RI doctors learn lessons from Soeharto saga

Emmy Fitri, The Jakarta Post, Jakarta

Treating an aging and ailing high-profile patient requires more than medical expertise.

The presidential medical team treating the late former president Soeharto was in the spotlight throughout his hospitalization, making the headlines with their daily updates on the condition of the former ruler.

What lessons can be learned from this 24-day medical ordeal?

Chairman of the Indonesian Doctors Association (IDI) Fahmi Idris said, as a fellow physician, he was proud of the dedication and teamwork of Soeharto's doctors.

"I think the (presidential) medical team showed to the public that doctors at home are able to demonstrate their competence. In a greater context, doctors are just human resources, part of the country's whole health service system," Fahmi said.

Wealthy Indonesians frequently travel to Singapore, Penang, Kuala Lumpur and Bangkok for medical treatment. Many others go the extra mile to Australia, the U.S. and Europe for medical help. The absence of public trust in local doctors is cited as the main reason for this.

"Hopefully, with what we've seen in the past few weeks, our people can be convinced that we have competent doctors and modern technology to treat them at home," Fahmi said.

The team, chaired by Army surgeon Mardjo Soebiandono, briefed the media on what medication was being given to Soeharto from day one -- Jan. 4 -- until the former ruler passed away on Jan. 27 as a result of multiple organ failure.

But Soeharto, Fahmi added, was a unique case for he was a former president and had an "unlimited budget" at its disposal for any treatment needed.

"What the government can learn from this is our doctors' competence must be supported with better macro health service management," he said.

"Good medical practices can only happen in a good health service system."

The government, he said, should be able to calculate the needs of general practitioners and specialists in different areas, referral mechanisms and the availability of reliable medical equipment.

"Medical equipment, which are also resources, will not be idle assets if hospitals network."

A better health service system would also see solid networking among doctors and hospitals, and a working insurance scheme, he said.

"A better health service system could therefore enable people, not only state officials or wealthy people, to get better services," Fahmi said.

Comprising 25 doctors, the presidential medical team can call in the top doctors in different fields if they need back-up or a certain expertise, and have privileged access to the latest medical equipment.

One cannot apply to be a presidential doctor, likewise one cannot refuse when appointed to the team," cardiologist Muhammad Munawar told Metro TV on the recruitment system for the presidential medical team.

Mardjo Soebiandono said overall, treating Soeharto was an extraordinary experience, not only in terms of the medical challenge but also the overwhelming media pressure.

"Geriatric patients like Pak Harto are more difficult compared to younger patients. On top of that, he also had a history of mild strokes, kidney stones, gastronomic and heart ailments. Decisions that we made had to be based on a comprehensive monitoring of his overall condition," he said.

"But with the help of colleagues, we were privileged to be able to use high-end medical equipment such as the Continuous Venovenous Haemodialysis (CVVHD), tissue doppler imaging and nuclear-powered thalium scan. I think it was a great experience for all of us on the team," said Mardjo, who also treated former vice president Sudharmono until his death in 2006.

Mardjo said doctors held meetings twice a day to review Soeharto's condition. In one of the meetings, usually the night meeting at around 9 p.m., family members were invited and briefed on Soeharto's condition.

"We were also challenged to communicate with the media. That's not part of the medical school curriculum," he said.

Three days before Soeharto's death, Mardjo said, doctors planned to perform a CRT (cardiac resynchronization therapy) to regulate Soeharto's cardiac muscles, but "God decided differently".

Early detection key to successful treatment

The Jakarta Post

One day when Nuraini was taking a shower, she felt a hard lump on her left breast. It was like a tiny, moving ball trying to break out from below the skin.

She went to visit a doctor at a nearby Puskesmas (community health center) and was told the lump was nothing to worry about. Luckily her husband insisted she get a second opinion at a hospital.

"It turned out it was a benign tumor at stage one," Nuraini said.

Breast cancer usually develops in stages, from stage one to stage four.

A month after the tumor was diagnosed, Nuraini underwent an operation, which was followed by radiation and chemotherapy. Now she is in remission from the illness that could have killed her.

However, Nuraini was lucky. Many women suffering from the symptoms of breast cancer delay paying a visit to the doctor.

"About 70 percent of people diagnosed with breast cancer are already at stage three or four, which is usually considered too late for medical treatment to be effective," oncologist and surgeon Sonar S. Panigoro from Cipto Mangunkusumo Hospital said.

Breast cancer occurs when cancer cells attack glandular breast tissue. Most cases of this type of cancer are found on the upper part of the breast closest to the arm.

Breast cancer can spread by way of the lymphatic system or blood stream to the lungs, liver, bones or other organs, or can spread directly to the skin.

It can also occur in men, although cases are very rare. In Indonesia, only one man diagnosed with breast cancer died in 2006.

Breast cancer is the world's fifth most common cause of cancer-related death, after lung cancer, stomach cancer, liver cancer and colon cancer. Breast cancer resulted in 502,000 deaths (7 percent of cancer-related deaths and almost 1 percent of all deaths) worldwide in 2005.

"Here it is estimated that between 18 to 20 percent of women may be diagnosed with breast cancer. It ranks second after cervical cancer," said Sonar.

Sonar said when breast cancer is at stage one or two, operations can be performed, followed by a combination of radiation therapy, chemotherapy and hormone therapy.

"However, if breast cancer is at stage three or four, the adjuvant therapies are pursued first before an operation is attempted. But in many cases, it is too late for an operation," he said.

Depending on each patent's age and the type of cancer they have, cancer cases are divided into various categories from high risk to low risk. Each category of cancer is treated differently. Treatment possibilities include radiation therapy, chemotherapy, hormone therapy and immune therapy.

Early detection is the best way to deal with breast cancer. However, in many cases slow-growing breast tumors may not be detectable by touch for up to eight years.

