RI's diseased healthcare system needs medication

Hera Diani, The Jakarta Post, Jakarta

The year 2005 saw a series of natural and health-related disasters in the country that putt huge pressures on the still wobbly healthcare system here.

It began with the colossal work of dealing with the health problems and the destruction of the healthcare system, in the aftermath of the Dec. 26 tsunami in Aceh province.

Subsequently, outbreaks of disease caused fear around the country, ranging from the reemergence of polio to bird flu.

Nearly a decade after polio was believed to have been eradicated in Indonesia, the water-borne disease, to which children are at highest risk, reemerged in April. The outbreak was first detected in villages near Sukabumi, West Java, and then spread to other cities and provinces.

Causing paralysis, muscular atrophy and death, the virus may have returned to this country via Saudi Arabia through migrant workers or Muslim pilgrims who contracted the virus from pilgrims from Nigeria.

The virus spread quickly, and within only six months had infected 236 under-fives in 22 regencies and cities in six provinces.

Immunization campaigns were then launched, But rumors about the safety of the vaccine following the deaths of three children after receiving it caused fear among parents, with the result that one million children had still not been immunized by the second round of immunization.

The next rounds, however, reached nearly 100 percent of 23.31 million under-fives after government assurances that the vaccine was safe, and that the deaths were attributable to dengue fever, cot deaths and low birth weights.

In May, shockwaves reverberated around the whole country following reports that hundreds of people were suffering from severe malnutrition in East Nusa Tenggara province. By July, 35 infants had died.

It is a sad irony that this could happen in a major rice producing area, and yet people are too poor to obtain food and ignorant about nutrition and diet.

Malnutrition cases were also reported in Central Java, with a total of almost 9,000 under-fives recorded as being malnourished between January and June 2005 alone, and with 25 attributable deaths.

In early December, reports of famine started to emerge from the remote Yahukimo regency in Papua, which reportedly has left at least 55 people dead and 112 others sick out of a population of 55,000. A failure of the sweet potato crop was to blame this time around.

Meanwhile in July, another outbreak of disease hit the headlines.

A father and his two daughters were confirmed as the country's first fatalities from Avian influenza, several months after the first human case was discovered in South Sulawesi.

As of Dec. 14, Indonesia has had nine confirmed bird flu deaths, and 14 cases of infection in total. The highly pathogenic H5N1 strain is endemic in poultry in parts of Asia, and has affected poultry in two-thirds of the provinces in Indonesia.

The bird flu virus has killed 71 people in Asia since 2003, out of the 138 people known to have been infected.

Aside from new diseases, the old reliables also continued to wreak havoc. Dengue fever, which infected around 18,000 people between December 2003 and March 2004, also caused hundreds of people to fall sick in 2005.

Diarrhea, meanwhile, has recently hit districts in Tangerang regency, with at least 329 people struggling with the deadly but preventable disease, and at least 16 children and adults having died from it.

As for HIV/AIDS, warnings have been sounded that Indonesia is on the brink of a major epidemic, with all of the elements in place for the rapid spread of HIV.

The executive director of the United Nations Program on HIV/AIDS (UNAIDS), Peter Piot, purposely came here to mark World AIDS day on Dec. 1.

It is estimated that there are between 180,000 and 250,000 people infected with HIV/AIDS in Indonesia, with the number rapidly increasing mainly due to injecting drug use.

Piot said that as yet there was no sense of urgency in the country about containing HIV.

A similar criticism was voiced by the United Nations Food and Agricultural Organization (FAO) bird flu team, which expressed concern at a lack of awareness in Indonesia's suburban and rural communities about the threat posed by the avian flu virus.

Indonesia's overall response, FAO said, had been inadequate. However, it noted that the government was "doing the best it can within the structures they have, but those structures need to change."

The various outbreaks of disease reflect the country's dismal healthcare system, where not enough emphasis is placed on prevention.

Health issues also need to be integrated with environmental rehabilitation. As things stand at the moment, diseases related to lack of sanitation and hygiene quickly spread.

Economist Jeffrey Sachs said recently that the health crisis is only part of a much more general poverty crisis -- it all boils down to poverty.

More money and assistance should be allocated to the public healthcare sector so as to improve remuneration for medical staff, improve infrastructure and the condition of healthcare facilities, procure essential drugs, training professionals and rural-based outreach workers, and so forth.

Government investment in the public health sector, Sachs said, would create a platform for subsequent economic development.

Another thing that is essential is good governance, particularly at the local government level following decentralization.

With particular regard to HIV/AIDS, it is time to shed the stigma and discrimination, and for every element of society -- religious leaders, the authorities, the private sector, etc. -- to become involved in improving prevention and treatment as the infection rate has reached alarming proportions.

All these outbreaks of disease reveal just how underdeveloped the healthcare system is in this country and provide valuable lessons on the need to improve things.