Study Trip to Makassar, Indonesia: October 6, 2012 to October 11, 2012

During the Public Health Management of Thailand course, we had an opportunity to visit Makassar, Indonesia for a week in order to compare the two country's public health systems.

A couple of weeks following our trip to Indonesia, we were worried about our safety traveling to Jakarta due to the various protests at the US embassy in Indonesia because of the release of an anti-Islamic trailer of the film "Innocence of Muslims" that was produced by Steve Klein in the US. However, we did not encounter any issues and everything was completely safe.

Early Saturday morning (6am to be exact), we all packed the vans with our luggage and left Khon Kaen for Bangkok. We arrived Bangkok in the early afternoon for our 5:10pm flight to Jakarta, Indonesia.

(Side note: Leah and I were a little bit crazy because we woke up at 4:30am in order to fit in an Insanity workout before our departure. We knew that we would not have a chance to work out during our 24-hour travelling adventure and we didn't want to skip a day of our workout routine, so we simply woke up before the birds and roosters were up!)

 Checking in at Bangkok airport! Next time that I will be departing from Bangkok I will be coming back home to Chicago!

Garuda Airlines treat their passengers so well-- personal television screen, great meals, unlimited wine....

 And we're off!!

Take-off is by far the best part of the plane ride... you gain so much speed, get a beautiful view of the landscape and get the little anticipation butterflies in your stomach....


After our arrival to Jakarta at 8:35pm, we transferred over to our flight to Makassar, which was scheduled to depart a little after midnight.

Lithuania has recently (2007 I think) been accepted by Indonesia to allow Lithuanian pass-holders to receive on-site visas at the Jakarta airport. 

I took these pictures while walking through the airport and when you look at them, you can almost get the sensation that you are walking with us through the airport with the background being blurry but the people in focus.

 

Relaxing before our 12:45am flight.

The Jakarta airport had free massage chairs available! It seemed as if we were the only ones at the airport so we completely took over the waiting room area and took full use of those massage chairs!

Going back on the airplane!

Midnight dinner on the plane.

Then, after our almost 24-hour exhausting trip, we finally arrived to Makassar at 4am with the Indonesian students from Hasanuddin University awaiting us with an energetic attitude and big smiles!


After arriving and settling into our hotels around 4am, we all went to sleep since we were all so tired! Later, we all met up at 1pm for breakfast/lunch at the hotel to discuss our plans and goals during our study trip.

Few notes on the hotel:
-no windows in our hotel rooms
-some of our hotel rooms did not have sinks in the bathroom
-our light bulbs turned into a strobe light and was on while we slept and we were unsure of how to turn it off
-keys would change daily and we needed to re-register for our rooms every evening
-restaurant at the hotel has amazing chips which we never found out if they were free or not
-public smoking is welcome (never truly appreciated the smoke-free public environment in the US)

-"Urban Legend" TV channel in the lobby played Lil Wayne, Drake and 2-Chainz music videos with girls in their bikinis dancing while Indonesia is conservative about appearance and sexuality.



At 5pm, we met up with the Indonesian student guides and the Dean of the Faculty of Public Health for dinner.

We were warmly welcomed as visitors to Hasanuddin University by the Dean of Public Health and enjoyed a delicious Indonesian meal.

After dinner, we all came back to the hotels and got a well needed rest.

Monday Schedule

Introduction to the Faculty of Public Health and meet President of Hasanuddin University

Lecture  on the Indonesian Health Care System

Presentation on the Thailand Health Care System

Meeting at the office of the Dean of Faculty of Public Health

Information from the International Relations Office

View from the Office of International Relations

Lunch at an Indonesian Restaurant

The eight of us gave a presentation on the Thailand health care system to the Hasanuddin University's faculty and students

The classroom was unlike anything that I have ever experienced

-students were on their computers watching YouTube videos

-students left throughout the presentation

-students were talking with their friends

-the Dean fell asleep while he was sitting in the front row

-the Dean was talking on his phone (and it was on speaker)

First, we thought that we were not given the proper attention and respect because we are visitors. Then we thought that it was because of the language barrier. Finally, we realized that it is a typical classroom environment because even when the professor of the university presented information on Indonesia's health care system, the students were acting the same way. 

This sort of behavior came as a complete surprise because I assumed that a country as conservative as Indonesia would have better mannerism and respect for speakers. It was incredibly upsetting to present to a group of people that had no interest in anything that you were saying. Perhaps I can't judge the country as a whole and can only implicate my judgement on those that were in the classroom, but I thought it was a complete waste of breath.

Also, one of the most interesting questions that we were asked at the end of our presentation was, "Since there is there free sex in America, aren't there high rates of HIV infection?" Apparently, the students thought that there are high rates of prostitution (and that it is free) in America and that everyone has one-night stands. I think it was helpful to clarify some misconceptions about the student's view of sexual intercourse in America. Media can definitely affect one's perception of one's culture and values.