Women can examine their own breasts regularly by pressing each breast firmly and carefully using three fingers. It is best to do this one week after menstruation.

However, it is more reliable to seek a mammogram (x-ray), USG (ultrasonography) or advanced MRI (magnetic resonance imaging) to check for breast cancer.

With technology improving rapidly, breast cancer cases are increasingly being detected early before any symptoms are present.

"The mammography is recommended for women over 40, while the other early detection methods are best for women under 40," said Sonar.

While the cause of breast cancer remains to a large extent unknown, many risk factors have been recognized. These include gender, age, hormones, a high-fat diet, alcohol intake, obesity and environmental factors such as tobacco consumption and radiation.

Psychological aspects should also be taken seriously as not all breast cancer patients cope with their illness in the same way.

Many larger hospitals are affiliated with cancer support groups, which help patients cope with the issues they may face in a supportive environment.

In Indonesia, the Reach to Recovery support group was formed in 1997 by the Indonesian Cancer Foundation (YKI).

The support group is made up of breast cancer survivors who voluntarily provide counseling to people diagnosed with breast cancer.

"The volunteers ensure patients that medical treatment is the best way to treat their illness. In many cases, patients listen to the volunteers more than their doctors," said program director Rabecca N. Angka, who also works at the YKI's Early Diagnostic Center in Lebak Bulus, South Jakarta.

However, she said temptation among breast cancer patients to try alternative treatments remains high.

Sonar said many breast cancer patients try alternative treatments before seeking medical advice because of what they see on television.

"They say traditional healers can transfer the disease to an animal. Sometimes patients even come to believe that breast cancer is the result of black magic," he said. --Alpha Amirrachman

Breast cancer survivors lend ears, hearts to counsel others

Alpha Amirrachman, Contributor The Jakarta Post, Jakarta

When Supraptini was diagnosed with breast cancer in 1986 she felt as if she had been sentenced to death. "I was two month's pregnant," she told The Jakarta Post. "My doctor gave my family a difficult choice: save the mother or save the baby. But my husband insisted that he wanted to save both."

Supraptini and her husband decided to have her wait until she delivered her daughter before receiving an operation to remove the tumors. The treatment included 25 courses of radiation treatment and six cycles of chemotherapy.

Although Supraptini's breast cancer was already at an advanced stage (stage three), her immense courage and positive attitude allowed her to overcome the disease. The years which have passed since her cancer went into remission have been blessed. With tremendous support from her family, Supraptini has been able to watch her daughter blossom to maturity.

"Although I could not breast-feed my daughter, her IQ reached 146," explains Supraptini. "She recently graduated cum laude from the School of Medicine at the University of Indonesia."

Since 2000, Supraptini has shared her experience with others diagnosed with breast cancer by becoming a breast cancer survivor volunteer in YKI's (Indonesian Cancer Foundation) Reach to Recovery program.

Reach to Recovery was formed in 1997 by the YKI under the service and rehabilitation division of the foundation. The program coordinates volunteers who have survived breast cancer to provide counseling to recently diagnosed breast cancer patients.

"I have talked to at least 100 breast cancer patients, through visit or phone, counseling them during their hard time," said Supraptini. "I feel relief and accomplishment when I can help patients to regain their self confidence so that they may focus and make a well informed decision for proper medical treatment.

"But there are, however, cases that have made me sad," she said, citing an example of a patient who insisted on alternative treatment when her breast cancer was at stage one, but failed desolately after the tumor became uncontrollable.

Speaking of the obstacles which hamper breast cancer, Supraptini specifically addresses the high costs of the medicines which are usually needed to treat breast cancer.

These expensive medicines are not covered by state-run insurance scheme ASKES or ASKESKIN, and have therefore forced many to pursue an alternative treatment. AKSES is a government-sanctioned health insurance for civil servants only, while ASKESKIN is for the poor.

"The tax is incredibly high since the medicine is still imported and classified as luxury goods," explains Supraptini. She added that it is time for the government to change its policies with regard to import duties imposed on life-saving medications.

Another survivor to participate in the YKI Reach to Recovery program is Agustia Ludbariana, who was only diagnosed with breast cancer once it had already advanced to stage three. Augustia explains that a close friend had urged her to consistently undergo medical treatment.

In 1996, Agustina received a successful operation which was accompanied by radiation and chemotherapy. Recognizing the strong influence that her friend had in giving advice to seek treatment, Augustina decided to become a volunteer counselor for the Reach to Recovery program.

The experience of helping others in their time of crises has been filled with emotional highs and lows. Augustina recalls counseling one breast cancer patient who happened to be a doctor.

"She seemed angry and decided to opt for 'spiritual' healing instead. Maybe because she knows 'too much'," said Agustia.

Despite helping cancer patients to cope with the psychological stress of the illness, patients who pursue spiritual or holistic avenues for treatment alone have a diminished opportunity to fully recover from the disease.

Besides Reach to Recovery, Augustina is also a member of Cancer Information and Support Center (CISC), another support group that facilitates her visits to Dharmais and Cipto Mangunkusumo hospitals to provide patients there with direct counseling.

Another survivor, Martini Lim recalls that when she was diagnosed with stage two breast cancer, she quit all her social activities." I confined myself to my room," said Martini.

Upon advice from colleagues and support from her husband, Martini decided to call the YKI and learn more about Reach to Recovery from its program coordinator Dr. Rebecca N. Angka who urged her to talk to survivors.

Martini's successful 2003 operation was followed by six cycles of chemotherapy. She has subsequently become a volunteer for the Reach to Recovery program. She regularly helps to conduct meetings and workshops among the survivors who are willing to help lift the burden of others.

Celebrities who are also breast cancer survivors such as Rima Melati are often invited to attend the workshops. Additionally Reach to Recovery also involves oncologists, psychologists and other specialists including communication experts.

