Ascorbat Gani: There is serious need for community health nurses

TEMPO.CO, Jakarta - Ascobat Gani's expertise requires him to travel to the country's remotest areas. He advises regional and local administrations on the management of mental health following the enactment of decentralization. What he found was shocking: mental health in most places he visited is a neglected problem. "We are too involved in global (health) issues, like infant and mother mortality," said Gani. Yet, according to a study he carried out in 2005, mental health cases constituted 13.8 percent of all illnesses in Indonesia. To properly address this problem, Gani-who is chair of the Rajiman Notodiningrat Psychiatric Hospital governing board in Malang, East Java-is of the opinion that health services throughout Indonesia must be made efficient. Tempo English contributor Amanda Siddharta interviewed Gani by telephone two weeks ago. Excerpts:

What is the proportion of mental health patients to the number of psychiatrists in Indonesia today?

The number of mental health patients is very high, about 11.4 percent of the total population. About six percent of these are very critical, cases who have lost total contact with reality. There are about 700 psychiatrists in the entire country, so many cases end up not being properly cared for.

Why are there so few psychiatrists?

I think the acute shortage applies not just to the mental health sector, but to general health services. There are 183 districts or regencies in remote areas. The quality of health services in those places are not as good as in other places. In East Nusa Tenggara for instance, there is only one anesthesist.

How can the problem be resolved, given the limited number of doctors?

The number of health personnel must be increased. In Aceh, for example, there are very few psychiatrists. In 2006, community mental health nurses were trained. They can teach patients some skills like making lace, sewing and become crafts-persons. Most of these psychiatric cases are disconnected to reality, but they are publicly stygmatized. If they live in the rural areas, those patients would be chained to a bed or a table. If they live in urban centers, they would be put in a psychiatric hospital, but they are then abandoned and forgotten. But with regular visits by community health nurses, these patients can be taken care of.

Has such an initiative been replicated?

It's been tried, like in East Java, but they could not prove too fast because there are hundreds of patients, including those suffering from other illnesses, like the common cold and diarrhea. Moreover, the nurses must walk long distances to reach patients.

What improvements are urgently needed to improve services to mental health patients?

I think the long-term health plan in Indoneia is generally not so good. And this applies not only to mental health. In the meantime, the population keeps on rising, chronic degenerative diseases and old age are on the increase. There must be an assessment and a projection of the need for health personnel for the future.

Do you think medical schools in Indonesian universities are capable of producing the quality personnel needed?

The number of doctors and specialists have increased, but the number of patients have also risen rapidly. Yet becoming a doctor takes a long time and costs a lot of money, particularly when the Health Ministry's budget is so small, only Rp5.1 trillion to cover all programs. Simply speaking, if the money's not there, the service must be made efficient.

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