can enhance private universities to open medical school, without neglecting the quality of their graduates. Second, the government can invite foreign doctor to work in Indonesia.

Besides quantity, the government, however, should also care for fair distributions of doctor in all regions in Indonesia. According to former director for medical care at the Health Ministry, Farid Husain, beside low quantity of doctors, their distributions is also unequal, with 64 percent of Indonesian doctor still concentrated in Java.

Another solution to the poor health program implementation is by establishing good health regulation and policies for regional government to cater to the need for health service in the regions.

In the autonomy era, local authorities sometimes are blamed by the central government for poor healthcare, while citing the minimum accessible healthcare data available in some provinces.

In addition, lots of report of health cases from the regions had failed to be treated properly as they were late reaching the Health Ministry that the illnesses had become severe and difficult to handle – thus taking a lot of victim.

In summary, there are still lots of healthcare problems, particularly in remote places across the country. It is the government’s responsibility to increase the accessibility of healthcare service for them.

The writer worked as a doctor in south Halmahera in 2008, and currently lives in Jakarta.

Exercising for 20 to 30 minutes a couple of times a week not only slashed Alzheimer’s risk by as much as 60 percent in a study but also cut the risk of regular dementia in half.

43% of Indonesia’s population lives in urban areas and recent studies have shown that people living in cities are more at risk to killer diseases then rural citizens.

Lifestyle vs. Genes
In the study, midlife exercise appeared to be key in warding off mental decline later in life. And those who had genes that made them more susceptible to Alzheimer’s reaped the greatest protective benefits from physical activity. Great to know that genes don’t necessarily control your destiny, right?  Your health and well being are in your hands. Indonesia has a huge supply of healthy food , great opportunities to exercise and stay fit can be part of your routine every day.

Little Effort, Big Rewards
People in the study didn’t have to exercise hard to protect their brain, either. A couple of moderately intense workouts a week was all it took. Researchers suspect that exercise protects the brain by promoting blood vessel health and boosting the brain’s ability to repair damage.

Keep your noggin young: There is no excuse here in Bali not to be fit and healthy
We all live in Indonesia to experience a better lifestyle and fitness is a major part of this so stay fit and see your medical health improve

Cheap and plentiful year-round, in Bali, Indonesia and Asia bananas are bursting with potassium. And a review of several major studies suggests that people who add the potassium equivalent of an extra 1 1/2 to 2 bananas to their day could drop their blood pressure 2 to 3 points, a simple insurance to continuing good health.

More Points for Potassium
Dropping BP by 2 or 3 points is nothing to sneeze at. In fact, it’s enough to lower stroke risk. In other research, people with the highest potassium intake levels cut their stroke risk by a whopping 38 percent compared with the people who got the least potassium. This magical mineral works by encouraging your kidneys to filter more pressure-boosting sodium out of your bloodstream. It also helps tiny blood vessels relax and makes pressure sensors in artery walls function more efficiently thus improving your health.

Mass A-Peel
Aim for 3,000 milligrams a day of potassium to get optimal Real Age benefits. But don’t rely on health pills; they can be dangerous if you have kidney problems. Go with fruits and veggies instead — not just bananas but prunes, watermelon, baked potatoes with the skin, mushrooms, tomatoes, and other produce, too. Produce will also give you a head start on these important blood pressure control strategies:

• Slash the sodium. Fresh produce is naturally low in salt. And licking the salt habit can lower your blood pressure even if it’s just a bit high.
• Mine more minerals. Fruits and veggies pack not just potassium but calcium and magnesium as well, two additional pressure-pampering minerals.
• Seek a sleeker you. Low-cal fruits and veggies can help you hit a healthy weight, which is important for your blood pressure.

Did you know? Nearly 90 percent of adults in Bali, Indonesia, Asia and the world over will develop high blood pressure by the age of 65, insurance for your health “Bananas”

In a study of people with high cholesterol, their blood samples showed less clotting potential just 2 hours after eating a breakfast containing phenolic-rich olive oil. Whilst not native to Indonesia this oil is well worth buying. Other fatty oils like coconut oil and vegetable oils are used in Bali, Indonesia and Asia for a large amount of frying needs. This has an obvious correlation with the health of Indonesian’s as many are diabetic and strokes occur very regularly. So decrease your need for health insurance needs by using olive oil in your cooking needs.

The Path to Heart Trouble
Ah, your endothelium. You may not think much about this thin layer of cells that lines your blood vessels, but that layer does critical things for your body. It controls how your blood vessels dilate and constrict, allowing oxygen and nutrients to flow to every part of your body. Endothelial cells also help regulate blood clotting — important because too much clotting can lead to blocked arteries.

