Care's an enemy to life

Can state hospitals in Indonesia compete with others in the region? The government clearly thinks so. The Jakarta Post reports that 'the government will turn five state hospitals into world-class medical clinics...' The five include the main Jakarta hospital, usually known as RSCM. This huge overcrowded hospital is well-known to many in Indonesia, acting as it often does as a sink-hole for patients who are beyond the capability of those in other areas.

I first got to know RSCM early one evening in 1991, when my partner was referred (dumped) there with an AIDS diagnosis. We were directed to the emergency department, which at that time of day was somewhat akin to Dante's inferno. It was crammed with accident victims and other acute cases. It was (it seemed to me) swimming in blood and vomit. The noise of screaming and wailing was pervasive. The amazing thing was that the staff, mainly young doctors and nurses, were unfazed, patient and quite helpful - within their capacity. Of course, we couldn't find a ward that was willing to accept someone with the dreaded disease - it was a long time ago (although this still occurs in hospitals outside the main towns).

Since then, I've quite frequently visited RSCM. On one World AIDS Day in the late 1990's, a group of use (together with Jane Wilson, then in charge of UNAIDS in Indonesia) cleaned and repainted the two or three wards reserved for people with AIDS. I don't recall a working toilet among them, and the nurse call was a bell - a real bell by the patients' bedside that had to be shaken. Being a small bell, the nurses rarely heard it.

From a couple of wards, a complete floor was allocated for people with AIDS in later years. Again, some surprises. On one survey we asked the chief nurse on the floor if injecting drug users (IDUs) were a problem. Yes, he said, their discarded syringes kept bunged up the toilets. So much for our concern over acceptance of IDUs in the hospital.

I think it is that block which has now been emptied and will be demolished (not before time) to make way for the new international wing. But one result has been that patients from out of town have been turned away, and recently had to rent a house to stay in. But then, they don't pay in dollars!

But it's not only a problem of facilities, as another Post report today notes. The Jakarta chapter of the Indonesian Medical Association is urging members to improve their quality of care. And the speaker of the parliament has said that medical officials should ask themselves why many people (and not just the rich) go overseas for treatment. Even patients in private hospitals get a very limited time in the doctor's office, and rarely get questions answered in a way they can understand. Even explanations, for example about side effects of drugs prescribed, are rare and brief.

Meanwhile, the main government hospital in Kupang burst into flames recently and patients had to be evacuated. Two or three died in the process.

I fear that the huge investment in 'internationalisation' will not stem the flow of patients to Singapore, Malaysia and Thailand, but will also provide limited benefit, probably at much greater cost, to the average Indonesian patient.

Babé