Hera Diani, Jakarta – In a village in West Kalimantan, a patient's relative threatened a nurse with a traditional sword because she was reluctant to treat him, a discussion heard on Friday.
"It was not even a nurse's job, it was a doctor's," Achir Yani S. Hamid, the president of the Indonesian Nurses Association, told a forum on Indonesian public health.
After the threat, the nurse improvised a treatment she had once seen doctors' perform, Yani said. She worked in the Kapuas Hulu regency, which had only four doctors serving 24 community health centers.
The situation in Kapuas Hulu was little different to those in other regions of the country, which were also short of trained health workers, Yani said.
With a ratio of one nurse for every 900 people, Indonesia was far below the international recommendation of one nurse for every 250 patients, she said.
Research by the Health Ministry and the University of Indonesia School of Nursing in 2005 surveyed community health centers in 60 rural areas throughout the country.
In almost all of the centers, nurses were being asked to do the jobs of doctors or midwives, procedures they were not qualified for, Yani said.
More than 90 percent of nurses were prescribing drugs, while 97 percent were making diagnoses and house calls. Nurses also regularly checked on the progress of pregnancies (70 percent) and delivered babies (57 percent). Most were also in charge of clinic cleaning and hygiene (78 percent) and administrative work (63 percent).
The majority of nurses had few qualifications, and many had little more than elementary school educations, further limiting their service to the public. It didn't help that they were often tired, uncommunicative or rude to patients, Yani said.
"Their skill level is not entirely their fault because 70 percent of nurses in this country have never been properly trained, let alone trained to do doctor's work. The error rate in their work is understandably also high." Another survey by the association showed most district health nurses were stressed and unhappy in their jobs, Yani said.
The skill shortage meant Indonesia had some of the worst health statistics in the region, she said.
The country's infant and maternal mortality rates are among the highest in South Asia, with 48 deaths per 1,000 live births and 470 deaths per 100,000 births respectively. Indonesia also has the world's third-highest number of tuberculosis cases, endemic malaria and dengue and problems with water-borne infections, malnutrition and HIV/AIDS.
Indonesian Public Health Experts Association head Kemal N. Siregar said improving the situation boiled down to the government getting serious about funding public health.
This year's national health budget amounts to 2.4 percent of the country's gross domestic product, while the World Health Organization recommends a minimum 5 percent allocation.
"The budget has to be increased, but it has to be allocated well. Most of the funding goes into buildings and medicines. The priority, however, should be on public service; primarily developing and empowering the health workforce," Kemal said.