tag:blogger.com,1999:blog-81270352915365532252024-02-18T22:48:40.662-08:00why Public Health (is important) ?what makes people living in one country healthier than others?
better health services and systems, better public health organization.
not just the healthcare workers!Unknownnoreply@blogger.comBlogger13125tag:blogger.com,1999:blog-8127035291536553225.post-31787792492893594942013-11-14T22:50:00.001-08:002013-11-14T22:50:10.525-08:00 .: Memilah sampah :.<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Musim hujan telah tiba, maka banjir pun mulai bermunculan di sejumlah daerah.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Kemarin malam saat menyaksikan tayangan berita di salahsatu stasiun TV lokal, saya merasa miris di saat pemerintah setempat dituntut untuk segera menyelesaikan permasalahan banjir (yang diwariskan semenjak jaman pemerintahan Belanda). <br />Di lain pihak warga yang bermukim di pinggiran kali sungai tanpa merasa bersalah membuang sampah seenaknya, tanpa memikirkan dampak yang ditimbulkan dari sampah yang terbawa aliran sungai.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Sementara dinas setempat mengeruk ratusan kilo sampah dari pintu air untuk mengurangi resiko banjir, ternyata masih banyak orang yang membuang sampah sembarangan di jalan, maupun di pinggir kali, sehingga menyebabkan penyumbatan aliran air.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Jangan salahkan (hanya) pemerintah kalau banjir, selama kita masih membuang sampah sembarangan.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Jadi teringat saat saya tinggal selama setahun lebih di beberapa negara Eropa, dimana banyak hal bisa saya pelajari dari cara mereka mengelola sampah.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Amsterdam contohnya, walaupun berada di bawah permukaan laut tapi kota pusat perekonomian negeri Belanda ini hampir tidak pernah dilanda banjir.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Sistem tata kota-nya memang dibuat sedemikian rupa, dengan banyak kanal dan sistem pemompaan untuk mencegah banjir. Sehingga walaupun curah hujan tinggi hampir sepanjang tahun tapi saya tidak pernah menemui atau mengalami yang namanya kebanjiran.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Di sana juga sangat haram hukumnya membuang sampah sembarangan. Bahkan saat diadakan festival besar atau perayaan dimana banyak orang biasanya minum-minum dan mabuk, mereka masih bisa membuang sampah pada tempatnya. Ini ajaib, artinya kesadaran membuang sampah pada tempatnya begitu melekat di tiap orang.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Sampah juga dipilah karena setiap sampah mendapat perlakuan berbeda. <br /><br />Sampah organik atau sampah basah (sisa makanan, sayuran, buah, dst) harus ditempatkan dalam kantung plastik berwarna khusus. Malahan di beberapa bagian Prancis, setiap rumah memiliki biopori untuk membuang sampah organik/ sisa makanan ini.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Lalu sampah kertas seperti dokumen, surat, kemasan makanan dari karton harus ditempatkan terpisah pada satu kontainer yang khusus untuk sampah kertas.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Sedangkan sampah plastik (bekas minuman/ makanan) juga mendapat tempat sendiri, dan beberapa botol minuman plastik ukuran besar bahkan bisa ditukarkan dengan uang jika kita mengembalikan ke tokonya.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Ada juga kontainer khusus untuk membuang sampah gelas, karena gelas ini harus dihancurkan sehingga tempatnya terpisah.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Memang kesannya ribet karena setiap orang berarti harus memilah sampah yang dihasilkannya.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Apakah semua orang mau menjalankan aturan ini?</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Saya lihat kebanyakan penduduk asli Belanda dan yang sudah lama tinggal sepertinya terbiasa dengan aturan ini, jadi mereka menjalankan tanpa ada masalah. Dan ngobrol-ngobrol dengan ibu kos saya (orang asli Denmark) dia sendiri merasa sudah menjadi kewajiban kalau setiap orang memilah sampah.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Dengan memilah sampah, mereka merasa melakukan sesuatu yang berguna untuk menjaga lingkungan tempat tinggalnya.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Yang tidak ikut aturan ini biasanya adalah teman-teman kuliah yang merupakan pendatang dari negara berkembang contoh, Bangladesh, Pakistan bahkan sesama orang Indonesia sendiri.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Mungkin kita tidak terbiasa diajarkan bahwa sampah yang kita hasilkan adalah tanggung jawab kita. Dengan membuangnya keluar rumah, kita merasa bahwa 'urusan sampah' tersebut beres dan lepas sudah tanggung jawab kita.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Persepsi inilah yang dimiliki kebanyakan orang Indonesia pada umumnya, yang juga menyebabkan masalah sampah tidak akan pernah selesai selama penanganannya selalu diserahkan pada pemerintah.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Sebanyak apapun tempat sampah yang dibeli oleh dinas kebersihan, ataupun sesering apapun sampah dikeruk dari sungai tidak akan menyelesaikan masalah banjir selama mayoritas orang masih membuang sampah sembarangan.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Saya percaya kalau kita ingin perubahan yang baik, harus dimulai dari diri sendiri dahulu.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Oleh karena itu, beginilah sampah diperlakukan di rumah saya.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Sampah sisa makanan sebisa mungkin dikumpulkan di ember terpisah (dan nanti diolah sehingga bisa dipergunakan sebagai pupuk).</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Sedangkan sampah yang berasal dari kulit buah atau sayuran dapat dibuat enzim sampah atau <a href="http://www.sobatbumi.com/solusi/view/182" target="_blank">eco-enzim</a>. Eco-enzim ini berguna sebagai cairan pembersih rumah tangga dan juga ramah lingkungan karena dapat mengurangi banjir akibat tersumbatnya saluran.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Selain sifatnya yang organik, ampas sampah dari <a href="http://www.sobatbumi.com/solusi/view/182" target="_blank">eco-enzim</a> tersebut juga dapat berguna sebagai pupuk.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Botol-botol atau sampah plastik (bekas minuman, shampoo atau sabun) juga biasanya dikumpulkan dan disimpan dalam kantung terpisah untuk diambil pemulung.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Sampah kertas (dokumen, karton, kemasan kertas) biasanya saya kumpulkan juga untuk diserahkan ke tukang loak.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Semenjak pertemuan saya dengan komunitas Sadar Lingkungan (MyDarling: dapat dibaca <a href="http://whyph.blogspot.com/2013/10/re-use-unused-belajar-ilmu-mengelola.html" target="_blank">disini</a>) saya juga mengumpulkan bungkus kopi/ teh instan/minuman instan agar bisa dijadikan bahan baku untuk pembuatan kerajinan tangan (dompet, tas).</span></span><br />
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<tr><td style="text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIzL3ZJxh3VmoawOxyhUumz9TNEEN-1kT5zO_9uDefQ0zuGDc1sejRZRLaeYMc_V-s1tDwc9UAHKwInYOiZyYu1KvngspNrQQZNZ3VearvQrtCtT08jIPIuqKtV7XoCJRqQkHk2Cf_JYkf/s1600/bekaskemasan.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="303" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIzL3ZJxh3VmoawOxyhUumz9TNEEN-1kT5zO_9uDefQ0zuGDc1sejRZRLaeYMc_V-s1tDwc9UAHKwInYOiZyYu1KvngspNrQQZNZ3VearvQrtCtT08jIPIuqKtV7XoCJRqQkHk2Cf_JYkf/s400/bekaskemasan.jpg" width="400" /></a></span></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;">bekas kemasan minuman instan ini bisa diolah lagi jadi kerajinan tangan</span></span></td></tr>
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<tr><td style="text-align: center;"><span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-pKQkIxK3vQLCJxLr0wsNJ2cV7ECqbReOaPQN2hfH4jgY1-15sGovAK11W3QnHsthFyHdii-_QPKuDTfDntZDsAiFemcBhJ-kcwYcE00mAbIr3jQxFTKguI9TaUd_Fc36NzgjalHW8DWZ/s1600/dompet+kecil+teh.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="235" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-pKQkIxK3vQLCJxLr0wsNJ2cV7ECqbReOaPQN2hfH4jgY1-15sGovAK11W3QnHsthFyHdii-_QPKuDTfDntZDsAiFemcBhJ-kcwYcE00mAbIr3jQxFTKguI9TaUd_Fc36NzgjalHW8DWZ/s320/dompet+kecil+teh.jpg" width="320" /></a></span></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;">dompet yang terbuat dari bekas kemasan teh instan</span></span></td></tr>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Setelah lebih jauh berdiskusi dengan teman-teman di komunitas MyDarling dekat TPS Cibangkong, ternyata salahsatu kesulitan yang mereka hadapi adalah kurangnya bahan baku untuk pembuatan kerajinan tangan ini.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Saat ini produk dompet dan tas yang mereka buat dari bekas bungkus kemasan memang sudah diekspor hingga keluar negri dan banyak permintaan juga dari pameran.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Saya jadi mengingat jaman dulu waktu masih kerja kantoran, ada berapa banyak bungkusan kopi/ minuman instan yang terbuang percuma di tempat sampah. Yang mana bila diserahkan ke tangan ibu Sri dan kawan-kawan di Cibangkong maka sampah tersebut bisa diolah menjadi produk yang punya nilai jual dan mendatangkan penghasilan tambahan.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Mungkin pak walikota Ridwan Kamil bisa membantu teman-teman di Cibangkong; setelah hari khusus untuk bersepeda dan berbahasa Sunda, ada baiknya jika dicanangkan juga hari khusus untuk 'Setor Sampah'.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Siapa tau ini bisa jadi salahsatu solusi untuk mencegah banjir dengan mengurangi sampah plastik daripada dibuang begitu saja ....</span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8127035291536553225.post-51200981385744367422013-10-20T08:29:00.000-07:002013-10-20T08:31:41.365-07:00Re-use the unused .: Belajar ilmu mengelola sampah :.<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Ya sekian lama menghilang dan belum sempat update blog ini, akhirnya saya kembali lagi dengan posting tentang mengelola sampah.</span><br />
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Tapi sebelumnya, ada yang ingin saya bagikan sedikit saat-saat dimana saya 'menghilang'.</span><br />
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Sebagian karena kesibukan pekerjaan yang cukup menyita energi dan bulan-bulan terakhir karena kesibukan berlibur, untungnya.</span><br />
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Berlibur ke tempat diluar Indonesia memberi saya kesempatan untuk belajar tentang bagaimana orang luar mengelola hal-hal yang berkaitan dengan kesehatan masyarakat.</span><br />
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Contohnya, saat berada di Prancis selatan, sering saya perhatikan saat iklan makanan cepat saji ditayangkan di televisi- selalu dibawahnya tertera tulisan</span> <span style="font-family: "Trebuchet MS",sans-serif;">"makanan yang dimakan setiap hari harus dalam porsi seimbang, tidak boleh terlalu banyak (jumlahnya), tidak mengkonsumsi banyak gula dan garam"</span>.<br />
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Lalu saat iklan minuman ringan atau makanan instan ditayangkan, ada juga pesan serupa berbunyi, </span><span style="font-family: "Trebuchet MS",sans-serif;"><br />"demi kesehatan, setiap hari harus mengkonsumsi sayuran dan buah dalam porsi cukup.</span>"<br />
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Ini adalah sebuah contoh bahwa pemerintah setempat peduli dengan kesehatan warganya.<br />Bahwa dampak buruk dari sering mengkonsumsi makanan cepat saji tentunya sudah diketahui banyak orang. Dengan adanya peringatan seperti ini (dan diulang-ulang) maka pemirsa diseimbangkan dengan informasi dan pilihan cara hidup yang lebih sehat.</span><br />
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Banyak lagi ilmu tentang kesehatan masyarakat yang didapat dari hasil 'studi banding' tersebut, tapi yang ingin saya bagikan sekarang adalah ilmu yang dari negri sendiri.</span><br />
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Ilmu ini didapat dari sebuah tempat pengelolaan sampah di Cibangkong, suatu daerah tak jauh dari tempat Trans Studio Bandung berdiri.</span><br />
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Hari Sabtu kemarin saya dan seorang teman berkesempatan untuk mengunjungi langsung tempat dimana Masyarakat Sadar Lingkungan (MyDarling), yang di-inisiasi oleh ibu Dewi Kusmiati.</span><br />
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Sayangnya, walaupun sebenarnya saya janjian dengan ibu Dewi tapi saat berada disana ternyata beliau sedang berada di RT lain untuk Sekolah Ibu.</span><br />
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Sekolah Ibu ini juga bagian dari program beliau, dimana ibu-ibu diajarkan cara membuat kerajinan dengan sampah sebagai bahan dasarnya.</span><br />
