Int'l cooperation for better health care

By Ivy Susanti

JAKARTA (JP): The constant war which mankind has had to fight throughout its existence is not political or even territorial, but the fight against disease.

Dr. Uton Muchtar Rafei, 62, has dedicated much of his life to this cause not only in Indonesia but throughout the Southeast Asia region.

As a candidate for the director general's post of the World Health Organization (WHO), Uton believes that health issues are transnational and that nations should learn to cooperate as they develop their health care sectors.

Born in Bandung, Uton graduated from the school of medicine at Airlangga University, Surabaya, East Java in 1963.

Throughout his career in the health field which began in 1964, Uton has served as director of the regional office of the ministry of health in West Java, and as executive director of the Regional Socio-Economic Planning and Development Board (BAPPEDA) for West Java.

A father of five, Uton also earned a masters degree in public health from Tulane University in the United States in 1970.

In 1976, he was part of an Indonesian delegation to a WHO conference, an experience which left a deep impression and prompted him to apply to work at the international organization four years later.

His first post at the WHO was as an advisor in primary health care for Southeast Asia at the organization's New Delhi office.

After serving in various posts, Uton was elected as WHO's Southeast Asia regional director in 1994, a post which he still holds.

He is one of seven nominees who could be appointed as the organization's director general next year.

Uton recently talked with The Jakarta Post about the health situation in Indonesia and further international cooperation in this field.

Question: What in your opinion is the health situation in Indonesia?

Answer: There are still many contagious diseases in Indonesia waiting to be eradicated, such as malaria, leprosy, hepatitis and polio.

The campaign to eradicate polio has obtained strong support from the government. I think polio will not exist in Indonesia in the next two years.

Next are diseases caused by aging and improper lifestyles such as smoking. They need more serious attention.

There are also medical problems resulting from poor environmental management such as respiratory ailments from forest fires or various problems resulting from overpollution and unsanitary living conditions. These also need serious attention.

Q: Are our medical practitioners capable of handling these challenges?

A: Compared to the past, I have seen extraordinary improvement in medical skills, particularly in coping with primary health care.

Medical professionals can be found at hundreds of thousands of integrated health service posts (Posyandu) and at community health centers (Puskesmas). They are quite well-trained.

Q: What is the current health problem facing Southeast Asia?

A: The region's problems are not too different from Indonesia's. Some countries are more developed in their capabilities to cope with the problems I already mentioned before while others are less capable.

Closer cooperation is needed in the region to be able to support each others needs. Such cooperation could help increase the quality of health care in each country.

Q: Has there been cooperation between the region's governments?

A: Yes. There are routine meetings each year, such as health minister forums, interparliamentary forums and secretary general forums. These meetings focus on bilateral and multilateral projects, including the drafting of memorandums of understanding. The WHO helps to organize such cooperation.

Q: What particular concerns do you have toward health problems facing the world in the near future?

A: We welcome the 21st century. The world will go through vast changes resulting from an advance in communication technology which will also bring about changes in values and of how we live.

People's lifestyles and life patterns will change. Some people's standard of living will decrease as we will see many living in a deteriorating environment.

It's impossible to stop it. We must be able to anticipate it through cooperation with other countries, so suffering can be alleviated.

We can start with the poor and the chronically ill. They can be helped through an improvement in health care quality.

Indonesia, for instance, will initiate the use of tele- medicine, so the government can reduce operational fees without reducing the quality of service.

Q: Do you have a concept of how to possibly upgrade global health care?

A: First, we have to develop health care facilities at the grassroots level. In Indonesia we have Posyandu as I mentioned before. Other countries also have similar facilities.

Second, we should educate the public so they possess a basic knowledge about health care and simple medical treatment.

This idea, if promoted through intergovernmental cooperation, could become a model for a better health care system.

We are aiming at improving people's wellbeing. Public participation is required.

Leading a healthy life is not only the government's responsibility, but depends much on the public's awareness on cleanliness and a healthy environment.

Q: But each society has different cultural values. Do you think such an approach can work globally?

A: Yes, it can.

The principle is the same -- only the strategies in the field are different according to the local situation.

For example, there are countries that we could approach by utilizing their belief system, cultural doctrines or traditional ethnic customs. This has been done in Africa.

Q: How do we encourage and motivate such a program globally?

A: Through international commitment. As a candidate for the WHO's director general's post, I can motivate governments to issue a comprehensive health policy.

But it's also impossible for governments to work alone. Governments must be supported by the private sector, social institutions, religious institutions and the public. If a mutually beneficial cooperation is established, I think we can achieve this goal.

Q: Are any of your children interested in being a doctor?

A: No, none of them. They were all educated abroad and they all entered either management or hotel schools.

Maybe its because I always had to work so hard -- so none of them wanted to be a doctor.