Cigarettes and breathing tubes — proudest moments and finest technology

My wife was distraught. Not only is her dad very ill, he’s being treated within the Indonesian public medical system.

“There’s a tree dad wants us to plant. The leaves can cure cancer. It’s very good. And aspirin. I’ve read its very good . . . isnt’ it?”

Oral cancer imagery tends to be heartrending, full of paradox and cliche. It’s a sad story that I”m not beyond telling —  about how taste and inspiration merge in a single breath and it eventually takes all the puff out of life, and it dries up and wisps away.

Until he got tongue cancer, my father-in-law was a big Sampoerna fan. Unfiltered and hardly fancy, I knew the Sampoerna Dji Sam Soe (now a Phillip Morris brand) prided itself on old-fashioned quality. From the TV ads one remembers the narrative about the innovative family business, the little leaf-stuffed paper tubes rolled by hand, perhaps even something about a female touch.

Exotic Indonesian kreteks >> garden variety oral cancerSure  enough, at we learn that Pak Fadil — who until a few years ago worked two jobs selling sate and as a night watchman — was hooked on a blend of “sweet smell of Madurese and American tobacco with finely elected cloves and special sauces delivering consistent tastes across the generation . . . a kretek cigarette complementing the hard worker. By smoking this cigarette, you shall immediately know what the difference.”

The blend of spices is indeed exotic and secret. But if you smoke it long enough you’ll immediately find out that the cancer it causes is of the everyday, garden variety.   While the burden of cancer in Indonesia — presumably passed down from generation to generation on the male side — is arresting, I’m afraid the level of innovation and technology in cancer treatment in Indonesia isn’t as impressive, especially within the state hospital system where Pak Fadil is being treated.  (He’s had in-patient status for the last several weeks and is recovering from a tracheotomy. The case is complicated by diabetes and heart  problems).

Today my wife and Mona were coordinating all afternoon via phone, text and BlackBerry messenger about a very different type of breathing tube — the Thermovent T2 from Smiths Medical. In fact, they know aspirin won’t do it. But anyone gets hopeful at times.

As nearly as I can tell, during a routine replacement of the medical device in question, the staff at RSUP Fatmawati discovered they didn’t have the required spare parts. [Editor: An orderly was apparently at fault. They didn’t know the part was to be saved.] So with little Fahri watching, grandpa suddenly lost all benefit of the operation and went back to where he was a week or so ago (breathing with great difficulty) as the women began running through the list of known Jakarta hospitals and pharmacies and pondering how to self-source the device.

Cipto? Pertamina? Medistra? This is the DIY-aspect of state-subsidized healthcare in Indonesia and we’ve been doing it with mixed results for a few years. (Just ask me where they sell oxygen after midnight: )  There were calls and search engine queries. Price, distance and traffic are always relevant. Sema called in the coordinates, cousin Rosi came by with the bike, they scored the T2 from Medistra and headed back to Fatmawati.

Indonesian men do themselves no favors by pretending to be in charge the way that they do. That’s like treating late-stage cancer with aspirin. Indonesia is a male-in-control society  where the men smoke and the women (who obviously get it second-hand together with the kids) stay quiet about it.

Cloves cancer connection

The table below (from a Pfizer Facts whitepaper) nearly 66% of Indonesians males over age 15 do smoke. And less than 5% of women.

While information from a 2010 news report headed “oral cancer symptoms  same as flu” that men here are twice as likely to get oral cancer as women isn’t surprising, the estimate of one doctor that 95% percent of oral cancer patients present with an advanced stage of cancer is really awful (same source).

If you’re a poor, hardworking male (that’s who “benefits” from the Indonesian government’s disguised and undisguised subsidies to the clove and tobacco industry) , then you’re going to turn up at RSUP Fatmawati or RSCM Cipto with a little bump on your tongue and a very long, tough row to hoe, as this family did.

And here’s another irony — perhaps not to the same degree as in the Middle East or even India, but women in Jakarta, especially older women, are much less likely than men to know their way around the city, drive motorcycles and even read.  And yet they’re the ones making the truly complex decisions about where to seek medical treatment and doing the community nursing (the men don’t like the hospital environment because they can’t smoke). It is not the case that you simply show up at the hospital, prove that you’re poor and turn treatment over to professionals and that’s why people wait until it’s too late to get treated — for example — for oral cancer.

Fathers are to be mostly respected and daughters seen and not heard. And that kind of dysfunctional communications policy spells disaster when the family finds itself up against  the medical bureaucracy desperately in need of expensive drugs (you’ll pay for those yourself, not matter what the law says), medical devices and procedures.

Pointing out to dad that acting macho thing in front of the doctor is undermining efforts to get the new painkiller prescription would normally be challenging at best. ( Except here, where Pak. Fadil can’t speak. But neither can his wife read. We got him a cell phone the other day but he won’t be texting Mama.  Disoriented because of the pain and the meds, he sometimes writes in Madurese much to the puzzlement of everyone but Mona.)

What would we do without Mona? Over the last few years, over the course of helping family members and other patients (since having a baby born with complications), she’s garnered a lifetime’s worth of knowledge about Indonesian hospitals, procedures, insurance schemes, medical devices and drugs — despite having a junior high education or less. And she’s inter-generational. She has no problem with Western medical protocol and follows along the dotted line as often as she can intuit where it lies. But she’ll also text a witch doctor back in Madura in a pinch. Who wouldn’t? Reliable as aspirin, most of the time.

Cancer prevalence Indonesia