Sunday, July 10, 2016

Indonesia - A hope for the voiceless and defenseless

“At my age it is thoroughly understandable that all these complications arise; I am totally aware of that […]”. Elderly patients often say this when seeking my health advice. This expression acts as a psychological “remedy” for different conditions such as visual impairment, neurodegenerative disease and other chronic diseases such as arthritis, hypertension and heart problems. But embracing their condition often means rejecting curative options.

The curse of old age does not stop there, as this portion of the community, who have partially or completely retired and depend on pension benefits, are often considered a burden on their families and society. They are often marked as “highly vulnerable” to mental health problems, mainly as a result of loneliness, low social interaction and untreated depression.

This is truly alarming given an estimated 36 million older people in Indonesia by the end of 2025. Such a huge demographic expansion as a result of increased life expectancy in developing countries such as Indonesia will be a true challenge for authorities.

The absence of appropriate geriatric management will amplify healthcare costs, though Indonesia has gradually laid the stepping stones for securing better health care for the elderly. A focus on health care for the elderly has been gaining increased governmental attention since 1998 after the inauguration of Posyandu Lansia (integrated health service posts for the elderly). In 2004, the government institutionalized the National Commission on the Elderly (KNLU). This state institution is responsible for managing cross-sectoral programs related to the elderly.

These initiatives aim to provide special healthcare for the elderly at the rural level. However, several bottlenecks now impede these programs.

Firstly, inefficient bureaucracy and absence of comprehensive guidelines result in a disproportionate distribution of patients among local health service centers, i.e. community health center (puskesmas), posyandu and public hospitals.

Instead of being properly ministered at smaller level healthcare providers, untreated patients end up queuing endlessly at hospital receptions.

Unbalanced allocation of government funds often causes inadequate numbers of paramedics and medication at community level health providers. Typically, patients face delayed services, increased waiting times and inadequate treatment quality.

Secondly, several factors related to the elderly are thought to exacerbate the problems. Lack of awareness, partly because of ineffective health promotion, insufficient funds and external factors, i.e. cultural perceptions and stigma, contribute to restrictions among the elderly on maintaining their health. This contributes to inefficient early monitoring of health and assessment of preventive and curative treatments.

Therefore it is urgent to reform health care for the elderly in Indonesia. Ineffective bureaucracy is the central problem. This can be remedied by revitalizing community health centers’ role through healthcare training and education, and improving remuneration for health professionals.

Reforming health care for the elderly should also include a comprehensive yet concise set of guidelines on how health professionals work, interact and address step-by-step care procedures. This would include early screening and post-screening treatments by relevant care givers.

Again, the solution needs to be holistically designed for better geriatric management in Indonesia,negating pessimistic stereotypes about aging. Older people are an integral part of the community.

As such, powerful support from the whole community, as well as the government, for better participation and post-retirement transition for the elderly is needed.

The wise say, “Treat others as you want to be treated.”

This counsel needs to be repeatedly echoed as a moral underpinning to properly manage health care for the elderly. I hope our good deeds will be paid back when we our self retire.

Ika Sudiayem (Medical Doctor)

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