How Indonesia’s Health Care System Let Me Down

By Jason Tedjasukmana / Jakarta Wednesday, Feb. 17, 2010

I never thought I would let the grim stories I’d heard about Indonesia’s health care system turn me into one of those expats who left the country at the slightest hint of a sore throat. I may have been skeptical of undergoing any major procedure in the country where I’ve been living since 1994, but I was pretty confident local doctors could handle a run-of-the-mill condition like vernal conjunctivitis. I was wrong.

In April 2009, my right eye started to itch and turned red. My vision turned blurry, and I couldn’t figure out why I was losing sight in that eye, so I went to see a general practitioner, who suggested I see a specialist as it looked as though the problem might be in the cornea. I followed his advice, and after enduring a merry-go-round of eye doctors in Jakarta, my eye continued to get worse. Weeks later, I decided to leave the country to seek treatment, but by then it was too late. The condition had already damaged my cornea. Doctors in Singapore, where many Indonesians go in search of better care, suggested a number of treatments, including a corneal transplant if the others failed to restore my sight. I opted for another opinion back in the U.S. (See the most common hospital mishaps.)

For me to say that Indonesia’s health care system is inadequate is, well, far from adequate, so let me quote a former head of the Indonesian Doctors’ Association. “We have no health system,” Dr. Kartono Mohammad recently told a group of journalists. “There is no quality control.” At a time when Indonesia is striving to reach the ranks of the BRIC countries, strong fundamentals and an economy set to grow around 5% this year have yet to boost the hopes of millions in need of basic, reliable health services. For 2010, the health ministry has been allocated $2.2 billion, which is a slight increase over last year but still half of what is generally spent by the defense department. Overall, spending on health comes in at less than 2% of the year’s total fiscal expenditures estimated around $110 billion. “It’s still not enough,” admits Health Minister Endang Rahayu Sedyaningsih. “Of course it is not right yet, but a national health system is there.”

That might come as a surprise to the hundreds of Indonesians that still die each year of tuberculosis, malaria, dengue fever and other treatable illnesses. As for myself, I wondered how something as treatable as vernal conjunctivitis, which generally afflicts allergy sufferers, could lead to blindness. I had to go back to the U.S. to find out what at least six doctors here couldn’t decipher; a doctor in Michigan diagnosed my problem in five minutes. “You have a case of vernal conjunctivitis,” the cornea specialist told me. “If your doctors over there had looked under your eyelid they would have caught it, or at least they should have.” (See “The Year in Health 2009.”)

In fact, they did look. A fairly senior doctor hastily flipped my eyelid but failed to notice anything, despite the development of bumps similar to cobblestones that were scraping my cornea every time I blinked. A simple steroid would have reduced the swelling (as it did once I was prescribed one in the States) but I was told over and over that steroid drops would make it worse. Instead, in addition to dozens of antibiotic and antiviral drops, the doctors in Jakarta “cleaned” my eye by scraping off a layer, hoping a new layer would grow over the damaged center that was now exposed like a scraped kneecap. The pain that ensued once the anesthetic wore off was like having shards of glass driven into my eye, yet it could have been mitigated with a bandage lens — a protective contact lens with no power, which I also never received.

Naturally, I thought about suing the doctors, an avenue which Kartono and other health care experts have warned me rarely pays off. “It is a very gloomy picture,” says Ajriani Munthe Salak, a researcher from the Legal Aid Foundation for Health. The chances of winning a malpractice suit in Indonesia are slim, she said, and the chances of damages being paid even slimmer.

I had already told myself that I was fortunate to have the means to seek treatment overseas, and that I would not pursue legal action if my vision was restored. After nine months, thousands of dollars and a procedure performed by an American doctor, about 50% of my vision has been restored. The imbalance between the right and left eye, which has normal vision, causes routine dizziness and discomfort, but I remain optimistic that I will get my right eye back.

If I don’t, though, I feel compelled to do something, not so much for myself as for the millions of Indonesians who are much less fortunate and have nowhere else to go. The more I ask about the doctors I saw in Jakarta, the more horror stories emerge. One person I contacted reached a settlement in a similar case, though it cost her an eye. Others feared the prospects of a legal battle similar to one endured by Prita Mulyasari, a working class Jakarta woman who dared to criticize a local hospital and spent months facing down its lawyers. She has become something of an icon for all that is wrong with Indonesia’s health care system. I don’t know what I’ll do yet, but I commend Mulyasari for having the courage to challenge a system that has let so many people down.

See TIME’s health and medicine covers.


About yuan ade sukma, MD

I'm an Indonesian doctor. I Believe that science and knowledge do not belong to anyone in the world. Science and knowledge is meant to be shared to make the world a better place to live. But if you find any material posted here is violating any copyrights, feel free to contact me and I will delete that. I believe that someday my blog can change the world. I BELIEVE in the POWER of WORDS! Do you..?
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3 Responses to How Indonesia’s Health Care System Let Me Down

  1. yuanadesukma says:

    it’s not just about who’s wrong or who’s right…we hope we can do something to fix this…

  2. Dian Kesumapramudya says:

    yes. you’re right. its not about right or wrong, its about how you treat your patient based on your experience. It is very simple for American doctors to diagnose vernal conjunctivitis and treat that simple case because its incidence is high in American. Try to diagnose malarial corneal invasion and conjunctivitis. you will find it a lot in papua and its a lot like vernal conjunctivitis and if you treat it by steroid alone, it is getting worse. Because Jason most likely came from abroad which has lots of
    The same for Indonesian doctors. Their brain is also too preoccupied for infectious disease, because its high incidence in Indonesia, so occasionaly they forgot about the other forms of disease such as allergy.
    So the question will be : How can a good examination system to minimize and to cover all kinds of disease by performing a thourough examination. However, it will take time, effort, energy and emotion. Do our doctors and especially OUR patients willing to do so. You know that Indonesian patient always wants everything must be done faster,cheaper. There is no disease which can cure fastly like magic. They need effort and creativity to be healed.
    So..which one are you?

    • Thank you for the thoughtful comment Andi :), Jason is actually one of the best Indonesian reporter or news reader in RCTI, trans TV and Metro TV, and I am quite a fan of him. and also I am sorry for the problem he had.

      Well, you’re right, due to very vast region in Indonesia, the incidence and prevalence of diseases also vary greatly. Infectious disease in Indonesia is very common, but that should not be our only focus. Especially when we’re dealing with “special” patient such as abroad patient, or at least spent most of the time not in this country, which the incidence and prevalence of the disease is very different. When laboratory test is not possible at first, at least we should reconsider our treatment when the treatment is not improving the condition of the patient. The preliminary test is a very crucial test which differentiates whether this is an allergic or an infectious disease. Did Jason already suggested to do that test or not. And that test is easily can be done in Jakarta.

      We’re not only talking about the doctors, but also the entire health system, including the educational process that made us doctors.
      But if we rely too much on the government maybe it will take more than 10 years to do so. The best thing to do now is to improve our quality as doctors to the best possible extent.

      Dont forget to back in Indonesia as we all need your excellent capabilities and quality as a doctor, Andi. 🙂

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