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."