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Dari mana saya mengenal ibu Dewi Kusmiati?</span><br />
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Saat menyaksikan beliau diwawancara untuk KickAndy di MetroTV.</span><br />
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Kekaguman saya terhadap ibu Dewi, yang hidup dari sampah dan mampu memanfaatkan sehingga mempunyai nilai jual, sehingga memberi penghidupan bagi keluarganya dan sekitarnya.</span><br />
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Walaupun alamat yang diberikan beliau kurang jelas, ternyata mudah saja menemukan tempat pengelolaan sampah. Karena rupanya kinerja beliau sudah dikenal di lingkungan sekitarnya, cukup tanya orang saja pasti ketemu.</span><br />
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Karena ibu Dewi mengajar di Sekolah Ibu pada saat saya berkunjung, maka sebagai gantinya ada ibu Sri- sebagai narasumber tentang membuat kerajinan tangan dari sampah.</span><br />
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Ibu Sri ternyata memang dipercaya oleh ibu Dewi, untuk memegang divisi pembuatan kerajinan tangan berupa dompet, tas dari bekas kemasan. Sedang ibu Dewi sendiri lebih fokus pada pengelolaan sampah organik sebagai bahan pupuk cair.</span><br />
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Menurut pemaparan Ibu Sri, bahan dasar yang dibutuhkan untuk pembuatan kerajinan ini bisa berupa bungkus kopi/teh instan (merk gak usah disebut ya). Bisa didapat dari pemulung, atau minta ke warung, atau office boy kenalan (karena di kantor kan biasanya sering ngopi/ ngeteh).</span><br />
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Tentu saja sebelum dijadikan bahan dasar semua bekas kemasan itu harus dicuci/ dibersihkan dahulu. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQx5DTMqOEueWqY2V0E2bzEcuT-5pbJUCFreM9nOqhGKn6kG3mDGnQL3AvH7vbAiYm7KcpKRL86hL0IfGeM8Vu_Uy-F0eOCKBkmBUYv1ubmLp_jeTDcCmb66okqBZugH-tv9qfVwD76ZWQ/s1600/tas+dompet+yogya.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQx5DTMqOEueWqY2V0E2bzEcuT-5pbJUCFreM9nOqhGKn6kG3mDGnQL3AvH7vbAiYm7KcpKRL86hL0IfGeM8Vu_Uy-F0eOCKBkmBUYv1ubmLp_jeTDcCmb66okqBZugH-tv9qfVwD76ZWQ/s320/tas+dompet+yogya.jpg" width="264" /></a></div>
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Satu dompet kecil saja ternyata bisa membutuhkan 66 buah kemasan kopi/teh instan!</span><br />
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Waktu saya tanyakan berapa lama waktu yang dibutuhkan untuk membuat satu buah dompet, ibu Sri sendiri tidak bisa menjawab. Karena mereka melakukan pekerjaannya bersama-sama, ada satu orang yang melipat, satu orang menjahit, satu orang memasang ritsleting.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjlHdKFXvcCKchxFUuz3_DdRHHQk87XOsAV-ToAmGzrg43-EBCI12hDgvj_3jD_8kkakqRTqPKjwDXYbRz4hd8FQdpyGBR-EqNyzbpNIUPS8SzKP_5PpOOPTt0-QVzBLSmwjv2XTdfB6AnD/s1600/rw11+cibangkong.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjlHdKFXvcCKchxFUuz3_DdRHHQk87XOsAV-ToAmGzrg43-EBCI12hDgvj_3jD_8kkakqRTqPKjwDXYbRz4hd8FQdpyGBR-EqNyzbpNIUPS8SzKP_5PpOOPTt0-QVzBLSmwjv2XTdfB6AnD/s320/rw11+cibangkong.jpg" width="249" /></a></div>
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Hasilnya? Bener-bener rapih dan bagus. Sama sekali tak terlihat seperti sampah lagi pastinya.</span><br />
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Dan saya pun membeli satu dompet yang kecil (untuk tempat uang receh). <br />Memilih dompet ini proses yang agak sulit karena semua motifnya terlihat menarik, tapi akhirnya pilihan saya jatuh pada dompet yang berbahan dasar bekas kemasan teh tarik [gambar di bawah].</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-pKQkIxK3vQLCJxLr0wsNJ2cV7ECqbReOaPQN2hfH4jgY1-15sGovAK11W3QnHsthFyHdii-_QPKuDTfDntZDsAiFemcBhJ-kcwYcE00mAbIr3jQxFTKguI9TaUd_Fc36NzgjalHW8DWZ/s1600/dompet+kecil+teh.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="146" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-pKQkIxK3vQLCJxLr0wsNJ2cV7ECqbReOaPQN2hfH4jgY1-15sGovAK11W3QnHsthFyHdii-_QPKuDTfDntZDsAiFemcBhJ-kcwYcE00mAbIr3jQxFTKguI9TaUd_Fc36NzgjalHW8DWZ/s200/dompet+kecil+teh.jpg" width="200" /></a></div>
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Selain dari bekas bungkus minuman instan, ibu Sri juga menunjukkan sebuah dompet yang terbuat dari bekas plastik yang sering dikasih toko Y*ogya.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfTdUuvY2AG72YmpiS0rRyROrjHeuWa3BxNXAUdIm8jio822nHB0OjYKZDSEr_eAUNkK1CsM3-A0ubH4UAD0DHhOLWtXdiRsxPtiVlBaQdOXy2neZkkEvTMayPou5h4hVcv2jTZbrwOOHF/s1600/dompet+yogya.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfTdUuvY2AG72YmpiS0rRyROrjHeuWa3BxNXAUdIm8jio822nHB0OjYKZDSEr_eAUNkK1CsM3-A0ubH4UAD0DHhOLWtXdiRsxPtiVlBaQdOXy2neZkkEvTMayPou5h4hVcv2jTZbrwOOHF/s200/dompet+yogya.jpg" width="196" /></a></div>
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Bahan dasar plastik seperti ini proses pembuatannya lebih sulit, makan waktu lebih lama, sehingga harganya juga lebih mahal. Tapi keuntungan dari beli dompet ini tentunya sih<i> waterproof/ </i>tahan air.</span><br />
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<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Selain menimba ilmu, saat berkunjung ini juga saya berbagi ilmu (dan dua buah botol) enzim buah dari bekas kulit buah untuk ibu Sri dan ibu-ibu lainnya.</span><br />
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Walaupun tampang ibu-ibu ini 'ndeso' tapi mereka sudah mengerti tentang konsep organik dan langsung antusias untuk membuat enzim buah/ <i>eco-enzyme</i> sendiri saat saya jelaskan apa kegunaannya.</span><br />
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Berikut link tentang penjelasan lebih jauh apa itu enzim buah/ eco-enzim buat yang mau bikin sendiri di rumah : )</span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://www.facebook.com/klubvegetarian/posts/378731538817074" target="_blank">https://www.facebook.com/klubvegetarian/posts/378731538817074</a><br /><br /><a href="http://www.sobatbumi.com/solusi/view/182">http://www.sobatbumi.com/solusi/view/182</a><br /><br /><a href="http://suprememastertv.com/ina/services_subt.php?bo_table=pe_ina&wr_id=123&subt_cont=&show=aw&flag_s=">http://suprememastertv.com/ina/services_subt.php?bo_table=pe_ina&wr_id=123&subt_cont=&show=aw&flag_s=</a></span><br />
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<blockquote class="tr_bq">
<span style="color: #660000;"><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Berkontribusi bagi bumi yang lebih baik itu sebenarnya mudah, asal kita mau sedikit 'berusaha'.</span></span><br />
<span style="color: #660000;"><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Mulailah dari diri sendiri untuk sebuah perubahan, dari hal yang paling sederhana, dan mulai dari sekarang.</span></span></blockquote>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8127035291536553225.post-56172745280199441982012-03-19T06:16:00.001-07:002012-03-22T11:13:46.066-07:00Bandung (Indonesia) kapan bebas asap rokok?<span style="font-family: verdana;">Baru saja minggu kemarin saya menghadiri sebuah acara publik bertemakan kuliner di kota tempat kelahiran saya ini. Ya Bandung memang gudangnya pecinta makanan dan inovasi yang bertemakan kuliner . . . . jadi wajar sih kalau disini banyak menerima kunjungan dari warga luar kota setiap akhir pekan.</span><br />
<span style="font-family: verdana;"><br />
Konsep acara yang diselenggarakan setahun sekali ini cukup bagus, karena selain mengundang vendor produk makanan, juga ada acara band, art performance, juga tenant fashion dan desain produknya okay.</span><br />
<span style="font-family: verdana;"><br />
Selama berada disana, memang penyelenggaraannya terkesan profesional sekali.<br />
Di pintu masuk bisa dilihat ambulans dan pemadam kebakaran yang berjaga-jaga.</span><br />
<span style="font-family: verdana;">Juga ada cooking live performance dan juga suguhan atraksi bertemakan kuliner yang menarik selain pilihan makanan yang beragam.</span><br />
<br />
<span style="font-family: verdana;">Sayangnya, sebentar saja bolak balik di tempat itu mata saya mulai terasa perih.</span><br />
<span style="font-family: verdana;">Yah memang ada beberapa orang yang mondar-mandir di ruangan terbuka itu sambil merokok.</span><br />
<span style="font-family: verdana;">Tidak banyak sih, hanya beberapa oknum saja tapi merata di semua penjuru.</span><br />
<span style="font-family: verdana;">Karena tersebar di setiap titik itulah hampir-hampir tidak ada daerah yang bebas asap rokok.</span><br />
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<div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhob2wY9I2cWPZ3Ic8QQY7FzC4PxmdYQnNMiexmS7tkIulyfQ5CabBDCwgumu5J4TQYoYOsn6qqpehiDZdkzH8BN9ZH5ig72TlQqjP7aXDovwdZKaJrY1-vnNJWNutxUU8LigMn_Vjyt_Eo/s1600/ph_smoker1.jpg"><img alt="bw pacar" border="0" id="BLOGGER_PHOTO_ID_5715304947759841042" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhob2wY9I2cWPZ3Ic8QQY7FzC4PxmdYQnNMiexmS7tkIulyfQ5CabBDCwgumu5J4TQYoYOsn6qqpehiDZdkzH8BN9ZH5ig72TlQqjP7aXDovwdZKaJrY1-vnNJWNutxUU8LigMn_Vjyt_Eo/s400/ph_smoker1.jpg" style="cursor: pointer; display: block; height: 256px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><span style="font-family: times new roman;"><span style="font-size: 85%;">ngerokok sambil gandeng pacar . . .<span style="font-style: italic;"> that is so uncool </span>!</span><br />
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<div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5Qfx9vsWL3mwRtxguwbUvscdJq3sSzuVx1Ag9XF8Lp7x89TvqHqw8lEs0k_NYlFhyphenhyphen23MMcCFp4_4P7FKIT9p9Nj6kxET6FliiEm818vDzDN5qzFhGGX71b8ySSHuRdI3GN5aDtb1kpy0J/s1600/ph_smoker2.jpg"><img alt="bw anak" border="0" id="BLOGGER_PHOTO_ID_5715305836952844802" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5Qfx9vsWL3mwRtxguwbUvscdJq3sSzuVx1Ag9XF8Lp7x89TvqHqw8lEs0k_NYlFhyphenhyphen23MMcCFp4_4P7FKIT9p9Nj6kxET6FliiEm818vDzDN5qzFhGGX71b8ySSHuRdI3GN5aDtb1kpy0J/s400/ph_smoker2.jpg" style="cursor: pointer; display: block; height: 245px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><span style="font-size: 85%;"><span style="color: #cc0000;">::</span> ngerokok sambil bawa anak <span style="color: #cc0000;">::</span><br />
membiasakan dari kecil kena asap rokok ya nak</span></div><br />
<span style="font-family: verdana;"><br />
Apakah karena acara ini diadakan di ruangan terbuka maka setiap orang merasa bebas untuk merokok?</span><br />
<span style="font-family: verdana;">Memangnya larangan untuk merokok itu hanya kalau berada di ruangan memakai AC saja?</span><br />
<br />
<span style="font-family: verdana;">Belakangan saya ketahui dari panitia penyelenggara acara bahwa mereka sesungguhnya sudah menyediakan smoking corner atau sudut merokok khusus supaya para perokok tidak menyebarkan asap kemana-mana.</span><br />
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<span style="font-family: verdana;">Sayang sekali, padahal rasanya saya ingin tinggal lebih lama, tapi mata sudah tidak kuat terekspos asap rokok. Juga ibu saya sudah mulai sesak nafas dan kesal kena asap rokok dari orang-orang sekitar.</span><br />
<br />
<span style="font-family: verdana;">Baru hari ini juga saya membaca posting dari Aliansi Bandung Bebas Asap Rokok membahas soal permasalahan yang sama.</span><br />
<a href="http://akbbbar.wordpress.com/2012/02/16/mall-berkonsep-ruang-terbuka-surganya-perokok/" style="color: red;">baca: Mall berkonsep ruang terbuka</a>.<br />
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<span style="font-family: verdana;">Saya menyadari sesungguhnya banyak orang (terutama yang tidak merokok atau sudah berhenti merokok) selain saya sendiri yang sesungguhnya merasa terganggu dengan adanya asap rokok.</span><br />
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<span style="font-family: verdana;">Tapi kenapa sepertinya kita tidak mempunyai hak untuk mengutarakan bahwa kita ingin udara bersih dan bukannya udara yang terkontaminasi asap rokok?</span><br />
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<span style="font-family: verdana;">Kenapa orang-orang yang tidak merokok cenderung untuk bertoleransi kepada mereka yang merokok tapi tidak sebaliknya?</span><br />
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<span style="font-family: verdana;">Dikatakan dalam <a href="http://www.voanews.com/indonesian/news/Lebih-43-Juta-Anak-di-Indonesia-Terpapar-Asap-Rokok-143092006.html" target="_blank"><span style="font-family: "Trebuchet MS",sans-serif;">blog VOA</span></a> bertajuk '</span>Lebih 43 Juta Anak di Indonesia Terpapar Asap Rokok'<span style="font-family: verdana;"> tgl 18 Maret bahwa Indonesia mengkonsumsi 220 miliar batang rokok per tahun (<b><span style="color: red;">!</span></b>) sebagai konsumen terbesar no 3 di dunia setelah Cina dan India (yang juga jumlah penduduk terbanyak di bumi ini).</span><br />
