Six months after COVID-19 strikes Indonesia, questions linger over healthcare capacity and equipment
JAKARTA: Last month, Jakarta resident Jurgen was desperate to find a hospital for his ill mother.
On a Saturday, a specialist doctor took an x-ray of her lungs. While waiting for the result of her Polymerase Chain Reaction (PCR) test, the doctor concluded that she was a COVID-19 suspect case.
But the hospital did not have an isolation room for COVID-19 suspect cases and could not take care of his mother who was in her late 60s and suffered from diabetes.
Jurgen, not his real name, asked the doctor whether they could use the hospital’s ambulance to transfer his mother to another hospital which could accommodate COVID-19 suspects.
His request was rejected. Hospitals in Indonesia do not usually use ambulances to transport suspect cases, as they say the vehicles may be required by other patients.
He searched around the city until 3.30am the following day. He continued his search the next day until he eventually found a hospital in central Jakarta that would take in his mother.
She was taken to a special emergency unit for COVID-19 suspects and spent the night there.
Things got more serious and on Monday morning, the hospital told him that his mother needed a ventilator. However, there was none available in the special room for COVID-19 suspects.
“I had hoped that a big hospital would be more prepared but at that moment, the number of COVID-19 cases was increasing in Jakarta so I understood (the situation),” Jurgen recounted.
She died later at night.
What Jurgen encountered may be one of many cases in Indonesia, reflecting what some believe to be an overall shortage of Intensive Care Unit (ICU) rooms and ventilators. This is despite the government's various efforts to contain the pandemic, six months after it recorded its first COVID-19 cases in early March.
The government has defended its handling of the pandemic and pledged to reform the healthcare system going forward.
For the past few weeks, Indonesia has seen a daily increase of more than 2,000 new cases with an average of 500-700 new infections daily in Jakarta, the current epicentre.
On Thursday (Sep 3), Indonesia reported 3,622 new coronavirus infections, a record high in daily cases, and 134 new deaths. Southeast Asia's biggest economy now has 184,268 infections, 132,055 recoveries and 7,750 deaths related to COVID-19.
AVAILABILITY OF ICU BEDS, VENTILATORS CONTINUES TO BE AN ISSUE
Dr Lia Partakusuma, the secretary-general of the Association of Hospitals in Indonesia said there are 5,635 beds for COVID-19 patients nationwide. Out of this, 483 are ICU beds with ventilators and 364 are ICU beds without ventilators.
Overall, there are sufficient facilities for COVID-19 patients, she said. But there may not be enough for those who need to be warded in an ICU with ventilators.
“It is not easy to build ICU isolation wards with ventilators because what is needed is not only the wards. It needs a hospital layout which is sufficient for isolation wards and sufficient medical equipment. Manpower is also needed in the form of doctors and nurses,” Dr Partakusuma told CNA.
She noted that ventilators are not evenly distributed across Indonesia.
Additionally, not every hospital has an ICU isolation ward. Even in big hospitals, there have been difficulties equipping ICU wards with the needed ventilators, she said.
In Indonesia’s westernmost province Aceh, Dr Edi Gunawan, the director of a regional public health facility Dr Zubir Mahmud Hospital said that his hospital in eastern Aceh does not even have a ventilator.
Based on Aceh’s provincial regulation, his hospital should only handle COVID-19 patients who display light to mild symptoms and do not need ventilators.
People who need ventilators must be referred to a national COVID-19 referral hospital in the provincial capital of Banda Aceh, about 360 km away. Getting there would involve a seven-hour drive with normal traffic.
“We have only procured one, a transport ventilator. The procurement is being processed," Dr Gunawan told CNA.
The government has tried to improve the overall system by building a few hospitals specifically to treat COVID-19 cases. It converted Jakarta’s 2018 Asian Games Athlete’s Village into an emergency makeshift hospital and inaugurated a new infectious disease hospital on Galang island in Batam.