After the lecture, we all exchanged our currency and it was the first time that I became a millionaire!! Thank goodness for the 1:10,000 exchange ratio between US dollars and rupiah.

Dinner at Pizza Hut! 

It was extremely surprising to as many Pizza Huts as we did. I think they are even more popular in Indonesia than in America.

After dinner (which was around 9 or 10pm), Rachel, Leah and I got in an Insanity workout (but decided soon after that there is not an appropriate amount of space for future workouts). Then, it was time to watch some "Urban Legend" music videos and drift off to sleep and be well rested for the upcoming day.

Tuesday Schedule

Makassar District Health Office

Banta-Bantaeng Health Center

Provincial Health Office

At the District Health Office, we were able to find out the general health condition of Indonesia (through the infant mortality rates, maternal mortality rates, life expectancy, etc.), general programs available to reduce health issues in Indonesia and the overall structure of maternal and child health care.

During the discussion of the Indonesian Public Health Care System, it seemed that they had more idealistic goals without a concrete sense of how to reach those goals through the different programs available to the country's residents. For instance, the 'Basic 6' Program strives for the following:

1. Improve access to public health care
2. Increase prevention and empowerment
3. Decrease infant/maternal mortality rates
4. Improve nutrition
5. Improve health environment
6. Prevent transmission of disease

These goals are fantastic and are important in every single country, but the way these issues were being approached did not seem long-lasting. 

For example, one way to improve nutrition in Indonesia was to provide milk and eggs to children who are undernourished for 100 days. One of my main questions was, "what happens after the 100 days" and "wouldn't the children's nutrition once again decrease once the milk and eggs were no longer provided?" It might be more important to look for a more stable instead of short-term solution.

Also, another goal of the 'Basic 6' Program was to increase the surveillance of diseases in order to prevent the transmission of diseases. However, there was no concrete was to increase surveillance of diseases and the majority of the country is afraid to admit to being infected with HIV/AIDS due to the high social stigma against people infected with STIs. Thus, it is definitely difficult to provide treatment and education regarding high-risk sexual behaviors due to the cultural stigma on those issues.

Banta-Bantaeng Health Center

This primary health center provides general services for all problems, but more severe cases that need more advanced equipment and human resources would be referred to a higher-level hospital. They are able to take care of regular cough/fever symptoms, diarrhea, etc. They also had a separate clinic for HIV patients to provide them with antiretroviral medication and counselling  Further, there was a methadone clinic to provide counselling and rehabilitation for drug addicts. However, since there is not a sterile room so surgery, including C-section, cannot be performed at the Health Center.

Education on condom use and family planning 

Medicines for HIV positive patients

Methadone Clinic at the Health Center

Provincial Health Office

At the Provincial Health Office, we continued to learn more about the Indonesian Public Health Care System, including the structure of the hospitals and insurance schemes.

Later in the evening, we went to a port, Pantai Losari

At the end of an informative day, we were able to spend a relaxing evening near a port and enjoy the sunset.

Wednesday Schedule

Visit Puskesmas (community hospital)

Visit Postyandu (maternal and child care)

Visit Poostu (midwife center)

Introduction of Puskesmas and the health status of the villagers near the community hospital

Availability of beds and resources

The little girl had dengue :(

 

Medications available

The Puskesmas, which was introduced as a community hospital, can provide basic care such as treatment for cough/fever, diarrhea, minor pain, etc and maternal care including labor. However, it was very surprising to not see a defibrillator, an ambulance or other equipment needed to provide care for patients. The hospital could also not manage emergency situations and would need to refer patients to regional hospitals.

View at the Puskesmas

We were surrounded by mountains and it was absolutely breathtaking...

The little green house with the blue roof is the Postyandu 

The Postyandu is open once a month and provides preventative maternal and child care. 

Children can play together

Children receive vitamins, biscuits, milks and eggs

Mothers have individual handbooks where they can learn more information about breastfeeding and can record their children's weight/height measurements

Scale to weigh the babies

One child who was sick at the Postyandu

After visiting the Posyandu, we went to the Pustoo which is a midwife center that specializes in maternal and child care. The Pustoo is staffed with a midwife and a nurse who provide antenatal, labor and post-labor care. The midwife and nurse live next door to the health center, so the center is considered to be open 24-hours a day.

Also, because the center is only equipped with a midwife and a nurse, we expected that the Pustoo would need to make frequent referrals to a larger and a more specialized hospital to handle complications. Despite our initial thoughts, we were told that complications hardly ever occur and no mother and no child has ever died during birthing. Even if there was a complication, the center does not have an ambulance in order to bring the patients to larger hospitals. Further, we asked if there were any cases of miscarriage and they responded as a quick 'no.' However, with our further questioning and continuous translation, they agreed that there have been some cases of miscarriage, especially during the second month of pregnancy.

