Conference addict :: Upcoming event on 2012

After my last scientific conference in Barcelona in the beginning of this month, I realized that I got addicted.

my poster in International Health Conference, Barcelona
with Prisca, my co-supervisor from KIT, Ams

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.

One of the speakers that I found very inspiring for me was Helen Rees. She brought a session about pre-exposure prophylaxis for HIV prevention, in a very practical manner. Also a stunning presentation!
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).

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).
Uh huh, no wonder why.

Now that I feel like I've learned so much from international conference, I got addicted to have some more !

Here's some of upcoming events (international scientific, clinical/ social conference) about HIV-AIDS in 2012 :

April 12-13, New South Wales (AU) Silence & Articulation

May 23-25, Marseille (FR) "Searching for Cure" - ISHED

July 22-27, Washington DC (US) Turning the Tide Together

So for those who are interested, don't forget to submit your abstract and hopefully I'll see you there !

NG :: 7 Billion Population in 2011

THis is an example of nice public health message from National Geographic.

It's about demographic, the world will reach 7 billion population by 31 Oct 2011.

Enjoy !

Health Promotion :: The Power of Information

When I was abroad, I talked to several friends that I know how did they get source of information about sexual reproductive health.

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.

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.

Also information about HIV.
HIV in Indonesia is actually not involving a big number.
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).

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'.
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).

These days, information plays a major role in our life.
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).
We all connected through invisible bonding, thanks to internet and mass media.

And we all may received also wrong or invalid information from media.

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.
Especially for uneducated people, when they can't be critical (for they concern about only their primary needs).

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.

I didn't watch TV (in Indonesia) that much because sometimes it could make me sick.
But I also noticed some channels consistently put nice public messages to inform viewers.

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.

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).

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.

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.

And it should be regulated in the Ministerial level!

I think for every junk food advertisement (McDonalds, KFC, etc) should be certain percentage aside for health eating habit advertisement !

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'.

Then again, smoking prohibition in public space.

Ah yeah, I should have mentioned first, that tobaccos are a big deal in Indonesia.
And it's so cheap ... even kids underage could afford it.

Compare with Europe, for example, you only could buy cigarettes if you're over 18 years old.
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).

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 !

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.

Maybe it sounds too cynical. But to be very practical, I would put higher tax on cigarettes -- then relocate the budget for health care --
And this works to stop people from smoking too, I believe.
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).

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.
Then again, it will be conflict of interest for them!

So, who should provide such information then?
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).

Sexual Reproductive Health :: It's not your own business

My mother always told me to mind my own business.

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.

But I can't !

I am a medical doctor, and what I always do is actually taking care others business.
I do care about other people's health, also about their financial insecurity, sometimes about their sex life's too.

It is so ridiculous everytime I heard people being so individualized and not really care about other people business.
Cause we know that we actually care!
And that's why we LOVE gossips so much.
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).

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.

I really think, if Indonesia people really like to mind other people business, they should do it in the right way.

There are so many rooms for help people, and yet we know that we're Indonesian good about it.

Remember Prita case?

Her case was so famous because it moved hundred thousands people to actually help her by donating small moneys.

It is in our blood. We're moved by social injustice. We could not see others people suffer.

So why we could not do it in a better way?

Talking about sex life. Hmmm... Yeah, it's always an interesting topic.

But why am I bring up this topic is because Indonesia, with 237 million of population, we're facing a problem of overpopulated country.

It's not as bad as India or China. But I'm sure we're getting there.
It's just a matter of time.

So why not propose something to stop this exploding number of citizens?

I would propose 3 things:
(a lesson learned from my scientific writing, only 3 points max.)

1. Family planning access for all reproductive ages people (women or men, married or not)
2. Sexual reproductive health information for all (esp teenagers, youth, adolescents, even kids).
3. Female education
[ Not necessarily in order, but those things are very essential ]

I was actually about to mention 'access to safe abortion' (if needed).
But I recognize this topic could be highly sensitive and leading to many discussions/debates, also touching religion/ belief perspective.
So I will set aside this topic after top 3 priorities that I've mentioned.

The first 2 priorities seem obvious and make sense to point out.
Therefore, I would start with my last point : Female education.

Why is it so important in sexual reproductive health program.

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.

