Sufferers Count Costs of Living With the Disease

Sufferers Count Costs of Living With the Disease

Elisabeth Oktofani & Dessy Sagita

Andriana Bintang has gotten used to taking entecavir first thing in the morning when she wakes up. Having been diagnosed with hepatitis B in 2008, the 28-year-old said it was something she simply had to learn to live with.

“Although it is very frustrating having to take medication every morning, I have to do it,” she said. “This is a decision that I made a couple of years ago, as I want to live longer and be healthier.”

Andriana is one of a growing number of Indonesians living with hepatitis B, but one of the few who can afford the medicine to treat the disease.

Tjandra Yoga Aditama, the Health Ministry’s director general for disease control and environmental health, said about 30 million people in the country were infected with some strain of the hepatitis virus. The disease attacks the liver and can progress to organ failure or cancer.

Half of those infected suffer from serious liver problems, he said, with some 1.5 million people at high risk of developing liver cancer.

Indonesia now has the third highest number of hepatitis B and C cases in the world. Only China and India have more.

Worldwide, an estimated 170 million people — one-twelfth of the global population — have either hepatitis B or C, according to World Health Organization figures. Some 1.5 million people die of the infections annually.

One of the major problems is that treatment for the disease is expensive.

Andriana, who began taking medication early in 2009, said she spends Rp 2.2 million ($260) for 30 pills each month.

“My life is not cheap, because I have to spend more than half of my salary on the medication, but I hope that the treatment can be made cheaper soon,” she said.

Tjandra said the government was working to make hepatitis drugs cheaper, but chances of a free hepatitis vaccine for adults remain slim without additional funding.

The vaccine for hepatitis strains A and B — there is no vaccine for type C — requires three shots at a cost of Rp 80,000 a shot.

The Health Ministry has declared that hepatitis poses a serious threat to the nation and, since 2003, has included the hepatitis vaccine on the list of mandatory basic immunizations required for all newborns.

Andriana, who has a 1-year-old son, said she made sure her child was vaccinated soon after he was born.

“When my son was born, I ensured that he got vaccinated in the hospital because I did not want him to get infected as it can never be cured,” she said.

“Other than that, I have to always remember to renew the vaccine once every 10 years because that is the only way to prevent him for getting infected with hepatitis B,” Andriana said.

“Life with hepatitis B is expensive.” 

Govt Urged to Promote Use of IUD Contraceptive

Govt Urged to Promote Use of IUD Contraceptive

Medical experts on Tuesday urged the government to heavily promote the use of intrauterine contraceptive devices as they were best suited for most Indonesians.

Djajadilaga, head of family planning and abortion at the Indonesian Society of Obstetrics and Gynecology (POGI), said that IUDs were one of the most effective forms of birth control available, but were not being promoted heavily enough.

“IUDs have no contra-indications like other forms of birth control, such as the pill or injections,” he said at a discussion on the use of contraception to reduce the nation’s maternal mortality rate.

More women die as a result of childbirth in Indonesia than in any other nation in Southeast Asia. According to the Health Ministry, some 229 women died for every 100,000 births in 2009.

Some medical experts hope that a rise in birth control will reign in the nation’s maternal mortality rate.

According to Unicef statistics, only 57 percent of the nation’s women use contraception.

Todd Callahan, the country director for DKT Indonesia, a nonprofit organization that focuses on family planning and HIV/AIDS prevention, said IUDs had never gained popularity as a form of birth control here because of a lack of promotion.

“The Indonesian government has tended to promote the use of short-term birth control methods such as pills or injections,” he said at the discussion.

IUDs have a failure rate under typical-use conditions of just 0.8 percent. Condoms fail 15 percent of the time, studies have shown.

Djajadilaga said that to raise public awareness about IUDs, doctors would have to explain the benefits to patients.

“It’s very important that a doctor explains all there is to know about IUDs because there are so many different types and everyone has different needs,” he said.

“We also need to counter the myths about the pluses and minuses of IUD use, including the misconception that it causes vaginal bleeding.”

Another benefit of using IUDs, he said, was that couples using it could still conceive anytime after removing the device.