Baby Scale at the Pustoo

Birthing beds

The Pustoo had a very detailed record system, including the number of pregnant women, infants and school children in the village, in addition to information how many people are sexually active and whether or not they use contraceptives. I wonder which survey method was used to find that second half of the information.

All of the hospitals and health centers that we have visited  thus far can only provide very minimal care, which makes me wonder whether we are truly getting a true view of the health system of Indonesia, or whether Indonesia does not have very highly developed hospitals. There is definitely a very high focus of first-aid/primary care and prevention care regarding maternal and child health.

After our health center visits, we came to the Taman National Park (Bantimurung-Bulusaraung)

Also, when we arrived to the National Park, the Indonesian students started yelling, "Look! The monkey is your brother! He is your brother!" All I said was, "He is more like a long lost cousin." They find it so funny that we believe in evolution.

Vendors at the National Park

Beautiful rock formations 

The National Park had a nice waterfall where people were able to tube down the waterfall's current

 We also got a chance to go into a cave!

Dinner at Pizza Hut again! Since being in Thailand, I have been really craving for pizza! I am not sure if it's because I do not consume as much dairy here since it is not as readily available, but I could eat pizza all the time-- even Pizza Hut pizza is amazing!

Thursday Schedule

Hasanudding University Hospital

Wahiding Hospital

Concluding Session

Visiting Hasanudding University Hospital

The entrance (and the entire hospital) was unreal. 

We walked into the hospital and heard a live pianist playing a beautiful melody on a grand piano. The reception desk was literally a 5-star resort check-in desk. After talking to our tour guides, it was explained to us that they want the patients to feel as if they are walking into a hotel instead of a hospital. This is a very interesting concept and makes sense why medical tourism is increasing in Thailand.

After the initial shock of the beauty and the expense of the building, we walked into a conference room which had leather chairs that were still wrapped in the plastic coverings that they originally came in. Right across the conference room, I noticed a bank branch and ATM machines which seemed to remind us of the high costs associated with getting care at a such prestigious hospital. 

Soon after coming into the conference room, we left to take a tour of the hospital. We first visited the outpatient department and saw different clinics that they have including gynecology, pediatrics, ear and nose, neurology, etc. In the outpatient department, there were no more than 50 seats. For a hospital it's size, it was difficult to understand why the outpatient department was so small. Each clinic was the size of a single dorm room. The clinics were staffed with first year medical students who were not properly trained to treat patients. Even worse, these medical students were not even studying for their medical school courses, but instead they were playing games on the computer and their iPhone's. 

Some of the medications available. 

The pharmacist mentioned that the doctor prefers to prescribe generic medicines instead of the patent medicines as it is cheaper and insurance will cover it with no extra costs to the patient. 

Available clinics in the outpatient department

After being incredibly confused regarding the outpatient department, we very quickly ran through the four floors of the entire hospital. The in-patient department had rooms that were completely separate from each other, were equipped with a single bed, and had access to air conditioning. As we walked through the rest of the hospital, we just saw empty hallways, no patients and no doctors as the hospital is still under construction.

After leaving the A-class hospital that was still under construction, we went to an A-class hospital right across the street that has been functioning for years.

 After the initial introduction of the second A-class hospital, we took a tour of the hospital and it was a complete replica of the A-class hospital that is being built.

The outpatient department

We had a chance to watch a surgery through angiography! 

As we left the public VIP hospital (costing 1 million rupiah per night), we went to the public tertiary care hospital, which was only across the street but the condition and the quality of care was drastically different. The rooms were divided into third, second and first class which differentiated with regards to the number of beds in the rooms (six, four, and two respectively). The beds were not as good quality, rooms did not have fans and the patients were not separated by curtains so infectious diseases could spread easily. It was unbelievable how health care was divided among the rich and the poor.

It upset me so much that the VIP hospital would spend so much money on a grand piano and a live pianist instead of distributing the equipment across all hospitals in Indonesia. It is also completely unnecessary to have an entire 'lobby' empty and be decorated with high-class furniture instead of providing patients and their family a place to be seated. 

Yes, making the hospital look and feel like a hotel might attract western patients and bring money to the hospital, but the unnecessary costs that the hospital expends could provide essential equipment to other hospitals. 

Lunch at a restaurant in the hospital. I had chicken teriyaki with rice and miso soup! It was the best lunch/dinner I had in Indonesia.

After lunch we had our concluding session where we debriefed our Public Health Faculty from Khon Kaen University and the Dean of the faculty of Public Health in Hasanuddin University regarding what we learned throughout the week.

Then, we took our last set of photos with the numerous gift exchanges.

We had our last dinner together as a group, had some great food and great laughs and said our final goodbyes to the students and the faculty.

All in all, it was a great opportunity to visit another Southeast Asian country during the study abroad program and it was incredible to gain a greater understanding of the different health care systems and tour the different hospitals available in the two counties.

After the conclusion of our Makasar, Indonesia study trip, it was time for us to venture off to Bali, Indonesia and enjoy some much needed relax time!