About Me

"I am a family physician and public health specialist, and have lived and worked in Africa, Asia and North America. I am passionate about health-care development and am a co-founder and director of Healtheon Asia.

This is a collection of my thoughts, travels and things I can't otherwise classify."
- Dr Armid Azadeh

Tuesday, 7 April 2009

Living in Indonesia

As with all manner of animals, one of the primary survival instincts or needs for humans is to find shelter. The ability to feel comfortable and secure in Indonesia, being the shelter you have “chosen”, may be regarded as vitally important, as this safety and security may be the foundation upon which you justify your choices.

In the Universal Declaration of Human Rights, there may not be a specific reference to medical care being a basic human right, but in Articles 3 and 25(1), where “Everyone has the right to life, liberty and security of person…” and “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services…”, respectively, reference is made to security and medical care. These aspects are vital to your sheltering in Indonesia.

As with most things in life, the quality of security and medical care available in Indonesia may not be easily described as a matter of black and white, but should rather be looked at as a spectrum or range of quality in services. There are numerous historical reasons why security and medical care in Indonesia may be generally considered further along the spectrum, being further to the right or down, depending on your scale of reference, which in itself are beyond the scope of this article’s endeavours. Suffice it to say, that health statistics for life-expectancy, infant mortality rate, ratio of hospital beds per population and numbers of health care personnel per population, reflect the disproportionate gap between the various Indonesian regions itself, and between Indonesia and its immediate neighbours.

Case Study 1:
In exploring “Indonesian Medical Care”, being the title for this section, it may be useful to present a small case study or example to demonstrate what is meant. We are living in the information technology age, with widespread access to all sources of up-to-date knowledge. The internet has opened up a wealth of information, good and bad, to anyone with the ability to click a button. Thus, what typically occurs when a person becomes ill is that they tend to self-diagnose. This of course varies from place to place around the world, with some nationalities more adept to self-diagnosis and treatment, through using the internet or books for example, or by merely following age-old traditional remedies etc.

The old adage that “a little knowledge is dangerous” comes to mind, which was experienced during my medical education. The initial 2 years of my medical education generally covered the basic sciences of physics and chemistry, human biology, physiology and cell histology. The 3rd year however was when things really became interesting, to me at least, when the various pathologies were studied. This was when chemical pathology, anatomical pathology and microbiology were covered.

This is the year all medical students periodically freak out as they firmly believe that they have some terrible disease, merely because they happen to share an overlapping symptom with the particular disease that they are studying on the day. The fact that the student is a 20 year old male student who stayed up late the night before drinking with his friends, and thus has a hangover, red eyes and body aches from being dehydrated, is self-misdiagnosed as having Reiter’s syndrome. This is a reactive arthritis that typically occurs in “reaction” to a previous urinary tract infection that typically presents with a conjunctivitis (red inflamed eyes), and an arthritis (painful knees, ankles and feet often), in addition to several other signs and symptoms such as painful urination, sores and rashes. Then there is another 20 year old female who becomes near panic-stricken as she believes she has Kuru disease. She has been stressing over exams, has not been sleeping well, and has been taking energy drinks to “boost” her productivity during the evenings. Little does she know that the headaches, body aches and shaky arms are as a result of sleep deprivation, stress, and energy drinks, and not as a result of Kuru disease. This was a fatal disease that was endemic in Papua New Guinea, and was transmitted by cannibalistic practices of eating the brains of diseased relatives.

In much the same way, contemporary patients often misdiagnose themselves, and cause undue stress on themselves and their families. A well informed patient is far more desirable than one that does not take interest in their health however, so the point of this anecdotal tangent is not to advise against the use of the internet and other information resources, but merely to recommend that when something is bothering you, and you are worried about your health, there is really no substitute for a medical consultation with a doctor, who will be able to hopefully put things into perspective and develop a rational diagnosis.

Thus when one becomes ill, a consultation with a doctor would be ideal. One would be faced with 2 options really, either find a clinic or find advice. For those that usually go directly to a clinic, the determining factor usually is that they have found something that closely resembles the level of care they would expect in their home country, or one that they would have confidence in. There are various clinics along the spectrum described earlier, and if you are not sure which one to go to, then finding one which has standardized treatment protocols and standards would be ideal. Alternatively, finding an information source for medical advice would be the ideal vehicle for the 2nd option above, finding advice, as there are several websites that can successfully be used to guide patients with regards to a variety of health issues, particularly on a primary care level. Care needs to be taken with regards to which sources are used for advice since merely searching on Google will result in so much information which is almost impossible to sift through reliably to avoid potentially harmful or biased advice.  

