Indonesia

The Republic of Indonesia covers a large archipelago of islands in southeast Asia and was the Dutch colony known as the Netherlands East Indies until World War II. During the war, it was occupied by the Japanese, and after the war, there was another conflict which saw the Indonesian nationalists defeating the Dutch, achieving independence. Indonesia has a population of 238,453,000 (2004) and has 16 doctors and 50 nurses per 100,000 people.

The provision of healthcare in Indonesia varies considerably with the capital, Jakarta, having the best facilities, and also good facilities in many other major cities, and on the island of Bali which is visited by many tourists. The Dutch did not invest much in healthcare, with hospitals catering for Europeans and the Indonesian elite. Indeed, the life expectancy was so low, with Europeans often only lasting one year in Batavia, the administrative capital (modern-day Jakarta), that when Willem Daendels was appointed governor of the Netherlands East Indies in 1807, he did try to improve the terrible levels of sanitation in Batavia. This involved moving the city's cemetery, and clearing the canals to allow for sewage to flow out of the city into the sea.

From 1910, the Dutch started to improve the provision of public healthcare, giving injections for smallpox to many people throughout the archipelago. During the 1930s as advances were made in tropical medicine, the provision of healthcare improved considerably in the country, and by 1936, there were 500 hospitals throughout the Netherlands East Indies, some of which were really clinics, 15 asylums for the insane, 42 leper colonies, and 970 dispensaries. Most of these were run by the Government Medical Service, but there was also a considerable private input. The Dutch also ran a model program [Page 901]which was established at Purwokerto in Jawa Tengah province (West Java). With the Japanese invasion of the Netherlands East Indies, the health services collapsed with the Dutch medical personnel either being killed, fleeing, or being interned by the Japanese. After World War II, the Dutch-Indonesian War saw little new investment in hospitals, but the situation changed in the 1950s.

The major health problems that faced Indonesia were to do with diet, and also malaria, dysentery, typhoid, and cholera. There has also been a problem with venereal disease, rabies, hepatitis, and, in more recent years HIV/AIDS, and also strains of influenza. In some places there has also been the need to treat people suffering from snake or jellyfish bites. To combat these problems, President Sukarno, who controlled the country until 1965, invested heavily in building up the healthcare system, with hospitals, clinics, and pharmacies opening throughout the country. President Suharto, who followed him, and ruled until 1998, presided over a period of great prosperity which saw more hospitals and medical care facilities being built. However, unlike most other countries in southeast Asia, the provision of healthcare has, since 1965, received little government subsidy, although it is overseen by the Ministry of Health and Social Welfare.

The Ikatan Dokter Indonesia (Indonesian Medical Association) was founded in 1950 and has 45,000 members. It publishes BIDI each fortnight, and the Majalah Kedokteran Indonesia. There are also a number of research institutes in the country catering for particular disease, including the Lembaga Malaria (Malaria Institute), founded in 1920; the Clinical Institute for Leprosy Research, founded in 1935; and the Unit Diponegoro, catering for nutrition, founded in 1937. A Research Center for Cancer and Radiology was established in 1974, under the direction of the National Health Research Institute; and three years later, the Indonesian Cancer Society was founded in Jakarta. Mention should also be made of the Indonesian Index of Medical Specialties (IIMS) which provides a list of pharmaceutical preparations which can be prepared in the country.

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