“Unlike with the pill or injections, the use of IUDs will not delay the time to conception,” he said.

Sugiri Syarief, chairman of the National Family Planning Coordinating Board (BKKBN), agreed that IUDs were the ideal form of contraception for Indonesians, not least because of their low price.

“IUDs range in price from Rp 15,000 to Rp 2 million,” he said.

“This it might appear expensive at first, but it works out much cheaper when you consider that it’s for long-term use. The government currently runs a program offering IUDs to the public at a subsidized cost of Rp 15,000.”

The lack of awareness aside, Callahan said the initial expense of buying the device and getting it fitted was one of the factors that may be putting many people off using IUDs.

“But the thing that makes IUDs appear more expensive is the [fee for the] doctor’s service, which is sometimes more expensive than the IUD itself,” Callahan said.

Cancer Foundation Says Thanks to Supporters

Cancer Foundation Says Thanks to Supporters

The Indonesian Cancer Organization marked its 34th anniversary on Sunday by honoring a long list of members and donors, including Lippo Group founder and CEO Mochtar Riady, for their support.

“Without the support of professionals and donors, our programs could not proceed smoothly,” said Karlinah Umar Wirahadikusumah, a board member of the charity, also known as YKI.

“Therefore, YKI is acknowledging the loyalty and dedication of those members and donors who have been actively supporting us either financially or professionally to raise public awareness on cancer,” she said.

The awards, in the form of certificates of appreciation, were awarded to a number of donors and several YKI branches, including those in Jakarta, Yogyakarta, Bali, Papua, South Sulawesi and South Kalimantan.

The award for Mochtar Riady was accepted by Theo L. Sambuaga, Lippo Group president. The Jakarta Globe is affiliated with Lippo Group.

In addition to educating the public about cancer, Karlinah said the foundation also actively helped cancer patients obtain treatment, especially those from poor families.

“Using funding from donors, YKI is trying to help cancer patients from disadvantaged families get treatment,” Karlinah said.“Other than that, we have also built a clinic, Sasana Marsudi Husada, in Lebak Bulus, South Jakarta,” she said.

Mei Ukas, the vice treasurer of YKI, said the clinic only charged patients Rp 30,000 ($3.50) per day to stay there.

“Currently, Sasana Marsudi Husada has 20 rooms for patients. Each patient is charged Rp 30,000 per day and for that they get a place to stay, three meals a day and also milk,” Mei said.

She said on average six to eight patients stayed at the clinic every month, most of whom were in Jakarta to seek treatment at Cipto Mangunkusumo General Hospital in Central Jakarta.

According to the World Health Organization, cancer is a leading cause of death worldwide, accounting for 7.9 millions deaths in 2007. Cancer of the lung, stomach, liver, colon and breast claim the most lives.

“Seeing that breast, liver, lung and stomach are listed as the cause of the most cancer deaths each year, we have prioritized the 10 most dangerous cancers to be part of our public cancer education programs,” Mei said.

“The 10 cancers are cervical breast, liver, lung, skin, colorectal [bowel], nasopharynx, leukemia, malignant trophoblastic and lymphoma malignum,” she said.

Karlinah said, “As cancer is listed as the leading cause of death worldwide, it is very important that we help to improve awareness of it by running campaigns and educating the public.”

YKI was founded by 17 people, including the country’s first vice president, Mohammad Hatta, former Health Minister Gerrit A. Siwabessy and former Jakarta Governor Ali Sadikin, to educate the public about cancer, with particular emphasis on minimizing risks, including through early detection.

Banning Prostitution Not the Way to Reduce AIDS in Indonesia, Minister Says

Banning Prostitution Not the Way to Reduce AIDS in Indonesia, Minister Says

Regional governments need to support a scheme to centralize prostitution in order to better monitor it and push down the number of HIV/AIDS infections in the country, the coordinating minister for people’s welfare, Agung Laksono, said on Monday.

“Some regional governments have pushed through regulations that shut down some of the red-light districts in their districts,” Agung said.

“That is counterproductive because prostitution will only go underground where there are no health guidelines for either the prostitutes or their customers.”