<span style="font-family: verdana;">Akibatnya, tanpa bisa memilih ada <u><span style="color: red;">lebih dari 43 juta anak</span></u> di Indonesia hidup bersama perokok dan terpapar asap rokok yang berbahaya, yang juga sumber penyakit saluran pernafasan pada anak. </span><br />
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<span style="font-family: verdana;">Bayangkan berapa besar keuntungan yang diraup perusahaan produsen rokok di Indonesia dari volume penjualan yang sedemikian besar.</span><br />
<span style="font-family: verdana;">Di lain pihak, bayangkan berapa besar kerugian/ biaya kesehatan yang dikeluarkan sebuah keluarga, masyarakat, dan pemerintah untuk menanggung penyakit saluran pernafasan </span><span style="font-family: verdana;"> yang diakibatkan oleh zat berbahaya dalam rokok </span><span style="font-family: verdana;">atau <i>smoking-related diseases</i> lainnya.</span><br />
<br />
<span style="font-family: verdana;">D</span><span style="font-family: verdana;">i beberapa negara maju begitu ketatnya peraturan ditegakkan pemerintah untuk para perokok.</span><br />
<br />
<span style="font-family: verdana;">Sebagai contoh, harga 1 bungkus rokok di kawasan negara Uni Eropa bisa berkisar sekitar 5 Euro (~ 60 ribu rupiah kalau dikonversi) dan tidak bisa dibeli eceran per batang tentunya.</span><br />
<span style="font-family: verdana;">Karena harga rokok yang mahal, banyak mahasiswa Indonesia yang tadinya perokok berat jadi mengurangi frekuensinya bahkan berhenti merokok selama berada di Eropa.</span><br />
<span style="font-family: verdana;">Aturan untuk membeli rokok juga ketat, hanya bisa dibeli di toko tertentu dan ada larangan usia minimum yang diijinkan.</span><br />
<span style="font-family: verdana;">Penjual rokok yang menjual rokok kepada anak di bawah umur tentunya bisa kena sanksi juga.</span><br />
<br />
<span style="font-family: verdana;">Selain itu fasilitas umum yang harus bebas asap rokok (contohnya sekolah, rumah sakit, dst) juga tersedia pojok khusus dimana para perokok hanya boleh merokok disitu.</span><br />
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<span style="font-family: verdana;">Di negara maju juga dilarang untuk mondar-mandir di jalan umum sambil merokok misalnya. Dan dendanya mahal kalau kita melanggar aturan tsb!</span><br />
<br />
<span style="font-family: verdana;">Bahkan kalau kita menonton serial TV yang berasal dari USA, tidak boleh ada tayangan orang dewasa merokok!</span><br />
<span style="font-family: verdana;">Kalau ada pun, biasanya gambar rokoknya disamarkan (tidak boleh terlihat jelas). <a href="http://www.voanews.com/indonesian/news/Lebih-43-Juta-Anak-di-Indonesia-Terpapar-Asap-Rokok-143092006.html" target="_blank">Laporan VOA</a> juga menyebutkan bahkan di televisi tayangan iklan rokok sudah dilarang. </span><br />
<span style="font-family: verdana;">Iklan rokok di ruang publik (<i>billboard</i>/ papan pengumuman) sangat dibatasi dalam segi ukuran, maupun konten- tidak seperti di Indonesia dapat kita lihat <i>billboard</i> berukuran besar biasanya dipenuhi oleh iklan rokok sepanjang jalan.</span><br />
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<span style="font-family: verdana;">Ini menunjukkan seberapa kuat komitmen pemerintah di Amerika dan negara maju lainnya membuat aturan tentang rokok supaya rakyatnya tetap sehat.</span><br />
<br />
<span style="font-family: verdana;">Kenapa sih pemerintah di negara maju bisa menegakkan aturan seperti itu sedangkan di Indonesia tidak bisa?</span><br />
<br />
<span style="font-family: verdana;">Salahsatu jawabannya tentu terletak pada sistem pembiayaan kesehatan yang berbeda.</span><br />
<br />
<span style="font-family: verdana;">Di negara maju, setiap orang diharuskan mempunyai asuransi kesehatan.</span><br />
<span style="font-family: verdana;">Entah asuransi itu dipotong dari pajak pendapatan, sistem subsidi silang, atau sumber pembayaran premi (dari pihak swasta).</span><br />
<br />
<span style="font-family: verdana;">Pooling dana pembiayaan untuk kesehatan itu yang nantinya akan dialokasikan untuk kesehatan. Apakah nanti akan masuk ke program promosi kesehatan, atau prevensi, atau kuratif dan seterusnya.</span><br />
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<span style="font-family: verdana;">Tentunya semua orang sebenarnya mengetahui dampak buruk dari merokok (ini diketahui oleh pemerintah negara maju maupun pemerintah Indonesia) yaitu gangguan pernafasan dan jantung, stroke/ pecah pembuluh darah di otak, impotensi/ gangguan ereksi, kematian dini pada bayi (jika ibu hamil merokok) dan sebagainya.</span><br />
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<span style="font-family: verdana;">Nikotin juga merupakan racun yang bersifat additif (menyebabkan ketergantungan) tapi pasal ini hilang dari UU tentang rokok karena dicurigai ada 'money politic' di belakangnya.</span><br />
<span style="font-family: verdana;">Maklum lah, apa sih yang gak bisa dibeli di negeri kita ini.</span><br />
<br />
<span style="font-family: verdana;">Kembali ke soal sistem pembiayaan negara maju, kenapa mereka lebih peduli mengatur UU dan pelaksanaan soal rokok merokok ini.</span><br />
<span style="font-family: verdana;">Soalnya, dalam jangka panjang, jika banyak perokok aktif yang seenaknya merokok dan juga perokok pasif terkena dampaknya, maka pemerintah harus mengeluarkan biaya yang sangat banyak untuk mengobati (kuratif) mereka-mereka yang terkena penyakit diakibatkan karena rokok (smoking-related diseases).</span><br />
<br />
<span style="font-family: verdana;">Dan ini bukan biaya yang sedikit, karena biasanya kalau sudah terkena penyakit gangguan pernafasan, penyakit jantung koroner, stroke ini membutuhkan penanganan dan terapi yang sifatnya tahunan (kronis) bukan hanya sekedar disuntik antibiotik langsung sembuh.</span><br />
<br />
<span style="font-family: verdana;">Akibatnya, pemerintah negara maju akhirnya memutuskan :</span><br />
<span style="font-family: verdana;">' Daripada kita keluar duit banyak nantinya gara-gara orang banyak yang sakit daripada rokok, mendingan kita bikin aturan/ program pencegahan aja supaya nanti orang gak banyak yang sakit.'</span><br />
<br />
<span style="font-family: verdana;">Jadi, untuk pemerintah di negara maju, mending keluar budget untuk promosi dan preventif (dalam hal ini aturan merokok) daripada keluar lebih banyak nantinya.</span><br />
<br />
<span style="font-family: verdana;"><span style="font-style: italic;">And it is a smart decision</span>.</span><br />
<br />
<span style="font-family: verdana;">Kalau di Indonesia bagaimana?</span><br />
<br />
<span style="font-family: verdana;">Di Indonesia memang sulit diterapkan karena :</span><br />
<br />
<span style="font-family: verdana;"><span style="color: #660000;">1. Sistem pembiayaan kita tidak ditanggung oleh pemerintah</span>, sebagian besar pembiayaan kesehatan berasal dari out of pocket payment (alias dibayar dari kantung sendiri).</span><br />
<span style="font-family: verdana;">Oleh karena itu, kalau pemerintah mau bikin aturan dilarang merokok, paling bagus dimulai dari lingkungan pemerintahan.</span><br />
<br />
<span style="font-family: verdana;">Contoh: PNS dilarang untuk merokok!</span><br />
<span style="font-family: verdana;">Karena kalau PNS sakit gara-gara rokok nanti kan ditanggung Askes (negara) jadi klop lah konsepnya dengan sistem di negara maju.</span><br />
<br />
<span style="font-family: verdana;">Saran lainnya dibuat aturan: Orang yang miskin dan tidak punya asuransi kesehatan tidak boleh merokok. Soalnya nanti kalau mereka sakit kronis tentunya akan mengeluarkan duit lebih banyak untuk berobat dan akan semakin miskin kalau tidak punya asuransi kesehatan.</span><br />
<span style="font-family: verdana;">Pemikiran yang masuk akal juga kan?</span><br />
<br />
<span style="font-family: verdana;">Selain itu yang tidak boleh merokok adalah tentunya anak yang dibawah umur 21 tahun, yang tidak punya informasi bahwa merokok itu berbahaya dan punya zat additif, dan mereka yang nantinya tidak dapat menanggung dampak negatif asap rokok terhadap kesehatan (contoh orang yang punya asma, punya gangguan kesehatan sebelumnya).</span><br />
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<span style="font-family: verdana;"><span style="color: #660000;">2. Indonesia termasuk penghasil tembakau terbesar</span> di dunia.</span><br />
<span style="font-family: verdana;">Tentunya banyak pihak-pihak yang merasa dirugikan kalau industri rokok banyak aturannya.</span><br />
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<span style="font-family: verdana;">Salahsatu orang terkaya di Indonesia (dari 5 besar orang terkaya) adalah pemilik pabrik rokok!</span><br />
<span style="font-family: verdana;">Ini sangat ironis mengingat industri ini dijalankan oleh orang-orang yang penghasilan minimum-nya hanya cukup untuk biaya hidup sehari-hari, belum tentu juga mereka punya asuransi kesehatan kalau sakit.</span><br />
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<span style="font-family: verdana;">Orang-orang yang bekerja di industri produksi rokok biasanya juga dapet jatah rokok gratis.</span><br />
<span style="font-family: verdana;">Ini saya ketahui karena kakek saya dulu juga pernah bekerja di industri ini dan selalu dapet jatah rokok gratis (beberapa pak) yang akhirnya kita bagi-bagikan ke tukang sampah, pegawai yang kerja dst.</span><br />
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<span style="font-family: verdana;">Tentunya bagi-bagi rokok gratis ini penting untuk menimbulkan ketergantungan.</span><br />
<br />
<span style="font-family: verdana;">Siapa sih yang gak mau nyoba kalau gratis?</span><br />
<br />
<span style="font-family: verdana;">Itu juga sebabnya kalau ada event yang disponsorin oleh perusahaan rokok selalu ada acara bagi-bagi rokok gratis.</span><br />
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<span style="font-family: verdana;">Semua orang pasti pengen lah kalau gratis mah!</span><br />
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<span style="font-family: verdana;"><span style="color: #660000;">3. Banyak juga yang diuntungkan kalau banyak orang sakit</span> (di Indonesia)</span><br />
<br />
<span style="font-family: verdana;">Berkaitan dengan sistem pembiayaan tadi yang sudah saya uraikan...</span><br />
<span style="font-family: verdana;">nah, nanti kalau ada orang sakit kan orang akan selalu pergi ke dokter, atau ke layanan kesehatan.</span><br />
<br />
<span style="font-family: verdana;">Tentunya kalau banyak orang yang sakit akan mendatangkan pemasukan juga bagi industri kesehatan kuratif.</span><br />
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<span style="font-family: verdana;">Jadi, selama industri kesehatan masih berorientasi pada kuratif dan bukan promosi atau preventif, semestinya akan sangat diuntungkan kalau banyak orang yang sakit.</span><br />
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<span style="font-family: verdana;">Apalagi ini sakit kronis yang membutuhkan perawatan jangka panjang terus menerus. Artinya pasien akan datang beberapa kali, dengan waktu beberapa lama, dan artinya sama dengan pemasukan bagi pihak penyedia layanan kesehatan.</span><br />
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<span style="font-family: verdana;">Artinya, <u>penyedia layanan kesehatan juga harus diberi insentif kalau punya program yang berorientasi pada promosi dan prevensi</u>.</span><br />
<span style="font-family: verdana;">Ini hal yang sering dilupakan, sehingga akhirnya program promosi dan prevensi kesehatan sering diambil alih oleh pihak LSM misalnya, atau aliansi berbasis komunitas dan bukan praktisi kesehatan itu sendiri.</span><br />
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<span style="font-family: verdana;"></span><span style="font-family: verdana;">Muncul sedikit titik cerah, menurut blog VoA - </span>Menkes Endang Rahayu Sedyaningsih <span style="font-family: verdana;">menyatakan bahwa pemerintah akan mengatur tentang pengendalian tembakau, dimana nikotin yang terkandung didalamnya akan dianggap zat addiktif (=dapat menimbulkan ketergantungan) sama seperti alkohol dan zat psikotropika lain.</span><br />
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<span style="font-family: verdana;">Kalau pasal dan pengaturan pengendalian tembakau ini sudah final, mudah-mudahan kita akan melihat nanti di masa depan: bahwa ruang publik adalah sebuah ruangan yang bebas asap rokok, dapat dinikmati oleh semua orang tanpa takut terkena infeksi saluran nafas.</span><br />
<span style="font-family: verdana;">Dan anak-anak kecil boleh menghirup udara segar, tidak dicekoki oleh kepulan asap orangtuanya.</span><br />
