2) Indonesia: Bela Negara action plan and pandering to the military
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1) Poor medical care costs thousands of Papuans their lives
Province suffers acute doctor shortage, governor blames 'greedy' staff and hospital managers for high rate of patient deaths
Indonesia
November 14, 2018
A health worker examines a patient at Kampung Harapan clinic, about 26 kilometers from Jayapura in Papua. (Photo by Benny Mawel/ucanews.com)
Benjamin Lagowan will forever be haunted by the death of his cousin, who was misdiagnosed with an intestinal infection and ultimately died due to a lack of adequate health care in his hometown in Indonesia's Papua highlands.
Alex Molama, 27, was rushed by stretcher to a hospital in Wamena, the capital of Jayawijaya Regency, in August after complaining of stomach cramps.
The family got him there as best they could in lieu of any other available form of transport in this remote corner of the world where ambulances are considered a rare luxury.
The doctor told the family Molama appeared to have an intestinal infection and referred him to a specialist.
However, as the specialist was out of town at the time, nurses with limited training and resources struggled to treat him, and his relatives had to sit by and watch as the young man's condition deteriorated from bad to worse.
"His belly was swelling and bile was pouring out of his mouth," Lagowan told ucanews.com.
On Aug. 24 Molama was sent to another hospital in Jayapura, the capital of Papua province, equipped with better facilities.
"The doctors there told us he wasn't suffering from an intestinal infection but acute kidney failure," Lagowan said. Molama died five days later.
The agony did not end there, however.
As the family attempted to take his body home they encountered frustrating and painful delays, as there were no medical staff on duty to sign his release papers.
Marcelina Matuan has a similar story to share.
Her sister in-law, Yuliana Lagowan, 37, was forced to try traditional herbs and medicines after feeling pain in her head, because there were no specialists available at the same hospital in Wamena to help identify what was wrong.
Lagowan (no relation to the other deceased patient) was rushed to another hospital in the town a few days later after she fainted one day.
Once there, the doctor informed her family that she had suffered a brain hemorrhage and had to be treated at the Jayapura hospital or she most likely would not survive.
"The problem is that it took us a week to get the referral letter so we could send her there," Matuan recalls.
When the family finally arrived in Jayapura, the doctors were unable to perform surgery immediately despite the urgent nature of her condition because they had to wait for a chief surgeon to arrive from Jakarta.
Due to a shortage of doctors, the surgeon was only available at that hospital on Fridays and Saturday.
"They asked us to be patient," Matuan said.
Lagowan died before the surgeon showed up.
Sepit Boma, 18, joined this chorus of despairing, bereaved relatives after watching his elder brother perish due to a shortfall in state funding for public health.
Simon Boma, 23, was taken to a local hospital in Abepura on Sept. 24 after he complained of chest pains and difficulty passing urine. The doctor suggested he be hospitalized to receive better treatment.
"But no one tended to him properly. The doctor just gave him some Paracetamol for the pain, and his condition never improved," Sepit said.
Realizing they could provide just as much if not better care at home, the family took him back to their village, where he died on Oct. 1.
A health worker tends to a patient at Kampung Harapan clinic. (Photo by Benny Mawel/ucanews.com)
Unhealthy business
There are thousands more examples of Papuans who have died due to poor health care services in the region. Tragically, many die in government-owned hospitals, which are considered to be the best in the province.
Three months ago a document on patients who have passed away at Jayapura Public Hospital was circulated among journalists in Papua.
It recorded 1,275 deaths from 2008 to 2012.
A similar survey published in Tempo, a weekly magazine, in February reported that from 2013 to 2017, 2,393 patients died at the same hospital — close to double the number of the previous four-year period.
Dr. Aloysisus Giyai, head of the Papua health department, said the number of patient deaths at the hospital was the highest in Indonesia.
"These numbers are very worrying. The average number of patient deaths at hospitals nationwide is 120 a year," Giyai told ucanews.com.
He said there are many contributing factors but the main cause was the limited number of trained personnel.
Papua has about 12,000 medical workers but pundits say it needs three times as many to provide an adequate level of service to the general population.
Another factor cited by Giyai is the widespread belief by people, especially those living in rural or isolated communities, in black magic, shamans, and other health healers usually considered "quacks" in the West.
"When a person gets sick, it is often assumed that someone has put a curse on them, or that some other form of sorcery is at play," he said.
"As such, the patient is taken to see the village shaman rather than a trained doctor at a proper hospital."
In too many cases, he said, the patient is only rushed to a legitimate medical facility when they are at death's doorstep and there is little doctors or nurses can do to save them.
Papua governor Lukas Enembe has blamed the unacceptably high number of casualties in Papua on a lack of genuine dedication on the part of medical staff and hospital administrators, many of whom are imported from other regions.
He said that in too many cases their chief concern is enriching themselves not ensuring the sick and wounded get the best possible treatment.
"Running a hospital is big business. There is a lot of money to be made. Too many people lack the heart to serve the people of Papua," said Enembe, who was re-elected as governor in June.
He said many health care facilities in the region are being mismanaged.
One of his top priorities is fixing the problems with the Papua Health Card (KPS), he said.
