Would you like to get a hug from Barack
Obama? Well, here’s one way to do it: contract Ebola, but make sure you recover
from it.
That was how Nina Pham got her much
publicized bear hug in October 2014 from the US president, in no other place
than the Oval Office itself.
So who’s Nina Pham? She’s a Texas nurse, the
first person to contract the disease on US soil after treating a Liberian
patient. The hug she got from Obama was not any ordinary hug — it was a
politically symbolic hug, as Ebola was a metaphor for a threat that comes from
outside of American shores.
The hug was meant to give a message of
protection and security, in addition, in the case of the Obama-Pham hug, a
congratulatory: “Yaaay, we beat this alien threat!” After all, cross-country
infectious diseases are as much a security threat as, say, a missile attack.
I bet Obama wished he could have hugged his
mother, Ann Stanley Dunham, upon recovery from uterine cancer.
Unfortunately, in 1995 she succumbed to the
illness after having first been diagnosed with appendicitis at a hospital in
Jakarta. After her appendectomy, she told me she still was not feeling well and
returned to her native Hawaii to get a second opinion. The second opinion she
got stopped her in her tracks: she never returned to Indonesia and died in
Hawaii about a year after she received her cancer diagnosis.
One of Obama’s personal motivations in
pushing for Obamacare was his mother. In a speech in 2009 to the American
Medical Association, he spoke about how “she fought cancer in her final days,
spending time worrying whether her insurer would claim her illness was a
pre-existing condition”.
What he was also probably thinking but did
not say, was how on earth could she have been diagnosed only with appendicitis
in Indonesia when the reality was that she had fourth stage uterine cancer?
Which brings me to the quality of healthcare
in my country. Giving the right diagnosis is obviously critical to fixing
someone’s health. Unfortunately mistaken diagnosis as well as malpractice in
Indonesia is not uncommon. Another lamentable fact is that doctors often overprescribe
medication because they are bribed by pharmaceutical companies.
In a Democratic Party debate in January,
Hillary Clinton said that the Affordable Care Act “is one of the greatest
accomplishments of President Obama, of the Democratic Party, and of our
country”. So let’s forget Obama’s drone war for now shall we, and focus on the
accomplishment of his presidency, which we can be inspired by.
Indonesia’s record of health care is not
exactly what one could call stellar. It’s been dotted with crises, the most
recent one being the fake vaccine scandal. It is obviously caused much concern
among parents, and even panic to the point that a doctor was attacked in
Jakarta.
What is significant is that it points to
deep-seated problems in the country’s health system. Indonesia may be the
biggest Southeast Asian country, and even dubbed as “the superpower” of ASEAN,
but its health system is one of the worst in the region.
Government expenditure on health is currently
a low five percent. Healthcare infrastructure is sparse: less than 2,500
hospitals with just over 300,000 beds. This means 0.9 beds for every 100,000
people. About 900 of these hospitals are state-owned and over 1,500 private,
however most are in urban areas.
At least there are over 9,700 community
health centers (Puskesmas) that provide comprehensive healthcare, and where
both modern and traditional health practices are used.
According to the Patients per Doctor Map of
the World, the ratio of doctors to patients in Indonesia is 1:7,700 — below Yemen
(1:3,000), Myanmar (1:2,800) and Pakistan (1:1,400). The WHO standard is
1:1000. Then of course there is the distribution whereby more doctors are in
urban areas, and much more sparse in the regions.
Government officials often mention
Indonesia’s demographic bonus, due to the fact that 29 percent of the
population is aged under 15. This means that in 2020 to 2025, the majority of
the population will be of productive working age. But is that enough?
A friend of mine recently commented that he
thought the demographic bonus was public relations’ spin for a nation with an
inadequate health-care system, high levels of pollution, lack of education
regarding proper health and nutrition and workplace and roadway safety,
widespread corruption and an alarming rate of smokers, all of which contribute
to the “drop-off” rate of Indonesia’s aging population.
Exactly. Healthcare does not exist in a
vacuum. There are so many factors that contribute to it: poverty (28 million
below the poverty line), inadequate education and unsafe drinking water, which
is a major cause of diarrhea, contributing to the death of 31 percent of
children between one month to one year old and 25 percent of children between
one and four years. It is also been suggested that one third of children under
five have stunted growth due to malnutrition. So much for demographic bonus,
huh?
Incidences of both degenerative as well as
infectious diseases like HIV/AIDS, dengue fever, dengue haemoragghic fever
(DHF), malaria, avian flu and other animal to human diseases are still high and
continue to pose a significant threat to human health in Indonesia.
Furthermore, government policies are also
inconsistent. Take tobacco for example. The bill on tobacco control is still
seen as being on the side of the tobacco industry and 400,000 die each year
from smoking-related diseases (see “The new Marlboro country and a generation
lost in smoke(s)?” in The Jakarta Post, April 27).
The government says it intends to increase
its health expenditure to 12 percent, reaching US$46 billion per year by 2019.
It is also true that since 2010, about 56 percent of Indonesians have had some
sort of health coverage, and in 2014 the Jaminan Kesehatan Masyarakat (JKN) was
launched to implement universal health care.
But unless it does not improve the overall
conditions that my friend mentioned, it will be money and effort poorly spent.
Now that Obama is nearing the end of his
eight-year presidency, perhaps we could ask him to come to the land where he
spent four years of his childhood, to help with Indonesia’s health system.
In fact, maybe he could be an informal
vice-president to his pal and lookalike (!) Joko “Jokowi” Widodo to help run
the country — minus drones of course! We would welcome him with all the hugs
that he wants and they would not be politically symbolic!
Julia Suryakusuma
No comments:
Post a Comment