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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


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A sick system produces dumb doctors in Indonesia

“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.