Thursday, November 3, 2016

Indonesia - Indonesia’s new campaign to end female genital mutilation

FGM can cause a host of health problems. In some cases girls may bleed to death or die from infections. — File pic

Indonesia is embarking on a renewed campaign to end female genital mutilation (FGM), according to its women’s minister Yohana Yembise, despite opposition from religious leaders who have stymied past efforts to combat a practice that is common.

Home to the world’s largest Muslim population, Indonesia tried to ban FGM a decade ago but opposition from influential Islamic clerics has meant it is still widely practised.

Almost half of Indonesian girls aged 11 and under have undergone some form of FGM, the United Nations’ children agency, UNICEF, said in February, citing government statistics fromIndonesia for the first time in a global study of FGM.

Together, Indonesia, Egypt and Ethiopia account for half of the estimated 200 million women and girls around the world who have been cut, according to UNICEF.

Yembise, Minister for Women's Empowerment and Child Protection, said the government has begun working with women's and religious groups to raise awareness of the dangers of FGM and a survey was underway to provide “scientific evidence” to support the government's goal to halt the practice.

“We try to approach the traditional and religious leaders to understand and to be aware that we have to end this female genital mutilation,” Yembise told foreign journalists.

FGM, which involves the partial or total removal of a girl’s external genitalia, is practised across a swathe of African countries and in pockets of Asia and the Middle East.

FGM can cause a host of health problems. In some cases girls may bleed to death or die from infections.

Others may suffer fatal childbirth complications later in life.

Rights groups in Indonesia have long called for a ban on FGM, while supporters of the practice argue that in Indonesia a less drastic form of cutting is usually carried out.

The UNICEF study showed that three in four Indonesian girls underwent FGM when they were under six months old, and the procedure was usually carried out by midwives.

After the government tried to ban FGM in 2006, the country’s top Muslim clerical body issued an edict arguing that the practice was a required part of religious tradition.

Grata Endah Werdaningtyas, a senior foreign ministry official, said the new campaign would target families.

“We have to target the concerned groups like the parents because they are the one who decide (on children’s circumcision) — not the doctors, not the religious leaders,” she told the Thomson Reuters Foundation.

But widespread superstition remains a hindrance, she said.

“In some parts of Indonesia, they say a girl has to be circumcised or else she can't cook rice properly, or she can't get a husband,” Werdaningtyas said.


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Indonesia - Indonesia takes pains to stop excessive use of antibiotics

In developing countries, it is a problem decades old but the rising antimicrobial resistance in Indonesia has rarely been raised in a public awareness campaign — even though the government has quietly been putting in a great deal of effort to reverse the trend.

Few people may have even heard that the Health Ministry runs a task force called the Antimicrobial Resistance Control Committee, or KPRA. To support the antimicrobial resistance campaign, the task force has been commissioned to draft a national action plan.

The basic concern over antibiotic resistance is that it can reverse decades of advances in medicine, bringing the world back to an age before the discovery of antibiotics, in 1928, when millions of people died from infections that could have been prevented today.

In Indonesia, doctors now already have to prescribe new types of antibiotics or higher dosages of current medicines because the bacteria are getting stronger.

The action plan will dictate a nationwide effort to reduce the abuse of antibiotics in human, animals and plants, as the medicines are also often misused for treatment and prevention of diseases in livestock, aquaculture, as well as crop production.

 “If antibiotics are used on livestock, they will infect people who consume its products, such as meat and milk. This also applies to shrimp and fish. We also have to monitor antibiotics used on them,” KPRA head Harry Parathon said.

According to the Agriculture Ministry, unchecked use of antibiotics is also rampant among farmers without them knowing it. The chemicals are found in the animals’ drinking fluids and feed.

Andi Hendra Purnama, a ministry official in charge of monitoring animal feed, says some antibiotics are disguised as “feed additive” as stated in their labeling.

Harry warns that excessive use of antibiotics on livestock can also adversely affect plants.

“Let’s say I have a chicken farm and give antibiotics to all of my chickens. Their feces on the soil find their way into plants. As a result, the plants will absorb the antibiotics, creating a cycle.”

Hence the government will adopt the “One Health” concept in its action plan. Introduced in the early 2000s, the concept assumes that human and animal health are interdependent and bound to the health of the ecosystems in which they exist.

