Indonesian hospitals head toward breakdown

By Carolyn Divjak
26 August 1998

The human misery created by the economic collapse in Indonesia is reflected in the hospital system across the country. The Jakarta Post has reported that the state hospital at Tangerang, just west of Jakarta, already has 600 million rupiah ($US7 million) in unpaid patients bills and three abandoned babies.

Patients have fled the hospital without paying their bills and, in some cases, abandoned their babies, whom presumably they could not afford to feed. Hospital director Syartil Arfan reported that patients began registering under false addresses and absconding when the economic crisis commenced in the middle of last year.

Many other patients simply cannot afford hospital treatment and the soaring cost of imported medicines since the collapse of the rupiah. Reports have emerged of patients dying or suffering terrible hardships as a result.

For example, AsiaWeek recently cited the case of a 62-year-old man having just had a spinal operation. His family camped on mats on the verandah of the Cipto Mangunkusumo Hospital, the largest public hospital in Jakarta, guarding bags of sutures, syringes and tubes they had purchased from the hospital.

The cost to the man's family was 200,000 rupiah ($13.80)--a huge financial burden. The bill was one-third his daughter's former monthly wage. She had just lost her job as an office worker. Pharmaceuticals used to be heavily subsidised by the hospitals, but no longer. In fact, many hospitals are facing difficulty in obtaining letters of credit to import medical supplies.

In another instance, 10 kidney failure patients died at the privately owned Islamic Hospital in Jakarta after being forced to cut back their twice-weekly dialysis sessions to one a week. Each session costs about 600,000 rupiah ($35), an amount far beyond the reach of ordinary people.

Conditions are even worse in rural areas, where hospitals have run out of medical stocks and people have no local pharmacies as alternative sources.

Hospital administrators and health officials openly voice fears that Indonesians will stop using hospitals when they get sick. This in turn will bankrupt hospitals.

At the Cipto hospital, with 1,300 patients, the medical director has already slashed food and medical expenses. Eggs or fish have been substituted for meat, and medical supplies such as x-ray materials have been rationalised. Generic pharmaceuticals are being prescribed rather than brand names, unless the patient can afford them. New sources of x-ray film and syringes are being sought in China and India, instead of the US.

Despite making patients pay for their own medical supplies, the hospital is still headed for a 1998 deficit of two billion rupiah ($138,000), twice that of 1997.

A picture emerges of a system on the verge of collapse. Unpaid bills, dietary cutbacks, limited stocks of supplies, inferior drugs and the loss of sanitary conditions--these are now the norm. By some accounts, even toilets are now only cleaned once a week.

Deepening poverty and deteriorating hospital facilities are creating the conditions for epidemics and a wholesale health breakdown. Even by official estimates, nearly half the population, or 98.5 million people, will be living below the official poverty line by the end of the year, unable to meet essential nutritional needs.

See Also:
Looting and land seizures in Indonesia
[30 July 1998]
World Bank warns of disaster in Indonesia
[22 July 1998]