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<span style="font-family: verdana;">Konser Lady Gaga aja katanya sudah dinyatakan haram, tinggal kita lihat saja apakah pemerintah juga berani bersikap serupa pada rokok. </span><span style="font-family: verdana;"> </span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8127035291536553225.post-60510275378350135332011-12-23T20:39:00.000-08:002011-12-25T13:21:23.073-08:00Ide untuk Indonesia<span style="font-family:arial;">Punya ide untuk Indonesia?</span><br /><br /><span style="font-family:arial;">Ikutan '+' Project aja dari Philips!</span><br /><br /><span style="font-family:arial;">Ide saya untuk Indonesia adalah untuk meningkatkan akses layanan kesehatan,</span><br /><span style="font-family:arial;">judulnya '</span><a style="font-family: verdana;" href="http://www2.yourhealthandwellbeing.asia/indonesia/submitted-ideas/tabungan-ibu-solusi-alternatif-untuk-pembiayaan-layanan-kesehatan">Tabungan Ibu</a><span style="font-family:arial;">'.</span><br /><br /><span style="font-family:arial;">Kenapa Ibu?</span><br /><br /><span style="font-family:arial;">Wanita dan khususnya seorang Ibu, sangat menarik perhatian dan juga kepedulian saya sebagai praktisi di bidang kesehatan.</span><br /><br /><span style="font-family:arial;">Angka kematian Ibu di Indonesia (sebagai salahsatu indikator kesehatan) merupakan yang tertinggi di Asia Tenggara.</span><br /><span style="font-family:arial;">Sayangnya, angka kematian Ibu yang tinggi ini bukan gara-gara kita (Indonesia) gak punya tenaga dokter/bidan yang handal.</span><br /><span style="font-family:arial;">Dokter/tenaga kesehatan kita tidak kalah pintar dan handal dibanding tenaga kesehatan di negara maju, dalam hal menangani pasien. Tapi teteup aja angka kematian Ibu kita tinggi walaupun makin banyak orang masuk sekolah dokter/bidan.<br /><br />Rasio tenaga kesehatan yang tidak berimbang dibanding jumlah pasien yang harus dilayani dan distribusi sebagian besar tenaga kesehatan yang tidak merata (perkotaan > pedesaan) menyebabkan beratnya beban kerja para tenaga kesehatan di Indonesia.<br /></span><br /><span style="font-family:arial;">Salahsatu penyebab lainnya, menurut pengamatan saya adalah karena sistem pembiayaan di Indonesia.</span><br /><span style="font-family:arial;">Saat ini sistem pembiayaan di Indonesia sebagian besar (60-80%) masih dibebankan pada pasien </span><span style="font-style: italic;font-family:arial;" >(user fees/ out-of pocket payment</span><span style="font-family:arial;">).</span><br /><span style="font-family:arial;">Ini berbeda dengan sistem pembiayaan di negara-negara yang lebih maju dimana hampir semua orang d</span><span style="font-style: italic;font-family:arial;" >icover</span><span style="font-family:arial;"> oleh asuransi kesehatan (</span><span style="font-style: italic;font-family:arial;" >universal coverag</span><span style="font-family:arial;">e).</span><br /><br /><span style="font-family:arial;">Dampaknya tentu saja sangat jauh berbeda.</span><br /><span style="font-family:arial;">Pengalaman saya sewaktu sekolah di Belanda/Denmark (yang menerapkan sistem</span><span style="font-style: italic;font-family:arial;" > universal coverage</span><span style="font-family:arial;">) ketika jatuh sakit, saya gak usah mikir-mikir dapet duit dari mana kalau mau berobat ke dokter.</span><br /><span style="font-family:arial;">Karena toh dengan adanya asuransi kesehatan, bisa dibilang saat berobat ke dokter jadi gratis.</span><br /><span style="font-family:arial;">Obat masi harus dibeli sih, tapi kan lumayan kalau layanan kesehatan sudah ditanggung negara.</span><br /><br /><span style="font-family:arial;">Berbeda dengan pengalaman sewaktu di Indonesia, ketika saya sakit mata dan harus dilakukan operasi kecil- saya harus keluar duit dari kantung sendiri karena asuransi dari kantor sudah habis masa berlakunya.</span><br /><span style="font-family:arial;">Masih mending saya punya uang untuk biaya berobat, dan juga kalau diobati sama kolega suka dapet harga 'diskon'.</span><br /><br /><span style="font-family:arial;">Tapi gimana dengan mereka-mereka yang gak mampu?</span><br /><br /><span style="font-family:arial;">Orang dari kalangan ekonomi lemah umumnya menghindari ke praktek dokter, bukan karena mereka gak percaya dokter, tapi karena ke dokter identik dengan mahal!</span><br /><span style="font-family:arial;">Makanya bisa dibilang pengobatan alternatif (contohnya dukun) sangat 'menjamur' dan diterima di Indonesia, karena itulah solusi layanan kesehatan buat mereka yang gak mampu pergi berobat ke dokter.</span><br /><br /><span style="font-family:arial;">Solusi yang saya tawarkan disebut </span><a style="font-family: arial;" href="http://www2.yourhealthandwellbeing.asia/indonesia/submitted-ideas/tabungan-ibu-solusi-alternatif-untuk-pembiayaan-layanan-kesehatan">Tabungan Ibu</a><span style="font-family:arial;">, karena memang khusus untuk wanita atau Ibu yang telah mempunyai anak.</span><br /><br /><span style="font-family:arial;">Kalau seorang Ayah, punya uang lebih, biasanya akan dia habiskan untuk beli rokok, atau sesuatu yang sifatnya menyenangkan kepentingan pribadi.</span><br /><span style="font-family:arial;">Kalau seorang Ibu, punya uang lebih, biasanya akan dia habiskan untuk kepentingan keluarga/ anak-anaknya. Seorang Ibu secara alamiah memang punya sifat/ jiwa yang rela berkorban.</span><br /><br /><span style="font-family:arial;">Oleh karena itu, dengan adanya tabungan Ibu, saya harapkan akan lebih banyak kaum ibu dan anak-anak yang bisa mendapat akses layanan kesehatan.</span><br /><span style="font-family:arial;">Ini bukan sesuatu yang mustahil, di Indonesia yang jumlahnya 236 juta penduduk ini, kita punya potensi yang besar untuk sebuah perubahan.</span><br /><br /><span style="font-family:arial;">Silakan baca tentang ide saya, dan vote untuk mendukung perbaikan akses kesehatan bagi mereka yang tidak mampu</span> <span style="font-family:arial;">^^</span><br /><a style="font-family: arial;" href="http://www2.yourhealthandwellbeing.asia/indonesia/submitted-ideas/tabungan-ibu-solusi-alternatif-untuk-pembiayaan-layanan-kesehatan"><br /><span style="font-family:verdana;">Tabungan Ibu: Solusi alternatif untuk pembiayaan kesehatan</span></a><br /><span style="font-family:arial;"></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8127035291536553225.post-38494157230908001012011-11-19T02:31:00.000-08:002011-11-19T04:34:38.879-08:00Public speaking :: Learning experience<span style="font-family:verdana;">Just yesterday I made an oral presentation in local symposium in my hometown (</span><a style="font-family: verdana;" href="http://www.bandungideas.com/">BIDEAS</a><span style="font-family:verdana;">).</span><br /><br /><span style="font-family:verdana;">The presentation was basically from my thesis research and most of the audiences were people that I already knew through med school or my health research unit.</span><br /><br /><span style="font-family:verdana;">But still, every time I have to made a presentation, I got a feeling of nervous - despite I have prepared it very well. I know the contents and very informed about what I was doing throughout my research. And of course, I made my own presentation and rehearsed it couple of times days before. </span><br /><br /><span style="font-family:verdana;">I have talked to myself that: <span style="font-family:trebuchet ms;">'There's nothing to worry about, these people won't harm you'</span> and blah blah to motivate myself.</span><br /><br /><span style="font-family:verdana;">Generally speaking, I would say it's a pity that we're Indonesian are always unprepared for public speaking since we were young.</span><br /><br /><span style="font-family:verdana;">Just before I left Netherlands, me and my friend (we both Indonesians who experienced master program abroad), who also acknowledged that we're tend to be unprepared for public speaking.</span><br /><br /><span style="font-family:verdana;">Also in the preparation for material. For example in scientific program, either the speaker always put too much information that it's just too difficult to digest or s/he would present it without enthusiasm - which makes it perfect for audiences to take a nap after lunchtime.</span><br /><br /><span style="font-family:verdana;">My first learning experience in public speaking, well not really public, it was in a class contained of 20 people actually- was in Amsterdam. I was taking a sexual reproductive health course in Royal Tropical Institute, and they gave us a group assignment. We had to made a small literature review and made a presentation out of it.</span><br /><span style="font-family:verdana;">At that moment, I was pretty nervous, not that I didn't grasp the material. I was one of the most experienced student in the class really, with enough work experiences to share.</span><br /><span style="font-family:verdana;">But I had to made a presentation (shared with others students) in English, which is not my first language. And I was not really prepare for public speaking, during my whole life. So lame.</span><br /><br /><span style="font-family:verdana;">So all I did was encouraging myself, that it couldn't be so bad- and even though it would be bad, it's just a class contained of 20 people that would remembered me as jittery young doctor from Indonesia, forever, anyway...</span><br /><br /><span style="font-family:verdana;">It turned out well, it's normal to have a high-pitched nervous voice in the beginning but then, as I familiarized with the situation- I could see myself took control.</span><br /><br /><span style="font-family:verdana;">Back to the conversation that I made with my friend, we both agreed that in Netherlands (or mostly west Europe) students were used to make a oral presentation/ public speaking since they were young. And we could see that is really an advantage if you want to be internationally (or nationally) recognized as professionals, either as a lecturer, researcher/scientist, or whatever it is. Because the presentation/ public speaking is how you 'sell yourselves' and how you also sell your content of presentation, as one package.</span><br /><br /><span style="font-family:verdana;">If I could made a change in my med school, I will definitely propose that med students should engage more in scientific events and practice for oral presentation/ public speakings.</span><br /><br /><span style="font-family:verdana;">During the</span><a style="font-family: verdana;" href="http://www.ectmihbarcelona2011.org/"> International conference</a><span style="font-family:verdana;"> last month in Barcelona, I realized that Indonesians are not lack of experts nor the quality of experts themselves are highly competitive for international standard. But mostly we're Indonesians are<span style="font-family:trebuchet ms;"> (1) not confident enough, to present something in English</span> (even though some of us are good enough if we have to present it in Indonesians), and/or <span style="font-family:trebuchet ms;">(2) for the same reason, not confident to present it in the front of international scope</span>.</span><br /><span style="font-family:verdana;">Which is very unfortunate for scientific world, because we have so much to share in terms of knowledge or experiences.</span><br /><br /><span style="font-family:verdana;">Again, I will mention Helen Rees- my favorite speaker throughout the International conference in Bcn. Just checked out in the website and they put </span><a style="font-family: verdana;" href="http://www.ectmihbarcelona2011.org/docs/Rees.pdf">her presentation</a><span style="font-family:verdana;"> (in .pdf file) so we can download it and take a look how neat she has made it. Also, the most stunning presentation that I've seen in my whole life (besides Elizabeth Pisani when she's giving lecture in our class in Copenhagen).</span><br /><br /><span style="font-family:verdana;">Hope you enjoy it too </span><span style="color: rgb(204, 0, 0);font-family:verdana;" >:)</span><br /><span style="font-family:verdana;"> </span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8127035291536553225.post-80981952423194441342011-10-29T02:28:00.000-07:002011-11-20T19:52:56.281-08:00What makes Indonesian (not) healthy ? [part one]<span style="font-family:verdana;"></span><blockquote><span style="font-family:verdana;">Do you know if you were born in Japan you will probably live 40 years longer than somebody who were born in Afghanistan?</span><span style="color: rgb(204, 0, 0);font-family:verdana;" >*</span><a style="font-family: arial;" href="http://www.infoplease.com/world/statistics/life-expectancy-country-2009.html"></a></blockquote><a style="font-family: arial;" href="http://www.infoplease.com/world/statistics/life-expectancy-country-2009.html"><span style="font-size:85%;"><span style="color: rgb(255, 0, 0);">*Life expectancy for Countries</span></span></a> <span style="font-family:verdana;"><br /><br /><span style="font-family:verdana;"></span></span><blockquote><span style="font-family:verdana;"><span style="font-family:verdana;">And the fact that Indonesian people have life expectancy 12 years shorter compared to their neighboring country, Singapore !