The KPRA expects it will take a long time to draft the national action plan because it is an interdepartmental undertaking that involves such institutions as the Maritime Affairs and Fisheries Ministry and the Agriculture Ministry.

The committee also aims to tackle other major causes of the increasing antibiotic resistance in Indonesia, like public misperception on antibiotics, unrestrained doctors’ antibiotic prescriptions and easy access to antibiotics in the market.

A recent survey conducted by the Indonesian Caring Parents Foundation (YOP) with 92 doctors in Jakarta and 35 doctors in Papua found that 91 percent of the doctors always prescribe antibiotics to their patients, while 75 percent of them prescribe antibiotics for mild illnesses like the common cough and influenza.

According to the YOP survey, 85 percent of pharmacies in Jakarta sell antibiotics without prescriptions. What’s more, 83 percent of them recommend that customers buy antibiotics, even when people only ask for drugs for mild ailments, like the flu.

Research by the Health Ministry in 2013 showed that only 27 percent of doctors in Indonesia had given the right dose of antibiotics and prescribed them for the right purposes.

It also gave a glimpse of how easy it was to access antibiotics in Indonesia. The survey found that 10 percent of families had antibiotics in their homes and that at least 86 percent of those obtained the drug without a prescription.

It turns out that unnecessary antibiotics are not only prescribed by doctors who open their private services, but also by hospitals, as Harry has noted.

“Patients have already developed antibiotic resistance from home. Then they are given antibiotics again at the hospital. Instead of being killed, these bacteria grow stronger. This is called healthcare associate infection. So the infection happens at hospitals,” Harry said.

In response, Health Minister Nila F. Moeloek has called on doctors to exercise maximum care in prescribing antibiotics.

She specifically asked the Indonesian Doctors Association (IDI) to remind its members to not authorize the use of antibiotics unless it is really necessary.

IDI secretary-general Adib Khumaidi promises the association will take action against any of its members who go against the rule. “Disciplinary actions will be in the form of membership termination or suspension,” he says.

But IDI doctors have an excuse. Very often, doctors prescribe antibiotics on the patient’s demand although they know the medicines are unnecessary.

“Besides, patients sometimes buy antibiotics over the counter because they know the drugs. We have to stop it,” Adib says.

Even worse is the fact that many people also fail to take antibiotics in the right dosage or fail to get through their prescriptions.

“Once patients begin taking antibiotics, they can’t stop midway. They must finish their prescribed duration of taking the drug,” Adib says.

Aside from the national action plan, the ministry actually had issued a regulation in 2011, which serves as a general guideline on antibiotic use. Then last year, it launched a campaign called “GeMa CerMat”, aimed to encourage the public to wisely use antibiotics.

For a better grasp on this critical issue, the government is currently researching the level of antibiotic resistance in 18 hospitals in major cities of the country.

Currently, it is assessing how well hospitals have been implementing the antibiotic-resistant management program.

“If the prevalence of antibiotic resistance is high in a hospital, its use must be unrestrained. And that hospital might fail to get accreditation. So the assessment will become part of hospital accreditation,” Harry says.

Hans Nicholas Jong

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Indonesia - Indonesia rejects U.S. research estimate of 100,000 'haze' deaths

An aerial view of a forest fire burning near the village of Bokor, Meranti Islands regency, Riau province, Sumatra, Indonesia in this March 15, 2016 file photo taken by Antara Foto. REUTERS/ Rony Muharrman/Antara Foto/Files

Harvard and Columbia university research showing smoke from land fires in Southeast Asia led to more than 100,000 premature deaths last year "makes no sense at all," an official at Indonesia's Health Ministry said on Tuesday.

Indonesian government records show only 24 deaths related to forest fires in 2015, but the disaster was estimated to have left more than half a million Indonesians suffering from respiratory ailments.

Indonesia is under global pressure to put an end to slash-and-burn land clearances for palm and pulp plantations which send clouds of toxic smoke over the region each year.

The university research estimates pollution exposure from last year's fires killed 91,600 people in Indonesia, 6,500 in Malaysia and 2,200 in Singapore in 2015 and 2016, significantly higher than government records.

"Given the severe haze in Equatorial Asia in 2015, the 100,000 premature deaths in that region are not so surprising," said Loretta Mickley, a senior researcher at Harvard focusing on atmospheric pollution, who contributed to the research.

Health Ministry director general of disease prevention and control Mohamad Subuh told Reuters the research data was wrong.

