One day, a patient went with his family to the health center on the coast of Werinama on the mainland of Seram Island in Maluku. This patient was weak, limp, helpless, and has endured extreme pain. Apparently, it was incarcerated hernia. Incarcerated hernias are hernias that have experienced entrapment. Only with an operation can this bondage be released. If not immediately operated on, the patient will fall into a state of sepsis and leakage of the intestine (perforation) can occur. This is one case that is feared by doctors who serve as general practitioners in very remote areas. Cases where he does not have the ability and authority to carry out major operations. The patient must be referred to the hospital. And that means this patient has to travel across the Banda Sea for 12 hours. Immediately, the doctor ran towards the beach where the waves could be heard from the examination room. From the roar, the condition of the ocean can actually be expected. But the doctor felt he had to make sure. That morning, the west wind season was really exciting; a season that presents large waves on the beach and the high seas. So, in conclusion, the patient cannot be referred. The waves on Werinama Beach seemed to be muttering with the beat of his heart. While taking a deep breath, he turned to the right and returned to his patient. He knew that day would be one of the most complicated days of his life.
This is similar to dr. Lie Dharmawan’s story. While doing social services on Kei Kecil Island, he found a 9-year-old patient with incarcerated hernia as well. This is a normal case for surgeons, including for a dr. Lie Dharmawan. What makes this case unusual is that this patient arrived very late. How would he not be late, with his mother going with him, this patient must undergo a sea trip for three days and two nights to reach the island of Kei Kecil in Southeast Maluku. Being in a condition between life and death, dr. Lie must immediately prepare the operation. Through extra fast service, this patient is saved. A drama in real life.
There are many other cases from the archipelago that require referral services that are not handled due to sea conditions that do not allow navigation. On an island that is relatively close to the mainland of Java, in 2017 there were six reported cases of obstetric and gynecological referrals that led to maternal death. According to the doctor, death can actually be prevented if the patient immediately gets help from a specialist. How difficult and expensive it is to get the services of a specialist doctor who can provide complete health services. This is a real problem that has not yet been resolved.
The island which is far away from the center of development coupled with the lack of means of transportation, information and communication, only makes this an island that is left behind. Left behind in many ways including health development. Remoteness with all of its derivative effects almost always makes people reluctant to come there, let alone stay there for a long time. Including doctors. Data on the distribution of doctors and health workers, especially specialists on the map of Indonesia, speak thus.
The lack of health and logistics infrastructure on remote islands is almost always a complicating factor. The difficulty of the community to access the hospital is the next complication when they are faced with this problem: they must be sent to the referral hospital. If the sea is bubbling, families only have two choices, die on land or die at sea. If you die on land, only the patient dies. If you die at sea, one family can die. That’s how they express their helplessness. Silent, crying people who are forced to surrender to fate.
Financing problem. True, indeed the government has guaranteed the financing of health services. Sincerely and thank you for the commitment. But there are still those who are forgotten. What does it mean to have a Healthy Indonesia Card (Kartu Indonesia Sehat) if they are unable to get service? It is not an easy matter for them to prepare travel costs and living expenses during the treatment process. They must prepare themselves. Often they raise their hands helplessly because of this problem. A silent reality that has no solution until now.
The presence of a hospital ship complete with operating rooms and doctors who are experts in it as has been done by TNI-AL with KRI Dr. Soeharso, Doctorshare, Sailing Medical Service, etc.. It turns out that it can provide real and complete support for the community. Real and complete on their island. Unfortunately this floating hospital ship is too small. The amount is very inadequate compared to eleven thousands of inhabited islands scattered in the vast ocean in this country. More hospital ships are needed to serve them all. More hands are needed to reach out to those who are widespread. From Sabang to Merauke, from Miangas to Rote Island. Not easy indeed. But a comprehensive health service for people on remote islands must continue to be fought for.
We cannot let another general practitioner associate be alone with the difficulties they cannot overcome on remote islands. We cannot let another child have to travel through the sea for days to get specialist services. We cannot let the patient’s family have difficulty providing travel and living expenses as long as the patient is treated. Don’t let the patient just hope and hope, hopefully there is help. While we are actually able and have the opportunity to help them. We must be able to make them feel that they are also Indonesian people who must be loved. We must be willing to proactively serve them. We must also be able to guarantee that they will get regular visits. We must be able to provide certainty of service when they are sick.
For this reason, alignments are needed for them, among others by allocating funds for the provision of adequate health services for them. In addition, human resource management must be made better prepared and highly committed to serving. This is very important to ensure the regularity and sustainability of the program. Incentive support that is quite interesting and realistic deserves to be considered so that they remain wholeheartedly caring for the noble values of medical science. Also wise planning is required considering the sea is not friendly all year long, even in certain seasons it is categorized as dangerous to navigate. In short, we must create a maritime-based health care system that is able to overcome the challenges and needs of health services in remote islands.
“The government that I lead will work to ensure every citizen in all corners of the country feels the presence of government services. We must work hard to restore Indonesia as a maritime country. Ocean, sea, strait and bay are the future of our civilization. We have turned to the sea for too long, back to the ocean, back to the strait and bay. Now is the time for us to return everything so that Jalesveva Jayamahe – in the sea, we are victorious, as the slogan of our ancestors in the past, can be revived … “(Speech by President Joko Widodo after being sworn in as President of the Republic of Indonesia). A noble promise and determination that must be supported. There is no other choice. We have to go to them on their island. Reaching out the out of reach. Reach the unreachable. We present proactive, comprehensive and sustainable health services. We must be able to prove that the country is truly present for them. So that every island person is no longer shy, Jalesveva Jayamahe!