Doctors at RS Dharmais Taken Aback by Results of Treatment at RS Cipto

The doctors at Dharmais Hospital, upon seeing Pak Fadil for a second time, were quick to assure us that his future treatment at Dharmais would be very different than the treatment he’d received at other government-affiliated hospitals over the past year when his cancer advanced from stage 1 to stage 4. They even made forward-looking statements on regained function such as swallowing and speaking (although I don’t know to what degree possible or not). Chemo was an option, again, we learned; and that the Chemo drug used at Cipto was not likely the right one (we heard that from docs at RS Fatmawati also).

While these BlackBerry snapshots don’t show all of Room Teratai 409 (on the fourth floor of RS Dharmais, Indonesia’s leading center for cancer research and), it was indeed sunny and peaceful with a breeze coming through the west-facing windows. While there would normally be six patients sharing the room, each one may close the curtains around his/her bed. The room is also larger than the comparable six-patient rooms at RSUP Fatmawati or RSCM “Cipto” falling into the Kelas III category and reserved for patients paying with government-supported health insurance like SKTM, Gakin, Jamkesmas, etc.

But most interesting of all, the room was empty. Besides Pak Fadil, the other five beds were available for anyone,even weary bloggers. This seems to support what we were told when we first inquired about the possibility of having Pak. Fadil treated here. They said, “Yes, we always have plenty of beds for [poor patients]. And later (when they saw how ineffective the treatment he’d received at the other government-supported hospitals had been) they said, “Why didn’t you come here sooner.”

Yes, indeed why? Why were we unaware that it was “the national referral center for cancer cases”? For that matter, why didn’t it occur to any of the doctors at MMC, RSCM, RS Fatmawati, RS Pertamina, RS Harapan Kita to refer us to RS Dharmais. After all the patient was known to have a hard-to-cure tongue cancer complicated from the get-go by diabetes and heart problems. (The patient is 52.)

While conspiracy theory is generally preferable to real research as a technique for increasing blog hits, I found myself actually forced to plug this one into Google: why is a bright, clean, sunny cancer hospital like Dharmais empty in a country where scantily-clad teen women (known as SPG or sales promotion girls) hand out free cigarettes to guys, 70% of whom smoke by age 19?

So I leaned that Dharmais was allegedly once a slush fund run by Noto Suwito, half-brother of former strongman Soeharto. But so were a lot of institutions in those days. And not much else. The Dharmais website tends to conceal as much as it reveals.

But besides the trickiness of hospital shopping (a de facto part of being poor and sick which I was aware of by the time I registered this blog), if there’s one more thing this blog — so far — tends to demonstrate, then it’s how tortured communications are in general as between low-income patients and their families in Jakarta and the Indonesian physicians treating them. I’ve seen a doctor conduct a 5 minute patient consultation using grunts only — no intelligible verbal communication (at RS Fatmawati, granted it was an interview for administrative purposes and perhaps he got all the info he needed by reading the file). This has got to be the epitome of unmanaged care.   To call it poorly managed care would be to suggest we know who’s in charge.

I am by no means a medical ethnographer, but I have ethnography experience and am an experienced interviewer, including in cross-cultural contexts and for immigration and human rights law. Still, it is beyond me to figure out just where in the course of treatment the average patient being treated in these public Indonesian hospitals might be. Certainly you can’t ascertain that by asking the patient, who frequently acts as if the treatment were out of his or her hands. Probe as you will, no one really knows. (Presumably that excludes the top doctor in charge, but almost no one has every been able to tell me who that is, let alone schedule a consultation.)

To return again to the perspective of the patient and his/her family, Mona said that Dharmais, which has national cancer center status in Indonesia, reminded her of a disco. Not sure about that, but it is rather unlike RS Cipto. I look forward to spending more time there, as much as required for Pak Fadil to get well soon. I understand the childhood cancer ward is on  Fl. 4 has been renovated a couple of times by Prudential Indonesia and look forward to peeking in.

In any event, we’re really happy to have doctors who appear to be kind and competent on this case. Yesterday the word was that doctors, not nurses, would be visiting the family’s home.  What a shock that would have been. It hardly makes sense, in fact. And — despite being “threatened” twice, it hasn’t  materialize. Instead,  Pak. Fadil was admitted as an in-patient, then released, then re-admitted.