Category Archives: Indonesia

In praise of Endang: A gem among Indonesian doctors

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© Kompas/HANDINING

Wednesday was a sad day for Indonesia. and for me. It marked the death of Endang Sedyaningsih, who encompassed what is best in the women in this great country: courage, determination, integrity, compassion and humility. It is a rare combination at the best of times; in the Indonesian cabinet, where Endang held the position of Minister of Health, these qualities are nothing short of exceptional.

In my last post, I was pretty rude about Indonesian doctors. Endang counts among the “several smart friends who were once great doctors”. Unlike many ministers in Indonesia, she knew her territory inside out. For three years, she worked as head of a rural health centre in Nusa Tengarra Timur, the poorest province in Indonesia. She gave up doctoring in favour of public health and research, a choice that I predictably enough applaud, not least because a lot of her research was among sex workers and other marginalised groups. Indeed her thesis at Harvard centred on the lives of the women who sold sex in Kramat Tunggak, Jakarta’s largest red light district. She argued for improving health services for the women that worked there. Jakarta Governor Sutiyoso, seeking to burnish his credentials with Moslem voters, responded by bulldozing the area and building a gopping mosque and Islamic centre in its place. When Kramat Tunggat was closed in 1999, HIV prevalence among brothel and street-based sex workers in north Jakarta was 0.4 percent. Since the rise of the mosque and the dispersion of the sex trade, it has risen to 10.5 percent.

Endang was fearless both physically (not many of my colleagues were prepared, as she was, to brave the Jakarta traffic on the back of my motorbike…) and politically. During the reign of her controversial predecessor, Siti Fadilah Supari, Endang had to put up with a lot of flack because the national health research institute she headed cooperated closely with foreign researchers in trying to develop vaccines against bird flu, which has a higher case fatality rate in Indonesia than in any other country. For Siti, this cooperation amounted to collaboration with the enemy. Her book “It’s Time for the World to Change! God’s Hand Behind the Bird Flu Virus” is actually more about the hand of the CIA behind the virus – a mish-mash of conspiracy theories which were such an embarrassment to the Indonesian government that the book was eventually pulled from bookshops.

Leading the research programme for the Ministry of Health, Endang kept her head down and got on with her work. In her eyes, finding a vaccine that could protect millions of her fellow countrymen from a strain of flu that killed eight out of 10 of those infected was more important than whipping up populist anti-Americanism to score cheap political wins. When she was appointed health minister in Indonesian president Susilo Bambang Yuduhyono’s second cabinet, the press showered her with nonsense about being a CIA plant. Again, she kept her head down and got on with her work, trying especially to improve services in the far-flung corners of the nation so often overlooked by those trapped in the political spider’s web of Jakarta.

Endang was an Indonesian nationalist in the truest sense of the word: not a knee-jerk Xenophobe, but someone who consolidated learning, skills and relationships acquired around the world and used them in the service of the men, women and transgenders of the Indonesia she loved so much. I am angry that she was taken from us by lung cancer at the age of only 57, but am proud to have called her a friend.

A sick system produces dumb doctors in Indonesia

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“Why don’t you go to Penang/Singapore?” is the first thing most Indonesians say when they hear I don’t have kids. Obviously childlessness must be fixed, and obviously it is far too important to be left to the Indonesian health system. I usually give people short shrift when they trash the health system here. I have several smart friends who were once great doctors. Ok, they’ve mostly shifted into management jobs now, but Indonesia’s med schools are full of bright young things to take their place.

Or are they? A recent report from the World Bank wrings its hands over the quality of medical education in Indonesia. It finds that accreditation standards for health schools are wonky in the first place, are not properly applied, and are in any case not published. Not too surprising really. Another recent report from the World Bank notes politely how absolutely crap Indonesia’s education system is. In internationally standardised tests of 15 year-olds, over half of Indonesians scored less than one out of six on maths tests, and not a single Indonesian student reached the score of five or six that, according to the OECD which runs the tests, indicates decent critical thinking skills. When basic education is so poor, it would be miraculous for medical education to be much better. But the World Bank health worker report doesn’t even mention the thing that worries me most: training for doctors and jobs as nurses are for sale.