Dr. Rebecca said that of the 100 survivors who received counseling from the program, about 50 became volunteers for Reach to Recovery.

Many of the planned events are restricted however due to the program's inadequate budget. Reach to Recovery relies mainly on the financial contributions from the survivors and a few pharmaceutical companies.

"One of the challenges of the program is to find permanent donors who can give full support to ensure the continuity and expansion of the program," said Dr. Rebecca. "While YKI branches in Surabaya and Bandung have run Reach to Recovery programs, much work is still required to expand the service to remote areas."

Early Diagnostic Center's Indonesian Cancer Foundation (YKI) Jl. Lebak Bulus Tengah No. 9, Cilandak, South Jakarta Tel. 021-7690704, email: pddyki@uninet.net.id

Referral opens trauma treatment center

The Jakarta Post, Jakarta

Smarting from flaws in the trauma healing of victims of disaster, Ciptomangunkusumo Hospital (RSCM) introduced Tuesday a post-traumatic stress clinic offering a new approach to mental illness.

Apart from victims of disaster, the clinic seeks to treat victims of domestic violence.

RSCM managing director Akmal Taher said the clinic would not only provide medical treatment, but would also serve as a center for studies on post-traumatic stress.

The clinic, the first of its kind in Jakarta, is meant to be the national referral center for treatment of post-traumatic stress, Akmal said.

Over the last two years, the state-owned hospital has treated nearly 1,000 victims of abuse, mostly women and children, with 80 percent of them having been victims of domestic violence.

The coordinator of the clinic, Suryo Dharmono, said over 60 percent of violence victims were likely to suffer from post-traumatic stress, a psychological disorder marked by three main symptoms: avoidance, hyper arousal and flashbacks that last for more than a month.

"Psychological treatment for these victims of violence was previously neglected. We used to only have the psychiatry department, which patients don't want to be referred to, as they don't think they're suffering from mental illness.

"That's why we decided to open this clinic, which provides comfortable, private waiting and consultation rooms, and is separated (from other sections of the psychiatry department), just exactly as the patients need," said Suryo.

He said without proper treatment, victims of violence, especially children, could experience permanent negative changes in behavior and become perpetrators of abuse when they grew up.

Akmal said 50 percent of people living in disaster-prone areas might suffer from significant psychological stress, with the number of those experiencing post-traumatic stress ranging from 10 to 30 percent.

Suryo added that 37 percent of the victims of the 2004 Aceh tsunami were still suffering from post-traumatic stress even though three years had passed since the deadly catastrophe.

The clinic will also be open to individuals traumatized by other events, such as terror bombings, riots, social and political conflicts and traffic accidents.

Akmal said the clinic would apply both psychotherapy and pharmaco therapy in treating patients, depending on the results of early assessments.

The former would include cognitive behavior therapy, prolonged exposure therapy, counseling, homecare and hotline services, while the latter would include the use of anti-depressants.

The clinic, whose establishment received support from the Pfizer Foundation, is open to low-income patients holding either Gakin or Askeskin cards.

Gakin is the healthcare for the poor funded by the Jakarta administration, while Askeskin is funded by the central government. (wda)

Indonesia bird flu death toll hits 100

Mon Jan 28, 2008 8:49am EST

JAKARTA (Reuters) - A 23-year-old Indonesian woman from East Jakarta has died from bird flu, taking the country's death toll to 100, according to a report from Indonesia's bird flu information centre on Monday.

The woman died on Sunday and two separate laboratory tests confirmed she contracted H5N1, the report said.

Earlier on Monday, a 9-year-old Indonesian boy who had tested positive for bird flu died, the health ministry said in a statement.

The boy from the outskirts of Jakarta died at the Sulianto Saroso hospital on Sunday after being treated in different hospitals for two weeks, said Joko Suyono, an official at the ministry's bird flu information centre.

It was not known how the boy contracted the disease.

Indonesia has had the highest number of human deaths from bird flu of any country.

A 31-year-old woman and 32-year-old man hospitalized at Persahabatan hospital for fever and respiratory problems also tested positive for the deadly H5N1 virus on Monday, the ministry said.

According to the statement, the woman lived in East Jakarta near a poultry slaughterhouse that kept many fowl believed to be the source of her H5N1 infection.

The man from Tangerang, west of Jakarta, is believed to have contracted H5N1 from his neighbor's pet doves, the ministry said.

Contact with sick fowl is the most common way of contracting bird flu, endemic in bird populations in most of Indonesia.

Although bird flu remains an animal disease, experts fear the virus could mutate into a form easily passed from human to human and kill millions.

Suyono said there are no obvious explanations for the sudden surge of cases. "We need to carry more tests and investigation first to be really sure."

(Reporting by Mita Valina Liem and Adhityani Arga; Editing by Sara Webb and Jerry Norton)

9-year-old boy dies of bird flu, bringing Indonesia's death toll to 99

The Jakarta Post

JAKARTA (AP): A 9-year-old boy has died of bird flu, bringing Indonesia's death toll from the disease to 99, health officials said Monday.

The boy died Sunday at the Sulianto Saroso Hospital for Infectious Disease in Jakarta, said Ningrum, an official at the Health Ministry's bird flu center.

Tests confirmed the boy had the H5N1 virus, she said, adding that the cause of the infection had yet to be determined.

The boy was from a neighborhood on the southern outskirts of Jakarta. He first developed symptoms on Jan. 16, said Ningrum, who like many Indonesians who uses a single name.

Indonesia has recorded human bird flu deaths regularly since the virus began ravaging poultry stocks across Asia in 2003.

Scientists have warned that Indonesia, which has millions of backyard chickens and poor medical facilities, is a potential hot spot for a global bird flu pandemic.

