When poor Indonesians lose everything<\/p>\n
Santi W.E. Soekanto and Maya Dahlan, Contributors, Jakarta<\/p>\n
Rika sits up in her bed at the maternity ward of a hospital in
\nEast Jakarta, crying bitter tears over the injustice at the death
\nof her baby because her husband was Rp 2 million (US$236) short
\nof the Rp 7 million needed for a caesarean section.<\/p>\n
The young housewife from Cikarang, West Java, is a madrasah
\nIslamic school teacher while her husband is an angkot (city
\nminibus) driver.<\/p>\n
\"We had been waiting for five years for this baby, but still I
\nthought that I could have it naturally with the help of a kampong
\n(village) midwife,\" she says. \"When the time came, however, the
\npain was such that I begged my husband to take me to the hospital
\nfor the caesarean.\"<\/p>\n
The first hospital, recommended by her doctor, refused to
\nadmit her because she didn't have enough money. Rika went to
\nseveral other hospitals, riding in her husband's angkot until
\nthey found one that accepted her. The doctor in attendance told
\nher the baby had been dead for up to two hours, and that the
\noperation was still needed anyway to take it out.<\/p>\n
\"I have become the poorest person in the world because I no
\nlonger have the most precious thing in my life,\" Rika, says as
\ntears flow down her cheeks.<\/p>\n
In Central Jakarta, Mardiyah busies herself folding a sarong
\nas she sits on her husband's bed in the oncology ward of Cipto
\nMangunkusumo General Hospital.<\/p>\n
\"Blood was spurting out of his nostrils, ears, gums, even his
\neyes were bloodshot,\" Mardiyah said of the day her husband was
\nadmitted to the emergency room and the doctors ordered a
\ntransfusion to ease the hemorrhaging.<\/p>\n
\"I was shocked, when I learned that I had to buy 15 bags of
\nblood for Rp 65,000,\" the 40-something-year-old woman says.
\n\"Fortunately, a nephew was willing to pay for it then ... but my
\nhusband's life now depends on the transfusions.\"<\/p>\n
Mardiyah's husband suffers from leukemia, which doctors say
\nhas reached a critical stage. Mardiyah, a snack seller, says her
\nhusband would not be alive if it were not for the financial
\nassistance of her relatives.<\/p>\n
\"I wouldn't know what to do without their help,\" she says
\ntearfully. \"I don't know what to do if my husband's illness
\nworsens and the relatives can no longer help us. I don't know
\nwhat to do about my two children, who are in junior school and
\nhigh school.\"<\/p>\n
\"I am hoping that one day there will be a fully-equipped
\nhospital dedicated to poor people like me so we do not have to
\nbear the burden of shame (of having to beg for help),\" she says.<\/p>\n
Fitri, a 28-year-old teacher, is facing the same predicament
\nas she lies in a bed of a third-class ward of a hospital in East
\nJakarta, for various ailments, including an ulcer and typhoid
\nfever.<\/p>\n
\"My husband has health insurance from his company, which does
\nnot cover me,\" she says. \"He now has to work hard to pay for my
\nhospital bills because my own salary is not enough.\"<\/p>\n
\"If it is only possible, I would only seek care at the
\ncommunity health centers -- we may have to wait for hours before
\na doctor can see us but at least we would not be hit on the head
\nwith hefty bills,\" she complained.<\/p>\n
Firmansyah, a 56-year-old self-employed man, thinks Cipto
\nMangunkusumo is already friendly enough to the poor. \"It is quite
\ninexpensive, it has sophisticated equipment and many of its
\ndoctors are professors. Those things really ease our fears,\" he
\nsays. \"If I had to go to a specialist in a private practice, I
\nwould have to have at least Rp 200,000 -- that sum is enough to
\ngive me another illness.\"<\/p>\n
While Firmansyah does not have any complaints about the
\nhospital, he says at the end his family has had to spend a lot of
\nmoney on other expenses, most notably the travel from home to the
\nhospital. He also has a lot to say about how the government is
\nfailing in its duty to improve the welfare of its people.<\/p>\n
\"What government subsidies have really meant benefits for us?
