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 doctors 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 patients 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 his 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 the 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 diseases, cancer and diabetes. It only works for infectious diseases.
Furthermore, the Indonesian 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 patients with degenerative disease 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 doctors in Indonesia, but former chairman of the Indonesian Doctors Association (IDI) Fahmi Idris once said there were 70,000 doctors — 50,000 are general physicians and the remaining 20,000 are specialists. That number is definitely not enough to cover a healthcare program in Indonesia.
According to Fahmi, the right ratio should be one doctor to 2,500 people. So Indonesia should have more than 90,000 doctors.
There are two solutions to increase the quantity of doctors. First, the government can enhance private universities to open medical schools, without neglecting the quality of their graduates. Second, the government can invite foreign doctors to work in Indonesia.
Besides quantity, the government, however, should also care for fair distribution of doctors in all regions in Indonesia. According to former director for medical care at the Health Ministry, Farid Husain, beside low quantity of doctors, their distribution is also unequal, with 64 percent of Indonesian doctors still concentrated in Java.
Another solution to the poor health program implementation is by establishing good health regulations and policies for regional governments to cater to the need for health services 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 reports 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 victims.
In this case, cooperation between the central and local governments is vital in setting up a good health system in Indonesia.
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 services for them.
The writer worked as a doctor in South Halmahera in 2008, and currently lives in Jakarta.