The Jakarta Post, April 07, 2006
Islanders suffer amid doctor shortage
M. Azis Tunny, The Jakarta Post, Ambon
Hila Community Health Center in Central Maluku regency, a three-hour drive from the
capital Ambon, is on the brink of losing the only doctor it has.
The physician, who passed his civil service exam in March, is waiting for a permanent
government placement, which is likely to be far away from the area.
The lack of general practitioners is yet another headache for center head Djamal
Palisoa, who has to deal with a lot of shortages.
Occupying a small, rundown house, the clinic does not even have rooms for patients
to stay in overnight, although it has to serve three villages and seven hamlets -- a
population of 16,677. There are only two beds, and the doctor's surgery also functions
as a patients' waiting room.
"We barely have enough space, let alone rooms for patients to stay overnight," Djamal
said.
During a recent malaria outbreak, 173 malaria patients visited the center, most
needing intensive care the facility could not provide.
Instead the health workers doled out medicine, when it was available, and sent the
patients home.
"If the malaria is very bad, we transfer them to a hospital in the city, but it costs a lot.
Most people here, farmers and fishermen, are poor," Nurlina Usman, the center's
nurse, said.
With the prospect of having no doctor at all, Djamal said the outlook for health care in
the area was bleak.
"We actually need a specialist, but nobody wants to work here. Most of them prefer to
work in Ambon," he said.
Before it was destroyed in the 2000-2002 sectarian conflict, the other health center in
the region was located far from residential areas and was unpopular. Now that center
has no roof, and tall grasses grow between its floor tiles.
The fighting also caused many doctors in the islands to flee and many have never
returned. These included government-sponsored physicians, who had qualified to
become regional specialists.
At one point near the end of the conflict, there were only an estimated 50 doctors left
in Ambon city, around 30 percent of the figure before the violence began.
Since the peace broke, however, the physicians have returned. There are now about
120 -- but 80 percent practice in Ambon, leaving regencies and remote areas like Hila
in crisis.
Maluku health office deputy director Fenno Tahalele said there were only three
doctors working in the entire East Seram regency, four doctors in West Seram, four
doctors in Aru, and three doctors in Buru.
He said there had been efforts to attract doctors to the province, with centers offering
extra incentives, housing facilities, better holidays and holiday pay.
"Yet, the scheme is not working because of poor infrastructure and facilities, and
unpromising prospects," Fenno said.
Accommodation and general infrastructure in the Maluku islands is still in short
supply and it has always been difficult to maintain health posts in what is an unwieldy
administrative area, spanning 18 health centers on five clusters of islands.
"Ideally, there should be at least two doctors for each cluster, but so far, we only have
seven doctors in total," Fenno said.
West Seram, which is among the poorest regencies in the country, is isolated and
has a single four-kilometer long asphalt road. Other regencies with many islands have
limited sea transportation. Boats only comes once every two weeks to once a month,
making it difficult for people to access health services.
When a malaria epidemic hit Wawasa hamlet in Gorom Islands regency May last
year, it killed 22 people and made 761 seriously ill.
The nearest health center was in Amarseru village, which is 90 minutes away by boat.
The head of the health office in West Seram, Umar Fauzi Attamimi, said it was
difficult for doctors to reach patients because there was only one mobile health center
-- a boat that could not sail when the seaa was rough. When the weather was bad,
most people in the area depended on traditional medicine, he said.
"There is only one hospital available in our regency, with poor facilities. If a patient is
badly ill, we try to transfer them to Ambon," Attamimi said.
There are seven government hospitals in Maluku, with three more under construction.
They are supported by four military and police hospitals in Ambon and four private
hospitals, along with 127 community health centers and five mobile health centers.
Attamimi hoped doctors would "show some dedication and serve people in remote
areas instead of staying in the big cities with all the facilities."
Meanwhile, the Maluku administration has allotted more than Rp 3 billion
(US$334,725) to hire 20 temporary doctors, with half to be placed at state hospitals
and the rest in remote areas. The budget would also be used to hire midwives, and
provide communications equipment like radios.
"We plan to swap the doctors so they won't get bored, particularly those living in
remote areas. Hopefully the program will start this year," Fenno said.
He said a lack of specialists had forced physicians do light surgery or give nurses
jobs they weren't legally supposed to do.
Doctor quality was not important right now, he said. Just having doctors on the
ground, however inexperienced, would be enough.
If there was one bright spot in Maluku health, he said, it was that there is no shortage
of nurses.
There are three nursing academies in the province, and the government is working to
open a medical school at Pattimura University.
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