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We offer more than a good health Insurance policy; our philosophy has been to develop a practical and effective system that ensures you are receiving the most appropriate medical treatment in the quickest possible time. Whilst not part of the benefits of any health Insurance policy, this is the most crucial element of care for those residents in Bali, Indonesia & Asia where standards of medical care vary significantly!

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- Indonesian Health Doctor Tommy Dharmawan provides insurance rational
- Decisions were made by the big man
- Surviving an earthquake
- Role of Nutrition in Dengue Risk

Indonesian Health Doctor Tommy Dharmawan provides insurance rational

This article was published in the Jakarta Post Opinion section on Tuesday, August 3, 2010 on page 7
Doctor Dharmawan writing the article makes reference to a number of issues that highlight the need for holding health insurance in Indonesia.

The health system in Indonesia varies to that of the West and Doctor Dharmawan provides an insightful summation of what he believes are the problems and how they should be fixed:

"Healthcare condition in Indonesian remote places"

I never imagined before that I would work in a remote island called Saketa in south Halmahera, North Maluku province. I worked as a medical doctor there upon graduation from medical school three years ago. I was on the island as part of the government’s program for young doctor in the province.

Saketa was totally different from big cities such as Jakarta, where I used to live. Cell phone reception, electricity, fresh water and petroleum were precious things on the island. The South Halmahera district covers 17 islands with a population of around 9,000.

I was the only doctor for the district at the time.  In the health center I worked at, I could check up to 46 patients with various illnesses in one day. The health center was very crowded with patient and their families, not only in the clinic, but also in the ward.

As a doctor, I met many patients and also many problems. For instance, there were no simple health facilities such as blood-test and radiology equipment, at the health center. Most times, people did not have a health insurance system fully covered by the local government.

There was one incident that I am still not happy with. One night I was called to a house of a 30-year-old man, located 100-meter away from the health center. He complained of pain with distended abdomen. When I arrived, I saw him almost in a delirious state.  His Abdomen was swollen his respiratory rate was abnormal at 30 times a minute, his body temperature was high and his radial pulse was weak. He surely needed an operation.
But  to take patient to the district hospital  was not easy  as normally it takes two hours by boat from Saketa. I then took him to the health center where I inserted an infuse set and a modified nasogastric tube from his nose through his stomach to decompensate his distended belly as emergency treatment before I decided to take him to the district hospital.

With 5-meter wave and rain that night, I managed to get the patient to the district hospital one hour longer than the normal journey. But, the long and risky journey was useless as the hospital surgeon was having time off to visit his children in java. The man died in hospital without further medical care. I was in a complete shock and could not believe what had happened.
Yet, the problem is not only in the health facility, but also the health system. The health system in Indonesia is not built to handle new emerging degenerative diseases such as cardiovascular disease, cancer and diabetes. It only works for infectious diseases.

Furthermore, the Indonesia health budget only constitutes 4 percent of the total national budget, which is too small to cover expenditures for all infectious diseases, let alone degenerative diseases. Moreover, life expectancy of Indonesians is more than 65 years nowadays. As a consequence, the number of patient with degenerative diseases is staggering.

Another problem is in the quantity of health workers. In the district hospital that I mentioned above, there is no permanent surgeon, pediatrician and internist, while the entire wards and emergency rooms are only covered by one general physician and two nurses.

The problem is apparently not specific to Saketa, but nationwide, as the overall number of doctors in Indonesia is not compatible with the population.

There is no formal data from the government or other source of the number of doctor in Indonesia, but former chairman of the Indonesian Doctor Association (IDI) Fahmi Idris once said there were 70,000 doctor -50,000 are general physicians and the remaining 20,000 are specialist. That number is definitely not enough to cover a healthcare program in Indonesia.

According to Fahmi, the right ratio should have more than 90,000 doctors.
These are two solutions to increase the quantity of doctors. First, the government can enhance private universities to open medical school, without neglecting the quality of their graduates. Second, the government can invite foreign doctor to work in Indonesia.