Thousands Yogya children malnourished

Slamet Susanto The Jakarta Post Yogyakarta

Two thousand children under five in Yogyakarta -- one percent of an estimated population of 200,000 -- suffer from severe malnutrition or marasmus while 20,000 others, or ten percent, are malnourished, a local official has revealed.

Chief of the Yogyakarta provincial health office Bondan Agus Suryanto said severe malnutrition could be caused by infections diseases such as tuberculosis and intestinal worms but that poverty was the main factor.

He acknowledged that compared to a national index of 8.1 percent the number of marasmus sufferers in the province was low, but he said he hoped it would be remedied "as soon as possible."

To overcome the problem, he said his office had provided medical care through the Jamkesos social health insurance program and promoted a foster-care program for toddlers, which handled 59 cases last year.

He predicted numbers of sufferers would rise this year due to people's low buying power and rising costs of food and other basic necessities.

Spokesman for Sardjito Hosptial Heru Trisno Nugroho said he was shocked by the eight cases of severe malnutrition the hosptial had treated so far this year.

"In 2007 there were 37 patients, but already in the first month of this year there have been eight patients."

Another problem was whether or not patients could meet their daily nutrition needs after being released. "It is national policy not to charge people (in cases like these). The question is how patients will get the nutrition they need after they're released, keeping in mind most people are facing a rough time right now," said Heru who believed the malnutrition cases were linked to soaring prices of basic commodities.

Sardjito patients such as one-year-old Ria Ariani, from Nglendah, Kulonprogo, come from poor families. Both her parents work as farm hands.

"Medical treatment is free but patients' relatives have to pay for transportation and food," said Ria's mother, Ponijah.

Ponijah said she that to buy medicine she had to sell one of her cows as well as borrow Rp 700,000 (approximately US$77) from relatives.

According to Mari Astuti, a food technology and nutrition expert from Gadjah Mada University, a diet with more raw bananas and tubers would be a good alternative rice, tempeh and tofu.

"Bananas and tubers are plentiful in the province, they cost less ... and contain nutrients and as many calories as rice and soybeans.

The problem, she said, was whether the government had the will to promote this message so people would change their minds about alternative diets.

Mari said babies should be breast-fed for at least six months after birth to insure maximum immunity levels.

She also recommended porridges made from bananas and tuber flour.

Household stress rises with higher food prices

The Jakarta Post, Jakarta

Yati and her family have rarely eaten fried food in the last few months. They have not committed themselves to a healthy lifestyle -- they just can't afford cooking oil or meat.

"I never buy tempeh anymore because we can't afford it. All we eat is rice and eggs and if we have vegetables we boil them in plain water," the resident of Cipinang Besar in East Jakarta told The Jakarta Post on Friday.

Yati was one of many housewives who attended a rally to protest against rising food prices organized by the Jakarta Residents Forum (FAKTA) in front of the Presidential Palace in Central Jakarta on Thursday.

Basic ingredients have gone up significantly in price since the start of the year. Soybeans recently experienced a massive price hike, driving some 5,000 tempeh and tofu producers to protest.

The price of eggs has almost doubled, with one kilogram increasing from Rp 7,000 (USD 74 cents) to Rp 12,000. The price of cooking oil has also jumped from Rp 4,000 to Rp 11,000 in the past five years.

Yati, a mother of three, said she found it hard to buy her family's everyday needs.

"I'm just so confused. I don't know what else we can go without to save money," she said, adding that one of her children no longer attended school.

Yati's husband works as a laborer, bringing home around Rp 1 million per month.

In Sunter, North Jakarta, Slamat, who is a squatter and works as a bus driver, said he was especially burdened by the rising cost of cooking oil.

He said he and many other squatters who live in the area often do not have enough money to buy basic ingredients to cook with.

"And now we are finding it much more difficult as cooking oil prices have gone up," he said.

FAKTA head Azas Tigor Nainggolan said the government has not been doing enough to help the city's poor.

"Some of these poor people have to go to unimaginable lengths to survive, such as eating old rice," he said.

"The government should be more concerned about this. Perhaps the government could subsidize shopping or give food away, but they are not doing anything at the moment to help ease the suffering of poor people."

Azas said the rising price of food may have other long term consequences, including a nutrition crisis among Jakarta's children.

"Young generations in Indonesia may become lazy, simply because they do not have access to healthy meals," he said.

He said the government should do something to help poor people or risk losing their vote in the next election.

"The government should stop protecting the interests of rich people. They already have enough to protect themselves. The government should protect those who need protection -- the city's poor," he said. (anw, ewd)

Indonesia`s former president Soeharto dies

Jakarta (ANTARA News) - Former President Soeharto (86) died on Sunday (Jan 27) at 13:10 after he was treated about two weeks at the Pertamina Hospital in South Jakarta.

The Indonesian second president was admitted to the Pertamina Hospital last Friday on January 4, 2008, for suffering from anemia and severe edema.

Soeharto began his New Order government after then President Soekarno authorized him in March 1966 to overcome the chaotic situation in the aftermath of the aborted Communist coup in 1965.

A special session of the provisional People`s Consultative Assembly (MPRS) in March 1967 appointed Soeharto acting president and he was officially sworn in Indonesia`s second president in March 1968.

Soeharto who was born in Kemusuk village, Yogyakarta, on June 8, 1921, ruled the country for 32 years through six consecutive general elections.

Between 1960 and 1965, the national economy grew merely by an average of 2.1 percent annually. The inflation rate reached over 250 percent in 1961-1965 and even jumped to 650 percent in 1966.

After the stabilization and rehabilitation drive carried out by the New Order in 1966 and 1968, economic growth reached an average of six percent.

Thus, in 1969, Soeharto began to implement his ideas to lift up the country from poverty through five-year development plans called "Repelita".

At the start of Repelita I, Indonesia`s per capita income stood at US$70, and Indonesia was rated as one of the poorest countries in the world.