\nElectricity and telephone bills keep climbing, so I don't think
\nthe government would bother establishing hospitals for the poor,\"
\nhe says.<\/p>\n
In every corner of the hospital, sob stories are to be found.
\nBut individual pains of being robbed of their rights to health,
\nwhen pooled together, can either become mere statistics or a
\nwake-up call for those responsible to introduce changes.<\/p>\n
Ill health saps not only the energy of those individuals, but
\nrobs the country of its resources as well.<\/p>\n
According to health expert Ascobat Gani, in North Central
\nTimor regency, East Nusa Tenggara, malaria causes extra spending
\nof Rp 38,981 per day while the average wage is Rp 30,000. A
\ncalculation of productivity loss and absenteeism finds that
\nmalaria \"robs\" the regency of Rp 800 million every year.<\/p>\n
Indonesia has approximately 600,000 new TB cases every year,
\nand 75 percent of all those affected are in their productive
\nyears who lose up to four months of working days in a year. Added
\nto the missing resources are expenditures incurred when they seek
\ntreatment, and Indonesia finds itself being robbed by TB of up to
\nRp 8 trillion a year.<\/p>\n
Yet another study found that in Yogyakarta in 1999, of the
\nmore than 166,000 people who fell ill every month, 50,000 of them
\nbecame unproductive. This meant that in that year, Yogyakarta
\nlost a total of 4.6 million working days. If one productive day
\nearned a worker Rp 10,000, then Yogyakarta had been robbed of Rp
\n15.5 billion that year alone (Gani, 2001).<\/p>\n
Gani said Indonesia ranks among countries with the lowest
\nhealth expenditure -- less than $9 per head of population per
\nyear -- placing it at 154th out of the 191 countries studied
\n(WHO, 2000). Neighboring countries Malaysia ranks 93rd, Thailand
\n64th while the Philippines ranks 124th, Gani told a
\nparliamentarian meeting in June.<\/p>\n
Legislator Sanoesi Tambunan agrees that despite WHO
\nsuggestions that countries spend at least 5 percent of their
\nGross National Product on health, Indonesia's spending had never
\nreached even 2.5 percent. He blamed the widespread failure to
\nview health costs as a strategic investment.<\/p>\n
An indicator of this failure is the fact that less than 20
\npercent of all people with formal employment are covered by
\nhealth insurance schemes of some sort. Millions of other
\nIndonesians just have to struggle to pay for their hospital bills
\nand make ends meet when they fall sick -- as the cases shown
\nabove.<\/p>\n
To give credit where it is due, the health status of the
\npopulation has improved significantly during the past 40 years.
\nWhereas a child born in Indonesia in the 1960s could expect to
\nlive for 46 years, one born in 1996 could expect to live for
\nnearly 65 years.<\/p>\n
But not everyone has benefited equally. In 1999, infant
\nmortality rates in West Nusa Tenggara (NTB) was 81 deaths per
\n1000 live births compared with 24 per 1000 in Jakarta. Inequity
\nin access to health services also exists. In 1999, only 2 percent
\nof the population in Jakarta had no access to healthcare while in
\nManokwari, Papua, 71 percent of people had no such access.<\/p>\n
Ironically, both the government and the public spend more on
\nhealth costs incurred by tobacco use by 62 percent of all adult
\nmen in Indonesia.<\/p>\n
Former minister Farid Anfasa Moeloek said the tobacco-related
\nhealth costs amounted to Rp 30 trillion a year -- but even this
\nwas a modest figure as other experts have calculated that while
\nthe government earns Rp 27 trillion this year from tobacco excise
\nand taxation, three times as much is spent paying the health
\ncosts.<\/p>\n
This may seem like a sideswipe, but experts of social security
\nsystems agreed in a recent workshop in Jakarta that tobacco firms
\n-- who make trillions from the industry -- should be made to pay
\nnot only for causing the deaths of 1,100 Indonesians per day but
\nalso for the health development of the country.<\/p>",
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