Besides quantity, the government, however, should also care for fair distributions of doctor in all regions in Indonesia. According to former director for medical care at the Health Ministry, Farid Husain, beside low quantity of doctors, their distributions is also unequal, with 64 percent of Indonesian doctor still concentrated in Java.
Another solution to the poor health program implementation is by establishing good health regulation and policies for regional government to cater to the need for health service in the regions.

In the autonomy era, local authorities sometimes are blamed by the central government for poor healthcare, while citing the minimum accessible healthcare data available in some provinces.

In addition, lots of report of health cases from the regions had failed to be treated properly as they were late reaching the Health Ministry that the illnesses had become severe and difficult to handle – thus taking a lot of victim.

In summary, there are still lots of healthcare problems, particularly in remote places across the country. It is the government’s responsibility to increase the accessibility of healthcare service for them.

The writer worked as a doctor in south Halmahera in 2008, and currently lives in Jakarta.


“Decisions were made by the big man”

A host of recent comments have been sent to the Jakarta Post in response to a bizarre case in the Indonesian medical system. A women who did not hold any health insurance needed a back operation. She walked into the operating theatre by her own power within few hours later she left paralysed. The response “As a doctor I have done my best, but the decision totally depends on Almighty God”.

This is a bizarre case that we felt we needed to highlight as a few comments that are made by the commentary apply to many facets of the Indonesian medical system. In particular there is no consumer protection in Indonesia, should malpractice be a factor in medical events there is a very acute chance of claiming of receiving compensation. This allows doctors to work without accountability of there actions. Remember to consult a second opinion when surgeries are prescribed. Medical practices rely on invasive surgeries to pay doctors wages, so in many cases the first prescription will involve the operating theatre.

Here are a few comments from the Jakarta Post March 22, 2010 ‘Indonesian and Malaysian doctors’ page 8:

Nine years ago, acting like a holy priest, the doctor tenderly told my wife who was immediately paralyzed after he had operated on her spine, “As a doctor I have done my best, but the decision totally depends on Almighty God.” We were shocked to realize that she could no longer move her body after the surgery. She walked into the operating theater confidently and left totally powerless.
Until now I still cannot find the right way to confirm the doctor’s claim that it was God’s decision that my wife be paralyzed at the doctor’s hands. As a devout Christian, the doctor did not forget to cite Jesus to support his claims. To Indonesian doctors, please do not take me to court for sharing my experience with Sunday Post readers. I just want to share the pain. And to this newspaper’s readers, I shared my experience with you in the hope that perhaps you can learn something from it (hopefully such an experience will never happen to any of you).
(By Kornelius Purba)

I was moved by your story and I personally empathize with you and your suffering wife.

Personally, when consulting a doctor I usually trust a practitioner not on his religious belief, but on
his medical expertise.

Spine surgery is one of the most delicate and fragile surgical procedures, it needs a very knowledgeable, experienced, skilled and qualified surgeon — a mistake, blunder or slipup by the surgeon can be critical to the patient involved,  just what happened to your wife.
The doctor or surgeon has to explicitly and openly discuss the matter with the patients about their chances and his qualifications and expertise as a medical practitioner. Patients should also do some research on the doctor. They may
also consult other doctors for a second opinion.
This way, the patient will have peace of mind before undergoing such a delicate medical procedure. By the way, do you have appropriate laws on medical malpractice in Indonesia? You can sue him for what he has done. I fervently hope your wife will be able to recover from her present condition and will be able to walk again someday. Meanwhile, I will be praying for her earliest
Rudy B.

