In late 2011, epidemiologist, writer and adventurer Elizabeth Pisani granted herself a sabbatical from the day job and set off to rediscover Indonesia, a country she has wandered, loved and been baffled by for decades. She was on the road and the high seas for a year, covering dozens of islands in 27 provinces. This site records photos and musings from that journey and beyond. See more about the project
I’m nearing the end of the first (nine-month long) leg of my Indonesian Odyssey and I don’t feel much closer to understanding the heart of this torturously complicated but endlessly fascinating nation. I’ve done my best to try and sum up some of my thoughts in the June issue of Prospect, one of UK’s more intelligent monthly magazines.
“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.
West Papua will lead the fight against corruption, drugs, and HIV/AIDS
After another giant geographic leap (roughly the equivalent of London to Tehran) I find myself in Manokwari, West Papua. Tanah Papua, Indonesia’s eastern extremity, has the country’s highest rates of HIV, and also its highest levels of stigma. Which makes me wonder who came up with this commitment, made on an ageing poster that has pride of place outside the provincial Governor’s office. It declares:
The West Papua government will lead the fight against:
KKN (Corruption, Collusion and Nepotism)
Narcotics and illegal drugs
Though hopeful donors have been pushing voluntary testing and counselling clinics on Papua for years, all the clinics I’ve visited in the last week report that the truly voluntary “I’ll just go along and see whether I’m infected” walk-in client is rare. Most are referred to the clinics by health staff who see signs and symptoms of AIDS — often, in other words, after people have been walking around with HIV for a decade or so. Why don’t more people want to get tested? Perhaps in part because we still tell people AIDS can’t be cured. But also because we are equating HIV with distinctly undesirable things like corruption and illegal drugs. It brings us back to the eternal prevention dilemma. We want people to think HIV is undesirable, because we want them to protect themselves from infection. But we also want to stop treating it like some horrid plague which deserves to be feared (and financed) more than any other inconvenient, chronic, treatable disease.
If you’ve been reading this blog much, you’ll have gathered that the parallel with corruption is not actually so far off for Indonesia, in that corruption is also an undesirable, inconvenient and chronic disease. At least HIV is treatable.
Stop Money Politic...! This poster from the elections commission in East Aceh, Indonesia, has the thought bubble: "Won't he have to use corruption to get back the money he's spent?"
It’s local election season in many areas of Indonesia. That means posters of well-fed used car salesmen promising vaguely to fight corruption and enrich the “rakyat”, the majority of Indonesians who live from day to day or month to month. It also means that towns and villages are filled with “Tim Sukses” — swarms of volunteers who try to get the vote out for their candidate, often with the help of envelopes of cash.
Here’s my question: why does money politics work? I put the question in a slightly more direct form to someone in Aceh who was cross because she’d been offered only 100,000 rupiah — less than US$ 11 — for her vote. “I got that in 2006, and there are more candidates this time, all of them making offers. Why would I give away my vote for just 100,000?” Why, I asked her, didn’t she just take 100,000 from all of the candidates, and then vote the way she would have voted anyway? She looked shocked. “If I’ve promised my vote, I have to deliver my vote!” In other words, money politics works because enough people are honest in their corruption.
As this poster from the election oversight commission in the East Aceh town of Langsa suggests, the vast spending on campaigns, including vote-buying, leads to a cycle of corruption. Elected leaders resort to graft just to get back the cash they’ve spent. Sometimes, the payback is in contracts, not cash. But every which way, it means public money is badly spent. This report from the World Bank gives a pretty clear picture of how it all works. It refers to the last round of elections in Aceh, the rich Westernmost province of Indonesia that teeters perpetually on the brink of independence, but — pace the separatists — there’s virtually nothing in it that is not just as true of the rest of Indonesia.
The exception is wrapped up in the final point about voter behaviour: intimidation. In Aceh, people are talking about “Terror Politics” as well as “Money Politics”. Last week I made a giant leap from the tuna fishing grounds by the Philippine border to the far West of Indonesia to witness the local election campaign in Aceh. I didn’t see it because the elections have been postponed for the third time, in part because the fractious former separatists, unhappy with the current governor who is also a former separatist, have been obliquely threatening unrest if Jakarta doesn’t roll over and do everything it can to undermine the incumbent. I can’t say that it is their camp, Partai Aceh, that was behind the drive-by shooting at the house of the Governor’s Tim Sukses head last week. But party activists in the local coffee shop were not denying it when I reflected that a postponed election increased their chances of getting “their man” — a crusty old soul who has spent much of his adult life in exile in Sweden — elected. If this all sounds complicated, it is (there’s a good run-down of the issues from the International Crisis Group and more in Inside Indonesia).