I will show this correlation with simple manner:

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).

Maybe not as simple as that.
In above calculation, there's always assumptions (and theories) applied e.g.
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).

Anyway, I'm not the expert of such theories as well.
May the social scientists explain such behaviour.

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.

Why female?

Because I am woman and I know how care we (women) toward our family (esp children).
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.

Women are more likely to sacrifice for the sake of their kids and family.
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!).

It is so common sense, right?

Another example is street kids. I've seen many of them without their parents in the street.
Some are altogether with the mother asking small money in the street.

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?'

Maybe they do dare for the money (it is a strong motivation though, as strong as many corruptors steal money from the government),
OR
maybe it's the only way they know how to get money.

Female education though is not a simple remedy for gender inequality.

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).

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.

Also religious sector, could influence the acceptance of contraceptive options (or basically many aspect besides contraceptive).
It is a country with biggest number of moslem population anyway ...

And oh, also talking about abortion.

Yes, I do believe God and I do worship Him, and I believe there is heaven and hell.

But it doesn't make me against abortion, because I believe safe abortion could be an option sometimes.
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!


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.

Now, remember Ariel case ?
Ariel is a famous lead vocalist from famous (cheesy) boyband from my hometown.

And he got prosecuted for having sex in his own place, because somebody publicized his videotape (?!???)

It is really confusing case. It's his own (sex) business, he's not even stealing government money like corruptors !

I'm not on his side at all. (I'm not taking side in this case).
I'm just upset how people could care wrongly about this sexual case, while they should more care rightly about other issue.

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?
Why not transparently educated our people about sexual and reproductive health facts-
instead of tell them what to do.

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 !

Why Public Health :: Matter of Life

Why Public Health ? Why International Health ?

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.

I would say: Because it's really important (especially in developing country, where I came from).

It's a simple answer, yet defines so many things that we're (Indonesia) lack of.

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.


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.

But I would limited my theme just into Public Health.
The area that I interested the most.

Back to my question in the first sentences,
' Why Public Health ? '

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.
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.
It was just TOO frustrated.

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.

Another patient that I treated, would just keep coming back for the same issue.
Malaria is highly prevalent in the area, and just medications to cure the symptoms not really actually treat the environmental cause of Malaria.

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.
And it has nothing to do with being a clinician.

Somebody has to do something. I want to do my part. It's my calling.

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 Erasmus Mundus scholarships) and I studied in 2 different universities in Europe; Royal Tropical Institute, Amsterdam and University of Copenhagen, Denmark.
It was a fantastic year and I learned a lot (still a bit from what I should know) about health systems, managements, and policies.
And I am sure this is my passion, this is what I would like to do further in my career path.

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.

Doing this as clinician, (if it's not one's calling) it's even more frustrated.

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).

Most of the time, these people not even aware that they actually AT RISK.
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).
Or those who already reached the health care facilities, sometimes get DISCOURAGED by the unfriendly approach of health care workers.

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.

It's a very interesting subject (for researcher) but also complex and confusing in its intervention.

And it was not easy because it cannot be intervene by only clinical intervention.

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.

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).

There's also a whole aspect of public health need to target.

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.

Does it bother you people?

I guess we all know about this fact, yet don't know what to do.
(Or don't care about it anyway).
It was so hopeless and we BLAME to the government how come they let this happen.

Of course we should blame someone when something wrong happen.
But it doesn't solve the problem.

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.

I was so annoyed by this fact!

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.

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).

I know I could do it in so many ways.

For now, I am writing it down as a promise to myself.

my learning experience (in PH)

Taken from my other blog http://klinikgratis.wordpress.com/

” Abis master ngapain ? Bakal praktek lagi ? “

Itu dia pertanyaan orang-orang yang pengen tau gimana kelanjutannya setelah saya menyelesaikan program master selama 1 tahun.

Dengan latar belakang pendidikan dokter, tentu aja saya bisa kembali lagi ke negara asal (Indonesia) dan kembali praktek atau melanjutkan spesialisasi.

Tapi untuk saya, buat apa?
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 health systems, management and policies = sistem, manajemen dan kebijakan kesehatan.

Menurut pendapat saya, sudah banyak dokter umum ataupun spesialis yang bertebaran di Indonesia. Istilah Sunda-nya mah ‘pabalatak‘.