</span></span> </blockquote><span style="font-family:verdana;">This intriguing fact is something that I learned during my core course in Amsterdam about health determinant</span><span style="color: rgb(255, 0, 0);font-family:verdana;" >**</span><span style="font-family:verdana;">.</span><br /><a style="font-family: arial;" href="http://www.phac-aspc.gc.ca/ph-sp/determinants/index-eng.php#determinants"><span style="font-size:85%;"><span style="color: rgb(255, 0, 0);">**What determines health?</span></span></a> <span style="font-family:verdana;"><br /><br />It has haunted my mind and spirit as medical doctor and public health practitioner.</span> <span style="font-family:verdana;"><br /><br />Epidemiology and statistics, branch of study that talked about important numbers/indicators on population, used to be unpopular class when I was a student in medical school.</span><br /><br /><span style="font-family:verdana;">I remember how bored it was and demotivated most of us to really learn something from it, or put it into practice.</span><br /><br /><span style="font-family:arial;">F</span><span style="font-family:verdana;">ew years after I finished my medical school, I realized how important it could be.</span> <span style="font-family:verdana;"><br /><br />It does tell whether we're moving from one point to another (or not), make any good or bad progress as nation in terms of managing health.<br /><br /></span><span style="font-family:verdana;">Maternal mortality rate (MMR) in Indonesia is one of the highest in Southeast Asia, but if you stratified by region- some more developed region (West Java) has lower MMR (lower than Southeast Asia rate in average) while another region, <span style="color: rgb(153, 0, 0);">Papua has MMR 3 times higher than national average</span>!</span> <br /><br /><span style="font-family:verdana;">Back to my main question, as a title:</span><span style="font-family:arial;"> </span><span style="font-family:verdana;">' <span style="font-family:verdana;">What makes Indonesian (not) healthy</span> ?'</span><span style="font-family:arial;"><br /><br />I would use the framework borrowed from <span style="color: rgb(51, 51, 51);font-family:verdana;" >Canadians :: Population Health</span>.</span><span style="font-family:arial;"><br /><br />This is actually looks like my assignment as master student in International Health program-<br />but in the name of knowledge, science, humanity and nationalism- I write this for you all who interested in this subject (as much as I do).</span><span style="color: rgb(153, 0, 0);font-family:verdana;" ><br /><br />1. Income and social status</span> <span style="color: rgb(0, 0, 0);font-family:arial;" ><br /><br />Pretty much makes sense for all of us, people who are poor would more likely have worse health status than those who are richer.</span><span style="color: rgb(0, 0, 0);font-family:arial;" ><br />Specifically in countries like Indonesia whereas most of the health expenditure come from out-of pocket (user fees) expenses.</span><span style="color: rgb(0, 0, 0);font-family:arial;" ><br /><br />Those who are poor assumed would spend less money on health care (they would prioritize on something that are considered basic needs e.g. foods).</span><span style="color: rgb(0, 0, 0);font-family:arial;" ><br />And this group would likely to come late (if they happen to be sick) to the doctors, they would collect money first, seek out alternative treatment etc- in this out-of-pocket systems.</span><span style="color: rgb(0, 0, 0);font-family:arial;" ><br />Because here doctors/health care institutions are considered as something 'expensive' or luxurious need for the poor.</span><span style="color: rgb(0, 0, 0);font-family:arial;" ><br /><br />It's likely this could be the case: they (the poor) couldn't afford money to go to the doctors, they become even sicker. When they go to the doctor, their worsened conditions would make them pay ever more (more treatment, more medication) compare if they seek treatment earlier.</span><span style="color: rgb(153, 0, 0);font-family:verdana;" ><br /><br /><span style="color: rgb(102, 102, 102);">next on health determinants . . . .</span><br /><br />2. Social support networks</span><span style="font-family:verdana;"><br /><br />3. Education and literacy</span><span style="font-family:verdana;"><br /><br />4. Employment / Working condition</span><span style="font-family:verdana;"><br /><br />5. Social environment </span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8127035291536553225.post-46996751176587709652011-10-28T23:11:00.000-07:002011-10-29T00:05:27.559-07:00Public transport :: Never ending problems<span style="font-family:verdana;">I love public transport.</span><br /><br /><span style="font-family:verdana;">Here or moreover abroad.</span><br /><br /><span style="font-family:verdana;">I am people person, and even though I know I could take my own car, joined with others who have their own personal car and make traffic jam in the street altogether- there were times that I kept telling myself I should stay to my idealism and take public transport.</span><br /><br /><span style="font-family:verdana;">For me, taking a public transport means a more environmental-friendly approach than personal vehicle (of course). And being in a public transport with people, it's like sharing not just a car but also a life, their stories. Sometimes, it could be very VERY annoying when you're stuck with thoughtless people, who smokes regardless the car was already suffocated enough with 10 persons. </span><br /><span style="font-family:verdana;">But also there were times it could be a rewarding moment, seeing interaction of people who help each other. Being a witness of such behaviour, I know it was not such a bad idea to stay on public transport.</span><br /><br /><span style="font-family:verdana;">I admit, though, public transport system in Indonesia is not the safest place in the earth.</span><br /><span style="font-family:verdana;">In fact, it's one of the dangerous experience that you could have in your whole life.</span><br /><br /><span style="font-family:verdana;">Just recently, a minivan crashed at the place close to my hometown and few people died.</span><br /><span style="font-family:verdana;">When I was a young doctor in a hospital, I saw too many cars/motorbikes accidents, some of them due to irrational behavior of the drivers.</span><br /><span style="font-family:verdana;">It is a crazy and tough life on the streets here.</span><br /><br /><span style="font-family:verdana;">Back again during my study (or traveling) year in Europe (or elsewhere in Asia), I analyzed what make these developed countries build a success public transport system.</span><br /><span style="font-family:verdana;">Is it a good system who drive users to oblige or start from capable users who drive the good public transport system?</span><br /><br /><span style="font-family:verdana;">I've come to the conclusion of: both.</span><br /><span style="font-family:verdana;">It has to be driven simultaneously by systems (also environmental) and users.</span><br /><br /><span style="font-family:verdana;">For example, any Indonesian people who have been to Singapore, they know that they have to adhere to such strict regulation (not just transport, but also not to spit in public etc. Gosh).</span><br /><span style="font-family:verdana;">Or any Germans (mostly they follow the rules) who have been to Indonesia they would find their way out from tricky traffic jams by doing exactly (or almost the same) like any Indonesian.</span><br /><span style="font-family:verdana;">It's just their adaptation behavior to the systems, either it's good or bad.</span><br /><br /><span style="font-family:verdana;">Even in Europe, there's a huge difference between public systems in Denmark and in Italy.</span><br /><span style="font-family:verdana;">My analysis: It's just because Danes have less emotional feelings on the street and stick to the regulation easily than Italians (and oh, I'm on the Italiano side :-)</span><br /><span style="font-family:verdana;">Biking rules in Netherlands is very laid-back compare to Denmark.</span><br /><span style="font-family:verdana;">So this is also applied to their personalities, I'd say.</span><br /><br /><span style="font-family:verdana;">What about in Indonesia?</span><br /><br /><span style="font-family:verdana;">Here, taking a public transport it's like the option of poor people.</span><br /><span style="font-family:verdana;"> For those who can't afford their own personal motorbikes or cars.</span><br /><span style="font-family:verdana;">It's very unreliable, chaotic, unsafe, dangerous (remember few weeks or months ago, about raping in public transport. It scares me and a lot of women too, I bet) and it's like risk taking every day when you don't have other choice.</span><br /><br /><span style="font-family:verdana;">And people, like me, who knows this experience, made a vow to themselves- </span><span style="font-style: italic;font-family:verdana;" >as soon as I get more money I would buy my own bike/car so I won't stuck in this crazy situation everyday</span><span style="font-family:verdana;">!</span><br /><br /><div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg43sL31YhzvttpObrdk1ovi633g522U_vzekajnd_q4UWzmBYbt8hrgWJrxLqbk9RBQhCUa71F53d5PxbWRk-BWx1C_P3f3KAEq03TnNQQ3za7jufwvT449dl2kpknAfpItcdrKvrN9Lrw/s1600/100_0598.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 263px; height: 360px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg43sL31YhzvttpObrdk1ovi633g522U_vzekajnd_q4UWzmBYbt8hrgWJrxLqbk9RBQhCUa71F53d5PxbWRk-BWx1C_P3f3KAEq03TnNQQ3za7jufwvT449dl2kpknAfpItcdrKvrN9Lrw/s400/100_0598.jpg" alt="too many cars!" id="BLOGGER_PHOTO_ID_5668806311494268178" border="0" /></a><span style="font-size:85%;">now we have too many cars in the street!<br /></span></div><br /><span style="font-family:verdana;">But that's not a long term solution!</span><br /><br /><span style="font-family:verdana;">People are getting rich these days.</span><br /><span style="font-family:verdana;">There will be more people who could afford their own personal vehicles.</span><br /><span style="font-family:verdana;">There will be more motorbikes and cars in the street (it's already happened actually)</span><br /><span style="font-family:verdana;">surely, there'll be more traffic jams here and there. We know it already!</span><br /><br /><span style="font-family:verdana;">At some point, every places in Indonesia, will be like Jakarta.</span><br /><span style="font-family:verdana;">People are physically and mentally test every day in the streets due to its chaotic conditions.</span><br /><br /><span style="font-family:verdana;">The solution: We need more public transport, which is secure, reliable and cost-effective (we're not saying cheap, I'm sure a lot of people would rather to pay reasonable price as long it's worth).</span><br /><br /><span style="font-family:verdana;">We should shout it out loud to our government!</span><br /><span style="font-family:verdana;">Or basically those who care, if the government burns out with too many task.</span><br /><span style="font-family:verdana;">It could be public-private-shared organisation, I won't go into detail and it's not my expertise either. But we surely need this, now or later.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8127035291536553225.post-20002538531014520222011-10-25T03:56:00.000-07:002011-10-25T04:37:59.621-07:00Conference addict :: Upcoming event on 2012<span style="font-family:verdana;">After my last </span><a style="font-family: verdana;" href="http://www.ectmihbarcelona2011.org/">scientific conference in Barcelona</a><span style="font-family:verdana;"> in the beginning of this month, I realized that I got addicted.<br /><br /></span><div style="text-align: center;"><span style="font-family:verdana;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiE_zgCI_6ts6qXiX67A8CmFnektQNScGj-giLMzN-LmpXjZovWcsCtaFK4ogC1CNVn_lLxasIwQ3MJDrwmV8L49vKSxP2taTL897IWCpl5RNJJxAjZqptYl5SkeQPvpXF6XjBnL2X5tXAt/s1600/poster_Bcn.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 315px; height: 400px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiE_zgCI_6ts6qXiX67A8CmFnektQNScGj-giLMzN-LmpXjZovWcsCtaFK4ogC1CNVn_lLxasIwQ3MJDrwmV8L49vKSxP2taTL897IWCpl5RNJJxAjZqptYl5SkeQPvpXF6XjBnL2X5tXAt/s400/poster_Bcn.jpg" alt="my poster presentation in Barcelona!" id="BLOGGER_PHOTO_ID_5667391301166387746" border="0" /></a><span style="font-size:85%;"><span style="font-family: arial;">my poster in International Health Conference, Barcelona</span><span style="font-family: arial;"><br />with Prisca, my co-supervisor from KIT, Ams</span></span><br /></span></div><span style="font-family:verdana;"><br /><span style="font-family:verdana;">Being in the international conference was very inspiring for me. I was there for a poster presentation basically, but I could also learned so many things e.g. how to make better poster for presentation, attending seminars with experts, building networks with people all around the world.