RI struggles to improve medical professionalism

RI struggles to improve medical professionalism

Hera Diani, The Jakarta Post, Jakarta

The lives and images of nurses are romanticized (or even
sexualized) on screen, as portrayed in television series like
E.R. and Chicago Hope, or on countless big screen films.

But the reality is not so glamorous for nurses here, although
their role is pivotal and they are even said to be the backbone
of the healthcare system in the country.

In community health centers all over the country, 50 percent
of the medical staff are nurses, indicating the significance of
their contribution to the health service.

However, figures from the Ministry of Health show that nurses
are still short in supply, and those that there are suffer from
poor education and training.

The ratio of nurses to the total population is still a
staggeringly low 1:2,850. Within the next five years, it is hoped
that the ratio will be lowered to 1:850, which is still far from
ideal.

Education-wise, up to 70 percent of nurses nationwide are
vocational high school (SPK) graduates. Only some 20 percent of
them hold a diploma while only 5 percent have bachelor's degrees.

"In rural areas, nurses are often only junior high school
graduate and many think that this is enough. Well, that's wrong,"
Junaiti Sahar, a professor at the University of Indonesia's
Nursing School, told The Jakarta Post on the sidelines of a
seminar on the issue last week.

Inadequately trained nurses resulted in poor medical services
and thus poor overall health, especially in rural and remote
areas where people depend on the services of their community
health center.

This country still faces multiple health problems, especially
related to children's and women's health, especially as women are
still perceived as being of lower status in the family but are
nevertheless responsible for children's health.

The infant mortality rate here, for instance, is 48 per 1,000
live births. Maternal morbidity is high (over 50 percent of
mother's are anemia), while the maternal mortality rate is 470
per 100,000 births, which is among the highest figure in
Southeast Asia.

Community outreach programs and the revitalization of
community health centers are two ways to help resolve the
problem, according to Junaiti.

"Community healthiness is still very far away. There are no
such things as outreach programs. Medical staff should come to
people's houses as there are many people who are still reluctant
to go to hospitals or health centers. Some of these people have
infectious diseases," she said.

This is where the nurses come in. They should be proactive
instead of just waiting for patients to come to them.

However, given the lack of education and training, not many
nurses are aware of the importance of community outreach
programs. The health service in the country is still focused on
the provision of services inside the designated buildings instead
of reaching out to people.

Nursing, Junaiti said, consisted of more than just the
curative aspect, the giving of medication to patients. The
responsibility of nurses also involved educating members of the
public to be more aware of their own health.

"Nurses should be running programs to educate the public. They
should be going out to the schools to teach our children some
health awareness," Junaiti said.

"But how can they develop programs and fight for people's
rights if they are only high school graduates? They should at
least hold diplomas."

Since 1970, Junaiti said, people have been talking about the
lack of education for nurses. But nothing has ever been done and
no money has ever been provided to overcome the problem.

Meanwhile, UI's Nursing School has been developing a pilot
project to improve community health nursing. Funded by the
Canadian International Development Agency (CIDA) and coordinated
with the Memorial University of Newfoundland's Nursing School in
Canada, the project, which is focused on women's health, began in
1996 in Waru Jaya village, Bogor, West Java.

"We train the nurses and employ a system whereby we identify
the problems based on community needs assessments, because not
every community is the same. We promote the establishment of
village health committees, conduct advocacy campaigns, visit
homes and schools, etc." Junaiti said.

The result have been encouraging so far. For instance, the 76
percent of women who suffered health problems during pregnancy
has been reduced to 48 percent.

"It's still ongoing despite the lack of resources. We hope
that other places will be able to replicate this project,"
Junaiti said.