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.

Kenapa? Jawabannya mudah. Karena dimana ada duit, disitu ada prakter dokter.

Mungkin itu jawaban yang terlalu vulgar.

Tapi biarlah, kan ini blog punya saya sendiri

Okeh, penjelasannya adalah : Karena sistem pembiayaan kesehatan di Indonesia didominasi oleh sistem out-of-pocket.

Dalam sistem out-of-pocket (OOP) ini artinya biaya yang keluar untuk berobat kalo ke dokter, ditanggung oleh pasiennya sendiri.
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.

Pada intinya, kalo punya duit (dalam sistem OOP) artinya kita bisa mendapat pelayanan apapun.

Sebaliknya, kalau tidak punya uang?
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…’)

Itulah dia yang terjadi di banyak tempat di Indonesia.

Itulah juga sebabnya kenapa walaupun banyak dokter dan tenaga kesehatan di Indonesia tambah banyak, tapi tidak mencerminkan bahwa rakyatnya akan semakin sehat.

Karena banyak tenaga kesehatan tidak menjamin rakyatnya sehat jika,

SISTEM KESEHATAN NYA tidak dirubah,

juga MANAJEMEN kesehatannya tidak berubah,
ditunjang oleh KEBIJAKAN kesehatan yang menopang kedua perubahan tersebut.

Mungkin untuk sebagian orang ini teori yang terlalu sulit untuk dimengerti.

Tapi, teruslah membaca, akan saya coba jelaskan konsep ini pada Anda.

Pertama-tama, kita ambil sistem kesehatan di negara maju.

Siapa yang disebut negara maju? Bukan hanya negara yang pendapatan perkapitanya besar, tapi juga negara yang indikator kesehatannya bagus.

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.

Saya ambil contoh dua negara dimana saya pernah merasakan tinggal dan juga nyicip sistem kesehatannya, yaitu Belanda dan Denmark.

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.

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.
Jadi, semua orang diwajibkan untuk punya asuransi kesehatan.

Apakah ada orang-orang yang dibebaskan dari premi? Tentu saja ada.
Kelompok veteran (pensiunan), anak-anak, orang yang gak punya kerja, orang yang tidak mampu dst, dibebaskan dari premi tapi masih dijamin oleh asuransi kesehatan.

Prinsip dari Social Health Insurance ini adalah: ‘Mereka yang mampu bayar (kelompok usia produktif), menanggung beban kesehatan mereka yang tidak mampu bayar.’

Secara logika, ini adalah sistem kesehatan yang adil. Ya kan?

Bagaimana kesan saya selagi jadi pasien di negara tersebut?
Untungnya, selama di Belanda (3 bulan lebih) saya jarang sakit. Atau paling sakit ringan yang gak perlu ke dokter.

Tapi waktu di Denmark, pernah saya lumayan sakit (sakit koq bisa lumayan) sehingga merasa perlu ke dokter.

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.
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.

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.

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.

Semua konsultasi dan pemeriksaan penunjang tersebut GRATIS, alias gak bayar.
Kenapa bisa, karena sistem kesehatan sosialis itulah. Dipotongnya tentu dari pajak.

Pajaknya juga gak tanggung-tanggung. Sistem pajak yang dianut adalah Progresif (sama seperti di Indonesia, hanya di Denmark pengelolaannya jelas dan tanpa korupsi
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.

Itulah sekilas yang saya pelajari saat menempuh program master, dalam bidang international health (yang juga termasuk bidang public health).

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.
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!).
Bisa dibilang itu semua bukan pekerjaan yang sepele, bahkan kalau liat kondisi Indonesia sekarang, ini adalah sebuah tantangan bagi praktisi ilmu kesehatan masyarakat.

Buat saya, pekerjaan itu menarik kalau ada tantangannya. Dan itulah sebabnya public health sebenarnya ilmu yang sangat menarik dan applicable!
Juga saya harapkan akan lebih banyak orang (baik dengan latar belakang medis atau bukan) yang lebih mendalami bidang ini.

Seengga-engganya kalau Indonesia mau semakin maju dan sehat, harus lebih banyak praktisi di bidang ini. Bukan cuman dokter doang yang dibutuhkan.
Lagian, dokter juga manusia . . .