About three decades later, the country`s per capita income went up to US$1,155 and Indonesia was regarded a middle income country. The economy grew convincingly by an average of seven to eight percent a year over a period of 25 years.

Entering the 80s and the 90s, the inflation rate was maintained at an average of 10 percent, and in 1996 it reached 6.5 percent.

The result of Soeharto`s economic programs made Indonesia which had been crippled by poverty in the previous three decades, one of the newly emerging economies in South East Asia.

The number of poor people declined from 60 percent in 1967 to 40 percent in 1980 and 21 percent or 37 million people in 1987. With a population of about 200 million, Indonesia was able to further reduce the number of its poor to 11.3 percent or 22.5 million in 1996.

The success of his economic development earned him the title "Bapak Pembangunan" (Father of Development) which was conferred on him by the People`s Consultative Assembly (MPR) in 1983 in recognition of his success.

Through diversification in the agricultural sector, Soeharto also succeeded in turning Indonesia from a rice-importing to a rice-exporting nation.

In 1980, Soeharto declared Indonesia self-sufficient in rice and traveled to Rome in 1985 to receive a crowning award from the Food and Agricultural Organization of the United Nations.

The New Order era leader resigned from the presidential post on May 21, 1998.

Soeharto still has heartbeat but in worst condition

Jakarta (ANTARA News) - Former president Soeharto`s health showed the worst condition on Sunday (Jan 27) morning since he was admitted to the Pertamina hospital about two weeks ago but heartbeat still continued, a docter has said.

Dr. Joko Raharjo, a member of the presidential medical team ,

made the remarks here on Sunday, adding that Soeharto was suffering `multi organ failure`.

"Since 03.00 a.m. until 07.00 a.m. local time on Sunday, his blood pressure read 90/35-70/35 mm Hg," Joko said, noting that at 10.00 a.m. the blood pressure declined to 60/25-70/30 mm Hg.

According to him, the medical team has conducted maximum efforts to raise Soeharto`s blood pressure.

Previously when the functions of his heart and lungs were improving, the ailing Soeharto`s blood pressure showed 110/40 mm Hg.

HIV/AIDS on the increase despite global decline

Desy Nurhayati, The Jakarta Post, Jakarta

Despite stabilizing figures globally, the National AIDS Commission says Indonesia's efforts to curb the spread of HIV/AIDS have been ineffective given a substantial national increase in infection rates for 2007.

The poor performance was due to lack of comprehensive measures targeting high-risk groups, particularly injecting drug users and sex workers, AIDS commission coordinator for reports and information systems Wenita Indriasari announced at a media conference Thursday in Jakarta.

"Efforts have yet to reach most drug users and sex workers, who have been our main target groups to prevent the spread of the virus," she said.

Preventive measures only reached some 18 percent of drug users targeted, and only around 14 percent of sex workers. This year, the commission aims to make contact with 40 percent of Indonesia's drug users and 50 percent of its sex workers.

Indriasari said, the commission hopes by 2010 the number of new HIV/AIDS infections would be halved.

She said targeting drug users needed better coordination between police and other related stakeholders -- which had yet to be accomplished.

Local values had also hampered efforts to control the spread, through promoting the use of condoms by sex workers and their customers, and couples, Indriasari said.

Indonesia held its national condom week in December 2007 in efforts to curb the spread of sexually transmitted diseases, including the HIV/AIDS virus, by promoting safe sex.

The program, however, was a source of controversy for some members of the community who considered it to promote promiscuity.

The number of reported cases of people with HIV/AIDS in Indonesia reached 10,384 in September 2007, of which some 2,190 were new infections, contracted last year.

With this rapid increase Indonesia is estimated to have the fastest growth in the number of new HIV/AIDS infections in Asia.

Conversely at a global level, the prevalence rate has stabilized at around 33.2 million cases, and the number of new infections has been declining. This is believed to be a result of massive efforts to control the spread of the disease.

"We should learn from other Asian countries, like Cambodia and Thailand, which have been more successful in controlling the spread of HIV/AIDS," Wenita said.

She said infections had occurred in most provinces in Indonesia, and was most commonly contracted among drug users and sex workers. The virus has also spread to couples and children in several provinces including Papua, Wenita said.

"In Papua, HIV/AIDS has occurred not only among high-risk groups but also in the broader population," she said.

Indonesia still depends on foreign aid to support its efforts to control the spread of the virus.

Of the budgeted Rp 1.3 trillion (US$138.7 million) needed for HIV/AIDS prevention this year, the Indonesian government could only provide around Rp 500 billion under its state budget.

Balikpapan seeing more mental illness lately

Nurni Sulaiman, The Jakarta Post, Balikpapan

The city of Balikpapan in East Kalimantan has seen a rise in the number of cases of mental illness, a development observers are blaming on economic hardships in the area.

The head of the rehabilitation and social services unit at the Balikpapan Community Empowerment Office (KPM), Andi Hasrah, said that based on a survey of families, a majority of cases of mental illness were triggered by economic difficulties.

"However, among the younger patients, we often found drug abuse as the main cause," said Hasrah.

The number of patients in the city seeking care for mental disorders reached 28 in 2006, according to the KPM. That number increased to 47 in 2007, while in January of this year, there were 13 new patients.

Hasrah said it was unusual that in 2006 and 2007, most of the patients seeking care for mental disorders were city residents.

"In the past year, 99 percent of patients came from the city, a stark contrast from the situation in 2005 when most of them came from outside the city, such as Makassar, Bondowoso and Banjarmasin," said Hasrah, who has been dealing with social issues in Balikpapan for dozens of years and is currently running a shelter for mentally ill patients on Jl. MT Haryono in Balikpapan.

According to a recent survey by the KPM, the increasing number of mentally ill people in the city had a lot to do with household problems triggered by economic troubles and the high unemployment rate in the province.

