I spent some time with a local doctor who gave me some insights into the Indonesian medical world.
A person’s medical training begins right out of high school. It is a six year program and you come out with an M.D. or the equivalent. The education is not free. I think he said the average cost is about $30,000 for the 6 years. When you’re done, you are obligated to the government anywhere from 2-5 years depending on where you want to practice. If you agree to a rural post, you only stay for 2 years. If you want to go somewhere civilized you stay for 5 years.
If you go rural, you’re supposed to get preference for specialty training and jump to the front of the line. But this, I’m told, is an empty promise and getting into a specialty program is dependent on how much money you can pay and perhaps your religion and who you know.
Where residency training programs in the US pay doctors a salary, in Indonesia, the doctors pay a fee to study in a training program. Sometimes this fee can be up to $100,000 dollars or more. They say the money goes to pay for equipment and infrastructure, but nothing new ever appears.
The medical system as whole is very leery of outside trained doctors. If a doctor goes out of the country for training and comes back he/she is excluded from practicing for a very long time. The local medical associations control the licenses and there is a fear that if an outsider comes in they will be perceived as being more knowledgeable and steal business from the locally trained doctors. This even goes so far as to effect doctors trained in one area of the country wanting to go to another area. So, the flow of knowledge is greatly impeded.
It is nearly impossible for doctors from outside the country to practice. If they are allowed in a hospital, they are only allowed to be observers and cannot touch or interact with patients.
On the plus side, I toured two local hospitals in Surabaya and they seemed to have up to date equipment and staff. Both had Cardiac Cath labs readily available and newer model MRI machines. They bragged they could get a patient catheterized in well under 30 minutes. When there is a need for an ambulance a doctor and nurse ride along instead of paramedics.
I did note the clear delineation of classes of rooms. I’m told all hospitals have to provide a certain percentage of beds for the indigent. And where, in the US, hospitals would just put all patients in the same type of room and eat the cost difference if a patient couldn’t pay. In Indonesia, the indigent are put in multi-patient “Social” wards rather than rooms and the doors are clearly marked as to what class of service you will receive. The beds are a little less comfortable, but they were quick to point out that the beds were all electric. There are fewer amenities, though I’m not sure if the level of actual care is varied or not.
The VIP rooms are pretty posh. Large, airy. There is a separated family area with it’s own bathroom and a small dining area. There is TV there. I can’t recall if I saw a TV in the “social” rooms.
And here’s an interesting thing. On our tour through one hospital, the Medical director,the marketing director, my counterpart and I approached the ICU which was behind a closed door. The Medical director bent over at a small shelf and grabbed a pair of Crocs and motioned for me to put them on, but there were four of us and only two pair of outsized Crocs. I slipped mine on. My partner slipped his on. The medical doctor slipped off his shoes. The marketing director slipped off her shoes and in we went. Us in our clown-sized (Pink, no less) crocs, the director in his socks and the marketing person in her bare feet! We just traipsed in there like that.
The purpose of the whole charade was lost in translation. The message that cleanliness was important was dropped, but the process of taking off shoes was still present.