"Data on deaths is clear. We have surveillance," Subuh said, adding that the assumptions of mortality based on mathematical calculations were "irresponsible".

Every year, Indonesia faces criticism from its neighbors Singapore and Malaysia over the smog, euphemistically known as "haze", and its failure to stop the fires from being lit.

Last year's fires were among the worst in the region's history, with billions of dollars worth of environmental damage, weeks of flight and school disruptions and thousands suffering from respiratory disease.

(This story corrects dateline and day of attribution in the lede.)

(Editing by Nick Macfie)

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Indonesia - Study Estimates 100,000 Premature Deaths From Indonesia Haze

Indonesian police extinguish a fire in the Kampar District of Riau Province, Indonesia on Aug. 28, 2016. Photographer: Afrianto Silalahi/NurPhoto via Getty Images

Jakarta, Indonesia (AP) -- Indonesian forest fires that choked a swath of Southeast Asia with a smoky haze for weeks last year may have caused more than 100,000 premature deaths, according to new research that will add to pressure on Indonesia's government to tackle the annual crisis.

The study by scientists from Harvard University and Columbia University to be published in the journal Environmental Research Letters is being welcomed by other researchers and Indonesia's medical profession as an advance in quantifying the suspected serious public health effects of the fires, which are mostly set to clear land for farming. The number of deaths is an estimate derived from a complex analysis that has not yet been validated by analysis of official data on mortality.

The research has implications for land-use practices and Indonesia's vast pulp and paper industry. The researchers showed that peatlands within timber concessions, and peatlands overall, were a much bigger proportion of the fires observed by satellite than in 2006, which was another particularly bad year for haze. The researchers surmise that draining of the peatlands to prepare them for pulpwood plantations and other uses made them more vulnerable to fires.

The estimate of premature deaths linked to respiratory illness that covers Indonesia and its neighbors Singapore and Malaysia dwarves Indonesia's official toll of 19 that included deaths from illness and the deaths of firefighters. However, the possible scale of serious heath consequences was indicated by a statement from the country's disaster management agency in October that said more than 43 million Indonesians were exposed to smoke from the fires and half a million suffered acute respiratory infections.

The study considered only the health impact on adults and restricts itself to the effects of health-threatening fine particulate matter, often referred to as PM2.5, rather than all toxins that would be in the smoke from burning peatlands and forests. The bulk of the estimated deaths are in Indonesia, by far the most populous of the three countries and the country with the biggest land area affected by haze.

The fires from July to October last year in southern Sumatra and the Indonesian part of Borneo were the worst since 1997 and exacerbated by El Nino dry conditions. About 261,000 hectares of land burned. Some of the fires started accidently but many were deliberately set by companies and villagers to clear land for plantations and agriculture.

Rajasekhar Bala, an environmental engineering expert at the National University of Singapore, one of five experts who reviewed the paper for The Associated Press and were not involved in the research, said the study is preliminary and involved a "very challenging" task of analyzing the sources and spread of fine particulate matter over several countries and a lengthy time frame.

Even with caveats, it should serve as a "wake-up call" for firm action in Indonesia to curb peatland and forest fires and for regional cooperation to deal with the fallout on public health, he said.

"Air pollution, especially that caused by atmospheric fine particles, has grave implications for human health," he said.

Frank Murray, an associate professor of environment science at Australia's Murdoch University, said the death estimates are not "precise health outcomes" but their overall scale should trigger intensified efforts to deal with the crisis. The study is a major contribution to addressing an international problem, he said.
The study finds there is a high statistical probability that premature deaths ranged between 26,300 and 174,300. Its main estimate of 100,300 deaths is the average of those two figures. It predicts 91,600 deaths in Indonesia, another 6,500 in Malaysia and 2,200 in Singapore.

The researchers involved in the study say the model they developed can be combined with satellite observations to analyze the haze in close to real time. That gives it the potential to be used to direct fire-fighting efforts in a way that reduces the amount of illness caused, they say.

The annual fires have strained relations between Indonesia and its wealthier neighbors Singapore and Malaysia, who are at the mercy of winds that carry the haze into their territory from Sumatra.

But the brunt of the crisis is faced by millions of Indonesians in Sumatra and Kalimantan, many of them poor and with little or no means to protect themselves from the blanket of smoke.