I know exactly how you feel and share your desperate feeling as well, Pak Purba. My mom was diagnosed with terrible fourth stage spinal cancer by doctors in Jakarta. They said my mom should undergo surgery followed by chemotherapy.
Fortunately, my family is among those who have lost faith in Indonesian doctors and hospitals, and soon resorted to a second opinion from Singapore. Based on their examination, they said my mom didn’t have cancer, but acute spinal tuberculosis.
After five hours of surgery and three months of intense treatment there, she can now walk again and
is currently planning to go to Helsinki to see her newly born grandchildren.
I couldn’t agree more when you said that Indonesian doctors were never wrong and quickly pointed their fingers at God for all their patients’ misery. It’s about a bad mentality and lack of professionalism as well as irresponsibility. My little brother is a doctor too. And I cross my fingers that he won’t become such a lame doctor.
A. Aron

Unfortunately, Indonesia is one the most dangerous places in the world to have to go into a hospital. Many never come out, and I have several friends who have been needlessly operated on twice, because it was the easiest way out, treatment-wise, for the doctor.
I have a list of horror stories regarding treatment and deaths pointing directly to incompetent doctors and related graft concerning money and care. But what’s the use of documenting them? Just have your plane ticket ready.
Jor Hyam

Some of the Indonesian doctors are too arrogant. They patronize their patients. After graduating from university, they think they are the best in the “world”. Sure, it’s a great achievement to be able to graduate as a medical doctor and became a specialist.
You have to sue them. Malpractice in Indonesia is rampant. People seek medical care in Singapore, but the Singaporean doctors also love money above anything else. But at least they offer a better service.
It’s sad when, after their graduation, they totally renege on their Hippocratic Oath! They act like the greedy fat cats from Wall Street. Hopefully, a new breed of Indonesian doctors will emerge who has a conscience.
Hadi Gunadi
Depok, West Java

I am truly on your side and really sorry for the pain your wife has undergone. But what you have written is true and it implicates Indonesia doctors.
There is no consumer protection in Indonesia whether it be a medical case, about education or even, say, parking a car. Every business unit turns out to be a law unto itself and puts its own terms and conditions. The most surprising thing is that the government is not concerned; they simply pass the laws, but do not implement them.

Health insurance products will give you options when it comes to medical decisions. If you are used to high levels of medical care ready free yourself from these financial restrictions. Medical costs have risen dramatically due to a number of factors here in Indonesia, but in many cases the level of care has not changed enough to justify these price increases. Misdiagnosis is rife in Indonesia.

Contact API Pacific for health insurance products in Bali, Indonesia and Asia. Health insurance policies are area specific as well as providing coverage worldwide. Expatriates expect a level of care similar to what they receive in their home countries so give yourself medical options. API Pacific will consult you on options that are available to you in your individual case; we have been active in Asia for 20 years.



Surviving an earthquake

If you do become trapped in a collapsed building, it will be important to immediately protect your airway against dust and debris by breathing through clothing or material (preferably a dust mask if one has been stored near the desk, bed, or other accessible location); check yourself for injuries and control any bleeding; find a source of light if possible; and make your location known to rescuers by tapping on a solid object with a rock or other instrument. Save your breath and energy. Delay yelling for help until you hear rescuers very nearby.

How rescuers operate

If a building does collapse, rescue teams will methodically search through the rubble for victims, using tools, search dogs, and electronic instruments that can detect the presence of live people. Survivors are usually found in spaces large enough for a human within the collapse debris, called “Survivable Void Space.” or ” triangle of life “It can be as large as an adult, or in the case of small children or infants, a very small space. The main goal of “Drop, Cover, and Hold On” is to protect you from falling and flying debris and other nonstructural hazards, and to increase the chance of your ending up in a Survivable Void Space if the building actually collapses.

Falling objects
Studies of injuries and deaths caused by earthquakes over the last several decades indicate that you are much more likely to be injured by falling or flying objects (TVs, lamps, glass, bookcases, etc.) than to die in a collapsed building. The “Drop, Cover, and Hold On” position will protect you from most of these injuries. If there is no nearby space beneath a table or other furniture that can provide protection from these objects, then you should get next to a large piece of furniture such as a sofa, cover your head, and hold on to the furniture when it moves. If there is no furniture, get next to an interior wall if possible. If you are in bed, the best thing to do is to stay where you are and cover your head with a pillow.

Several Options
There are several opinions on what to do when caught in a building during an earthquake. The best choice options differ depending on the materials and construction of the building.