According to a former candidate for mayor in Langsa, home to the anti-money politics poster pictures above, terror Politics is the order of the day, at least in rural areas. “If you stay in a village for a week before the elections, I guarantee you’ll get a knock on the door in the middle of the night.” In an area where a knock on the door at night meant near certain death for over 15 years, either at the hands of a shadowy group of thugs and rebels who eventually gelled into Partai Aceh, or at the hands of the Indonesian army that fought to suppress them, it’s pretty persuasive. Even more persuasive, perhaps, than 100,000 rupiah.
When Indonesians ask me what I find so special about their country, I often throw the question back at them. There’s usually much head-scratching and no clear answer. So then I ask: OK, what do you think defines Indonesia, then? Again, rarely a clear answer. The other day, though, a random unemployed guy I met on a boat came out with this: “Indonesia is a country based on the rule of law”. I nearly fell into the Banda sea (the deepest in the world, apparently). Indonesia is a country based on many things: the avarice of the Dutch, the populist nationalism of the founding fathers and the stubborn tenacity of the military are all candidates. But the rule of law would not appear in my top ten. Or even top ten thousand.
When Indonesians talking of siphoning millions out of the public purse they don’t call it theft, any more than Americans call their multi-squillion dollar lobbying industry “corruption”, though giving donations to politicians in return for legislation that profits your business smells a lot like corruption to me. In Indonesia, corruption is so deeply entrenched that it has it’s own set of time-saving initials: KKN (for Korupsi, Kolusi, Nepotism). And attempts to cut it off at the roots seem only to underline the hopelessness of the task. I read about one such in Kompas this week. “I’ll stop cheating when I know my stuff,” declared a 15 year-old middle-school student. This was considered a success of an anti-corruption programme which hopes to get schoolchildren to set themselves time-bound goals for going clean. The premise, apparently supported by survey data, is that all students cheat some of the time, and most of them cheat most of the time. Teachers do little about this because they are under severe pressure to produce “results” for the school (something that will sound familiar to anyone who teaches in an inner London school). Teachers in the wonderful Indonesia Mengajar programme, which sends graduates from the best universities to the most neglected parts of Indonesia to teach in primary schools for a year, say they feel the same pressure from a different source. “If I fail a student, the parents take it as an insult and just stop sending the kid to school” a teacher in the north of Tanimbar told me.
So cheating becomes a norm. And from cheating to lying, and from lying to not telling the whole truth about the distribution of funds, and from there to 100 th place on Transparency International’s list of least corrupt countries. In fact, Transparency International is one of the groups behind the programme to reduce cheating in schools. Its slogan: “Dare to be honest. That’s cool!” (“Berani jujur: hebat!“). Maybe it was just because I still had sea-legs after stepping off a 48-hour boat journey at dawn, but I was also pretty baffled by the large banner across the office of the harbour-master in Ternate (an island famed for perfidious double-crossing by greedy colonists and overbearing Sultans alike). The banner, which translates roughly as: “Don’t justify your habits, make a habit out of justice!” (Jangan benarkan yang biasa, biasakan yang benar!) is apparently a rallying cry for honesty in the workplace.
It seems to me it’s a long road between those sorts of slogans and a country based on the rule of law.
Sumba is a graveyard of bodies and good intentions. Physically, it is littered with impressive megalithic tombs and their hideous modern counterparts. Financially, it is littered with development projects that haven’t quite developed anything.
“Megalithic” sounds ancient, and many are, but they are still being built today. The tomb in the photo above was built in the 1970s; it took several hundred people the best part of a year to drag the stones on wooden rollers from the quarry to the burial site, and months more to carve. It’s “voluntary” work, but workers need to be fed, and richly. That makes for a lot of dead buffalo. No huge surprise that many people are now using cement and tiles. Since the tile-piles have doors in them (to make it easier to shove family members in as they die) the island looks increasingly like a repository for surplus public loos, though some families are prettying them up (and covering their bets) with pictures of Jesus.
Not wanting to be outdone, the island’s Christians Proper (often ethnic Chinese) have got Public Works to weigh in with cement. The Christian graveyard has a lovely new fence, in a delicate shade of primrose. Its cement pillars are carefully placed so that any Indonesian child and most adults can walk comfortably between them. And it cost this district, which scores close to the bottom of the national ranking on education and health, just 314 million rupiah (a cool US$ 30,000). This certainly doesn’t compare with the cost of a traditional West Sumba tomb, but still…