</span> <span style="font-family:verdana;"><br /><br />One of the speakers that I found very inspiring for me was </span><a style="font-family: verdana;" href="http://www.ectmihbarcelona2011.org/speaker.asp?apt=14&codi=69">Helen Rees</a><span style="font-family:verdana;">.</span> <span style="font-family:verdana;">She brought a session about pre-exposure prophylaxis for HIV prevention, in a very practical manner. Also a stunning presentation!<br />One of the most impressive presentation (slides, also how she came up with the talks) that I've ever seen in my whole life as researcher (yeah I'm stil young researcher btw).</span><br /><br /><span style="font-family:verdana;">Then I googled her name and it turned out that she's indeed a very professional and dedicated person in her area (and she's part of WHO Advisory Committee).</span> <span style="font-family:verdana;"><br />Uh huh, no wonder why.</span><br /><br /><span style="font-family:verdana;">Now that I feel like I've learned so much from international conference, I got addicted to have some more !</span> <span style="font-family:verdana;"><br /><br />Here's some of upcoming events (international scientific, clinical/ social conference) about HIV-AIDS in 2012 :</span> <span style="font-family:verdana;"><br /><br />April 12-13, New South Wales (AU)</span> <a style="font-family: verdana;" href="http://nchsrconference2012.arts.unsw.edu.au/">Silence & Articulation</a> <span style="font-family:verdana;"><br /><br />May 23-25, Marseille (FR)</span> <a style="font-family: verdana;" href="http://www.isheid.com/">"Searching for Cure" - ISHED</a> <span style="font-family:verdana;"><br /><br />July 22-27, Washington DC (US)</span> <a style="font-family: verdana;" href="http://www.aids2012.org/Default.aspx?pageId=422">Turning the Tide Together</a> <span style="font-family:verdana;"><br /><br />So for those who are interested, don't forget to submit your abstract and hopefully I'll see you there !</span> </span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8127035291536553225.post-27892559361255935722011-10-24T07:05:00.000-07:002011-10-24T07:09:12.737-07:00NG :: 7 Billion Population in 2011THis is an example of nice public health message from National Geographic.<br /><br />It's about demographic, the world will reach 7 billion population by 31 Oct 2011.<br /><br />Enjoy !<br /><br /><iframe width="580" height="326" src="http://www.youtube.com/embed/sc4HxPxNrZ0" frameborder="0" allowfullscreen></iframe>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8127035291536553225.post-18063907789920410932011-10-23T05:12:00.000-07:002011-10-24T06:13:33.596-07:00Health Promotion :: The Power of InformationWhen I was abroad, I talked to several friends that I know how did they get source of information about sexual reproductive health.<br /><br />It was quite common in Europe, that young people know about their sexual and reproductive rights since very early age. Either they get the source information from school or mass media.<br /><br />I asked a friend of mine, she's Indonesians but has been living in one of the state in Europe for years. She said that she never heard anything before this kinda information when she stayed in Indonesia. Then when she lived abroad, it's clearly such information were commonly spread in public.<br /><br />Also information about HIV.<br />HIV in Indonesia is actually not involving a big number.<br />In general population the prevalence (only) 0.2 % but among at risk population it ranges from less than 5% (among sex workers) to more than 50% (among people who inject drugs).<br /><br />While it's pretty common in developed countries, where they put every one (especially young people, who presumably sexually active groups) at risk - public health professionals put the message that 'preventive is important'.<br />Its implication: (Hopefully) Every young people know that they should use condom with a new sexual partner (to protect from STI) or use another form of contraceptive, if they long term partner (as birth control).<br /><br />These days, information plays a major role in our life.<br />And it's really fast in our globalization era. Just hours ago Simoncelli had an accident in Sepang, Malaysia and it was spreading whole around the globes in one click away (if you have internet connection).<br />We all connected through invisible bonding, thanks to internet and mass media.<br /><br />And we all may received also wrong or invalid information from media.<br /><br />That's why leaders (community leaders, religious leaders) used to be and still nowadays, play essential role-- because they may be the source of information, like it or not.<br />Especially for uneducated people, when they can't be critical (for they concern about only their primary needs).<br /><br />Unfortunately we can see in our mass media (yes I am talking about Indonesian TV channels) we have limited room for public health messages that can educated people.<br /><br />I didn't watch TV (in Indonesia) that much because sometimes it could make me sick.<br />But I also noticed some channels consistently put nice public messages to inform viewers.<br /><br />I know that every one has their own agenda, whether it's profit (and I believe cheesy movie/ infotainment could bring a lot of profit) or better motives.<br /><br />Just few weeks ago I came back from Europe, then I started to notice few commercials break in TV. There's this nice public commercial talked about food substitute for rice (because in Indonesia we have so many food staples beside rice, yet they less popular).<br /><br />I wish for more public health message like this. If I have people who work in media, I would like to contribute my idea to develop public health message.<br /><br />We are in great need of this message e.g. how to overcome traffic jam (driving behavior), also safety in the street (also for pedestrians), or talking about healthy eating habit.<br /><br />And it should be regulated in the Ministerial level!<br /><br />I think for every junk food advertisement (McDonalds, KFC, etc) should be certain percentage aside for health eating habit advertisement !<br /><br />It's a pity, too many young people with unhealthy eating habit were considered as 'normal' because it represent the sign of 'success' or 'wealthy'.<br /><br />Then again, smoking prohibition in public space.<br /><br />Ah yeah, I should have mentioned first, that tobaccos are a big deal in Indonesia.<br />And it's so cheap ... even kids underage could afford it.<br /><br />Compare with Europe, for example, you only could buy cigarettes if you're over 18 years old.<br />I've noticed in some countries e.g. French, Italy, Spain I saw people from younger age also smoke cigarettes. But they have concern that if they smoke, that doesn't mean other people have to smoke too (at least better than here).<br /><br />And because it's so cheap (cigarettes in Europe also very expensive because they put higher taxes) there are so many poor people that could not afford buy food, they will buy cigarette instead. That's tragic !<br /><br />I think only rich people that should buy cigarettes, because when they got sick (due to respiratory problems) at least they could afford their medical care.<br /><br />Maybe it sounds too cynical. But to be very practical, I would put higher tax on cigarettes -- then relocate the budget for health care --<br />And this works to stop people from smoking too, I believe.<br />I know many Indonesian friends who stop smoking when they lived in Europe for some while (because it's too expensive to buy cigarettes there).<br /><br />We've seen so many innovative and impressive advertisement from this tobacco companies in Indonesia. We should also asked them to be balance by provide the information of how harmful cigarettes could be for our health.<br />Then again, it will be conflict of interest for them!<br /><br />So, who should provide such information then?<br />I would say, us, community, public health professional, clinicians, if not government in general (only if they interest in the health state of their citizens).Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8127035291536553225.post-74427190705202894572011-10-14T01:10:00.000-07:002011-10-24T02:27:24.894-07:00Sexual Reproductive Health :: It's not your own business<span style="font-family:verdana;">My mother always told me to mind my own business.</span><br /><br /><span style="font-family:verdana;">Everytime I'm babbling around about this world could be a better if only people would do their task responsibly, she stopped me to talk further. For her, we could only done our part and let the rest do their own business.</span><br /><br /><span style="font-family:verdana;">But I can't !</span><br /><br /><span style="font-family:verdana;">I am a medical doctor, and what I always do is actually taking care others business.</span><br /><span style="font-family:verdana;">I do care about other people's health, also about their financial insecurity, sometimes about their sex life's too.</span><br /><br /><span style="font-family:verdana;">It is so ridiculous everytime I heard people being so individualized and not really care about other people business.</span><br /><span style="font-family:verdana;">Cause we know that we actually care!</span><br /><span style="font-family:verdana;">And that's why we LOVE gossips so much.</span><br /><span style="font-family:verdana;">Just look at the television where they talked about nonsense, these celebrities doing this and that (And oh how public adore them, for their shallow attitudes).</span><br /><br /><span style="font-family:verdana;">They (the celebrities) don't even care if you're injured and couldn't afford your hospital bills, but still it's so commercialized (and uneducated) that we're people thought it's normal for daily consumption.</span><br /><br /><span style="font-family:verdana;">I really think, if Indonesia people really like to mind other people business, they should do it in the right way.</span><br /><br /><span style="font-family:verdana;">There are so many rooms for help people, and yet we know that we're Indonesian good about it.</span><br /><br /><span style="font-family:verdana;">Remember Prita case?</span><br /><br /><span style="font-family:verdana;">Her case was so famous because it moved hundred thousands people to actually help her by donating small moneys.</span><br /><br /><span style="font-family:verdana;">It is in our blood. We're moved by social injustice. We could not see others people suffer.</span><br /><br /><span style="font-family:verdana;">So why we could not do it in a better way?</span><br /><br /><span style="font-family:verdana;">Talking about sex life. Hmmm... Yeah, it's always an interesting topic.</span><br /><br /><span style="font-family:verdana;">But why am I bring up this topic is because Indonesia, with 237 million of population, we're facing a problem of overpopulated country.</span><br /><br /><span style="font-family:verdana;">It's not as bad as India or China. But I'm sure we're getting there.</span><br /><span style="font-family:verdana;">It's just a matter of time.</span><br /><br /><span style="font-family:verdana;">So why not propose something to stop this exploding number of citizens?</span><br /><br /><span style="font-family:verdana;">I would propose 3 things:</span><br /><span style="font-family:verdana;">(a lesson learned from my scientific writing, only 3 points max.)</span><br /><br /><span style="font-family:verdana;">1. Family planning access for all reproductive ages people (women or men, married or not)</span><br /><span style="font-family:verdana;">2. Sexual reproductive health information for all (esp teenagers, youth, adolescents, even kids).</span><br /><span style="font-family:verdana;">3. Female education</span><br /><span style="font-family:verdana;">[ Not necessarily in order, but those things are very essential ]</span><br /><br /><span style="font-family:verdana;">I was actually about to mention 'access to safe abortion' (if needed).</span><br /><span style="font-family:verdana;">But I recognize this topic could be highly sensitive and leading to many discussions/debates, also touching religion/ belief perspective.</span><br /><span style="font-family:verdana;">So I will set aside this topic after top 3 priorities that I've mentioned.</span><br /><br /><span style="font-family:verdana;">The first 2 priorities seem obvious and make sense to point out.</span><br /><span style="font-family:verdana;">Therefore, I would start with my last point : Female education.</span><br /><br /><span style="font-family:verdana;">Why is it so important in sexual reproductive health program.</span><br /><br /><span style="font-family:verdana;">Because I believe the core of the problem in my developing countries (with overpopulated problem) is somehow interrelated with the (inequality) woman's position in society.