While the system was designed to help impoverished Papuans who are unable to afford their own medicine, surgery, or other health services, it is open to abuse by unscrupulous medical practitioners, he added.
"We need to employ people who genuinely care about Papuans," he said, adding he plans to build more hospitals that will be staffed exclusively by local doctors and nurses.
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2) Indonesia: Bela Negara action plan and pandering to the military
BY Luke Lischin
13 November 2018 06:00 AEDT
Between Prabowo Subianto’s promise to “Make Indonesia Great Again” and Joko “Jokowi” Widodo’s warning that “winter is coming”, all eyes in Indonesia are transfixed on the upcoming presidential election.
Yet beyond the campaign trail, Jokowi’s pandering to the Indonesian armed forces has had a profound impact on Indonesia’s civil-military relations. On 18 September 2018, Jokowi issued Presidential Instruction Number 7 (Inpres 7), the “Bela Negara National Action Plan”. According to Defense Minister General (Ret.) Ryamizard Ryacudu, Bela Negara is intended to strengthen citizens’ patriotism while protecting Indonesia from harmful ideologies through policy, and Inpres 7 is “a bid to make Bela Negara (State Defence) program more systematic, structured, standardised, and massive”.
Inpres 7 is a major concession to the Tentara Nasional Indonesia (TNI) and the national security establishment, which has been clawing its way back into politics through participation in national food security, infrastructure construction, public safety, and disaster relief efforts.
Bela Negara became policy in October 2015 through the 2015 Defence White Paper, initially aiming to mobilise 4,500 “national defence cadres” comprised of civilian volunteers. Defense Minister Ryacudu was Indonesia’s most prolific public advocate for Bela Negara and helped elevate the program to the level of the National Resilience Council or Dewan Ketahanan Nasional (Wantannas), which is now given the job to implement the three-step Action Plan under Inpres 7.
According to Inpres 7, the first step of implementation is the “dissemination, harmonisation, synchronisation, coordination, and evaluation” of Bela Negara, which is broken down into twelve actions and bulleted standards of evaluation.
These actions include the creation of instructional modules for Bela Negara programs, organising national consultation meetings and conferences, designing curricula, forming coordination and evaluation bodies, and planning multi-tiered cadre training programs.
The second step is the “internalisation of Bela Negara’s Basic Values” through eight actions intended to internalise Bela Negara’s values among civil servants, military personnel, police officers, and the general public.
Success at this stage is defined by the implementation of curricula that inculcate an adequate understanding of the urgency of Bela Negara, and feelings of love of country, loyalty to Indonesia’s national philosophy Pancasila, and a willingness to sacrifice for the nation.
The third step is the “Action” movement, which is subdivided into non-military and military threats.
Non-military threats fall into the fields of demography, geography, environment, ideology, politics, economy, socio-cultural affairs, and technology. Within these fields are threats such as unchecked population growth, public health, natural disasters, agrarian conflict and resource exploitation, energy scarcity, and ideologies contrary to Pancasila (i.e. terrorism, radicalism, separatism, and communism). The section of military threats is limited to specific military threats such as horizontal conflicts, violations of territorial sovereignty, and the potential threat of foreign invasion/foreign aggression.
This illustrates how Inpres 7 is sprawling in its scope of issues it seeks to address, and shallow in its delegation of authority.
Although Inpres 7 does highlight some specific policy initiatives like reviving family planning initiatives to prevent demographic disparities, the vague and repetitive language of the document does more to obfuscate national priorities than clarify them. The only clear message of Inpres 7 is that Bela Negara is the key to Indonesia’s survival and prosperity and that the TNI holds this key.
While the TNI plays a leading role in in the action plan, regional governments and political parties also play their part.
From 15 to 19 October, 55 high school students led by their school principal in Magelang, Central Java completed Bela Negara training at a local military academy. Meanwhile in Purbalingga, also in Central Java, 540 youth, including the children of local representatives, completed Bela Negara instruction under the auspices of the regional government from 15 to 27 October. Similar training is being organised across the nation in Cikajang, Gowa, Denpasar, Palangka Raya, and elsewhere.
Even though Inpres 7 came and went without much public discussion, the implementation of the Bela Negara Action Plan will be sure to provoke debate in light of previous Bela Negara scandals. Among the most infamous scandals was the January 2017 discovery that TNI officers were providing military training for members of the “anti-vice” vigilante group Fron Pembela Islam (FPI) in Lebak, Banten.
Bela Negara programming is also controversially promoted as an antidote to “deviant” ideologies including LGBT lifestyles and communism; the Bela Negara action plan labels communism as a threat to the nation, while LGBT lifestyles are not mentioned by that acronym, but plausibly fall under the anti-Pancasila ideology of “hedonism”.
Jokowi’s embrace of nationalist rhetoric, choice of his conservative ulama running mate Maruf Amin, or “accidental” authoritarian politics may not reflect the president’s personal politics so much as a hedging strategy for the upcoming election.
Nevertheless, Jokowi has proven not to be the liberal reformer many had hoped for, allowing hard-earned reforms in democratic governance to backslide under his watch. By inviting the national security bureaucracy to play a more active role in government outside the normal role of the military in other countries, Jokowi is trading the norm of civilian-led governance in exchange for the survival of his administration.
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