30 April 2007

Questioning the concept of family doctors in Indonesia

By Albert Buntoro

REGARDLESS the story problems and the many criticisms, this next quotation is the least short message from an American movie entitled Patch Adam (1999). This comes from a true story telling the struggle of an idealistic doctor who was well interpreted by artist of fame Robin Williams. He was very critical against the hospital system that makes difficult the patients for high cost for getting better. He broke the rigid attitude in treating patients.

Young Patch had a dream to build a hospital as a pleasant place for patients in which they could help and cure each other among them. His dream was realized when along his friends he built Gesundheit Institute, an open venue for sick people in the periphery of West Virginia, US. Apart from delivering free medical treatment, the doctors also position themselves as family members and they did not maintain distance with the patients.

The existence of the institute then became the axes of major changes in medical affairs in the US. A doctor did no longer wear her or his special suit and remained in the world of their patients. The doctors did not sit behind the desks waiting for the patients coming but they were actively contacting the patients and their families for health matters. These active doctors were later known as ‘family doctors’. This health system materialized as Dr. Patch was very convinced that individual health condition could not be separated from the health condition of their families, their communities and their worlds.

This kind of social health system has been long applied in some advanced countries like the US, Britain, Australia, etc. Assuming it would work elsewhere, the Indonesian health ministry maintains its plan to apply this system as an alternative to reach the so-called Healthy Indonesia 2010 program. The long-term target is to provide one doctor for 2.500 people or 500 households.

Ideally each individual has a family doctor who would later become the partner in maintaining health of the family members. The idea that the department tries to implant among the people is healthy home paradigm concept. Meaning to say the doctor has not only the task to wait for the patients coming but she/he should take preventive actions before any disease attacks, such as consistently monitoring the patient health development during treatment. In other words, the doctor becomes like the police but also like sharing partner of her/his patients. The system is expected to increase knowledge about and behavior for health life and in its turn the society at large would do the same.

Samsuridjal Djauzi, an internist doctor and a lecturer at the school of medicine of the University of Indonesia in Jakarta, tells his experience while witnessing the free service of the family doctors at a densely populated urban area in Cuba, C. America. According to him, the success of family doctors in the country was supported by the existence of good clean water and electricity services, the exhaustive health facilities and environmental cleanliness. Even the services of health centers in Cuba has been made a reference for clinic services because there have been specialist doctors, emergency services and medical rehabilitations. As a result, the family doctors have been able to increase people’s health degree in Cuba. They have very low infant death of 5.8 in 1,000 while Indonesia has 30/1,000. Maternal death reaches 31/100,000, while in Indonesia 300/100,000. Infant death in Cuba is in fact lower than those in advanced countries like the US.

As a concept, the family doctor system could be labeled “ideal” but in reality of being applied in Indonesia it conditions other necessary supports in advance such as better public services in transportation, water and electricity supply and medical equipments. To reach such conditions, inter-departmental teamwork is of absolute necessity including the education services to condition the people for increased health awareness in their daily life.

Given the fast increasing commercialization of medical services, the question now is whether such family doctors in Indonesia, if any, could reach lower middle class people like in Cuba? Or they would only serve for people of higher social grouping in urban areas. We will see the results, then.**

Comments from indah in Philadelphia, US:
The idea of family doctors is interesting but to my opinion it is too difficult to apply in Indonesia, given the doctors are too few as compared to the population. Furthermore, in our country, the doctors prefer to stay in big cities than villages or remote areas.

In the US, this concept has not been able to apply perfectly. There are too many people who do not have health insurances and only go to the doctors or hospital when they become too weak or ill. Of course to take service from the government clinic is free of charge but the patient has to wait for hours (from 2 to 6 hours) to get the service. And the doctors who are diligent in contacting the patients at their home as described in this article is a very idealistic picture (that applied by doctors at hospital or private clinics but paid by insurance). The doctors (or medical officials) at government clinics normally only remind by letters or phones, if there is an appointment that will take place or if there is an emergency condition.

My suggestion for Indonesia:

- Increase the number of the free-of-charge health clinics up to the point of balance with the population,
- Public health services have to consider the geographical scale that the people from smaller towns need not to go to bigger cities to get services,
- Increase the number of paramedics (whose education period relatively shorter and less expensive than doctors).


Indah Nuritasari-Philadelphia

See the Indonesian version.

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