"Particles penetrate indoors, and housing in Indonesia is very well ventilated, so I don't think there is any avertive behavior that people there could have taken that would have been effective," said Joel Schwartz, an air pollution epidemiologist at Harvard who co-authored the study. "In Singapore, if you close all the windows and turn on the air conditioning you get some protection, which may have happened."

The Indonesian Medial Association's West Kalimantan chapter said Indonesia faces an overall decline in the health of future generations with social and economic consequences if the situation is not tackled.

"We are the doctors who care for the vulnerable groups exposed to toxic smoke," said Nursyam Ibrahim, deputy head of the West Kalimantan chapter of the association. "And we know how awful it is to see the disease symptoms experienced by babies and children in our care."

Howard Frumpkin, dean of the School of Public Health at the University of Washington, said it is possible the health consequences are greater than indicated by the study because higher incidence of certain health problems in developing countries could make populations more susceptible to the effects of fine particulate matter.

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Indonesia - Govt woos specialists to work in regions

Bracing for a stream of foreign medical professionals entering the country after the implementation of the ASEAN Economic Community (AEC), the government is devising a set of incentives to encourage local specialists to work in the regions.

The Health Ministry hopes the incentives will lure surgeons, pediatricians, internists, obstetricians and anesthetists to areas in short supply of specialists for at least a year.

The plan also aims to keep local specialists competitive compared to the foreign doctors that will soon be allowed to move freely between countries in Southeast Asia.

The ministry’s Director General of Community Services, Bambang Wibowo, when opening the Indonesian Medical Council (KKI) national coordination meeting in Surabaya, East Java, said foreign doctors would make efforts to take over regions in Indonesia that have a shortage of doctors.

“The number of specialists is very limited in those regions, especially in the eastern part of Indonesia as well as in border regions and on islands. This requires awareness of the doctors that they are needed there,” said Bambang Wibowo in Surabaya on Tuesday.

Indonesia, according to Bambang, has become a lucrative market for players in the health service. Doctors are still in short supply at many of the country’s 9,754 community health centers (Puskesmas) and 2,573 hospitals. Moreover, the population of Indonesia is estimated to reach 270 million people in 2020, which would include a significant number of middle-income earners able to afford private health care.

The policy to assign specialists to areas that lack doctors for at least a year is backed up by an existing program to assign teams of newly-graduated physicians, dentists, midwives and health analysts to remote areas in a bid to cover the shortage of doctors in Indonesia.

Based on KKI data, Indonesia currently has 175,410 registered doctors, 31,414 of whom are specialists.

KKI chairman Bambang Supriyatno said synergy between all stakeholders was needed to address the issue.

“This month, we will discuss domestic regulations in response to the potential and threat of the influx of foreign doctors to Indonesia,” said Bambang.

At the same occasion, University of Defense professor Rear Admiral (ret.) Setyo Harnowo said Indonesia faced no obvious military threats from outside in the next 10 years, but it faced non-military ones instead.

“Indonesia is facing the threat of a proxy war, or a weakening of the nation using non-military means, such as economic and health threats, and the health threats must be faced by those in the health sector,” said Setyo.

Separately, House of Representatives Commission IX chairman Dede Yusuf Macan Effendi, who also spoke at the forum, said he was encouraging the Health Ministry and KKI to maintain an equal distribution of doctors across Indonesia.

The Democratic Party politician related his experience in meeting with the regent of Membramo in Papua, who he said was willing to provide Rp 50 million as “settling-down” cash, aside from regular income and other facilities, to specialists willing to serve in the regency.

“Seeing that the administration is willing to give Rp 50 million, imagine the desire of the regency to have specialists there,” said Dede.

Dede urged KKI to encourage the presence of medical schools in regions with a shortage of doctors, because doctors generally gathered in campuses with medical schools.

Wahyoe Boediwardhana

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Indonesia - Minister Nila to Investigate Fund Flows to Doctors

Health Minister Nila Djuwita F. Moeloek said that she had not received official reports about fund flows from pharmaceutical companies to doctors.

“I just found out about it from a running text,” Nila said at the Research and Technology and Higher Education Ministry’s office in Jakarta on Friday, September 16, 2016.

Nila explained that it would be irregular for doctors to receive money from pharmaceutical companies.

