and I don't care

I'm sure we all frequently use acronyms and abbreviations without thought as to their underlying meaning. One example that always sticks in my craw is 'WTS' (wanita tunasusila, or women without morals), a euphemism for sex workers. While some are quite likely 'amoral', no more than members of the general population, and many that I have met are more moral than me (OK, not saying much!). It's an extremely judgmental, inappropriate and unempowering term. Yet it's still used by the Social Welfare Ministry, where there is a subdirectorate providing social rehabilitation service for those without morals (Subdit Yanrehsos Tuna Susila). Sadly I can't tell you much more about it, because the web page for this subdirectorate only displays 'Lorem ipsum dolor sit amet, consectetur...". But I have refused to attend activities of the Ministry until they change the name.

Today, another example came my way, although raising very different concerns. 'CST' is increasingly used for Care Support and Treatment (mainly for HIV-infected people or PLHIV) and this English abbreviation is often used even in Indonesian. In fact, the report I was listening to, while frequently referring to CST, in fact focused almost exclusively on treatment, with little concern for care and support.

We have frequently emphasised that provision of antiretroviral therapy (ART), while important, is by no means the only need of PLHIV. For example, we have still made little progress in retaining PLHIV in care, especially those who have yet to meet the criteria for starting ART. The result is that, even if we manage to identify infections at an earlier stage, the PLHIV concerned will rarely return for follow-up until he or she falls sick with a serious opportunistic infection, and with an immune system that is already shot. In addition, as Dr. Chavelit pointed out in the meeting, we almost totally ignore palliative care.

Fact is, as my colleague Dr. Hendra recently pointed out to me, while we've made a degree of progress in provision of treatment, and Spiritia and partners are doing a reasonable job of support, we've made almost no progress on care. Those who are normally the main providers of care, nurses, are often viewed as skivvies (a menial for those from the ex-colonies), and frequently lack caring skills.

Clearly changing this requires a very long-term effort, but at least we could start to acknowledge the need, and avoid lumping this important activity with the other two.

Babé

PS A Happy Thanksgiving to all (two?) of my US readers. As you probably know, the English celebrate thanksgiving on 4th July (grin!)