While a lack of personal protective equipment (PPE) was initially an issue, President Joko Widodo announced in June that Indonesia was able to produce 17 million units of PPE per month, exceeding the 5 million units required by the country every month.
A team of Indonesian engineers has also managed to produce compact ventilators and other countries have donated ventilators to Indonesia, including Australia and the United States which have sent 100 and 600 ventilators respectively.
DOWNWARD TREND FOR ACTIVE CASES: JOKOWI
While the number of new cases may appear alarming, Mr Widodo said that every country is different and Indonesia does have its unique challenges and ground conditions.
“Indonesia is one of the top five countries with the biggest population in the world,” said Jokowi, as the president is largely known, on Tuesday.
“COVID-19 is new,” he said when asked about the health situation by foreign journalists at the presidential palace in Bogor, West Java.
He also pointed out that the percentage of active COVID-19 cases in Indonesia is showing a downward trend, despite the fact that daily infections continue to rise.
Jokowi also said people must bear in mind that the number of recoveries has been growing. “It is better than the global average,” he said. Indonesia has a total of 132,055 recoveries, which constitute about 70 per cent of the total number of cases.
He explained that when looking at statistics, one must check with the reality on the ground before making a firm conclusion.
The government has tried to stop the spread of the virus by implementing a partial lockdown named large-scale social restrictions in some parts of the country for two months. However, it was later decided that restrictions should be imposed on a smaller scale such as in villages as it would be more effective, the president added.
GOVERNMENT TO EMBARK ON HEALTHCARE SYSTEM REFORM: SENIOR OFFICIAL
Dr Subandi Sardjoko, a senior official with the Ministry of National Development Planning who is in charge of human, community and cultural development, said the government is going to reform the healthcare system to increase its capacity and quality.
He noted that the capacity of hospitals in eastern Indonesia is significantly lower than those on Java island, where the overall level of development is higher.
Policies might also not have been implemented in a uniform fashion throughout the nation, considering the different situations of each province.
He noted that there are six main points the government can conclude from the pandemic.
Dr Sardjoko said that there is uneven capacity of isolation wards and beds at hospitals across the archipelago. There is a lack of emergency facilities and intensive care at hospitals, and the case management is not ready to handle the pandemic, he added.
There is also a disparity between specialised health workers across the regions, while the hospital referral system is not adaptive to the national needs.
He also noted that there is a lack of integration between health service facilities - including health clinics, hospitals and laboratories - in case detection and surveillance.
READ: Indonesia aims to produce 70% of required medical supplies as part of self-reliance efforts: Coordinating minister
But Dr Sardjoko said the government is trying to improve the conditions.
“This is one way to ensure that we are not overwhelmed in dealing with the ever-increasing cases of COVID-19, especially in the eastern region,” he said on Monday during a webinar about reforming the healthcare system.
LOOKING AHEAD: RACE TO SECURE VACCINE
The overall healthcare reform programme is set to take place over a four-year period. In the meantime, there are high hopes for the COVID-19 vaccine currently under development.
Indonesia is working with a few companies from several countries to secure vaccines for its citizens. There are also attempts to develop a vaccine locally, named the Merah Putih (red and white) vaccine. It is named after the colours of the Indonesian flag.
Notably, the government is also cooperating with Sinovac Biotech, one of the few vaccine developers in the world to enter phase 3 clinical trials.
Mr Widodo said the government has secured 290 million doses of COVID-19 vaccines for its 260 million people by the end of 2021.
Even though the effectiveness of the various vaccines under development is still unknown, the president remains optimistic that Indonesians can be vaccinated next year.
On Tuesday, Mr Widodo said one unknown factor is how long the vaccine would be effective for. He said that he wants to know whether people must be regularly re-vaccinated or the shot would last for a lifetime.
In the meantime, Jurgen, the Jakarta resident hopes that "the cooperation between hospitals can be enhanced so they can refer (patients) to each other with their ambulances".
“Hopefully it will help and COVID-19 suspects as well as positives can be taken care of better.”