Earlier, Corruption Eradication Commission (KPK) chairman Agus Rahardjo revealed an indication that a pharmaceutical company had sent money amounting up to Rp800 billion (US$61.5 million) to doctors over the last three years. The KPK received the report from the Financial Transaction Reports and Analysis Center (PPATK).

According to Agus, the money was channeled by a pharmaceutical company. In addition, he said that the company was not a major one. He viewed that the report could not be used to describe the actual condition of the pharmaceutical industry.

Agus revealed that the company’s expense reflected the huge amount of money spent for health care services. Based on a research conducted by the KPK, Indonesia’s expenses for health care services accounted for 40 percent of the country’s total expenses, which were higher than those in other countries, such as Japan and Germany.The PPATK’s report was in line with Tempo magazine’s investigation into a graft allegation involving doctors and pharmaceutical companies. The investigation, conducted in 2015, revealed that about 2,000 doctors were involved in the practice.

The article also mentioned that the transaction value for medicines reached Rp69 trillion (US$5.3 billion) as pharmaceutical companies allegedly bribed doctors to put their products in prescriptions for patients.

The KPK and the Health Ministry worked together to make an agreement that strictly governed the practice of providing funds from pharmaceutical companies to doctors. Despite the regulation, Nila said that a doctor would be allowed to receive a gift from a pharmaceutical company if the aim was to improve the doctor’s competency or to conduct a research.

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Indonesia - Get Happy Campaign Fights Stigma on Mental Illness

Mental illness is often considered a silent disease in Indonesia, with many sufferers remaining undiagnosed and not getting the proper treatment, but Get Happy — a new campaign to reshape the way people think about mental health — is now trying to turn things around.

Traditionally in Indonesia, many people with psychosocial disabilities are confined to their homes, some even in shackles. Although shackling was banned in the late 1970s, a recent study from Human Rights Watch (HRW) estimated that around 19,000 people with mental problems are still confined at home or at unofficial institutions where they face very high risk of abuse.

Clinical psychologist Wulan Danoekoesoemo said many Indonesians choose not to seek help from mental health professionals because they do not want to be labeled as "crazy."

The HRW study also cited a 2015 report from the Ministry of Health that described spending on mental health as "negligible" and showed only 10 percent of Indonesians who need mental health services actually have access to them.

The country currently only has 800 psychiatrists and 48 mental hospitals — this in a country of 250 million people. Combine that with a deep-seated stigma against mental illness, it is no wonder that many Indonesian with mental illness are often left alone and untended.

"A lot of people are suffering in silence and unable to ask for the help they need because of the taboo and stigma surrounding mental illness," Caecilia Tedjapawitra, one of Get Happy’s co-founders, told the Jakarta Globe recently. "We believe providing free access to mental health education can help reduce the stigma."

To put their ideas into action, Get Happy runs light-hearted monthly workshops where the public can learn how to take care of their mental health from a variety of resources and take time to focus on their mental well-being.

The group's most recent workshop featured an advertising agency executive talking about creative thinking and finding new ways to express yourself. Other workshops have featured zen doodling, drumming exercises and vocal jamming.

Caecilia said the idea to form Get Happy stemmed from a genuine concern about the widespread misunderstanding of mental illness. She said, "It’s easy for people to understand physical illness; people can see if you have a broken leg or need stitches. But it’s much harder to understand an illness you cannot see."

She said in Indonesia, when people are feeling depressed or overwhelmed, they often refrain from talking about it because they feel doing so would be tantamount to "airing their dirty laundry."

When Caecilia started sharing about her own mental struggles on social media, many people reached out and said they were feeling the same way. What Caecilia found out is that people who experience or are in touch with mental illness on a daily basis feel good knowing they were not the only ones feeling stressed or sad.

This inspired Caecilia and her husband, Andreas Adianto, to start Get Happy to create a space to discuss mental health issues.

"We’d like to provide a safe place for people who have mental health issues to share their stories without being judged," Andreas said. "It is very rare to find a place where people can share their experiences without getting judged by people around them."

In only eight months, the movement has already helped educate and raise awareness about the importance of mental well-being to more than 500 people through their offline events and online platforms.

The group hopes to continue to promote the importance of mental well-being, and educate the public about resources available to cope with mental illness. They hope these small steps can start to change the way people think about mental health and create a "happier Indonesia."

"Too often, the only help people need [to improve mental well-being] are other people who are willing to listen to them, hugs, smiles and happiness," Wulan said.

