Remote Bengkulu province lacks healing hands

Remote Bengkulu province lacks healing hands

By Maswandi

BENGKULU (Antara): Bengkulu on Sumatra's windswept western coast is trying to cope with shortages of medical facilities and qualified personnel.

The province has five hospitals, only one of them classified as a type B facility with full specialist services but limited subspecialist treatment. Its total of 28 specialists is, according to the regional office of the health ministry, insufficient to provide services to its 1.4 million population.

Only 32 general practitioners work in Bengkulu; an additional 96 doctors are assigned on a temporary basis at community health centers.

"The shortage of general practitioners and specialists in Bengkulu has resulted in the inadequacy of the public health service," said Dr. Dewi, a specialist in Bengkulu.

Lack of private hospitals, absence of big business and poor awareness of the local community to seek medical advice are among the factors keeping doctors away from Bengkulu.

Any extra income that doctors might earn aside from their official duties would be negligible compared to possible earnings in a major city.

These are important concerns for specialists who, like government officials in other scientific disciplines, earn standard salaries according to their rank.

Dr. Dewi explained that a doctor studied at medical school for six years and served a temporary internship for three years in the field as part of the process of becoming a specialist. After passing these requirements, it took another five years to obtain the rank of specialist.

After so many years spent studying, many doctors are interested in earning appreciation from the community and material gains, without compromising their dedication to helping others.

The shortage of specialists has led to patients being referred to hospitals in neighboring provinces, according to the deputy director of the regional general hospital in Bengkulu, Zulkarnain Kasim.

There can be fatal consequences if the patient is in a critical condition, the referral hospital is full or transportation facilities are unavailable, he said.

For example, there is no hemodialysis equipment in the province for kidney patients. "If patients need to be treated with the machines, they must go to Jambi, Padang, Palembang or Jakarta," he said.

Everything is acutely limited. Hospitals in Bengkulu do not have complete facilities and instruments for surgery, ICU or ICCU units, physical therapy, the central supply sterilization department or pathology.

The province has no cardiac, kidney, orthopedic or physical therapy specialists, Zulknarnain said, and there was an insufficient number of radiologists, neurologists, pathologists and anesthetists.

Conditions are worse in rural areas as there are no representatives of the four basic medical specializations of pediatrics, obstetrics, internal diseases and surgery, a requirement for type C hospitals.

"Regional hospitals each have only one or two doctors with basic specialization. The requirement for four general practitioners for district hospitals has yet to be met," said chief of the Bengkulu regional office of the health ministry, Dr. Bachtiar Karatu.

None of the hospitals have received type C accreditation.

Since the promotion of the Bengkulu regional general hospital from type C to B, the regional health ministry's requests for more general practitioners and specialists have not been answered.

"Specialists and subspecialist doctors are scarce here. Other provinces in Indonesia have the same experience, especially in the eastern part of the country," he said.

Bengkulu does not have a teaching school, which means that all doctors must be recruited from other parts of the country.

Doctors assigned to Bengkulu as part of their obligatory training sometimes object, he said.

"They wish to be assigned to a bigger and more challenging province to dedicate their scientific knowledge to the society," he said.

Some of those who do accept ask for a transfer to Java or other areas after a couple of years.

Incentives

The provincial administration is dangling a financial carrot to attract specialists by providing a bonus payment of Rp 500,000 to Rp 1 million a month for a regional posting.

Bachtiar said this was a reasonable measures and not in violation of any rules. Regional administrations in eastern areas of the country offer even higher bonuses.

More specialists are coming now, Bachtiar said.

"We hope that many more specialists will work in district areas until the minimum basic requirement is met," he said, adding that many of the doctors were not motivated by the bonuses, but by their moral responsibility to help others.

The local health ministry office is also offering scholarships to general practitioners wanting to specialize in a field, said the office's head of planning, Dr. Wahyu Sudarsono.

He said his office would make it easier for the health ministry to assign specialists, including those already certified and others following completion of the terms of their scholarship contract.

There is great demand for the scholarship as it helps defray study and living expenses, he added.

Duration of the work contract depends on the number of years of the scholarship, but it is also hoped the scholarship recipients would feel a personal moral duty to continue practicing in remote areas.

Dr. Bachtiar Karatu said the regional administration should also offer the scholarships as it was too burdensome for the health ministry office to shoulder alone.

He added that the province's own qualified doctors could help out.

"It would be even better if Bengkulu residents who have studied medicine give an example to their colleagues by practicing in their home province after graduation."