Jakarta: Can we trust the doctors?

For the original entry, click here

We’ve returned to Singapore and now struggling with deadlines and work. We’ll put down the stories of our Indonesia trip one by one, once we have time to write it down. And let this writing be the last rants about our last trip. I’d like to emphasize that our trip has been really pleasant and fun, but we just want to put down some of the negative experiences that we had before going on talking about the good stuff. This last rant will be about several things, first, can we trust Indonesian doctors? And second, about the living cost in Indonesia. I promise, this will be our last rant from our last trip! Next time, we’ll write about the great, fabulous, orgasmic food we tasted in Surabaya!

1. Can we trust the doctors?

Noe Down with Fever

Every time we visit Indonesia, Noe has always been healthy despite the tiring schedule and erratic feeding time (that must be due to mommy’s breastmilk). But ever since he was weaned off breastmilk, he’s more prone to germs (although, thanks to his past history of breastfeeding, he recovers himself relatively fast as well). At the beginning of this trip, Noe was relatively healthy, but towards the end of the trip he was feverish. Perhaps his stamina was down due to flying off to three different cities in one week, going out at night for dinners, and because we’ve been sleeping under aircons for two weeks straight.

On 17 July morning, in Bali, he began to have fever. We gave him paracetamol and it helped to lower the fever. Noe felt really good in the early evening that he began to run around the hotel, and we decided to go out for dinner thinking that he had overcome his fever. Bad decision, we should’ve taken a rest that night, because Noe’s fever recurred that night due to his exhaustion. We then decided to stick around using Paracetamol to hold off the fever during our morning flight out of Bali, until we see the doctor in Jakarta.

Going to a Doctor in Jakarta Hospital

We decided to see a doctor in Jakarta because we were worried that it could be typhoid fever or dengue, since Noe had been vomiting, had bad appetite, and the fever had run into the second day already. We chose to go to a pediatrician in a hospital in the fringe of south Jakarta which has the reputation to be a baby-friendly hospital (according to the discussion in ASIforbaby yahoogroups).

When we arrived in the hospital, we were quite impressed to see that there is no blatant promotion of pharmaceutical products and infant formula. Then we saw the pediatrician, Dr. ND, a middle aged male doctor. He came across as a friendly guy. We began with describing Noe’s fever symptoms to him. He proceeded to ask the nurse to take Noe’s weight and quickly (I mean, really quickly) check Noe’s physical condition. Note, the doctor and the nurse did not take Noe’s temperature, which was odd, because in Singapore it is a standard procedure. Basically it was a really rapid assessment.

Upon assessing Noe’s condition, the conversation continued as follows:

It’s OK, ma’am, your son is only having sore throat. I will prescribe antibiotics for him so that he would recover quickly.

Antibiotics? But viral illness won’t be helped by antibiotics!

Hmmm… who said it’s viral? Antibiotics will surely help him recover faster.

Well, doctor, how do you know that it is bacterial and not viral?

Hmm.. he has sore throat and antibiotic will help to prevent the illness to spread. If it spreads away, it could get really bad, he can even get pneumonia.

But his fever is only for one day, doctor, are you sure antibiotics is necessary?

I was questioning the doctor because I’m so used to the Singaporean procedures, where they prescribe antibiotics to Noe or me after having a fever 4-5 days straight, or when clear signs of infection is visible, such as green mucus or coughing with phlegm. Besides, I’ve read about the danger of hastily prescribing antibiotics. That’s why I was rather shocked to be given antibiotics only at the beginning of the second day of fever. At this stage, the doctor was clearly annoyed because I was not obliging to him.

Look, Ma’am. If this kid is my own, I would give him antibiotics without hesitation!

So, now he’s saying that I’m a bad parent for hesitating to give antibiotics!

Besides, what have you been giving your son? He’s a bit underweight. Does he have feeding difficulty?

No, he likes to eat, including meat, rice, vegetable.

Hm.. so what brand of milk has he been drinking?

Well, he had just recently been weaned off breastmilk, and now he loves drinking fresh milk with chocolate flavor.