Even the best state universities, the ones that in the past gave scholarships to my smart friends, are raking in money selling places in med school. The starting price to get in, for students with exceptional grades, is 10 million rupiah, over US$ 1,000. The lower your grades, the more you have to pay to get in. Medical school is so fashionable these days that I’ve heard of people paying up to 250 million rupiah just to get in. That’s not for tuition, of course, that’s purely for the privilege of being able to say “My eldest is studying to be a doctor”. If they are either stupid or lazy or both, they will have to pay another great whack each year to pass their exams. When they graduate they’ll have had a very expensive education. But would you want them taking care of your tumour?

The sale of jobs starts at a much lower level. Nurses and even midwives now have to put out to get hired even in small town health centres. The going price in Aceh, where I’ve spent the last few weeks, is 60 million rupiah for an entry level job (assuming that you have already earned, or indeed bought, the appropriate qualifications). Sixty million rupiah, US$ 6,600 dollars, to get a job that will earn less than US$ 300 a month. Is it any surprise that most health centre staff, doctors, nurses and midwives included, go to work in the morning and run a private practice in the afternoons or evenings?

I often ask people why they pay to see the doctor in the evening when they could see exactly the same doctor for free in the morning. The universal response is that doctors keep the “strong” medicine for their private patients. At the health centre you get obat warung – “kiosk drugs”, cheap, over-the-counter stuff. Given the deterioration of standards required of people studying medicine in the first place, I would have thought the drugs they give you would be the least of your concerns.

Forbidden pleasures: What Elizabeth eats for tea

Giant clams hung out to dry in front of a fisherman's house in Pulau Banyak, Aceh
Giant clams hung out to dry in front of a fisherman's house in Pulau Banyak, Aceh

Indonesian food is varied and generally wonderful, though in out of the way spots like Pulau Banyak, off the West coast of Aceh, the choice for travelers is not extensive. I eat whatever is on offer on any given day at the one food stall in town — usually indeterminate fish in a yellowish or a reddish gravy. Yesterday the gravy was yellowish, and the first mouthful took me back to my grandmother’s kitchen. I was eating clam, of a very, very delicious sort. The cook’s husband, seeing my pleasure, rummaged behind the stove and came out with a clam shell about a foot across. “This is it’s shell”, he said. “They’re getting harder and harder to find.”

Turtle eggs for sale in Banda Aceh market. One pile sells for under two dollars.
Turtle eggs for sale in Banda Aceh market. One pile sells for under two dollars.

I don’t think giant clams are officially an endangered species, but I still wondered if I should feel guilty about eating one. Getting moral about what we eat presents us with so many dilemmas. I’ve always been surprised by moral vegetarians who happily eat fish. That’s the one thing that we still hunt in the wild, despite their getting harder and harder to find — surely that makes fish more morally problematic that meat which is bred for consumption? Giant clams are probably a no, though they are widely available here (and so very, very delicious). Turtle eggs are a definite no; there are even regulations against selling them, thanks in part to the work of conservation NGOs such as Yayasan Pulau Banyak. But that didn’t stop a young neighbour of the NGOs pleading with me to bring some back for her from the turtle breeding island of Bangkaru: “I’m pregnant. It’s my duty to eat things which are good for me”. And it doesn’t stop the traders in the main market in Banda Aceh, the provincial capital, selling them quite openly. A clutch of seven goes for just 20,000 rupiah, about US$ 1.80. I have no moral dilemma at all over turtle eggs; I don’t eat them. Though that may be because the only time I’ve ever tried them, in this very province some 20 years ago, I felt like I was eating slightly fishy snot bombs. If they were very, very delicious, I might be more conflicted.

