Sunday, 7 June 2009

Pedestaled in triumph

Some of you may have followed the story of the young (nursing) mother who was remanded in prison on the charge of defaming a private hospital in the Jakarta area. A test at the hospital lab had indicated she had very low platelets, and as a result she was diagnosed with dengue and was admitted and infused. But the next day, it appeared that her platelets were in fact normal, and the diagnosis was incorrect.

She moved to another hospital and was correctly diagnosed and treated. Following this, she apparently tried to view her medical record at the original hospital, but this was allegedly refused. She then sent a private E-mail to a friend, indicating that she felt that she had been treated badly. This E-mail was then forwarded to a mail list, resulting in wide distribution. As a result, the hospital took legal action, and she was arrested by the police and locked up.

A number of things about this case have upset many in Indonesia. First, how could the doctors in the hospital concerned allow such a thing to happen? Should they not have put pressure on the hospital management to be more compassionate - do we not expect all our doctors to show that quality? Second, the Minister of Health washed her hands of the problem, saying she has no control over private hospitals.

Although the law on Doctors' Practice (no. 29/2004) very clearly states that patients own the contents of their medical records, and that they are entitled to a second opinion, requests for both in Indonesia are routinely effectively denied.

As the BMJ pointed out several years back, Doctors will get off their pedestals when patients get off their knees. One of our efforts is indeed aimed at trying to get HIV-infected people to get up off their knees and become empowered patients. But actions like this will set back the whole process.


Saturday, 6 June 2009

All sorts and conditions of men

My friend and colleague, Theo Smart, has embarrassed me into returning to this task. Theo edits the HATIP (HIV/AIDS Treatment in Practice) newsletter for NAM (don't ask what that means; it used to be National AIDS Manual, but now like BP it's just an acronym). For several years (almost since its inception) I've been one of the review panel for HATIP, among a very distinguished list of clinicians, including Graeme Meintjes from South Africa, and Anthony Harries, formerly from Malawi.

Frequently HATIP's topics are above my head and outside my experience (such as 'Managing meningitis in people with HIV in resource-limited settings'), but sometimes Theo comes up with a topic which I can contribute to. Last week he circulated some initial thoughts on an article about services for men who have sex with men (MSM). It became clear that (as is so often), although the term MSM was coined to be more inclusive and not just limited to those who identify as gay. the focus was mainly towards gays and bisexuals, with little emphasis on transsexuals.

I have been involved with the waria (transsexual) community in Indonesia since 1995, when I first met up with Gaya Celebes in Makassar, a group doing outreach to this community. Coincidentally, at the same time I met with Tom Boellstorff (almost the only person to comment on my blogs; thanks Tom!). Although based in the US, Tom has had deep involvement with waria in Indonesia since the early 90's, and his recent book 'The Gay Archipelago: Sexuality and Nation in Indonesia" is the first to explore the lives of gay men in Indonesia.

From Tom and the dedicated volunteers at Gaya Celebes, together with contact with waria groups throughout the country, I have also been lucky enough to get some insight into the challenges faced by waria in Indonesia. For obvious reasons, they are extremely vulnerable to HIV infection, and as I have noted previously, in many groups they are 'queuing up to die.' So as I say, Theo hit my hot-button, and I responded by describing some of my experience with waria, and asking him not to ignore transsexuals when discussing MSM. Theo has just posted this to the HATIP blog ('Reaching the Waria of Indonesia'), at the same time kindly promoting this blog. So I must make a renewed effort to keep up with the news here.