1. If you are in a building made of wood or low tech materials the potential for personal damage is different than if you are in a concrete building or a multi storey building. The most favoured course of primary action in all cases is drop, cover and hold on, however if you are in a concrete building or one with significant weight above you there is a school of thought which suggests it is better to lie beside a big object rather than under it if the weight of the ceiling above is substantial and solid it will potentially crush the table or bed, which will then crush you, These objects will not crush flat and in most cases a triangle of life is created beside the object for you to survive in. this does make sense in this situation.

2. If you are in a lower tech building of bricks or wood then the potential for injury from falling masonry and objects being flung around is significant. In that situation being under a solid table or bed is a better option, as its not likely to collapse on top of you from the weight of objects that are falling but things that are knocked loose can easily cause you significant injuries . Big loose pieces of furniture are dangerous you need to be away from them and other objects that are solid. Wooden buildings tend to move and bend more so they can maintain their structural integrity, while brick buildings will have the potential for “broadcasting ” or spreading bricks and masonry with significant energy.As with everything else in survival its up to you to think clearly and make swift relevant decisions. The conventional wisdom is stay away from Lifts and Stair cases, both of these have significant risk factors attached to using them.Its also a good idea to put a little time into developing exit strategy’s, if you are in a place frequently. if you have decided what to do in advance IF there is an earthquake this will drive your actions. Its all about seconds here, being on automatic in terms of response is what its all about …I may continue this process , if you do not wish to receive any more of this just let me know

Role of Nutrition in Dengue Risk
Dengue is a major medical threat to people living in Bali and Indonesia. Recent studies show that malnourished children are just as likely as their well-fed counterparts to develop life-threatening complications following repeated infections with the dengue virus, according to work from researchers at St. Jude and Hospital Nacional de Niños Benjamin Bloom in El Salvador.

Although infectious diseases often pose the greatest threat to children with an inadequate diet, study lead author Gabriela Maron, M.D., a St. Jude Infectious Diseases clinical fellow, said earlier reports from health providers in regions of the world where dengue is common suggested that the infection hit well-nourished children the hardest. Researchers have noted that one possible explanation is that even mild malnutrition blocks the immune system from launching the strong inflammatory response linked to severe dengue infection.

“There must be subtle differences between patients, possibly related to their immune response,” Maron said. St. Jude investigators are now collaborating with colleagues in El Salvador to see if differences in gene expression might identify those at high risk for severe infection.

The study was published in a recent issue of the American Journal of Tropical Medicine and Hygiene.

Health officials estimate about one-third of the world’s population is at risk for infection with one of the four dengue viruses, including a high percentage of children living in the Central and South America, Bali, Indoenesia and parts of Asia. “Without a vaccine to prevent infection, international flights and the overall shrinking of the planet mean it could become an even more important problem for health officials.”

An individual’s first dengue infection typically produces mild symptoms. But later infections can lead to life-threatening dengue hemorrhagic fever and dengue shock syndrome, which are associated with internal bleeding and a dangerous reduction in the platelets that help blood clot. The challenge for health providers, especially those in countries where resources are scarce, is to rapidly identify patients at higher risk for complications.

In this study, researchers compared the height, weight and body-mass index (BMI) of three groups of children, ages 5 through 12. The groups were youngsters hospitalized for dengue fever and dengue hemorrhagic fever who were compared with healthy classmates living in the same neighborhoods. BMI is a measurement of body mass based on a person’s weight and height.

Those results were compared with an international sample of children of the same age compiled in the World Health Organization’s standardized database. Roughly the same proportion of children in each of the study’s groups qualified as either underweight, overweight or stunted, a possible sign of chronic malnutrition. There was also no difference in the average BMI of study participants, whether healthy or ill.

Remember the best way to insure against dengue is to prevent being bitten in the first place, keep your living space clean and uncluttered. Remove stagnant water build-ups. Dengue mosquito’s bite after sunrise and before sunset, so keep yourself covered during these times. Contact us as insurance when dengue symptoms occur. | Contact | © 2007. All right reserved Api Pacific |
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