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Asian meltdown hits Indonesian hospitals

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Washington Post - February 19, 1998

Keith B. Richburg, Jakarta – At The Cipto Mangunkusumo Central Hospital here, doctors found that they no longer could afford the specially treated plastic bags which hold blood for transfusions. So the hospital director asked staffers to scour the local markets in search of old-fashioned milk bottles that could be washed out and used instead.

In the hospital's operating rooms too, frugality is the watchword; expensive imported thread is out, catgut is in. And surgeons are being told to make more economical use of the thread when stitching up a patient. "We have to use less expensive materials and supplies," said Hermansyur Kartowisastro, the hospital's deputy director for medical care. "We are also asking the surgeons not to use so much."

In the kidney dialysis ward, $10 artificial kidney tubes no longer are thrown away after each treatment but are rinsed and reused as many as eight times for the same patient.

Indonesia is struggling to reverse a debilitating economic meltdown in which its currency lost at least 70 percent of its foreign-exchange value since last summer and the price of imported goods – including medical supplies, equipment and drugs – soared beyond reach.

State-run hospitals such as this sprawling facility – one of the largest in the city – are searching for ways to tighten their belts and adjust to the new reality. "With some creativity, we can overcome the problem," Ahmad Djojosugito, the hospital director, commented. "We have to innovate." Younger doctors – trained in the recent years of Indonesian affluence – became accustomed to ordering a battery of tests and X-rays before making a diagnosis. Now they are instructed to be very selective in the tests they order and to take only essential X-rays.

Ahmad was trained as a physician during Indonesia's leaner times, when supplies were short and hospitals made do on bare-bones budgets. "We have to return to the difficulties we had in the 1960s and '70s," he said. For intravenous feeding and blood transfusions, he said, "I remember using the old bottle with the tubing. I had to rinse it out and reuse it. Now we have to go back to that again."

Local newspaper reports said four people had died on the island of Bali in January because they could not continue expensive kidney dialysis treatments. Pudji Rahardjo, a physician who runs the Cipto Mangunkusumo hospital's dialysis ward, said the cost of one five-hour treatment has shot up from 150,000 rupiah ($15) to about 500,000 rupiah ($51) – all because of the plunge in the local currency in relation to the U.S. dollar. He said regular patients complained vigorously about the cost but that most have no alternative because they depend on the weekly treatment to survive. "Maybe you can encourage your people to help us," the doctor said to an American reporter. The biggest problem, health workers say, is the high cost of medicine – chiefly imported drugs, but also locally manufactured medicines made with some imported raw materials. At the Medica pharmacy in Jakarta, Ane, the assistant manager, said she has seen the prices for most drugs double since the economic crisis began.

At the nearby Aries pharmacy, Naomi, the assistant manager, said the price of one common antibiotic, amoxycillin, has jumped from 400 rupiah per tablet to 1,000 rupiah.

World Bank President James Wolfensohn announced during a visit here this month that the bank would provide extra funding to help Indonesia purchase drugs and basic medical supplies for its public hospitals. Wolfensohn said Indonesia's more than 200 pharmaceutical companies rely on imports for 90 percent of their materials, and he called the problem critical.

1998 The Washington Post Co. The Guardian Weekly Volume 158 Issue 8 for week ending February 22 1998, Page 19

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