Health

Medicine chain gang

Good Distribution Practice in rural Indonesia. Photo: Elizabeth Pisani Getting medicines to patients across Indonesia’s 13,000 islands: what could possibly go wrong? Let’s start with an apology for a silence which some of you have been kind enough to point out has been going on muuuuuuch too long. It turns out that pandemics are busy times for people whose day job is in infectious disease epidemiology. They also keep one away from loved-ones, including Bad Boyfriends. This is the longest…


Indonesia has great data on COVID. Does anyone want to look at it?

For months, Indonesia’s “pray-for-prevention” Health Minister and “virus-free-vaccation” President pretended that the country was shielded by some miraculous force-field from the pandemic that was consuming much of the world. For months, most thinking people in Indonesia and elsewhere have know that was absolute nonsense. The country was able to maintain its claims that it had virtually no [confirmed!] cases because it was doing virtually no testing. A few people, including Jakarta governor Anies Baswedan, was more realistic about the dangers,…


Indonesian kids are starving to death: where are the health services?

2018 started badly for children in Indonesian Papua; though it’s a miraculously fertile province, at least 70 children in the Asmat district died of malnutrition in December and January, and measles and other vaccine-preventable infections are running high. We know about this because Kompas, Indonesia’s leading paper, sent reporters to Asmat to spotlight the crisis. But in truth, it’s probably been going on for a very long time. And it’s probably happening in other parts of Indonesia too; the 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…