"I personally think Get Happy has been doing an amazing job providing a safe haven where people can educate themselves about healthy coping mechanisms, self-inserting happiness and providing supportive and positive surroundings."

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Indonesia - Why artists die young: A tale of suicide and mental health

Every year, nearly 800,000 people commit suicide. Suicide was the fifth leading cause of death among those aged 30 to 49 in 2012, globally, and the second in the 15 to 29 age group. The International Association for Suicide Prevention (IASP) and the World Health Organization (WHO) are committed to preventing suicide.

Suicide is complex because it has no single cause. Suicide is most of the times caused by a combination of many different factors, such as psychiatric disorders, social pressure, psychological trauma, biological factors, genetic factors and physical disorders.

Data from psychological autopsies carried out in 1999 showed that mental illness was among the major factors for suicide with more than 90 percent of suicide cases accompanied by mental disorders. Based on data from the Indonesia Health Research (Riskesdas) in 2013, the prevalence of severe mental disorders (psychosis or schizophrenia) in Indonesia's population was 1.7 per 1,000 people. The prevalence of mental emotional disorder in the population aged 15 and above was 6 percent.

Previous research shows that artists were more susceptible to committing suicide than other population groups because of the ostensible prevalence of mental disorder in artistic people. Two contemporary painters, S (1973-2003) and A (1975-2005), both decided to end their lives by hanging themselves in 2003 and 2005, respectively.

This is my story of performing a psychological autopsy of the two deceased painters.

Coming to Yogyakarta

I tried to locate S’s and A’s paintings in Yogyakarta and a curator introduced me to their family members and fellow painters.

I managed to find the locations of the deceased painters’ rented houses. One of the painters committed suicide in a rented house in Yogyakarta while the other did it in his parents’ house in Magelang, Central Java. There was a similarity to both houses: quiet and isolated, providing an opportunity for a painter to seek ideas, think, and reflect.

Both painters hung themselves at the age of 30, still considered within the young adulthood group, according to Erik Erikson’s psychosocial development category. At this stage, people share themselves more intimately by exploring relationship toward long-term commitments with someone other than family. Successful completion of this stage can lead to comfortable relationships and a sense of commitment, safety, and care within a relationship. Avoiding intimacy, fearing commitment and relationships can lead to isolation, loneliness, and sometimes depression.

Back in Jakarta: Psychological autopsy

In my psychological autopsy on photos of the paintings by the deceased painters and the interviews with family members and fellow painters, I found streaks of psychopathology appearing. 

S’s psychopathology began to appear with a change in behavior beginning 2001. He complained of hearing voices that he felt as an attack against himself (auditory hallucinations). He felt that he was being harmed by black magic and persecuted by those devilish people (persecutory delusion). Approaching his death, he felt his hands were rotting and ravaged by maggots (bizarre delusion). Affective components can be seen from the great energy he had in painting various paintings of great size, day and night without stopping, and sadness towards suicide. Meanwhile, A experienced dominant psychotic symptoms, such as auditory hallucinations, delusion of being controlled, and persecutory delusion. There were somatic symptoms and sadness toward the end of his life. Family witnessed him cry and lose interest in painting.

Protective factors did not prevent them from committing suicide. S showed social withdrawal prior to suicide. He also came home and showed worsened psychopathology, but the family did not take him for psychiatric treatment. A turned to religion but was misguided by a spiritual healer. Both had precipitating factors: S got dumped by his girlfriend, while A became increasingly desperate with his illness and showed warning signs by saying he wished to die and bought rope at the nearest warung. He even came back to look for a longer rope.

Family history also plays a major role. S had no family history of suicide or substance abuse. Neither did A, but A’s brother showed signs of psychopathology in auditory hallucination.

An expert, Dr. Eugen Koh, who is a psychiatrist from the art psychiatry unit of St. Vincent's Mental Hospital, director of the Dax Collection and Anthony White Lecturer in art history at the University of Melbourne, has also helped me analyze the paintings.

Koh analyzed the photographs of the paintings I sent through e-mail and came up with possible differential diagnoses. A definite diagnosis was not possible because the deceased painters did not undergo psychiatric interviews. 

Koh’s Differential diagnosis on S:

Possible schizophrenia and schizoaffective with narcissistic personality traits. Narcissistic Personality Disorder tends to use the defense of mania. There seems to be an impression of mania (visible from the habit of painting the whole night while singing) in the early stages of his psychosis.