A comfortable T-shirt culture

If I had the courage to stick my camera into people’s chests, I’d by now have a vast repertoire of photos of absurd and inappropriate T-shirts. Pretty young school-girls sporting obscenities that would make a punk blush. Elderly crones decked in gyrating boy-band idols. Moslem clerics declaring their love for Jesus. And plenty of slogans that just make no sense at all. Most Indonesians love to pose for pictures; it’s me that’s uncomfortable snapping things that will make people look silly. So I have to settle for what I can capture from behind.

Aceh’s new leaders: Militantly religious?

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A proto-military jeep in front of a mosque at a Partai Aceh rally in Aceh, Indonesia
Partai Aceh: religiously combative

Well it’s official. The Partai Aceh candidates for Governor and Vice Governor will rule Indonesia’s most fractious province for the next five years. Their election campaign was a strange mix of proto-militarism and religious fervour. At every rally, hundreds of the young men who are the party’s most fanatical supporters stood in serried ranks in red, black and white “camouflage” uniforms, saluting the candidates, one of whom is a rather homey doctor who has spent most of his adult life in Sweden. They (and I) listened also to sermons about how Partai Aceh would keep the province free of “kaffir” religions — anything that is not Islam, effectively. There were strange digressions about protecting the territory from the Jews, although to my knowledge the Jewish community is, uuuum, somewhat under-represented in Indonesia as a whole, let alone in Aceh.

As he formally acknowledged his election, the doctor from Sweden, Zaini Abdullah, said he would seek to implement a “purer” form of Islamic Sharia law. His bitter rival in this election, former governor Irwandi, is seen by some to have sold out because he refused to sign a bill implementing Sharia law, finding some if its provisions too harsh. Stoning adulterers to death, for example. I’ll be interested to see how Zaini Abdullah negotiates this one. His running mate, the former guerilla commander Muzakir Manaf (who looks like he’s been sent over to Party headquarters by Central Casting), is widely known to have at least five wives. That’s one more than is allowed by Sharia law (which, says Zaini, “is about how to educate our youths about what is right and wrong”). Technically, then, the Vice Governor is an adulterer. Will Partai Aceh’s dedication to purity put it’s own number two at risk of death? Watch this space.

Shaking up infrastructure and politics in Aceh and Papua

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Poor David Cameron; something always seems to steal his thunder. During his visit to Indonesia today, it was two huge earthquakes in Aceh. I’m in Aceh just now, and was watching his press conference on Indonesian TV when the room started to shake and we had to tear ourselves away from his platitudes. The UK Prime Minister is reportedly looking for business for UK companies. If investment decisions were based on need, or on the impact they might have on the daily lives of poorer people, Cameron might encourage UK businesses to turn his blah blah about bridge-building into something more concrete. In the last couple of months I’ve been in two of Indonesia’s richer provinces, Aceh in the extreme west, and Papua in the far east. In both, there are shocking lapses in investment in infrastructure — lapses that make life miserable for kids on their way to school, women on their way to sell vegetables in the market, people trying to scrape together a living running motorbike or pick-up truck taxi services.

The high-wire act that passes for a bridge near Tangse, in northeast Aceh, shown in the video is the remains of a wooden bridge washed out by a massive flash flood in early 2010 — what the locals call “our tsunami”. Although there are still millions of dollars sloshing around in unspent funds donated for reconstruction after the 2004 tsunami, nothing had been done to fix this bridge 18 months after its evaporation. You’ll have to excuse the shaky filming — I had to keep one hand on the wire as I crossed….

A woman carries vegetables to market across a half-collapsed bridge in Wamena, Papua, Indonesia
A woman carries vegetables to market across a half-collapsed bridge outside Wamena, Papua

This other photo was taken in Wamena, in the stunning central highlands of the country’s richest province, Papua. Wamena is the main town in the highlands, and this bridge is on the main road out of town, linking the hospitals, markets and high-schools of town with the rural hinterlands. Or rather not linking them; motorbikes can get across but it has been months since a truck or minibus made the leap.