</span><br /><br /><span style="font-family:verdana;">I will show this correlation with simple manner:</span><br /><br /><span style="font-family:verdana;">Uneducated female -> early marriage, lower wages in employment sector, low bargain power in intimate relationship, lower position in society -> (limited?) access to health service -> worse health outcome (for herself and her children).</span><br /><br /><span style="font-family:verdana;">Maybe not as simple as that.</span><br /><span style="font-family:verdana;">In above calculation, there's always assumptions (and theories) applied e.g.</span><br /><span style="font-family:verdana;">uneducated female less to have access to health service because she doesn't know how to find it (not informed) or doesn't know that she actually need the service (health seek behavior).</span><br /><br /><span style="font-family:verdana;">Anyway, I'm not the expert of such theories as well.</span><br /><span style="font-family:verdana;">May the social scientists explain such behaviour.</span><br /><br /><span style="font-family:verdana;">What I'm concern is, how serious the government (yes they should) and also other sector (including religious sector) put effort to female education, if not gender equality in this country.</span><br /><br /><span style="font-family:verdana;">Why female?</span><br /><br /><span style="font-family:verdana;">Because I am woman and I know how care we (women) toward our family (esp children).</span><br /><span style="font-family:verdana;">I believe if a woman well-raised, she could also able to raise a healthy child (or children) and taking care her family well. And hopefully the final outcome is a healthy nation.</span><br /><br /><span style="font-family:verdana;">Women are more likely to sacrifice for the sake of their kids and family.</span><br /><span style="font-family:verdana;">We all know the story about women who struggle of her financial crises so that her children could have better life. And women would invest more on her child's need (men, even if he has kid, would spend more on gadget or his own pleasure!).</span><br /><br /><span style="font-family:verdana;">It is so common sense, right?</span><br /><br /><span style="font-family:verdana;">Another example is street kids. I've seen many of them without their parents in the street.</span><br /><span style="font-family:verdana;">Some are altogether with the mother asking small money in the street.</span><br /><br /><span style="font-family:verdana;">Mothers are always to blame in this case. We're gonna say (in our heart, or loudly), 'How come the mother dare to do this to their children?'</span><br /><br /><span style="font-family:verdana;">Maybe they do dare for the money (it is a strong motivation though, as strong as many corruptors steal money from the government),</span><br /><span style="font-family:verdana;">OR</span><br /><span style="font-family:verdana;">maybe it's the only way they know how to get money.</span><br /><br /><span style="font-family:verdana;">Female education though is not a simple remedy for gender inequality.</span><br /><br /><span style="font-family:verdana;">There's another aspect e.g. male education (likewise we educate female, our society indeed need smarter men, too. Just look at our public figures these days and we're realized they could be as ignorant as uneducated people as well).</span><br /><br /><span style="font-family:verdana;">In my area of intervention, if we educate the women about HIV and contraceptives- we should not forget to inform the couple (likely men) as well. Otherwise, the men would think it's ONLY WOMEN responsibility to take charge of family planning program, while it should be BOTH.</span><br /><br /><span style="font-family:verdana;">Also religious sector, could influence the acceptance of contraceptive options (or basically many aspect besides contraceptive).</span><br /><span style="font-family:verdana;">It is a country with biggest number of moslem population anyway ...</span><br /><br /><span style="font-family:verdana;">And oh, also talking about abortion.</span><br /><br /><span style="font-family:verdana;">Yes, I do believe God and I do worship Him, and I believe there is heaven and hell.</span><br /><br /><span style="font-family:verdana;">But it doesn't make me against abortion, because I believe safe abortion could be an option sometimes.</span><br /><span style="font-family:verdana;">I could not imagine the woman who got raped and have no access to safe abortion had to carrying fetus for 9 months unwillingly in her womb!</span><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" style="font-family: verdana;" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibzbykZWL6Qt6Gd4xRiq4inCT1UoaRD19SbxppxOVBbnYl0XivlnB9YlxPCGJO5r1__jwZvugcPAYJGS2ayfAHD444Y7k4pxe_mRxMlUhTPTvVCiTLj13C_j0pWmtxWVWieRzMFBKSigtl/s1600/pregnant+belly_.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 267px; height: 400px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibzbykZWL6Qt6Gd4xRiq4inCT1UoaRD19SbxppxOVBbnYl0XivlnB9YlxPCGJO5r1__jwZvugcPAYJGS2ayfAHD444Y7k4pxe_mRxMlUhTPTvVCiTLj13C_j0pWmtxWVWieRzMFBKSigtl/s400/pregnant+belly_.jpg" alt="pregnant belly" id="BLOGGER_PHOTO_ID_5666987417288333522" border="0" /></a><br /><span style="font-family:verdana;">And if we're pretty good at access to family planning to those who need it, we're actually don't have to face abortion issue at all.</span><br /><br /><span style="font-family:verdana;">Now, remember Ariel case ?</span><br /><span style="font-family:verdana;">Ariel is a famous lead vocalist from famous (cheesy) boyband from my hometown.</span><br /><br /><span style="font-family:verdana;">And he got prosecuted for having sex in his own place, because somebody publicized his videotape (?!???)</span><br /><br /><span style="font-family:verdana;">It is really confusing case. It's his own (sex) business, he's not even stealing government money like corruptors !</span><br /><br /><span style="font-family:verdana;">I'm not on his side at all. (I'm not taking side in this case).</span><br /><span style="font-family:verdana;">I'm just upset how people could care wrongly about this sexual case, while they should more care rightly about other issue.</span><br /><br /><span style="font-family:verdana;">So my conclusion is, if we're so care about other people's business especially sex life, why not doing it in a right way?</span><br /><span style="font-family:verdana;">Why not transparently educated our people about sexual and reproductive health facts-</span><br /><span style="font-family:verdana;">instead of tell them what to do.</span><br /><br /><span style="font-family:verdana;">I believe when people well-informed enough, s/he could weighed decision what's best for her/him. It's time to take our responsible to our body !</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8127035291536553225.post-894248051026090972011-10-13T23:19:00.000-07:002011-10-24T00:52:00.244-07:00Why Public Health :: Matter of Life<span style="font-family:verdana;">Why Public Health ? Why International Health ?</span><br /><br /><span style="font-family:verdana;">That question appeared in my mind. And also in minds of others people; friends, colleagues, families, who has questioned my decision. Why am I taking interest of this subject and even pursued my master on this subject.</span><br /><br /><span style="font-family:verdana;">I would say: Because it's really important (especially in developing country, where I came from).</span><br /><br /><span style="font-family:verdana;">It's a simple answer, yet defines so many things that we're (Indonesia) lack of.</span><br /><br /><span style="font-family:verdana;">We have (currently) huge problems in mass transportation, infrastructure, community health, waste managements and sanitation, human capacity, emergency/ disaster preparedness, development problems... Just name it and you could find it here, in Indonesia, the biggest archipelago with 237 millions of population.</span><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" style="font-family: verdana;" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKM0rDs5-rOVnt0QJbPhGPl0vCPG3WNr8aQqDAYHtBQTrQ64p84CZlKWpoyYLVzNkigTd-4sLtwI_PWkCitbrW0cxnRdQfzsI2R5uYG-LeGyS6WwxjX_3ofpGAdhwHESMSyTJh2A2M8InV/s1600/brage+corner.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 450px; height: 307px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKM0rDs5-rOVnt0QJbPhGPl0vCPG3WNr8aQqDAYHtBQTrQ64p84CZlKWpoyYLVzNkigTd-4sLtwI_PWkCitbrW0cxnRdQfzsI2R5uYG-LeGyS6WwxjX_3ofpGAdhwHESMSyTJh2A2M8InV/s400/brage+corner.jpg" alt="homeless, Braga corner" id="BLOGGER_PHOTO_ID_5666955663026109810" border="0" /></a><br /><span style="font-family:verdana;">It does really sound fantastic to have such big number for population. It also describe our problem to organize the system (politic, economy, health) that would fit enormous number of citizens, spreading in more than thousands islands, with different needs and characteristics.</span><br /><br /><span style="font-family:verdana;">But I would limited my theme just into Public Health.</span><br /><span style="font-family:verdana;">The area that I interested the most.</span><br /><br /><span style="font-family:verdana;">Back to my question in the first sentences,</span><br /><span style="font-family:verdana;">' Why Public Health ? '</span><br /><br /><span style="font-family:verdana;">When I was doing my governmental duty, post graduated from my medical school (I was so proud that I had finally graduated from a long and suffering yet impressive medical study. I was ready to save people's life and also the whole world). I was located in Sumbawa, an island next to east of Lombok. Why I was there is part of my plan, a bit of accident also coincidence.</span><br /><span style="font-family:verdana;">I was there only about 9 months. But it was enough for me to decide I could not save the world just by saving people's life one at a time.</span><br /><span style="font-family:verdana;">It was just TOO frustrated.</span><br /><br /><span style="font-family:verdana;">Basically what I did, I was saving this patient from one disease but then he would died by something else. He would died because he even couldn't get the money to come into the nearest health facility to get treatment in time. He would died due to lack of nutrition. He would died cause his ignorance that simple medication would actually could cure his symptoms.</span><br /><br /><span style="font-family:verdana;">Another patient that I treated, would just keep coming back for the same issue.</span><br /><span style="font-family:verdana;">Malaria is highly prevalent in the area, and just medications to cure the symptoms not really actually treat the environmental cause of Malaria.</span><br /><br /><span style="font-family:verdana;">In the end, I decided that if I really want to save this people, or this nation (in terms of health issue) I have to do something bigger.</span><br /><span style="font-family:verdana;">And it has nothing to do with being a clinician.</span><br /><br /><span style="font-family:verdana;">Somebody has to do something. I want to do my part. It's my calling.</span><br /><br /><span style="font-family:verdana;">So I took a master program in International Health. It took 3 years (I sent my application 3 times, in 3 consecutive years) to get what I want. My whole 1 year entire program was funded by European Union (I got </span><a style="font-family: verdana;" href="http://emundus.wordpress.com/">Erasmus Mundus scholarships</a><span style="font-family:verdana;">) and I studied in 2 different universities in Europe; Royal Tropical Institute, Amsterdam and University of Copenhagen, Denmark.</span><br /><span style="font-family:verdana;">It was a fantastic year and I learned a lot (still a bit from what I should know) about health systems, managements, and policies.</span><br /><span style="font-family:verdana;">And I am sure this is my passion, this is what I would like to do further in my career path.</span><br /><br /><span style="font-family:verdana;">Before I got enrolled in my master program, I also had a chance to work as a researcher in the field of HIV. Most of the time I was doing social studies that related to people living with HIV.</span><br /><br /><span style="font-family:verdana;">Doing this as clinician, (if it's not one's calling) it's even more frustrated.</span><br /><br /><span style="font-family:verdana;">If only we're clinicians could treat all the symptomatic people with HIV, it still will not eliminate the problem (because far more people with asymptomatic actually need intervention as well).</span><br /><br /><span style="font-family:verdana;">Most of the time, these people not even aware that they actually AT RISK.</span><br /><span style="font-family:verdana;">Or those who already aware that they at risk are AFRAID of SEEK further treatment (sex workers and transgenders are highly stigmatized, they hardly seek treatment if they get sexually transmitted infections. Self treatment are pretty common for them).