This brings me to the point of language. What we have observed as the most common reasons for breakdowns in medical service have been predominantly as a result of miscommunication. At a time when you are not feeling well, are worried because you’ve read up about some terrible disease, and generally are not in your comfort zone, as you are away from your familiar surroundings of your home country for instance, language barriers may become huge obstacles to your health outcome. In the vast majority of general practice consultations, the manner in which the doctor communicates with you plays an immense role in the confidence you have in them to “heal” you, and your general perception. If for example, you are not able to understand them as you only speak English, then a positive outcome is less likely.

In general, for routine medical care, local healthcare facilities offer good services. However, particularly for more serious medical conditions, when there is a discrepancy with regards to the standard of medical care available compared with the quality of healthcare you are accustomed to, it would be recommended that you consult the closest centre of medical excellence. This would ordinarily be in a larger urban area and may not be limited by geographical borders.

Case Study 2:
To expand on this case study further, were one to require emergency medical services as a result of an accident for example, the lack of established medical emergency services in Indonesia would be a major determining factor for one’s wellbeing. There generally is no organised pre-hospital training available in Indonesia, and as such there are no paramedics, at least none like those we visualise when we hear about paramedics in North America, Australia or South Africa. The ambulances witnessed on the roads in Indonesia are often transport vehicles and may not be able to deliver any adequate degree of pre-hospital care. Traffic congestion in the larger cities furthermore limits the responsiveness of these vehicles.

Having 1st aid training, for family members, baby-sitters, drivers and employees etc. would be ideal in addressing the lack of emergency response services. Readily available Automated External Defibrillators (AEDs) are also useful equipment to have access to, as they may provide the life-saving shock within the golden 3-minute period from when a person goes into cardiac arrest. Having evacuation coverage is furthermore extremely important for the purposes of medical and security evacuations. Adequate medical insurance will be useful for general medical ailments, but may have limited abilities when it comes to emergency evacuations.

Life in Indonesia may have its medical challenges, with its pollution, tropical diseases such as malaria and dengue, widespread hygiene concerns, disproportionate medical services, and pharmaceutical limitations, but the solutions do exist. Preparing your shelter for your stay is doubly important thus as the safety and security aspects need to be planned for and mitigated.


  1. I know that this is no-where near as medical as some people will be able to get in their comments but nonetheless: I had a chuckle when reading your description of Kuru as I recently re-watched an episode of Scrubs in which having not been able to successfully diagnose a patient 'JD' decides that he must be suffering from Kuru.

  2. Scrubs is a hilarious show, and it may be surprising to you to know that sometimes its not too far from the reality of what actually happens in hospitals... scary huh?

  3. I actually remember speaking to some of the doctors here, including Gareth Mannheimer, and them saying how close to real life the show actually is. Kind of makes you worried about having to go to hospital, especially when they start telling you their horror stories - granted though the majority of those stories come from their community service sints at Katatura State, where Medical Aid members hope to not have to go.

  4. It can be a bit of a horror show in the state system, although sometimes these things do happen in private hospitals too... they're just forced to hide things better!

  5. Doc,

    Maybe you can tell me what is with that Indian Pediatrician that SOS has down there. Does he answer any questions of parents or does the parent have to book another appointment to get questions answered. Such arrogance by him leads me to beleive he could care less about the patients, he only cares about the money.

    Late last week I asked him about a possible condition he brguth up that might affect my child, I asked him about it and he glossed over it. I asked him another question about it and ignored the question. It is like we are all medical specilists and we should understand his medical terms and go with it. I asked him again as I spoke to him and he said come back next week and we can discuss it at length. So what was I paying the fee last week for? Is it a 1 question limit with per vist with this arrogant money grubber.


  6. Hi Gavin,

    Sorry its taken so long to reply to your comment... the ex-swine flu has kept me really busy!

    In brief, I hear your frustration and can't even try to attempt to defend the doctor. I'm not in a position to comment on that specific case as I was not privy to the consultation.

    That being said however, it is a frustration I share often when I interact with our doctors, who may have all the theoretical background at times, but often lack the knack of being able to really communicate with patients. I think perhaps they are either intimidated by language issues, don't welcome questions as per old-school-type doctors, or actually don't know the answer and thus avoid the question.

    I would strongly recommend you try to speak to the expatriate doctor on duty at the clinic when things have so obviously gone wrong as you describe.

    Hope this helps? :)