Chocolate milk? That does not have any nutritional value. You have to give your son Pediasure formula milk!

But he doesn’t like Pediasure, I’ve tried.

Well, just give other brand, but it has to be formula milk! If your son is as skinny as this, his growth could be hindered! Do you give him vitamin?

Yeah, I give him toddler vitamin..

What brand?

I don’t remember, but it’s for toddler..

I don’t think it’s a good enough vitamin. I will prescribe a better vitamin supplement for your son. Gosh, chocolate milk! Your son must be calcium and iron deficient, I will prescribe supplement for that also.

He then continued to get a phone call at his blackberry, when he was still consulting us. I was really pissed off at this stage. I wonder if this person is a real doctor or a pharmaceutical product salesman. He’s also very judgmental, and not open to discussion. At that point, I just zip my mouth shut so that I could get out the clinic really fast.

Paying for the Medicine

When I was out of the clinic, I went to the pharmacy and only paid for the paracetamol drops to lower the fever, and decided not to pay for the antibiotics and vitamins. Out of curiosity, I asked the pharmacist about the price of the prescribed medicine.

The paracetamol: Rp. 13K

The antibiotics and vitamin: Rp. 200K That is, like, a fourth of a monthly salary of a state school teacher in Jakarta.

When I saw the invoice of the paracetamol, I saw the doctor’s name. Hmm. So the medicine paid is linked to the doctor’s name. I wonder if he had been receiving commission or perks from the pharma company.

When I was paying for the paracetamol, I saw a group of medreps swarming at the pharmacy counter, talking to the chief pharmacist. I overheard them, roughly:

Medrep: Ma’am, the prescription for this medicine has been really low.

Pharmacist: Yes, I know… I have been asking the doctors to prescribe this medicine to the patient, but so far the usage has been quite low.

Medrep: I’d really appreciate if you could always remind the doctors to use our products.

At that time I was really sick to be in the hospital. Somebody should make a documentary movie about the healthcare system in Indonesia, which is overwhelmed with pressure from pharma companies.

To certain extent it is similar to the situation described in Sicko (Michael Moore). The difference is: in the US, the doctors are sponsored by the insurance company, while in Indonesia, the doctors are sponsored by pharmaceutical company. The similarity: there is no control over such nepotistic practices.

Noe’s Recovery sans Antibiotics

Back to Noe. we decided to just give him paracetamol to lower the fever, and take a rest in the house to let Noe fight the virus by himself. No antibiotics were given. The next day, the fever had fully subsided, but we stayed home for the day to minimize the risk of recurrence (besides, we have a wedding to attend, the next day). And true enough, Noe’s fever has totally subsided by the wedding time on 20 July.

I am glad that I didn’t have to pay for those expensive antibiotics! But then, seeing Noe’s speedy recovery, I become skeptical too, can I trust Indonesian doctors?

2. Living Cost in Jakarta

Indi has been living away from Jakarta since 1992, and it’s funny to see that he is still gauging the living cost using the 1992 prices. But even for me, who only had been away from 2001, is still shocked by how high the living cost nowadays.

Indi still remembers when 1 USD to Rupiah was just 1,500. Even until now, Indi still thinks that Rp 20,000 is a lot of money.  As for me, I still remember when I began college in 1996, I can still go to warung tegal and get a complete fulfilling meal for Rp 1,000, with meat or egg.

When we visit Jakarta this year, we realized that virtually everything comes in 5 digit price! Rarely can we find food in the restaurant that is priced with four digits. It is interesting to see, that Rp 100,000 felt as “cheap” as Rp 10,000 in 1997. And indeed Rp 5,000 felt like Rp 500  in 1997. Really, there is no use to have Rp 1,000 and Rp 5,000 in paper bill anymore, they are should be in coins. I am not an economist, so those figures are not based on any calculation, but I was just using my feeling. I don’t know how far have the inflation or the shift in purchasing power been quantitatively, but for me, it really felt that everything is 10 times more expensive than ten years ago.  Why is it the case? Can any economist answer this?

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