Health

Can Indonesia do better than Obamacare?

So 2014 will be an exciting year for Indonesia. Mostly, of course, because of the elections. But also because, if things go well, a national health insurance scheme will be expanded to cover all Indonesians. It’s an incredibly ambitious plan. But in a wonderful report on BBC radio by Claire Bolderson, Health Minister Nasfsiah Mboi is optimistic. Asked if the government can achieve a target that appears to elude even the mighty United States, she replies “Inshallah, by 2014, we’ll…


Better politics is the only medicine for Indonesia’s health system

The picture above was taken in Lombok, in what I thought was an abandoned health centre. There was a little lab, a couple of consulting rooms, a dispensary, all mouldering with neglect. But on a door to a room in the back yard I saw a sign “The midwife is IN”. I knocked on the door, and to my amazement there she was. Could this derelict place be a living Puskesmas, a village health centre? I asked where the rest…


In praise of Endang: A gem among Indonesian doctors

Wednesday was a sad day for Indonesia. and for me. It marked the death of Endang Sedyaningsih, who encompassed what is best in the women in this great country: courage, determination, integrity, compassion and humility. It is a rare combination at the best of times; in the Indonesian cabinet, where Endang held the position of Minister of Health, these qualities are nothing short of exceptional.


A sick system produces dumb doctors in Indonesia

“Why don’t you go to Penang/Singapore?” is the first thing most Indonesians say when they hear I don’t have kids. Obviously childlessness must be fixed, and obviously it is far too important to be left to the Indonesian health system. I usually give people short shrift when they trash the health system here. I have several smart friends who were once great doctors. Ok, they’ve mostly shifted into management jobs now, but Indonesia’s med schools are full of bright young…


Indonesia’s antibiotic resistance mystery solved

Some years ago, when I was working on HIV prevention in Indonesia, we diligently treated sex workers for common infections such as gonorrhea and chlamydia, using national treatment guidelines. They were not cured. After much head-scratching, we sent some samples off for resistance testing. The results were pretty shocking. We found that 100% of our gonorrhea samples were resistant to tetracycline (marketed here as “SuperTetra!”), and 40% to Ciprofloxacin, the second commonly-subscribed antibiotic. (It took a shameful four years to…