Hasrah expressed concern over the rising number of people in the city seeking care for mentally illnesses, saying the KPM lacked the funds to deal with the problem.

The city administration disbursed just Rp 50 million (about US$5,500) to the group in 2007, despite the fact that the KPM spent Rp 72 million treating 47 patients.

"Rupiah 50 million is only enough to send 19 patients to the mental hospital in Samarinda. Last year, the city administration delivered 29 patients," he said.

The KPM is working with Atma Husada Mental Hospital in Samarinda to treat the patients.

According to Hasrah, most of the patients are aged between 20 and 60 years. The KPM often has trouble determining patients' names and towns when they arrive.

"We will have them cross-checked after they have undergone the standard treatment. If they come from outside the island, we will return them to their places of origin and the municipality will cover their travel cost," said Hasrah.

Those who are from the city will be returned to their families after treatment, while patients with no families will be placed in orphanages or homes for the elderly.

The treatment duration varies between two weeks and years. After patients are treated, they must undergo a post-rehabilitation period where they are continuously monitored to ensure they continue to show progress.

Giving shelter to Bogor's homeless population

Theresia Sufa, The Jakarta Post, Bogor, West Java

Seeing many neglected people on the streets of Bogor, West Java, couple Helena Folamauk and Hapoltahan Philipus Sitorus decided to do something to help.

They set up a shelter, where they provide homeless people with care and medical attention, before sending them back to their families.

"We built this shelter in 2003 because our hearts were touched seeing those people sleeping on the streets and eating from the garbage," Helena said.

She said all of the people they helped suffered from some kind of mental disorder, in addition to health problems.

Since its founding, the shelter has given care to 50 people, including 30 who have been returned to their homes, Helena said.

The shelter gives these people food, vitamins and acupuncture treatment, as well as social interaction with other patients and the couple's own family.

They are given a taste of normal, domestic life, Helena said. People in the shelter are given domestic chores like washing dishes, cleaning the shelter and cooking. They all sit down together during mealtime.

The shelter, located in North Bogor district, occupies 450 square meters of land. The common room for the patients can only hold four to five people.

"We wait until some of our patients return home and then we go out to the streets looking for new people," said Helena.

Helena and Sitorus said not all patients were able to return to their homes, even after they had been nursed back to health.

Helena said they once had a patient who they helped return to health, before taking him to his family in Tanjung Priok, North Jakarta.

"But the family wouldn't accept him. They told us they were afraid he would have a fit again," she said.

The shelter's inhabitants come from a variety of backgrounds, said Helena. They range in age from 14 to 50, some are college educated and others have no formal education at all.

"Reasons for their mental problems also vary, from broken family, drugs, heartbreak," Helena added. "They have lived on the street for five months to three years."

The couple said they often found people who did not even know their names or addresses. They had forgotten who they were.

Helena said that from the beginning, the shelter was established to focus on street people with mental disorders.

The shelter and the couple receive support from the local Pentecostal church as well as other donors.

They don't collect money from patients or their families, except those patients who check themselves into the shelter.

"For vitamins and medication, we spend two million (rupiah) per month," said Helena.

The shelter does not employ an in-house health professional, but they send patients to general practitioners and acupuncturists. For psychological problems, the couple themselves provide counseling.

Word has spread through the community of the work being done at the shelter, and a number of people having trouble with their children have sent them to Helena and Sitorus.

Novian Untung Hariyadi is one such parent. His son, Stenly, often disappeared for long periods of time. Both Novian and his wife were working, and did not have much time to care for Stenly.

"We decided to entrust Stenly to the shelter's care," Novian said.

For such patients, the families are charged a fee. "But the amount is decided by the families. It could be Rp 100,000 (US$11) a month or Rp 500,000."

One of the donors, Willy Darmawan, said he was surprised to find out there was a shelter providing care almost for free. "I'm touched by their endeavor," he said.

Helena acknowledged it was not always easy caring for the patients.

"In the beginning some of these people don't go to the toilet. They just do their business wherever they want to. My husband and I have to clean the mess ourselves," said Helena. "Sometimes I have to bathe them, brush their teeth."

"I love them like they are my own children. My principle is, if you want to help people, do it totally, not half-heartedly."

FAO cooperates with Indonesia to monitor H5N1

Jakarta (ANTARA News) - The United Nations Food and Agriculture Organization (FAO) is working with the Indonesian government to implement a program to monitor virus of H5N1, a FAO statement from UN News Center in New York said on Friday.

FAO said that 31 of 33 provinces in Indonesia, one of the countries hit hardest by avian flue, had been infected since 2004 and thus more investigations and better poultry vaccines were needed to fully protect the poultry from the virus in the country.

It warned that despite advances in controlling the virus, recent avian influenza outbreaks in more than one dozen countries revealed that the epidemic remained a global threat.

"Globally, much progress has been achieved in keeping the H5N1 avian influenza virus under control," said Joseph Domenech, FAO`s Chief Veterinary Officer, noting that great strides have been made in the past three years.

He said surveillance, early detection and immediate response efforts have been bolstered and many countries have been able to eliminate avian flu from poultry.

But since last month, Indonesia and 14 other countries - Bangladesh, Benin, China, Egypt, Germany, India, Iran, Israel, Myanmar, Poland, Russia, Ukraine, Turkey and Viet Nam - have confirmed new outbreaks in poultry, mostly in domestic stocks.

"The H5N1 avian influenza crisis is far from over and remains particularly worrying in Indonesia, Bangladesh and Egypt, where the virus has become deeply entrenched despite major control efforts," Domenech said.

He also cautioned that while H5N1 has not become more contagious to humans, "it could still trigger a human influenza pandemic."

In Bangladesh, nearly one-third of the districts have been infected, and the disease appears to be endemic. Therefore FAO said it is strengthening its presence to help the country bring avian flu under control.