Limiting prostitution to one clearly delineated area would not only help control and monitor the activities but also provide the appropriate health guidance and services, he said.

Nafsiah Mboi, the secretary general of the National AIDS Prevention Commission (KPA), called on regional governments to reassess their regulations on prostitution.

“The idea of shutting down red-light districts is actually very dangerous because there is no control over reproductive health, no condom distribution and also no regular health checks,” Nafsiah said.

She said that the banning of prostitution only pushed it out of sight, with places like ports — of which there are more than 2,000 in Java and Sumatra — and bus terminals becoming centers for the illicit trade.

Gamawan Fauzi, the minister of home affairs, said poverty was the driving force behind prostitution and the rising number of HIV/AIDS case.

Agung called on all political parties and civilian organizations not to politicize the issue of centralizing prostitution or distributing free condoms because they were main keys to combating the spread of the HIV virus in the country.

Unfortunately, he said, there were many who did not support these methods, saying they were “not in accordance with cultural and religious values.”

The official number of people with HIV/AIDS in the country as of December 2010 was 79,979 in 32 provinces, 24,131 of which had full-blown AIDS, Ministry of Health data showed.

The data also showed that the main cause of transmission was unsafe sexual activity among heterosexuals at 52.7 percent, followed by drug injection at 38 percent and homosexual encounters at 3 percent.

Agung said prevention was the only option as there was no cure for the disease.

“Giving away free condoms to those who engage in high-risk sexual activities will help reduce the number of HIV/AIDS cases, as will providing sex education to people in 15 to 24 age bracket,” the minister said.

Agung also honored 10 governors, including Jakarta’s Fauzi Bowo, for their commitment to combating the spread of the disease. The other governors were from Riau Islands, Riau, Bangka-Belitung, Central Java, Yogyakarta, South Kalimantan, South Sulawesi, North Sulawesi and East Nusa Tenggara.

“I hope this award will prompt all provincial leaders to produce the same efforts as those 10 governors,” Agung said, adding the award was based on three criteria — leadership, concern for the HIV/AIDS population and support for the regional AIDS Eradication Commissions.

Jakarta's Suicide Hotline Ringing Off The Hook: Ministry

Jakarta's Suicide Hotline Ringing Off The Hook: Ministry

Jakarta. The Ministry of Health’s suicide hotline has seen a sharp rise in the number of calls since its launch almost three months ago, officials said on Friday.

Dr. Bella Patriajaya, chairwoman of the Suharto Heerjan Mental Health Hospital, said more Jakartans were turning to the crisis center, reached at the hotline number 500-454, for help with their emotional problems.

“[Before], there were only three or four people calling a day,” said Bella, who works at the West Jakarta hospital chosen by the ministry to run the project.

“After the center was [mentioned] in the media in early January, the number of [callers] is now increasingly high,” he said.

Bella said about 50 to 60 calls were now handled by 30 trained counselors at the 24-hour center, launched on World Mental Health Day in October last year.

The ministry created the center to help reduce the number of suicides in the city.

While no official statistics are available to indicate rising suicides, the Jakarta Police reported 81 cases of suicide last year.

Newspapers have recently reported cases of people jumping to their deaths from mall balconies or stepping in front of trains.

Though the majority of callers at the crisis center confessed to wanting to kill themselves, Bella said, the rest experienced depression and other mental disorders.

Most of the callers, he said, were between the ages of 30 and 50, suffering from a variety of problems, from stress to relationship woes.

“It varies, ranging from job loss, like being demoted,” Bella said. “If it’s a teenager, usually the problem is romance troubles with the opposite sex.

“If the person is above 50 years old complaining about love, usually it’s because their children all live in different cities.”

Dr. Irmansyah, chairman of the Health Ministry’s directorate for medical care, said counselors at the center were not expected to solve problems but should listen with a sympathetic ear.

“If necessary, the caller will be advised to seek optimal care in a hospital, or inform them of the nearest mental health services,” Irmansyah said.

He said the ministry was planning to scale up the project and launch crisis hotlines beyond the capital, especially in stressful areas such as big cities.

