A silly accident and a painful, but not-too-serious injury provides a little insight into the workings of the Indonesian health system.
Fortunately, it only hurts when I laugh, cry, cough, sneeze, breathe, stand up, sit down, lie down, sleep, wake up, walk, run, swim, talk, shout, sing, hug, get hugged, or engage in any other activity required for day-to-day existence.
No, I am not talking about life in general. This is about an injury I sustained to my side a couple of weeks ago.
To recap (please read my August 18 blog), I was with my extended family of in-laws in South Jakarta to celebrate Indonesia’s 74th Independence Day. As with most such gatherings, which were taking place all over the country, this one began with the family sitting in the living room. They talked while children ran around playing and food piled up on a side table for later consumption.
After an hour someone turned on a stereo and popular patriotic songs came out of the speakers – several of them repeated with people singing along: the national anthem Indonesia Raya (Great Indonesia), Ibu Pertiwi (Mother Indonesia, from an ancient name of the archipelago) and Gugur Bunga (Dead Flowers), which is about the many who died for Indonesian independence.
Once the songs were sung, everyone went outside for the traditional games. That’s when my troubles began.
The first contest was no problem: speed-eating crackers suspended on strings. I didn’t do very well – I came in dead last, in fact – but it was all in good fun and I didn’t hurt myself. That happened in the second event: the potato-sack race. In my bare feet (as was the custom), I ran across the concrete to where my burlap bag waited. I struggled into it, pulling it to my waist and held it up like a loose pair of trousers. I hopped toward the finish line, but I never made it. About half way I tripped and fell face down onto the cement. Since I was clutching the bag to hold it up, I did not throw my hands out to break my fall. I landed with my right forearm between the ground and my ribs. This knocked the wind out of me, like getting punched in the stomach, but somehow more profoundly painful.
I tried for a moment to regain my breath and was helped to my feet. I walked back into the house. At first my hands smarted from some scrapes, but that faded. As I joined the others in eating the ache in my ribs gradually took over and grew.
Over the next few days it never went away. I felt the ribs and did not experience any sharp pain, so I assumed I had only bruised them. I waited for the soreness to fade. It did not. On the contrary, when I roused myself from my apartment and did anything extra, like swimming or going to the office, the pain got worse.
When I laughed, it hurt. When I sneezed, it hurt. When I walked, when I stood up, when I lay down, when I talked too much, when I carried anything of any weight, it hurt. I was having trouble sleeping because most of the positions I could find in bed just made the pain get worse.
I was still convinced I hadn’t broken any ribs, but after a full week with no improvement I finally followed some good advice and I went to see a doctor.
Hospitals in Indonesia look much like hospitals in Canada, but the healthcare systems differ markedly. In Canada people worry that a new two-tier system may be imposed over our long-standing single-payer public care. In Indonesia they have just begun to overlay a public system on multiple private tiers.
Tiers also exist even within the five-year-old BPJS Kesehatan insurance scheme, with the level and speed of services dependent on how much a patient has supplemented the basic premiums. In addition, while all citizens and legal residents are now supposed to partake of the BPJS, people can choose to bypass it entirely by paying cash. This considerably shortens waiting time and enhances personal attention. Despite holding egalitarian views, I confess I took the cash route, since it saved me hours and perhaps days of waiting.
The actual experience of seeing a doctor also differs between Indonesia and Canada. In Canada a nurse shows me into an examination room where the doctor eventually joins me. Then I sit or lie on a raised bed, sometimes after removing my shirt, and the doctor examines my various bodily functions, like my heartbeat, while asking me questions.
In Indonesia the nurse showed me into the doctor’s office, where the doctor was sitting at his desk behind a computer. I sat opposite, feeling less like a patient and more like an employee undergoing a work performance assessment. The doctor never got close and never made any kind of physical examination. He only asked questions. I did not take my shirt off until I was downstairs getting the X-ray he ordered.
The diagnosis: No rib was broken and my lung was not punctured, he told me. I only tore some ligaments. Painful, yes, but some prescription drugs would take care of that.
In the meantime, for the next week or so, no walking, no swimming, no sneezing, no going to work and definitely no racing in potato sacks.
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