Domenech said that reporting of new outbreaks, disinfection, culling, movement control and farm bio-security must be stepped up in Egypt.

He also observed that a potential change of virus strains needs to be investigated further, and FAO is supporting the Government`s detection, control and communication measures.

With the help of FAO, over 50 countries have been able to bring avian flu under control and eliminate it from poultry.

Indonesia thanks world for post-tsunami aid

The Jakarta Post

When the deadly tsunami devastated Aceh and Nias in 2004, the global response was unprecedented. Millions of people -- from children to senior citizens -- donated huge amounts of money and goods to tsunami victims.

Indonesia on Thursday expressed its gratitude to the international community during a special ceremony called "Indonesia Thanks the World", held at Balai Sudirman in Jakarta.

Representing the international community, the chairman of Singapore's Red Cross, Winston Choo (photo above), said rebuilding Aceh and Nias was a difficult process.

But with the help of the Indonesian Red Cross and the Aceh-Nias Reconstruction and Rehabilitation Agency (BRR), he said, the international community was able to channel aid to tsunami victims.

Singapore donated some S$100 million in medical aid, food supplies, housing, pier and hospital construction.

"I would like to congratulate Mr. Yudhoyono's (President Susilo Bambang Yudhoyono) decision to establish the BRR, which has helped donors and partners contribute in the reconstruction process," Winston said. (JP/Esther Samboh)

Residents urged to fight mosquitoes

The Jakarta Post

East Jakarta residents are still not doing enough to prevent dengue fever, an official said Thursday, as more and more patients are being admitted to hospitals in the municipality.

"Residents need to work harder to implement mosquito breeding site eradication procedures because we should not be seeing this many cases," East Jakarta administration public relations head John Jefferson told The Jakarta Post.

Jefferson said the eradication procedures include drying out any wet hollow areas, closing them and filling holes in the ground, as mosquitoes which carry the disease breed in damp and dark areas.

At least 29 patients, comprising 24 adults and five children, had been admitted to various hospitals in East Jakarta, as of Thursday.

Some 9,277 dengue cases, with 17 fatalities, were reported in East Jakarta last year -- a sharp increase compared to the 7,773 cases and 15 fatalities reported in 2006.

Bekasi's blind get voting aid

The Jakarta Post, Jakarta

Bekasi Elections Commission has equipped polling booths with Braille templates to help disabled voters participate in the city's first direct mayoral election this Sunday.

Commission member Ucu Asmara Sandi said the commission distributed the templates to all the city's 2,568 polling stations, which had features making them more wheelchair-accessible.

"We hope more disabled voters can vote that day, either by themselves or with the help of chaperones," Ucu told The Jakarta Post on Tuesday.

The commission predicts some 1.2 million voters will cast ballots, including 10,000 blind people and 20,000 with other disabilities.

Braille templates were used for the first time during the 2004 presidential election and again in recent Jakarta gubernatorial elections.

The head of the Bekasi chapter of the Association for Disabled Indonesians, Suparlaut Adiprasa, said the supporting facilities made his members excited about the election.

"The decision shows us that the commission really wants us to be involved in it (the election). Some other local elections like the city's legislative election and the regency election held last year didn't use the templates."

However, he said he worried there would be inconsistencies on polling day with officials at some booths hindering chaperones from escorting blind voters inside the station.

"If the officials are the ones who escort the blind people, it would destroy the privacy," he said, since the officials were strangers to them.

Thus, Suparlaut hoped the commission would prepare Braille ballots for future elections so Bekasi's blind wouldn't need escorts to assist them in placing the ballot paper properly inside the template.

He said he also regretted that the commission only held two meetings to educate the disabled about the election process -- a familiarization meeting last September attended by 300 disabled people and an election simulation last Saturday attended by 150.

"Due to a limited budget the commission only allowed 150 people to join the simulation. We picked the 150 people from each district so they could pass the information on to friends living in the same area."

He added his organization would deploy volunteers to monitor and report any violations involving disabled voters.

The commission has also provided polling stations at 14 hospitals, five health centers and the Bulak Kapal penitentiary. (tif)

Thousands support early breast-feeding

Agnes Winarti, The Jakarta Post, Jakarta

Thousands of pregnant women gathered Wednesday in the Plenary Hall of the Jakarta Convention Center.

A small group of them sang a rendition of a popular song, replacing the lyrics with: "Aku takut, bayiku tidak diberi ASI. Aku takut, bayiku menjadi anak sapi. Aku takut, bayiku menjadi kurang gizi."

The lyrics roughly translate as, "I'm afraid, if my baby doesn't get breast-fed. I'm afraid, if my baby becomes a calf. I'm afraid, if my baby doesn't get enough nutrition."

During Wednesday's event, about 1,800 pregnant women and midwives from 42 districts in Jakarta's five municipalities and Thousand Islands regency pledged to initiate early breast-feeding right after childbirth.

"There's no better place for a newborn infant than on her mother's bare chest," said pediatrician and chairwoman of the Indonesian Lactation Center, Dr. Utami Roesli.

"Let the baby instinctively crawl by herself and find the mother's nipple, at least within an hour after delivery," explained the doctor, who has campaigned for the past several years for early breast-feeding.

"First-hour breast-feeding can prevent up to 22 percent of newborn deaths," Utami said.

The latest research on early breast-feeding by a team of researchers, led by Karen Edmond of the UK, published in scientific journal Pediatrics in March 2006, shows 22 percent of neonatal deaths of 10,947 breast-fed infants in Ghana could have been prevented had all infants been breast-fed within the first hour.

But early breast-feeding alone is not enough to reduce the infant mortality rate, Utami said. She said it should be followed by six months of exclusive breast-feeding, and then breast-feeding with additional food until the age of 2.

"If mothers took all three steps the mortality rate of children under five in the country could be reduced by up to 41 percent," she said.