World Health Organization data from 2001 pegs the country’s suicide rate at 1.6 to 1.8 incidents per 100,000 people. However, Irmansyah said the number could be “much larger.”

“In Jakarta alone, the suicide rate is more than 10 cases per month,” he said

Magelang Scores High, Papua Low In Health Survey

Magelang Scores High, Papua Low In Health Survey

Jakarta. Magelang in Central Java and Pegunungan Bintang in Papua have come out at the top and the bottom, respectively, in a survey ranking health care quality across the country.

The results of the Ministry of Health’s Community Health Development Index (IPKM) survey of 440 districts and municipalities, unveiled over the weekend, measured the quality of health care systems based on 24 criteria.

Trihono, from the Health Ministry’s Research and Development Board, said the indicators included the prevalence of mental disorders, access to clean water, the ratio of doctors to the general population and immunization rates.

He said that the purpose of the ministry’s survey was to help formulate intervention programs specifically tailored to the unique health issues facing each region.

The areas surveyed were given scores between 0 and 1, the latter denoting the highest possible rating.

The latest survey shows that Magelang in Central Java has the best health care quality with a score of 0.709.

Meanwhile, Pegunungan Bintang, in the mountainous range running through the center of Papua, has the worst health care quality with a score of 0.247.

“Of the 20 districts at the bottom of the ranking, 14 are located in eastern Indonesia, mostly in Papua province,” Trihono said.

According to Umar Fahmi Ahmadi, a public health expert from University of Indonesia, one of the main reasons many parts of the nation’s eastern reaches had weak health care systems was geographic inaccessibility.

“In these places, which are surrounded by difficult terrain, more money has to be spent on overhead such as transportation instead of health care systems,” Umar said.

Trihono said the government was planning to provide areas with low scores more intensive assistance, including experts to help them deal with some of the major problems they faced.

Purnawan Junaidi, another public health expert from University of Indonesia, said that a district’s wealth was not necessarily an indication of its health care quality.

“Yogyakarta is one example of a district that is not rich but has a good health care system,” Purnawan said. Yogyakarta’s score, 0.695, puts it in fourth place, just after Salatiga, also in Central Java.

According to Umar, the reason some of the poorer districts had better health care systems was because they did not have high levels of social and economic inequality.

“Let’s take South Jakarta as an example. South Jakarta is in a lower position than Magelang, Bantul or Madiun because it has a high level of inequality and a big gap between the rich and poor,” he said.

Magelang, Yogyakarta and Salatiga, he said, had more homogenous societies with larger middle classes.

Drug Distribution Better Regulated to Fight Fakes

Drug Distribution Better Regulated to Fight Fakes

Jakarta. The national drug administration has announced a new campaign to control the distribution of medicine and stem the circulation of counterfeit drugs.

Lucky S. Slamet, deputy director of the Food and Drug Monitoring Agency (BPOM), said on Monday that of the approximately 7,500 medicines in current circulation in the Indonesian market, counterfeiters were producing copies of up to 20 of the more popular ones.

He said these included “lifestyle medicines” such as Viagra, as well as life-saving drugs such as the antimalarial Fansidar.

“Those products sell very well,” he said. “The counterfeiters make a lot of money, but they overlook the health impact.”

To deal with the issue, he said, the BPOM had set up the National Single Point of Contact, a post within the agency that would be responsible for the national circulation of medicine.

“Besides establishing the SPOC, we’re also campaigning through the media for greater public awareness about counterfeit medicines,” he said.

“We lack the manpower to campaign directly to the public, so we need help from NGOs and the media to run campaigns on how to identify counterfeit medicine. However, it’s possible some people might not be able to make the distinction.”

He added in this case, people should only purchase medicine at authorized places, such as pharmacies or hospitals.

“This is the easiest way to avoid purchasing counterfeit medicine,” Lucky said.

The Indonesian Consumer Protection Foundation (YLKI) says the lost revenue from counterfeit drugs amounts to Rp 2.5 trillion ($280 million) annually.

Tulus Abadi, a YLKI official, said the high cost of patented drugs had provided the opportunity for counterfeiters to flourish with much cheaper knockoffs.