Koh’s Differential Diagnosis on A:

Possible schizophrenia or anxiety neurosis with episodes of depression with obsessional personality.

Are these differential diagnoses stigmatizing their suicide? No. These diagnoses are evidence that mental illness should have been treated like any other disease before it leads to suicide.

I conducted my research in 2008, until now, no further research has been done on this psychological autopsy level. 

Stigma often inhibits the reporting of suicide cases so that not all cases are reported. In many countries, suicide cases are underreported. The World Health Organization (WHO) and the UN recommend all governments to have a national suicide prevention program linked to related public health policies.

Screening mental illness in vulnerable groups is a form of suicide prevention. Connection is crucial to individuals who may be vulnerable to suicide. World Suicide Prevention Day sponsored by the IASP that fell on Sept. 10, promotes the theme "Connect. Communicate. Care." And the media—according to the 2014 Mental Health Law, has a role to play in socializing the importance of being aware and taking part in suicide prevention in a way that is conducive to the growth and development of mental health.

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Indonesia - Indonesian clerics issue fatwa against forest fires

Indonesia’s top Islamic clerical body said Wednesday it has issued a fatwa against intentionally starting forest fires in a bid to stop the blazes that cloak Southeast Asia in haze every year.

The religious edict by the Indonesian Ulema Council said it was “haram,” or against Islamic law, for Muslims to start fires on purpose in forests or on plantation land.

“The Koran states that we are not allowed to harm the environment, and forest burning causes damage not only to the environment but also to people’s health — even neighboring countries are complaining,” Huzaemah Tahido Yanggo, head of the body’s fatwa council, said.

The fires and subsequent smog occur annually to varying degrees in the archipelago’s Sumatra island and the Indonesian part of Borneo during the dry season, and are started to quickly and cheaply clear land for palm oil and pulpwood plantations.

The blazes last year were among the worst in memory and cloaked large parts of Indonesia, Malaysia and Singapore in choking smog for weeks.

Environment and Forestry Minister Siti Nurbaya Bakar welcomed the fatwa and said she hoped Islamic preachers would spread news of it to local communities: “The most important follow-up is communicating it to the public.”

Fatwas have no legal force and are aimed at encouraging the devout in the world’s most populous Muslim-majority country against taking a certain course of action.

But it remained unclear whether the latest edict, issued Tuesday, would have any practical effect in the sprawling archipelago of more than 17,000 islands and 255 million inhabitants.

The council has previously issued fatwas to protect the environment, including one against the illegal hunting and trade in endangered animals in the biodiverse country, which environmentalists said was the world’s first.

The move by the clerics follows efforts by Jakarta to prevent a repeat of last year’s haze disaster. Authorities plan to stop granting new land concessions for palm oil plantations, and have established a new agency to restore millions of hectares of carbon-rich peatlands susceptible to fires.

The blazes have not been as serious this year with Singapore so far suffering just one day of serious haze, although it is unclear whether that is due to official efforts or a late rainy season.


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Cambodia - Health Ministry insists system ‘ready’ for Zika

An official with the Ministry of Health, responding to a Pasteur Institute analysis that indicated the Kingdom is at high risk of a Zika outbreak in 2017, yesterday said Cambodia’s health service teams were ready to respond.

Ministry spokesman Ly Sovann said Cambodia is employing an existing multi-source surveillance system that includes scanners at airports and key border checkpoints to detect Zika early on. Hospitals across the country have also been ordered to report any suspected cases.

“Our public health measures are in place to respond to an outbreak,” said Sovann, also the director of the ministry’s Department of Communicable Diseases. “We are ready to respond, in collaboration with Pasteur, the World Health Organization, [the US Centers for Disease Control] and other partners.”

The Pasteur Institute’s brief analysis, authored by researchers Dr Didier Fontenille and Dr Philippe Dussart, was posted on its website on October 19.

The Kingdom saw seven Zika cases from 2007 to 2010, but no recent cases have been reported, despite cases cropping up in Vietnam, Thailand and elsewhere in the region.

Multiple attempts to get Fontenille and Dussart to provide the basis for their conclusions over the last two days were unsuccessful.

Sovann, meanwhile, said he couldn’t provide an explanation himself. “We are the public health response officers and we follow advice from our experts to be ready,” he said.

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