Eat for Better Blood Vessels
More and more research is showing how diets affect endothelium. Eating just one high-fat meal can inhibit artery function, but eating healthful antioxidant-rich fats like olive oil is a love pat for your endothelial cells. Researchers credit the phenolics in the oil for helping endothelium do its job in making blood less “sticky” (translation: less likely to clot). Give your circulation a boost with olive oil, its health insuracnce for your heart. Tell your friends around Bali, Indonesia and Asia to switch to olive oil.

Walnuts are already in a heart-healthy league of their own because of their cholesterol-improving powers. And now a small new study suggests that eating walnuts every day may help give blood vessels a much needed tune-up in people with diabetes.

Thy Daily Nut
In the study, people with type 2 diabetes were asked to eat about 2 ounces of walnuts every day. After 8 weeks, endothelial function improved significantly in the walnut eaters. Why is this good news? Because endothelial cells — that thin layer of cells that lines the inside of blood vessels — may be one of the first places to go bad when people with diabetes start developing vascular disease.

Walnut Wonders
Compared to other nuts, walnuts have higher amounts of alpha-linolenic acid, which may help protect against plaque formation in arteries. Walnuts also are a great source of an amino acid called L-arginine, which helps relax blood vessels and control blood pressure. And surprisingly, the nut eaters in the study didn’t suffer any deleterious effects to their weight and waist sizes. Could be all the protein and fiber in walnuts helped the study participants eat less overall

Walnuts can be bought through Bali, Indonesia and Asia in particular in westernized shopping food distributors, so supplement your health and reduce your need for using your medical insurance policy.

This is a bizarre case that we felt we needed to highlight as a few comments that are made by the commentary apply to many facets of the Indonesian medical system. In particular there is no consumer protection in Indonesia, should malpractice be a factor in medical events there is a very acute chance of claiming of receiving compensation. This allows doctors to work without accountability of there actions. Remember to consult a second opinion when surgeries are prescribed. Medical practices rely on invasive surgeries to pay doctors wages, so in many cases the first prescription will involve the operating theatre.

Here are a few comments from the Jakarta Post March 22, 2010 ‘Indonesian and Malaysian doctors’ page 8:

Nine years ago, acting like a holy priest, the doctor tenderly told my wife who was immediately paralyzed after he had operated on her spine, “As a doctor I have done my best, but the decision totally depends on Almighty God.” We were shocked to realize that she could no longer move her body after the surgery. She walked into the operating theater confidently and left totally powerless.
Until now I still cannot find the right way to confirm the doctor’s claim that it was God’s decision that my wife be paralyzed at the doctor’s hands. As a devout Christian, the doctor did not forget to cite Jesus to support his claims. To Indonesian doctors, please do not take me to court for sharing my experience with Sunday Post readers. I just want to share the pain. And to this newspaper’s readers, I shared my experience with you in the hope that perhaps you can learn something from it (hopefully such an experience will never happen to any of you). (By Kornelius Purba)

I was moved by your story and I personally empathize with you and your suffering wife.

Personally, when consulting a doctor I usually trust a practitioner not on his religious belief, but on
his medical expertise.

Spine surgery is one of the most delicate and fragile surgical procedures, it needs a very knowledgeable, experienced, skilled and qualified surgeon — a mistake, blunder or slipup by the surgeon can be critical to the patient involved,  just what happened to your wife.
The doctor or surgeon has to explicitly and openly discuss the matter with the patients about their chances and his qualifications and expertise as a medical practitioner. Patients should also do some research on the doctor. They may
also consult other doctors for a second opinion.
This way, the patient will have peace of mind before undergoing such a delicate medical procedure. By the way, do you have appropriate laws on medical malpractice in Indonesia? You can sue him for what he has done. I fervently hope your wife will be able to recover from her present condition and will be able to walk again someday. Meanwhile, I will be praying for her earliest
recovery.
Rudy B.
Manila

I know exactly how you feel and share your desperate feeling as well, Pak Purba. My mom was diagnosed with terrible fourth stage spinal cancer by doctors in Jakarta. They said my mom should undergo surgery followed by chemotherapy.
Fortunately, my family is among those who have lost faith in Indonesian doctors and hospitals, and soon resorted to a second opinion from Singapore. Based on their examination, they said my mom didn’t have cancer, but acute spinal tuberculosis.
After five hours of surgery and three months of intense treatment there, she can now walk again and
is currently planning to go to Helsinki to see her newly born grandchildren.
I couldn’t agree more when you said that Indonesian doctors were never wrong and quickly pointed their fingers at God for all their patients’ misery. It’s about a bad mentality and lack of professionalism as well as irresponsibility. My little brother is a doctor too. And I cross my fingers that he won’t become such a lame doctor.
A. Aron
Helsinki

Unfortunately, Indonesia is one the most dangerous places in the world to have to go into a hospital. Many never come out, and I have several friends who have been needlessly operated on twice, because it was the easiest way out, treatment-wise, for the doctor.
I have a list of horror stories regarding treatment and deaths pointing directly to incompetent doctors and related graft concerning money and care. But what’s the use of documenting them? Just have your plane ticket ready.
Jor Hyam
Bali