“The government doesn’t provide medicine for free, so when it comes to buying them, most patients opt for the cheaper alternative, which can turn out to be counterfeit,” he said, adding the term “counterfeit” did not necessarily mean a drug had no medicinal properties whatsoever.

“It can be just as potent as the original, albeit imported and distributed illegally,” Tulus said.

Meanwhile, Slamet Budiarto, secretary general of the Indonesian Doctors Association (IDI), accused the government of putting the interests of the legitimate producers above those of consumers in this issue.

He said this was apparent in the Health Ministry’s definition of counterfeit drugs, which makes no mention of harmful ingredients. “It’s fine as long as there aren’t any harmful ingredients in the drugs, but what if there are such ingredients, which can delay the healing process or even cause death?” he said.

He added there was also no official data on deaths caused by the use of counterfeit medicine in the country.

Puspo Sumadi, country manager for US pharmaceutical company Eli Lilly, called for harsher punishment for drug counterfeiters.

“I hope the government changes the laws dealing with drug counterfeiters, because in addition to threatening lives, they also cause losses to the state,” he said.

According to World Health Organization statistics, 10 percent of medicines sold worldwide are fake; while in Indonesia, that figure is closer to 25 percent, as stated in a US Trade Representative report.

The WHO also estimates some 200,000 people die worldwide every year because of the problem.

Indonesia's Geography Holding Back Immunizations: Doctors

Indonesia's Geography Holding Back Immunizations: Doctors

Jakarta. The Health Ministry’s mandatory immunization program for children has been successfully introduced in the majority of provinces, but has yet to take hold in the underdeveloped east of the country, doctors say.

Under the program, all Indonesians must have received 13 different vaccinations before the age of 18, eight of which are available for free at community health centers and general hospitals.

However, health officials meeting in Jakarta at the 2nd National Symposium on Immunization say the program is not reaching enough people in the provinces of Papua, West Papua and West Sulawesi.

“Immunization is very important because it’s an investment in future health,” Dr. Prima Yosephine, an immunization official at the Health Ministry, said during the symposium on Friday.

“Unfortunately, though, we face geographic challenges in implementing the immunization program for all of Indonesia.

“The central government has actually already provided all the vaccines to all 33 provinces across the country, with the provincial administrations expected to manage the distribution down to the district and municipal level,” she said.

“So while we expect the vaccines will be distributed properly, we understand that there are several challenges such as the tough mountainous terrain in West Papua.”

Another obstacle to the success of the program concerns religious belief.

In 2002 and 2005, the Indonesian Council of Ulema (MUI), the country’s highest authority on Islamic affairs, declared that the IPV and OPV polio vaccines were haram , or forbidden under Islam, because they were developed using strains of the virus.

While the MUI’s edicts are not legally binding, they carry substantial weight among the country’s majority Muslim population.

“But even if there are a couple of vaccinations that we’ve declared forbidden, that doesn’t mean we’ve closed our eyes to the importance of human health,” said Saleh Daulay, from the MUI.

“Islam allows its followers to use forbidden substances in emergency situations.”

He added that as long as there were no alternatives to the IPV and OPV vaccines in their current form, then it was allowed for Muslims to be immunized with the existing vaccines.

Of Indonesia’s 237 million people, 30 percent, or 71 million, are under the age of 18 and eligible for immunizations under the Health Ministry’s program.

As of this month, the country has immunized 90 percent of minors against measles.

However, the country is still in the top 10 worldwide for the fewest number of children below the age of 5 who have never been vaccinated for any disease.

“According to the WHO, approximately 1.4 million children under 5 years old die in Indonesia every year from diseases that could have been prevented by immunization, such as measles or tetanus,” said Dr. Toto Wisnu Hendarto, the chairman of the symposium.

“In addition, Unicef also recorded that 30,000 to 340,000 Indonesian children die every year from measles.”

The 13 mandatory vaccinations include DPT (for diphtheria, whooping cough and tetanus); HIB (for haemophilus influenza); PCV (for streptococcal pneumonia); and MMR (for measles, mumps and rubella).