The Association of Indonesian Tropical and Infectious Disease Researchers and the Association of Indonesian Travel Health Experts recently held a national congress on tropical and infectious diseases in Kuta, Bali. The Jakarta Post’s Rita A.Widiadana and contributor Luh De Suriyani compiled the speakers’ latest studies on the country’s most vulnerable health issues and on how the Indonesian government is facing these challenges.
Smoky weapon: Officers fumigate the area around Kuningan, Jakarta. JP/J. Adiguna Heavy rains and frequent floods have occurred in many parts of Indonesia, not to mention tropical storms, earthquakes and other natural disasters.
In the last few years, wet seasons, rainfalls and floods have increased in frequency and intensity. During the dry seasons, long and severe droughts occur everywhere.
Local and international pundits have frequently warned Indonesians and the government to be cautious about these changes, but it seems we do not pay much attention unless environmental disasters strike us.
Floods not only inundate the capital city of Jakarta but also the once flood-free areas such as Denpasar in Bali. Sumatra, Sulawesi and Kalimantan have become hotspots for natural catastrophes such as floods, landslides and forest fires due to excessive deforestation.
Extreme weather has badly affected the fundamental requirements for health — clean air, safe drinking water, sufficient food and secure shelters.
Indonesia is a tropical country currently facing significant health problems. The country has always been a perfect breeding ground for vector- and water-borne diseases including malaria, dengue, cholera and diarrhea, dubbed as major killers in the world’s poor regions.
“The current weather condition has boosted the number of cases of each vector- and water-borne disease. The disease’s clinical manifestation has also become more severe and often difficult to diagnose,” said Tuti Parwati Merati, a professor at Udayana University’s Medical School’s tropical and infectious disease department.
In recent years, an increasing number of dengue fever cases caused by a virus transmitted by the aedes agepty mosquito, for instance, present unusual clinical manifestations, such as neurological manifestations. The neurological features include headaches, alteration of consciousness, convulsions, neck stiffness, depressed sensorium, behavioral disorders, delirium, general paralysis and cranial nerve palsies.
Merati said a team of doctors at Sanglah Hospital in Denpasar found a teenage patient with infrequent symptoms of the dengue infection. The patient presented a cardiac manifestation of dengue, an uncommon case. Bali is among the “endemic” red area for dengue cases with a prevalence of 181.3 cases per 100,000 population in 2009. In 2010, dengue cases are predicted to increase significantly.
In a Jakarta hospital, a young army soldier was diagnosed with dual infectious diseases — malaria and dengue. He was stationed in Papua, a malaria endemic area, where he also contracted dengue fever.
The World Health Organization (WHO)’s report said Indonesia had the highest dengue case prevalence among ASEAN countries with 90 percent of patients being children and babies.
Another serious tropical disease is malaria, which is strongly influenced by climate. Transmitted by Anopheles mosquitoes, malaria kills almost 1 million to 2.7 million people worldwide every year. In Indonesia, there are 15 millions of cases of malaria annually, around 30,000 of sufferers die.
According to the United Nations Development Program (UNDP)’s report, illnesses associated with malaria costs the Indonesian economy. The loss of individual income from malaria is estimated at US$56.5 million annually. This does not take into consideration revenue lost from foregone business investment and tourism in malaria endemic areas.
Indonesia is among the world’s countries that are more vulnerable to malaria disease. More than 90 million of its 238 million population live in malaria endemic areas, mostly in the eastern provinces of Kalimantan and Papua. The climate change pattern has re-emerged malaria endemic areas in West and Central Java.
Based on the National Household Health Survey (conducted in 2001), the malaria-specific death rate was at 11 per 100,000 for men and eight per 100,000 for women.
The resurgence of tropical diseases badly affects areas with weak health and sanitation infrastructure. Indonesia with a meager national health budget of only 2.8 percent of state budget or around Rp 21 trillion will be among the least able to cope with such huge health threats. Although the Health Ministry planned to propose a health budget increase to 5 percent of the state budget in 2011, the amount would be sufficient to overcome these huge health problems.
Djoko Widodo, medical professor and chairman of PETRI, said Indonesia was facing gigantic health challenges. “Our country still has to deal with basic health services, limited skilled medical professionals and a limited health budget,” Widodo said.
Citing an example, in dealing with zoonostic diseases like malaria, dengue, avian flu and rabies, the country needs to spend huge amount of money to provide ample vaccines and health services for affected people.
Suffering: Malaria patients from Jeringo are admitted into emergency care. JP/Panca Nugraha “The problem is [Indonesia] doesn’t have enough money for vaccines, especially the anti-rabies vaccine, which is very expensive.”
A limited number of trained medical staff and experts on infectious diseases are other major obstacles.
“There are only eight medical programs that specialize on tropical and infectious diseases across Indonesia. This is not enough. We have to increase the number of such programs, especially in the eastern provinces,” he maintained.
Malaria and other tropical diseases frequently affect people living in remote villages lacking in health infrastructure, the professor added. The disparity of the number of medical professionals in urban and rural areas remains very wide. “The majority of fatalities occurred in villages and isolated areas,” he noted.
The Health Ministry has estimated that in 2010, Indonesia would annually need 500 new medical specialists, 7,000 family physicians and more than 10,000 new public health professionals and sanitarians. Such a prediction was simply based on the desired population ratios rather than on actual demand by the public and private sector.
Data from the Health Ministry shows that the number of public health professionals remains far below what is needed for 230 million people. There are only 13,583 health promoters and workers. The number of public health administrators reached only 7,059. This means that one health promoter must work for 16,000 people, and one public health worker must handle 28,000 people.
Experts believe that even with conservative estimates, if every public health education program can produce on average 200 new graduates in public health, the needs of the targeted new medical professionals would not be met.
Jahya Kusyanto, chairman of the Association of Indonesian Health Travel Experts, said that the government’s lack of readiness in handling infectious diseases was closely related to the number of travelers to Indonesia.
Many countries immediately issued travel advisories or even travel warnings on visiting Indonesia during the outbreak of rabies, avian flu, dengue, cholera and malaria.
“Health security is among traveler’s concern when visiting any foreign country. Singapore draws 12 million foreign tourists every year as compared to Indonesia, which can only attract 7 million visitors.”
