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span class="inline inline-left">Out of service: A patient and her relatives pass an isle of state run Cipto Mangunkusumo General Hospital in Jakarta. The government has for decades tried, to no avail, to stop the flow, including by improvements in the quality of Indonesian health facilities and human resources. JP/NurhayatiWhat else could an Indonesian doctor say after listening to speakers from more advanced countries proudly promoting their hospital services and the progress of health care in their countries?

That was the situation apparently faced by Dr. Juferdy Kurniawan from Indonesia’s largest government hospital, the Jakarta-based Rumah Sakit Cipto Mangunkusumo (RSCM), on Sunday, when he spoke about liver disease during a two-day liver symposium here. The young doctor chose to talk about the reality of general health conditions in his country.

The symposium itself was organized by the Asian Center for Liver Disease & Transplantation (ACLDT) and ParkwayHealth. The Jakarta Post, along with some other Indonesians were also invited to the symposium.

Doctors from Singapore, South Korea, Belgium demonstrated — if not showed off — the incredible achievements of their countries or hospitals in living donor liver transplantation (LDLT). The lives of hundreds of patients have been saved through highly sophisticated, and also super expensive, liver-transplanation surgery.

Dr. Lee Kang Hoe, Dr. Desmond Wai, a transplant hepatologist, Dr. Tan Yu Meng, surgeon of hepatobiliary-pancreatic surgery, and other speakers from Singapore had strong self confidence because of their rich academic backgrounds and expertise.

Singapore is very agressive in selling its health and hospital services to Indonesia and other neighboring countries. For Singaporean doctors, the huge Indonesian population means big healthcare-business opportunities. Singapore is one of the favorite destinations for Indonesians. Meanwhile Malaysia, especially Penang, is popular for people from Sumatra.

A Singaporean doctor even advertised himself in an Indonesian newspaper as having a quick solution to cure pimples.

“Liver disease and liver cancer are very common in Asia, and as such, the role of liver transplantation has become an important part of the overall treatment strategy. Living donor liver transplantation is the main form of liver transplantation in Asia,” said Dr. Lee.

The center has conducted 185 liver transplant operations since 2002, and the success rate is very high although the patients will continue to undergo regular treatment for life. Most donors are related, either siblings, children or parents. The oldest patient was already 72 years old when he underwent the surgery.

“The patients must find their own donors,” said Lee.

Park Joong-won from South Korea talked about the era of targeted therapy for the management of liver cancer. Korea, Japan and China are the most advanced countries for transplantation in Asia.

When Juferdy came to the stage, the lecturer at the Faculty of Medicine of University of Indonesia painted a painful picture of his country.

“The population of Indonesia is 240 million people. There are 20 million hepatitis [mostly Hep B] sufferers in Indonesia. About 20-40 percent of them could become cirrhosis patients,” said Juferdy.

All insurance companies, including the state-owned PT Askes, refused to cover liver transplantation due to its expensive costs, said Juferdy.

However, he also cited one good thing about the government. “Since 1997, the government has mandated hepatitis [B] vaccination for children and now it is provided to all children for free,” said the doctor, adding that the measures would be effective because hepatitis B is contracted immediately after birth.

According to the Health Ministry, Indonesia has the third largest number of hepatitis cases, with 30 million people infected, after India and China. But China is the world’s most succesful country in transplantation, partly because it is much easier to find donors there than in other countries.

Five transplant operations have been conducted in Indonesia, including two at RSCM and at a private hospital in West Jakarta. The latest surgery was held in December last year. The 19-year-old patient’s donor was his own father.

“It was a succesful operation. We conducted it in full cooperation with our partners from China. It is a kind of transfer of technology,” Juferdy noted.

The cost of the transplant operation alone was about Rp 1.5 billion. “It was still very expensive even though we only paid the Chinese doctors’ expenses. But it is a learning process.

We are still at the preliminary stage. Hopefully, the cost can be reduced later,” he explained.

So far at least, only rich people can afford to pay this for this treatment because the post-surgery therapy is also expensive. Hospitals in Singapore refused to reveal their tariffs but some doctors gave a rough estimate, “It is about S$300,000 [US$241,196].”

“There is a problem of lack of confidence [in Indonesian doctors],” senior consultant interventional-cardiologist Charles Chan responded when asked about the increasing number of Indonesian patients who come to Singapore for medical treatment. The government has for decades tried, to no avail, to stop the flow, including by improvements in the quality of Indonesian health facilities and human resources.

Apart from the overburdened doctors, Indonesia lags far behind its neighboring countries in providing the latest health technology. Dr. Chan said that Singapore hospitals always offer the newest and most advanced technology apart from continuously upgrading doctors’ knowledge.

The cardiologist showed a great deal of sympathy for his Indonesian colleagues, many of whom receive patients until 2 a.m. “Your standards must be raised,” the doctor answered when asked about the quality of Indonesian healthcare.

Dr. Juferdy concurred. “We have big problems in our communication with our patients.” According to him, for new patients a doctor needs at least 15 minutes for the initial interview and the next session needs to be not less than 10 minutes.

“The conversations with patients are also part of the treatment,” he said.

On the sidelines of the symposium, Indonesian journalists were invited to attend a public lecture on heart attack problems, including “sudden cardiac death”. The audience had to pay for the lecture.

The doctors’ explanations were very helpful for ordinary people to learn more about the deadly diseases, because the three speakers spoke like entertainers.

In Indonesia, doctors have little time to entertain their patients while ensuring the best treatment for them. The doctors are too preoccupied with their own problems.