Sun, 26 Mar 2000

Charles Suryadi moved by unhealthy urban poor

JAKARTA (JP): Twenty four years ago, a young doctor by the name of Charles Suryadi was posted at a puskesmas (community health center) in Penjaringan, one of North Jakarta's most impoverished subdistricts.

He found hundreds of sick people, malnourished children, dilapidated houses, dirty and smelly public toilets, heaps of garbage and thousands of flies and mosquitoes. "I was quite shocked, but it was the real picture of our society," Charles recalls.

For years, Charles and the Penjaringan people worked hand in hand to make their environment healthier and more livable.

"Ever since then, I have dedicated myself to the field of public health," he says.

Charles graduated from the University of Indonesia's School of Medicine in l976.

In l981, he obtained a masters degree in public health from the University of the Philippines in Manila and a doctorate degree from the University of Amsterdam's Faculty of Medicine in the Netherlands in l997.

Last February, Charles was appointed professor of public health at Jakarta's Atmajaya Catholic University.

Together with several health and urban planning experts, community-based organizations and academics, he initiated in 1998 a "Better and Healthier City" program in several towns in Indonesia.

Charles shared his ideas and knowledge of urban health issues with The Jakarta Post recently.

There follows an excerpt of the interview.

Question: What are the most important urban health issues that should be dealt with immediately?

Answer: There are at least five big issues that need dealing with in urban health. Namely, health problems related to poverty, environment, industrialization, socioeconomic factors and natural disasters.

The problems have increased because living conditions in most cities in Indonesia, particularly the capital city of Jakarta, have seriously deteriorated in the last three decades.

Among the city's problems are overpopulation, a growing social gap between rich and poor, high unemployment and poverty rates and pollution -- all of these threaten the physical and mental health of urban inhabitants from all economic groups.

Q: What are the common diseases that strike urbanites?

A: Lack of food, sanitation and substandard housing have caused malnutrition, respiratory problems, diarrhea and tuberculosis among the urban poor.

Don't say that rich people are all healthy. Their lavish lifestyles and lack of physical exercise has led them to suffer from various degenerative illnesses such as cancer, heart-related diseases, diabetes and many others.

Q: How serious are urban health problems?

A: Health problems are getting more and more serious every year in line with the rapid growth of city populations and shortage of health facilities and other supporting infrastructures.

We have to promptly deal with them because they are related not only to the health of an individual but also to all of a city's residents.

If a lot of people are sick, they can't work and earn money for their families. Bosses complain of low productivity and in the end it affects the nation's economy.

The problems are complicated and multidimensional. They have social, cultural, economic and political dimensions.

A high unemployment rate may create social unrest and an increase in crime and violence which will in turn affect the stability of a city and the nation in general.

To deal with them, we should understand the fundamental causes and major risk factors.

Q: Is there an effective way to solve the problems?

A: Urban health problems cannot be solved only by medicine and treatment. To cite a simple example, the outbreak of dengue fever in some districts of Jakarta that has struck hundreds of people.

Of course, we can cure these sick people, but the problem is not yet over. Dengue fever is related to sanitation and the state of the environment where these people live.

The fever is caused by the virus transmitted by aedes aegpty mosquitoes. This kind of mosquito breeds mostly in stagnant water, something which is everywhere in a kampong's narrow alleys, public toilets and bathrooms.

To eliminate dengue fever, we should clean up the kampongs, build good sanitation and water facilities and adequate dumping sites.

It is useless to send people to hospitals, while at the same time their kampongs are still dirty and polluted.

Q: Are there any efforts from the government, medical world and other parties to jointly deal with the issues?

A: Some city administrations have started city cleaning programs and the Ministry of Health has just initiated a healthy city campaign. A number of universities are also involved in some urban health improvement programs. But, there is still a lack of coordination among those agencies.

It is high time for them to set up a joint force because the problems are so serious. They can launch an integrated program in Jakarta, for instance, as it is the capital city.

Jakarta is considered one of the worst megacities in the world with bad traffic and transportation, high crime and violence rates, poor housing and sanitation facilities and lack of green and open spaces.

In such a condition, how can we expect Jakarta residents to be healthy, safe and prosperous?

It is quite difficult to carry out any city improvement program without a strong political will from the government and a commitment from those involved.

Q: Coming from academic and medical circles, do you feel these two institutions have done their best to improve public health?

A: To be honest, our efforts are still very limited and unfortunately our national public health care systems are incoherent.

So far, government and medical people have focused more on the curative side of things rather than preventive medicine.

To make matter worse, our health service still favors the rich. Public health services in poor areas tend to be underrated.

This is ironic, because poor people are prone to health problems and badly need cheap and good healthcare facilities.

Private hospitals and clinics prefer to give their best services to rich patients.

There is also a tendency for private health institution to provide unnecessary health care services.

Q: The government has built hundreds of puskesmas for less fortunate people to have their health checked and illnesses cured...

A: Yes, we have so many puskesmas in almost every subdistrict but a lot of them are not functioning properly. Originally, doctors and health officers working in puskesmas, especially those located in urban slums or remote villages, were supposed to be active giving their best services to the nearby community. They were also supposed to reach out to the patients and continually educate the people on health issues and healthy living, rather like a flying doctor in Australia.

Now, many puskesmas function as a clinic where doctors and nurses wait for their patients. Those doctors feel reluctant to involve themselves in community-based activities, let alone educate them.

Q: Does this mean the doctors are lacking in dedication?

A: We shouldn't generalize. It is more about the public's perception of this profession. Being a doctor, one can be famous and rich. They can live in luxury houses, work in modern hospitals and drive classy cars -- this is a misleading portrait of a doctor, perceived by many people including doctors and medical students to be true.

To tell you the truth, most doctors prefer to work for specialist programs and work at famous hospitals or private clinics.

Very few continue their graduate studies in public health, which is considered a "dry field" (not profitable) and dirty.

Yet, urban health problems should not be burdened only on the medical community or the government. They are also the responsibility of the whole community. (raw)