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Web-only Exclusives
November 30, 2000

From Our Correspondent: Hirohito and the War
A conversation with biographer Herbert Bix

From Our Correspondent: A Rough Road Ahead
Bad news for the Philippines - and some others

From Our Correspondent: Making Enemies
Indonesia needs friends. So why is it picking fights?

Asiaweek Time Asia Now Asiaweek story

IN A STATE OF COLLAPSE

Indonesia heads toward breakdown


Check-Up Reading Asia's Vital Signs

Challenges Hospitals face up to changing times

Checklist How hospitals stack up

Rights Patients push for a bigger say

Rural Warriors A humanitarian organization trains an army of doctors in China

The East The future of traditional Asian medicine

The West Americans are turning to alternative therapies

Therapy Sang Lan: The injured gymnast hopes to walk again

Celebrities The "inside" stories of people in the news

Longevity The latest on staying healthy in Asia

Advances Breakthroughs in medical technology

INDONESIAN HOSPITALS ARE IN crisis. And people such as Kaslim Sutiadisastra are feeling the effects. The 62-year-old has just had a spinal operation and now his family is camped out on mats on the verandah of the intensive-care unit at Jakarta's Cipto Mangunkusumo Hospital. They are guarding plastic bags full of sutures, syringes and tubes that they have purchased from the hospital. "This bag of supplies alone cost us 200,000 rupiah [$13.80]," says daughter Nia, 28, who recently lost her job as an office worker. The amount was a heavy financial blow - one third her former monthly wage.

Before the economic crisis hit, the hospital offered a considerable subsidy on such supplies. But not any more. Prices of imported medical goods and drugs have skyrocketed because of the ailing rupiah - forcing hospitals to rewrite their budgets. Even with government subsidies, and with families like the Sutiadisastras forced to buy essential supplies, many hospitals acknowledge they will not be able to operate for much longer.

"The whole operational budget plan has been jeopardized by [the collapse of] the rupiah, says Dr. Hermansyur Kartowisastro, medical director of Cipto, as he pores over financial reports stacked on his desk. Kartowisastro expects the hospital's 1997 deficit of $138,000 to swell to more than double by the end of this year. Cipto - Jakarta's largest public hospital, with 1,300 patients - has already slashed expenses by cutting back on food costs and rationalizing the use of medical supplies such as x-ray materials. "We have substituted egg or fish for meat because they are much cheaper, but we have managed to keep up the calorie intake in the meals," says Kartowisastro. The hospital's purchasing agent is looking for cheaper x-ray film and syringes from India and China, rather than from the U.S. Doctors prescribe generic pharmaceuticals unless the patient can afford brand names.

"Everything has become extremely expensive," says Dr. Robert Kim-Farley, World Health Organization representative in Indonesia. "Not only that, medical products are difficult to import because of [the problems in obtaining] letters of credit." Still, Kim-Farley describes the situation as "patchy," with some establishments making do on limited stocks. "Other hospitals, especially in rural areas, have already run out. Unfortunately, it's there that people don't have pharmacies as an alternative," he says.

In the hemodialysis unit of the privately owned Islamic Hospital in Jakarta, six aged patients suffering kidney failure are hooked to machines for their twice-weekly dialysis sessions. One of them, retiree Nurdin Ali Syarief, has already borrowed $275 to pay for his treatment. Each session costs him $35. With no health insurance, the former spice trader cannot meet the bills without borrowing from family and friends and selling his possessions. "This dialysis cure is like a leech," he says. "It just sucks away your belongings." Mohamad Siban, head of nursing staff in the unit, says 10 patients died after cutting back their twice-weekly treatment to once a week. "We recommend against reducing the treatment, but many people simply can't afford to continue," he says.

The navy-owned Mintohardjo Hospital in the Jakarta suburb of Benhil is beginning to take on some of the aspects of a field hospital. Stocks of equipment and supplies have reached critically low levels. Maintenance has also suffered. American citizen Debby Schlick pulled her seriously ill partner, Djoko, out of the hospital because of poor sanitary conditions. "The bathrooms are only cleaned once a week and there were cats wandering into the wards," she says. "In the 10 days we were there, the toilet was not cleaned once."

Dr. Bagus Mulyadi, director of private and special hospitals at the Department of Health, says hospitals are undergoing a "logical rationalization" to survive the monetary crisis. "If a patient used to have three or four x-rays comparing left and right sides of the body, that may be cut back to just one. Our new national policy says every hospital must use only essential procedures for diagnosis and treatment."

Despite the crisis, Mulyadi says hospitals are maintaining proper medical procedures. "We are ensuring that standard practices are implemented. Patients are still safe," he says. Mulyadi's greatest fear is that Indonesians' purchasing power will drop so low that people will stop using hospitals when they fall sick. "If the utilization of hospitals drops below a safe level, the hospitals will be facing bankruptcy."

- By Jenny Grant


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