</span><br /><span style="font-family:verdana;">Or those who already reached the health care facilities, sometimes get DISCOURAGED by the unfriendly approach of health care workers.</span><br /><br /><span style="font-family:verdana;">This is a chronic disease (and also infectious disease). And it has so many social aspect apart from merely the clinical aspect. It touches issue of gender relation, sexual behaviour, addiction, adherence, stigma and discrimination & so forth.</span><br /><br /><span style="font-family:verdana;">It's a very interesting subject (for researcher) but also complex and confusing in its intervention.</span><br /><br /><span style="font-family:verdana;">And it was not easy because it cannot be intervene by only clinical intervention.</span><br /><br /><span style="font-family:verdana;">You have to talk with religious leaders, political officers, sex workers and their pimps (also the owner of pubs/ karaoke bars), local governments (of course) to really target the cause of social problem of HIV.</span><br /><br /><span style="font-family:verdana;">As you can see, public health could be indeed a very important and essential aspect in Indonesia- by giving example of HIV epidemic (my interest).</span><br /><br /><span style="font-family:verdana;">There's also a whole aspect of public health need to target.</span><br /><br /><span style="font-family:verdana;">Just take a stroll in the streets of Bandung- my hometown- and see how many street kids on the red light asking for small money.</span><br /><br /><span style="font-family:verdana;">Does it bother you people?</span><br /><br /><span style="font-family:verdana;">I guess we all know about this fact, yet don't know what to do.</span><br /><span style="font-family:verdana;">(Or don't care about it anyway).</span><br /><span style="font-family:verdana;">It was so hopeless and we BLAME to the government how come they let this happen.</span><br /><br /><span style="font-family:verdana;">Of course we should blame someone when something wrong happen.</span><br /><span style="font-family:verdana;">But it doesn't solve the problem.</span><br /><br /><span style="font-family:verdana;">This street kids represents (common) social issues in Indonesia: lack of social insurance, huge social inequality (riches get everything, poor left with nothing), public ignorance etc.</span><br /><br /><span style="font-family:verdana;">I was so annoyed by this fact!</span><br /><br /><span style="font-family:verdana;">And I felt it long before I got the chance to study to Europe to see how this wealthier nations managed their health systems and managements.</span><br /><br /><span style="font-family:verdana;">I would like to do the same for my country! Because this is my country (many expats or international donors would help Indonesia, but few of Indonesian themselves feel the same calling).</span><br /><br /><span style="font-family:verdana;">I know I could do it in so many ways.</span><br /><br /><span style="font-family:verdana;">For now, I am writing it down as a promise to myself.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8127035291536553225.post-81636859027927332242011-09-24T02:29:00.000-07:002011-10-24T02:34:58.552-07:00my learning experience (in PH)<span style="font-size:85%;"><span style="font-family: verdana;">Taken from my other blog </span><a style="font-family: verdana;" href="http://klinikgratis.wordpress.com/">http://klinikgratis.wordpress.com/</a></span><br /><p style="font-family: trebuchet ms;"></p><blockquote>” Abis master ngapain ? Bakal praktek lagi ? “</blockquote><p></p> <p style="font-family: verdana;">Itu dia pertanyaan orang-orang yang pengen tau gimana kelanjutannya setelah saya menyelesaikan program master selama 1 tahun.</p> <p style="font-family: verdana;">Dengan latar belakang pendidikan dokter, tentu aja saya bisa kembali lagi ke negara asal (Indonesia) dan kembali praktek atau melanjutkan spesialisasi.</p> <p style="font-family: verdana;">Tapi untuk saya, buat apa?<br />Kalau memang ingin terjun di bidang klinis, gak akan kemaren ‘ikut-ikutan’ sekolah master. Keukeuh lagi apply bidang yang paling banyak permasalahannya di Indonesia, yaitu <em>health systems, management and policies</em> = sistem, manajemen dan kebijakan kesehatan.</p> <p style="font-family: verdana;">Menurut pendapat saya, sudah banyak dokter umum ataupun spesialis yang bertebaran di Indonesia. Istilah Sunda-nya mah ‘<em>pabalatak</em>‘.</p> <p style="font-family: verdana;">Sayangnya proporsi tenaga kesehatan ini tidak merata, kebanyakan dokter dan tenaga kesehatan tentu aja lebih suka berdiam di kota-kota besar daripada di pedalaman atau kampung-kampung.</p> <p style="font-family: verdana;">Kenapa? Jawabannya mudah. Karena dimana ada duit, disitu ada prakter dokter.</p> <p style="font-family: verdana;">Mungkin itu jawaban yang terlalu vulgar.</p> <p style="font-family: verdana;">Tapi biarlah, kan ini blog punya saya sendiri <img src="http://s0.wp.com/wp-includes/images/smilies/icon_smile.gif?m=1303185160g" alt=":-)" class="wp-smiley" /> </p> <p style="font-family: verdana;">Okeh, penjelasannya adalah : Karena sistem pembiayaan kesehatan di Indonesia didominasi oleh sistem <em>out-of-pocket</em>.</p> <p style="font-family: verdana;">Dalam sistem out-of-pocket (OOP) ini artinya biaya yang keluar untuk berobat kalo ke dokter, ditanggung oleh pasiennya sendiri.<br />Dampaknya sudah jelas, mereka yang punya duit akan cenderung bisa memilih dokter sendiri, memilih mau berobat dimana (ke Puskesmas, praktek dokter pribadi, atau langsung ke Rumah Sakit), juga bisa menentukan mau beli obat yang mahal atau menentukan mau periksa laboratorium dkk.</p> <p style="font-family: verdana;">Pada intinya, kalo punya duit (dalam sistem OOP) artinya kita bisa mendapat pelayanan apapun.</p> <p style="font-family: verdana;">Sebaliknya, kalau tidak punya uang?<br />Mereka yang tidak punya uang, atau yang penghasilannya terbatas (bahasa halusnya) harus memilih jalur alternatif. Yaitu berobat ke tempat yang lebih murah (biasanya dipilih Puskesmas), berobat ke dukun dulu (karena ke dokter mahal), atau mencoba mengobati sendiri. Inilah juga sebabnya kenapa banyak orang miskin suka telat berobat ke dokter (dan kalau sudah nyampe dokter biasanya kena marah lagi: ‘Pak, koq sakitnya nunggu parah gini baru ke dokter…’)</p> <p style="font-family: verdana;">Itulah dia yang terjadi di banyak tempat di Indonesia.</p> <p style="font-family: verdana;">Itulah juga sebabnya kenapa walaupun banyak dokter dan tenaga kesehatan di Indonesia tambah banyak, tapi tidak mencerminkan bahwa rakyatnya akan semakin sehat.</p> <p style="font-family: verdana;">Karena banyak tenaga kesehatan tidak menjamin rakyatnya sehat jika,</p> <p style="font-family: verdana;">SISTEM KESEHATAN NYA tidak dirubah,</p> <p style="font-family: verdana;">juga MANAJEMEN kesehatannya tidak berubah,<br />ditunjang oleh KEBIJAKAN kesehatan yang menopang kedua perubahan tersebut.</p> <p style="font-family: verdana;">Mungkin untuk sebagian orang ini teori yang terlalu sulit untuk dimengerti.</p> <p style="font-family: verdana;">Tapi, teruslah membaca, akan saya coba jelaskan konsep ini pada Anda.</p> <p style="font-family: verdana;">Pertama-tama, kita ambil sistem kesehatan di negara maju.</p> <p style="font-family: verdana;">Siapa yang disebut negara maju? Bukan hanya negara yang pendapatan perkapitanya besar, tapi juga negara yang indikator kesehatannya bagus.</p> <p style="font-family: verdana;">Artinya umur harapan hidupnya tinggi, juga angka kematian ibu dan anak yang rendah. Ini semua mencerminkan bahwa negara itu makmur, sehingga kelompok populasi rentan (orangtua, wanita, anak-anak) bisa menikmati pertumbuhan ekonomi negaranya.</p> <p style="font-family: verdana;">Saya ambil contoh dua negara dimana saya pernah merasakan tinggal dan juga nyicip sistem kesehatannya, yaitu Belanda dan Denmark.</p> <p style="font-family: verdana;">Di kedua negara ini, karena sistem politiknya cenderung ke arah sosialis maka sistem kesehatan yang digunakan juga didominasi oleh Social Health Insurance atau asuransi kesehatan sosial.</p> <p style="font-family: verdana;">Pada sistem ini, semua orang yang sudah mempunyai penghasilan (kelompok usia produktif) diwajibkan membayar premi asuransi kesehatan. Biasanya langsung dipotong dari pendapatan. Buat mereka, haram hukumnya gak punya asuransi kesehatan. Karena, biaya ke dokter di negara maju ini sangat mahal.<br />Jadi, semua orang diwajibkan untuk punya asuransi kesehatan.</p> <p style="font-family: verdana;">Apakah ada orang-orang yang dibebaskan dari premi? Tentu saja ada.<br />Kelompok veteran (pensiunan), anak-anak, orang yang gak punya kerja, orang yang tidak mampu dst, dibebaskan dari premi tapi masih dijamin oleh asuransi kesehatan.</p> <p style="font-family: verdana;">Prinsip dari Social Health Insurance ini adalah: ‘Mereka yang mampu bayar (kelompok usia produktif), menanggung beban kesehatan mereka yang tidak mampu bayar.’</p> <p style="font-family: verdana;">Secara logika, ini adalah sistem kesehatan yang adil. Ya kan?</p> <p style="font-family: verdana;">Bagaimana kesan saya selagi jadi pasien di negara tersebut?<br />Untungnya, selama di Belanda (3 bulan lebih) saya jarang sakit. Atau paling sakit ringan yang gak perlu ke dokter.</p> <p style="font-family: verdana;">Tapi waktu di Denmark, pernah saya lumayan sakit (sakit koq bisa lumayan) sehingga merasa perlu ke dokter.</p> <p style="font-family: verdana;">Caranya: di Denmark semua orang punya kartu tanda pengenal (semacam KTP) yang bisa dipakai untuk kartu berobat ke dokter. Kartu ini multifungsi, juga bisa dipake untuk buka tabungan di bank, atau pinjam buku ke perpustakaan, atau buka nomor kartu SIM telefon. Jadi nomor identitas yang ada di kartu ini identik dengan nama kita sendiri. Pada saat kita nelefon dokter untuk bikin janji – nomor identitas inilah yang harus disebutkan.<br />Owhya, dokter yang bisa mengobati juga hanya dokter tertentu yang tinggalnya dalam wilayah tempat tinggal kita. Dan harus didaftar sebelumnya. Jadi seperti dokter keluarga ASKES lah kurang lebih.</p> <p style="font-family: verdana;">Selanjutnya, saya tinggal datang ke tempat praktek dokter tsb (dekat rumah, jalan kaki hanya 7 menit) sesuai dengan waktu yang telah ditentukan. Lalu menyebutkan nama saya dan nomor identitas. Juga menyertakan kartu saya tentunya. Nunggu sekitar 10 menit karena masih ada 1 pasien anak. Gak berapa lama dipanggil oleh dokternya.</p> <p style="font-family: verdana;">Asik juga karena selain tempat praktek deket dan gak usah tunggu lama, dokternya tertarik untuk ngobrol-ngobrol. Juga dia menyarankan pemeriksaan penunjang dan tes darah. Dibuat lembar referal untuk tes darah ke laboratorium.</p> <p style="font-family: verdana;">Semua konsultasi dan pemeriksaan penunjang tersebut GRATIS, alias gak bayar.<br />Kenapa bisa, karena sistem kesehatan sosialis itulah. Dipotongnya tentu dari pajak.</p> <p style="font-family: verdana;">Pajaknya juga gak tanggung-tanggung. Sistem pajak yang dianut adalah Progresif (sama seperti di Indonesia, hanya di Denmark pengelolaannya jelas dan tanpa korupsi <img src="http://s0.wp.com/wp-includes/images/smilies/icon_smile.gif?m=1303185160g" alt=":-)" class="wp-smiley" /><br />Tapi tentu aja walaupun pajak yang dipotong bisa sebesar 40% dari pendapatan, tapi penduduk Denmark dan Belanda lebih bisa merasakan ‘hasil’ dari pajak daripada di Indonesia. Seengga-engga, saya pendatang sementara, sudah bisa merasakan hasil pajak mereka, yaitu fasilitas dan layanan publik yang nyaman termasuk layanan kesehatan.</p> <p style="font-family: verdana;">Itulah sekilas yang saya pelajari saat menempuh program master, dalam bidang international health (yang juga termasuk bidang public health).</p> <p style="font-family: verdana;">Dan sampai saat ini saya yakin, Indonesia sebenernya gak (cuman) butuh lebih banyak dokter atau tenaga kesehatan saja, tapi juga praktisi di bidang ilmu kesehatan masyarakat.<br />Lihat saja di sekeliling kita, masih banyak pekerjaan rumah yang bisa ditangani pakar bidang ilmu kesehatan masyarakat/ public health : menangani sampah/ waste management, promosi gaya hidup sehat (kampanye anti rokok, pola makan sehat, anti junk food), penyediaan trotoar di jalan (supaya orang yang jalan gak ketabrak motor/ mobil!).<br />Bisa dibilang itu semua bukan pekerjaan yang sepele, bahkan kalau liat kondisi Indonesia sekarang, ini adalah sebuah tantangan bagi praktisi ilmu kesehatan masyarakat.</p> <p style="font-family: verdana;">Buat saya, pekerjaan itu menarik kalau ada tantangannya. Dan itulah sebabnya public health sebenarnya ilmu yang sangat menarik dan applicable!<br />Juga saya harapkan akan lebih banyak orang (baik dengan latar belakang medis atau bukan) yang lebih mendalami bidang ini.</p> <p style="font-family: verdana;">Seengga-engganya kalau Indonesia mau semakin maju dan sehat, harus lebih banyak praktisi di bidang ini. Bukan cuman dokter doang yang dibutuhkan.<br />Lagian, dokter juga manusia . . .</p>Unknownnoreply@blogger.com0