In Indonesia, this would mean saving the lives of some 30,000 children each year, while globally, up to one million lives might be saved.

According to a 2005 WHO report, an infant dies every six minutes in Indonesia, while a child under the age of five dies every two-and-a-half minutes.

Farida, a midwife at a public health center, or Puskesmas, in Cipinang Besar Selatan, East Jakarta, said she started introducing early breast-feeding about two or three years ago.

"Most of my patients come from low-economy families. They are enthusiastic about breast-feeding because it can cut the expenses for buying expensive baby formula," said Farida, who has worked as a midwife since 1993.

According to Utami, buying formula can cost Rp 3.3 million per baby per semester.

It is estimated that every six months, more than Rp 18 trillion is spent nationwide for formula milk.

Nasiah, 25, who is 8 months' pregnant, said she originally planned to feed her baby with formula, because she worked long shifts in a factory.

"I've changed my mind. I will breast-feed, although it probably won't be easy since I'm working."

State Minister for Women's Empowerment Meutia Hatta, Jakarta Governor Fauzi Bowo and his wife, Tatik F Bowo, who is an ambassador for the early breast-feeding initiative in Jakarta, were present during Wednesday's ceremony.

"We feed infants processed cow milk for the sake of practicality. We must stop doing that," Fauzi said.

Indonesia reports 98th bird flu death

Jakarta (ANTARA News) - A 30-year-old man has died of bird flu, the health ministry said Thursday, bringing the toll to 98 in the nation worst hit by the H5N1 virus.

"(The) total number of cumulative avian influenza human cases in Indonesia is 120 with 98 deaths," a release from the ministry's bird flu information centre was quoted by AFP as saying.

Indonesian, Chinese firms to ensure antibiotics supply to RI market

Shijiazhuang (ANTARA News) - Two Indonesian pharmaceutical companies and a Chinese counterpart have signed an agreement here to ensure stability in antibiotics` supply and prices for the Indonesian market.

The two Indonesian companies were Kimia Farma and Indofarma, while the Chinese company was CSPC.

Kimia Farma Director M. Sjamsul Arifin, Indofarma President Director P. Sudibyo and CSPC executive Cai Dongchen signed the agreement in Shijiazhuang, Hebei Province, China on Tuesday.

Also present at the signing ceremony were Indonesian Ambassador to China Sudrajat, Deputy Mayor of Shijiazhuang Zhang Fawang and acting economic officer at the Indonesian Embassy in Beijing Iwan S. Amri.

"The cooperation is meant to ensure stability of supply and prices of antibiotics from the Chinese pharmaceutical company. We thus expect there will be no more antibiotics shortages in Indonesia in the next one year," Syamsul said.

He added his company had intentionally signed the agreement early this year as antibiotics production and prices were fluctuating and there was even a lack of supply so it would be risky if the agreement was not signed now.

Through the cooperation with the Chinese company, the two state companies would also be helping the government in its effort to keep supplying medicine to the people at stable prices.

He added the company had actually imported the raw material for the medicine but it was only a common trade, meaning if necessary it would import or buy.

"We will try to tie (the Chinese company) with the agreement on secure supply and price as the raw material for the medicine is badly needed to make generic medicines for low income people," he said.

He added based on the agreement the two state pharmaceutical companies would get the supply with the agreed price even though there was an increase in the market prices.

He added China was elected to supply the raw material as most of the countries, such as Europe and the United States, also import from China to meet their respective demand following the closure of the factory due to the environmental issue.

Sudrajat, meanwhile, said the agreement would be one of the instances of bilateral Indonesia-China cooperation which would be increased in the coming years, not only for buying raw material but also for inviting Chinese companies to cooperate with Indonesian pharmaceutical companies and invest in Indonesia.

IVF program successful: Doctors

The Jakarta Post, Jakarta

Doctors said Monday the success rate of infants born using the in vitro fertilization (IVF) program had increased over the last five years amid ongoing debates over the quality of life of such infants.

"The success rate has increased from 30 percent in the 1980s to 50 percent," gynecologist R. Mucharam said in a talk show organized by the University of Indonesia to observe its 58th anniversary.

He said technological advances, including the invention of more effective drugs for stimulating embryos, had contributed to the rise in the success rate.

The program, first introduced in the 1950s, involves the fertilization of human egg cells outside the body, hormonally controlling the ovulation process, removing the ova (eggs) from the woman's ovaries and allowing sperm to fertilize them in a fluid medium. The successfully fertilized embryo (zygote) is then transferred into the woman's uterus with the intent of to establishing a successful pregnancy.

Individuals can opt to undertake the IVF program when in-body fertilization and/or artificial insemination programs do not result in successful pregnancy. Artificial insemination is the process by which sperm is manually placed into a woman's uterus or cervix by means other than sex.

Gynecologist Indra Nurzam C. Anwar said the success of the IVF program depends on the age of participants.

"Patients under 30 years old have the highest success rate, while those between 38 and 42 have seen the least success," he said.

While technological advances have contributed to more frequent successes, Indra said experts still debated the quality of life of IVF infants, including their life expectancy.

"The first IVF baby in the world, Louis Brown, is less than 30 years old now. No one can predict how long she will survive and so we cannot really tell you whether she is going to live as long as anyone else," he said.

Indonesia began developing its own IVF program in the 1980s and the first baby from the program was born in 1988. Since 1978, there have been some 300,000 babies born globally from the program.

Another gynecologist, Ali Baziad, said besides the survival rate doctors had also debated the intellectual and mental agility of IVF babies.

"Gynecologists across the world have been conducting extensive research into the quality of life of persons born from IVF programs," he said.

"It has been alleged they will face problems in the future because they were not conceived 'naturally'. They are conceived through human intervention."

The gynecologists plan to convene in Italy this March to release their study.(lln)