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.