Home > South-East Asia >> Indonesia

Woman's plight highlights gaps in health system

Jakarta Globe - March 8, 2011

Arientha Primanita – Sitting on the wooden plank next to the railroad tracks that has become her home, 55-year-old Kariyah offers an apology.

For years she has suffered from a large, foul-smelling tumor on her bottom. After her husband died and the medical bills began piling up, she was forced to move out of her low-cost apartment in Bendungan Hilir, Central Jakarta. With nowhere else to go, she cleared a spot for herself next to the tracks that run behind her old building.

Doctors at Cipto Mangunkusumo General Hospital (RSCM) have diagnosed her with anal cancer. Kariyah said she had expected the hospital to operate on her, but that she was still waiting for surgery.

"It hurts me to sit. The tumor has become so big in the past few months," she said. "I go to RSCM for temporary treatments, but I really need to be operated on. "I have to use tampons to stop the continuous bleeding, which is mixed with pus," she said. "I have to work, but I can't. I have to scavenge for a living."

Like thousands of poor patients across the country, Kariyah was referred to RSCM by a local clinic.

Her case is alarmingly common. Many poor patients do not receive emergency treatment because of the large backlog of cases at the state-run hospital.

The media has recently been critical of regional administrations and hospitals for failing to care for the poor – particularly those covered by government health schemes. Many clinics refer non-emergency cases to RSCM, which ends up overwhelmed and unable to treat all the patients.

A recent editorial in Kompas daily said that 75 percent of the 2,000 patients who arrive each day at RSCM seeking care are from low-income families. The editorial also noted that regional administrations had yet to pay bills totalling Rp 24 billion ($2.7 million) at RSCM.

Savitri Handayana, head of the Bendungan Hilir Public Health Clinic, said Kariyah was eligible for government health insurance, but that she was unable to get the care she needed because of the severe backlog of cases at RSCM.

According to Savitri, Tarakan Hospital in Central Jakarta had referred Kariyah to RSCM last October. Doctors at Tarakan had determined that she was suffering from two-sided glandular enlargement as a result of anal cancer and required immediate surgery.

"But it requires further diagnosis to determine if the tumor is malignant or not," she said.

Savitri said the clinic did not know at what point Kariyah left RSCM. "We know that RSCM, as a national hospital, is overburdened because of it receives patients from all over the country," she said. "Maybe Kariyah did not want to wait so long at RSCM."

On Monday afternoon, following media coverage of Kariyah's plight, an ambulance arrived from the Bendungan Hilir urban ward and transferred her to Dharmais Cancer Hospital.

"She was taken to Dharmais for better treatment," Savitri said. "It will be entirely free under the SKTM health scheme because she is poor and she has no one to take care of her," she added, referring to a public health scheme for low-income residents.

Suharni, a former neighbor who helped Karsiyah organize the documents for her treatment, said that she had checked with the imaging department at RSCM, which was supposed to arrange a CT scan.

"Kasriyah did not stay at RSCM, she went back and forth, but she said she was tired of waiting," Suharni said. She added that she and another friend, Tuti, had accompanied Kariyah to the hospital and asked for donations from local residents to pay for her treatment.

Jakarta Governor Fauzi Bowo has said that the city's health office will cooperate with RSCM, the medical school at the University of Indonesia and city-owned health centers to increase the quality of care and improve the patient referral system.

"A good referral system can help obtain a more balanced distribution of patients," he said.

He added that the majority of patients preferred referrals to RSCM even though other hospitals in the city could provide the same treatments and services. This, he said, pointed to a lack of trust in the health care system.

Kartono Muhammad, a public health expert, said a more comprehensive auditing of health care services was needed and that patients should be involved in assessing the quality of care they received.

He said the government should also provide more precise referrals specifying at which hospital patients must be treated. Under the current system, people can go to any hospital they want.

See also:


Home | Site Map | Calendar & Events | News Services | Links & Resources | Contact Us