Some of the Indonesian doctors are too arrogant. They patronize their patients. After graduating from university, they think they are the best in the “world”. Sure, it’s a great achievement to be able to graduate as a medical doctor and became a specialist.
You have to sue them. Malpractice in Indonesia is rampant. People seek medical care in Singapore, but the Singaporean doctors also love money above anything else. But at least they offer a better service.
It’s sad when, after their graduation, they totally renege on their Hippocratic Oath! They act like the greedy fat cats from Wall Street. Hopefully, a new breed of Indonesian doctors will emerge who has a conscience.
Hadi Gunadi
Depok, West Java

I am truly on your side and really sorry for the pain your wife has undergone. But what you have written is true and it implicates Indonesia doctors.
There is no consumer protection in Indonesia whether it be a medical case, about education or even, say, parking a car. Every business unit turns out to be a law unto itself and puts its own terms and conditions. The most surprising thing is that the government is not concerned; they simply pass the laws, but do not implement them.
Rajesh
Jakarta

Health insurance products will give you options when it comes to medical decisions. If you are used to high levels of medical care ready free yourself from these financial restrictions. Medical costs have risen dramatically due to a number of factors here in Indonesia, but in many cases the level of care has not changed enough to justify these price increases. Misdiagnosis is rife in Indonesia.

Contact API Pacific for health insurance products in Bali, Indonesia and Asia. Health insurance policies are area specific as well as providing coverage worldwide. Expatriates expect a level of care similar to what they receive in their home countries so give yourself medical options. API Pacific will consult you on options that are available to you in your individual case; we have been active in Asia for 20 years.

Breathing
If you do become trapped in a collapsed building, it will be important to immediately protect your airway against dust and debris by breathing through clothing or material (preferably a dust mask if one has been stored near the desk, bed, or other accessible location); check yourself for injuries and control any bleeding; find a source of light if possible; and make your location known to rescuers by tapping on a solid object with a rock or other instrument. Save your breath and energy. Delay yelling for help until you hear rescuers very nearby.

How rescuers operate
If a building does collapse, rescue teams will methodically search through the rubble for victims, using tools, search dogs, and electronic instruments that can detect the presence of live people. Survivors are usually found in spaces large enough for a human within the collapse debris, called “Survivable Void Space.” or ” triangle of life “It can be as large as an adult, or in the case of small children or infants, a very small space. The main goal of “Drop, Cover, and Hold On” is to protect you from falling and flying debris and other nonstructural hazards, and to increase the chance of your ending up in a Survivable Void Space if the building actually collapses.

Falling objects
Studies of injuries and deaths caused by earthquakes over the last several decades indicate that you are much more likely to be injured by falling or flying objects (TVs, lamps, glass, bookcases, etc.) than to die in a collapsed building. The “Drop, Cover, and Hold On” position will protect you from most of these injuries. If there is no nearby space beneath a table or other furniture that can provide protection from these objects, then you should get next to a large piece of furniture such as a sofa, cover your head, and hold on to the furniture when it moves. If there is no furniture, get next to an interior wall if possible. If you are in bed, the best thing to do is to stay where you are and cover your head with a pillow.

Several Options
There are several opinions on what to do when caught in a building during an earthquake. The best choice options differ depending on the materials and construction of the building.

1. If you are in a building made of wood or low tech materials the potential for personal damage is different than if you are in a concrete building or a multi storey building. The most favoured course of primary action in all cases is drop, cover and hold on, however if you are in a concrete building or one with significant weight above you there is a school of thought which suggests it is better to lie beside a big object rather than under it if the weight of the ceiling above is substantial and solid it will potentially crush the table or bed, which will then crush you, These objects will not crush flat and in most cases a triangle of life is created beside the object for you to survive in. this does make sense in this situation.

2. If you are in a lower tech building of bricks or wood then the potential for injury from falling masonry and objects being flung around is significant. In that situation being under a solid table or bed is a better option, as its not likely to collapse on top of you from the weight of objects that are falling but things that are knocked loose can easily cause you significant injuries . Big loose pieces of furniture are dangerous you need to be away from them and other objects that are solid. Wooden buildings tend to move and bend more so they can maintain their structural integrity, while brick buildings will have the potential for “broadcasting ” or spreading bricks and masonry with significant energy.As with everything else in survival its up to you to think clearly and make swift relevant decisions. The conventional wisdom is stay away from Lifts and Stair cases, both of these have significant risk factors attached to using them.Its also a good idea to put a little time into developing exit strategy’s, if you are in a place frequently. if you have decided what to do in advance IF there is an earthquake this will drive your actions. Its all about seconds here, being on automatic in terms of response is what its all about …I may continue this process , if you do not wish to receive any more of this just let me know