It’s sobering to see the people of Aceh’s reaction to today’s earthquakes, even in the hills where I am just now and where there’s no risk of a tsunami. The girl I was talking to went so faint that she to had to be helped out of the building for the second earthquake, 8.8 on the Richter scale. A little later, still shaky, she told me that she had lost several family members in the 2004 tsunami. She also agreed with someone’s only half-joking suggestion that this was the earth’s reaction to Monday’s elections in Aceh. These were comprehensively won by Partai Aceh, the political offspring of the GAM guerilla movement improbably directed out of Sweden. Though they’ve been widely accused of election-related manipulation, violence and intimidation, Partai Aceh played the Peace card in this election. But they played it upside down. Rather than say: “if you vote for us, we’ll keep the peace”, the rank and file, at any rate, were saying: “if you don’t vote for us, your precious peace will be no more”.

I rather suspect Partai Aceh would have won even without the scare tactics. But Earthquake-Girl’s reaction to my idiocy (as I wandered back in to the shaking building to get my computer) reminded me of this fact: the more people know the bitter taste of fear, the more effectively it controls their behaviour. The people of Aceh spent the 15 years to 2005 finding corpses by the roadside in the morning, trembling at midnight knocks on the door from guerillas and soldiers alike, being shaken down for cash, rice, a motorbike. They’ll vote for anything that avoids a return to that.

The drill in Aceh: whipping up support

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I happen to be in Aceh for the local elections. These are interesting times, with rivalries between former comrades in the para-political movement formerly known as GAM hotting up. It’s a sensitive topic in a still-fragile part of this increasingly centrifugal nation; I’d say a lot more, but I have promised the Indonesian intelligence services that I won’t report on the ins and outs of local politics.

Indonesian Intel checks me out at a campaign rally in Aceh
Heri, an Intel agent in north Aceh, takes my photo on his iPad while his boss checks my papers.

True to my word, I’m going to write instead about Aceh’s creativity with power tools. A regular household drill can be used to make one of the province’s breakfast specialities — whipped raw egg with coffee, as well as to whip up support at campaign rallies.

Hike skirts, not prices: diversion for Indonesian politicians

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Indonesian ministers pose with mini-skirted golf caddies
Who should we arrest? Indonesian ministers pose with golf caddies in soon-to-be-illegal mini-skirts (Photo: Rakya Merdeka)

Indonesians think about sex, or at least search for it on the internet, more than most: Indonesian was the number one language for Google searches on sex last year, and the country ranked 6th overall in sex searches (the good fellow Moslems of Pakistan led the pack for the umpteenth year; indeed seven out of the top 10 sex-searchers are Moslem-majority nations). If the legislator caught with a long-lens camera watching porn in Indonesia’s national parliament is in any way representative, politicians are not immune from this obsession.

Indonesia’s government has reacted to the uncomfortable clash between its prudish self-image and its lascivious reality in the way that it deals with most of this culturally scattered nation’s manifold contradictions: legislate, then fail to enforce. The controversial anti-pornography bill was first passed in 2008. Many people, especially women who could be prosecuted under the law for exposing undefined body parts, were furious. The law was put on hold while civil rights groups argued in the country’s highest court that it was unconstitutional, in part because pornography was not clearly defined. Would the temple carvings of central Java and Bali have to be dismantled because they qualify as “erotic art works”, prohibited by the law for example? The constitutional court in 2010 ruled that the definition of pornography in the bill was just fine, and that the law should be enacted.

Ok, so now we’ve got the law, we can get on and ignore it. But earlier this month President Susilo Bambang Yudhuyono (SBY) put the controversy firmly back on the agenda, establishing an anti-porn task force to clarify the definition of porn (yes, the same definition ruled clear enough by the constitutional court) and implement the law. Religious Affairs Minister Suryadharma Ali has jumped in to the fray, saying that the task force will tell women how to dress, probably prohibiting them from wearing skirts above the knee. It is hard not to agree with House of Representatives Deputy Speaker Pramono Anung, who protested at a ban on mini skirts: “What we need to take care of are mini-brains and mini-morals,” he said. It’s worth noting that the legislator caught watching porn was from the Islamic Prosperous Justice Party (PKS), which was one of the motors behind the drafting of the anti-pornography bill and which wastes no opportunity to preach to the nation about the importance of morality.

