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Nila Djuwita Moeloek: Don't blame the doctors  



10 November 2015 12:36 WIB

Nila F. Moeloek, Indonesia Health Minister. TEMPO/Frannoto

TEMPO.CO, Jakarta - The thick haze blanketing parts of Indonesia compelled Health Minister Nila Djuwita Moeloek to fly back and forth between Jakarta, Sumatra and Kalimantan these past two weeks. She did this to ensure that health services in the provinces affected by the haze were being provided effectively. "I went to Palangkaraya three times these past two weeks," said Nila, last week.

It has been more than four months since the haze engulfed Sumatra and Kalimantan, yet the problem is far from under control. There have been victims, many had to be hospitalized, a few died. Among the fatalities was a baby. Understandably, some of the public anger was directed at her ministry, which was criticized for being slow in anticipating this human disaster. 

Nila, 66, denies that the health units in the provinces were slow to react to the haze crisis. She maintained that a series of action had been deployed, from alerting local health posts, setting isolation tents to dropping medication in remote areas. 

Tempo reporters Stefanus Pramono, Cheta Nilawaty, Mitra Tarigan, Nur Alfiyah, Raymundus Rikang and Rusman Paraqbueq, met the health minister twice for interviews. She was open to questions on the haze but somewhat reluctant to respond to queries on the recent scandal over doctors receiving gratuities from pharmaceutical companies in exchange for prescribing them to patients. "Don't create a polemic," Nila cautioned them. 

During both interviews, the health minister was accompanied by her expert staff advisor in charge of primary health services, Diah Saminarsih. At the second interview, Yudhi Prayudha Ishak, an expert staff on governance issues, was also present.


So far, what has the health ministry done to manage the impact of the haze crisis? 

I made sure that all health posts were ready to treat patients suffering from respiratory infections. They had the necessary equipment and the hospitals were also good at ministering to people who came. I went to look at public areas in Palangkaraya, run by the social affairs ministry, which took in many of the haze-affected residents. We provided them with and set up isolation tents.

What were they for?

The tents have pure, clean air. The materials were made doubly strong to prevent haze from penetrating. Doctors checked the patients to see who needed to be placed in the tents.


How many were set up by the health ministry?

Nine in all, but they are temporary and can be dismantled when they are no longer needed. The ministry also made use of the houses reserved for haj pilgrims about to leave on their trip, and turned them into a kind of safe-houses. In those buildings, there are many rooms with bedding facilities. We just needed to provide a space for small children.

How about medication?

We supplied them with 48.2 tons of medication and masks. In April, we sent letters to all health posts advising them to anticipate the haze. The national disaster management board had also set up units in Sumatra and Kalimantan. We also provided them with basic necessities like supplement food, medicine and oxygen. We also distributed over seven million face masks. Yet people still said the ministry didn't do much. We even ran out of masks.

The government has deployed warships to evacuate residents. What do you think of this? 

This caused quite a stir at our meeting because the TNI (Indonesian Military) had deployed ships, as if every resident wanted to be evacuated. I told them that was unlikely because of the risks involved. Their reluctance to leave would be for the distance (from their homes). If a patient dies on the way, I would be blamed. My medical staff would be accountable.

So, you disagreed with this policy?

Yes, I didn't agree with it. Just how many people could have been evacuated?

So what does the health ministry suggest?

If necessary, start with ensuring treatment at the health posts (puskesmas). They are the frontline people. If people's infection spreads to their lungs, only then should patients be directed to hospitals, where the treatment will be done in phases. We also asked that air-conditioned areas be used as evacuation centers and as safe-houses. Yet those areas remained empty.


How many infants have died because of the haze?

I won't deny there have been infants who died as a result of the haze. One was a-month old baby born prematurely, because its lungs hadn't healed from the strain and its lungs were still weak. My notes show 20 infants (below 5 years of age) have died. Figures may differ according to sources. The coordinating minister for human development and culture asked that my data be validated.

What will be the long-term impact of the haze on victims, especially on infants? 

I don't dare to give you an answer yet. But the types of fires differ (from place to place). Forest fires in Indonesia must be looked at from the soil, whether it contains pesticides or not. Fires in the United States or Australia mostly affect weeds and reeds. That factor determines the kind of particles in the smoke or haze. So far, there is no link between fires and chronic diseases.

* * * *

IN its November 2-8, 2015 edition, Tempo featured an investigative report on the soaring medicinal prices and the collusion between pharmaceutical companies with doctors. Why is medicine so expensive in Indonesia?

Medicine in this country is expensive because pharmaceutical companies must still import their raw material, and the cost depends very much on the exchange rate. So, when the dollar rate goes up, so does the raw material and the price of medicine.

The analogy is that the pharmaceutical companies buy the flour, which they process, package and ultimately sell. But they forgot how to make that flour domestically. They've become complacent and that's been acknowledged by the industry. After the price of raw materials soared, they were shocked.

Are there other factors?

Companies buy imported raw material and they must pay import taxes. They produce the drugs and they still must pay taxes on their production, and sales tax when they sell the drugs. So, they are taxed three times from production to distribution.

What can be done to deter those factors?

I've asked the Pharmaceutical Companies Association to try and produce the raw materials domestically. I challenged them to do so because Indonesia is rich in flora that can be turned into medicinal material, although they are so many varieties that we are unlikely to process them all ourselves.

Why can't domestic companies produce their own raw material?

Plants and medicinal raw material needs to be researched further, and they need to be clinically tested. This is a difficult process because the drugs must be proven to be safe for human consumption. Certain countries will never skip this clinical trial process. They seek the evidence base to prove that the drugs they produce are safe and cures illnesses. In Indonesia, one example is the jamu (herbal medication). But not all medicine is comparable to jamu, because they need to undergo a long process of testing.

Tempo's investigation found that doctors accept commissions after they prescribed certain medication. 

No, that's not always the case. For example, maybe I would be compensated for using their products, but not all doctors do it. Don't accuse all doctors of accepting gratuities.

Do you approve of giving doctors commission for the drugs they prescribe?

I approve so long as it is tightly regulated and it is not given on an individual basis, because then it can be chaotic. For example, I'm a doctor who's also a professor about to present a paper overseas. I could ask a pharmaceutical company to pay for my family to travel with me. That would be very arbitrary.

How would you regulate that?

The gratuities should not go straight to the doctors, but could be given to associations, hospitals or campuses. The institution concerned can then evaluate the doctor responsible for dispensing the drugs and determine that he is indeed the right person to present his paper at an international forum, which would enhance Indonesia's reputation. In the process, the association could help the doctor with his expenses because he can't afford it.

Has the ministry drafted regulations to cover such issues? 

I haven't decided yet. I think, if the factories have promotional money, the funds must be carefully regulated. Nothing should be given on an individual basis, and certainly not to be used for pleasure but to complement knowledge and appreciate doctors and other medical personnel who have contributed significantly in their areas. (*)


Read the full interview in this week’s edition of Tempo English Magazine

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