It seems more than likely that SBY resurrected this issue now because he is trying to distract attention from a (quite sensible but wildly unpopular) move to cut subsidies on fuel, as well as an ongoing corruption soap opera involving his own party.

The essentials of life: handphones where there’s no power

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A shop offering phone charging services in Enarotali, Indonesian Papua

Just a couple of years ago, it was a source of wonder: “Wah! In Indonesia, even the hookers/farmers/becak drivers have cell-phones!” The citified loved to take photos of small buffalo-riding Javanese children or half-naked Papuan adults busily chatting on their cell-phones (HP, or “hah pay” in Indonesian, from the English Hand Phone). Now, cell-phones are such a universality that no-one even bothers to take note. But I still find it amusing that cell phones have entrenched themselves quite so firmly even in places where there’s no electricity. This has led to a whole secondary industry, illustrated by the roadside stall in the small town of Enarotali, in the highlands of Papua, pictured above.

CASS HP: what can it mean? In Indonesian, “C” is pronounced “Ch”: Chass HP, the local rendering of Charge HP. This shop will fill your battery for you, for 5,000 rupiah, about 50 cents. You’ll find stalls like this all over Indonesia, and plenty of people using them even in areas with no phone signal, especially near areas where electricity is sporadic or non-existant. Because after all, even if you can’t talk to anyone on it, a charged phone makes a very good torch.

What drugs are they on? Madness in Indonesia’s jails

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Balinese boys flick gang symbols before parading thir evil spirits around town

I spent Nyepi, the Hindu day of silence, in Bali. Things have quietened down a bit here, but earlier in the month prisoners in Kerobokan, the main jail, went on the rampage. Officially the riot was about overcrowding, though the trigger seems to have been some spat about drug dealing. It is old news that drugs are cheaper inside Indonesia’s jails than outside. But it is the link between drugs and overcrowding in jails that we need to be thinking about.

At the start of this year there were over 143,500 prisoners and pre-trial detainees in Indonesia’s prisons and detention centres, according to a friend at the UN who follows these things. That’s in a system that has a capacity of 97,200, so that’s one and a half bodies in every bed. Some 21,500 of these prisoners are banged up just for using drugs, and almost the same number again for dealing them, very often in very small quantities. One person I know of in Jakarta occupied a cell for four years because he ferried 10 ecstasy pills across town. Four years for 10 pills, for God’s sake. Four years is the amount of time that Tommy Suharto spent in jail after being convicted of masterminding the murder of a High Court judge. My pill-carrying friend would have been clogging up a cell for seven years, but a judge reduced the sentence after he was paid US$ 40,000 to help him in his decision-making.

In short, almost the whole of the overcrowding problem in Indonesia’s jails could be solved just by not giving people sentences for getting high or peddling small packets of drugs. In Kerobokan itself, over half the pre-riot population was in on drug charges. A lot of the guys (and they are mostly guys) in jail have not even been sentenced: over 51,000 are being held before being tried. This, according to friends who have been there, done that, is sometimes a money-making ploy on the part of the cops. They pick people up for drug use (or other minor “crimes”), then negotiate a pricey release before a formal sentencing. The high proportion of unconvicted prisoners also reminds us that the courts are at least as overcrowded as the jails. But again, if we weren’t taking up judges’ time processing people for getting high, that problem might be more easily solved, too.

In an informal meeting with groups interested in providing health services in jail, Justice and Human Rights Minister Amir Syamsuddin recently questioned the wisdom of prosecuting people for use and possession of small quantities of drugs. He should be encouraged to support a more rational approach to drug use.

Aside: The photo above is of a group of Balinese louts-in-training getting ready to carry an “oga-oga” around their village on the eve of the Nyepi festival. These representations of evil spirits are paraded to the village limits, then burned in a ritual that is supposed to cleanse the community of evil before the start of the New Year. Let’s hope it works, and that none of these lads wind up in Kerobokan. For more on that infamous jail, check out Kathryn Bonella’s “Hotel Kerobokan”.