The next fortnight should show whether the nation with the world’s fourth-largest population will tumble into the plague pit where the second place holder currently writhes.
As India struggles with the pandemic, reportedly caused by a failure to stop crowds clustering around the Ganges to perform religious rites, Indonesians fear the same fate lurks as millions return to their jobs in the big cities.
The end of the Ramadan fasting month in mid-May triggered Mudik (exodus) the traditional visit to relatives in distant parts. President Joko Widodo banned the Islamic pilgrimage but his orders were widely ignored and poorly policed.
Officially Covid-19 has a hard grip on the archipelago though that’s not obvious. In the centre of East Java, supposedly the most severely stricken of the nation’s 34 provinces, hospitals and cemeteries are not reporting overloads. There are no standout signs of distress, seemingly just the usual number of black-cross flags hung on street corners to announce a death. So far no queues at graveyards or ramping of ambulances outside emergency units.
If Indonesia becomes the next India, how will it cope? Patchy at best. Adjacent and better-disciplined Malaysia is already getting anxious. Lockdowns have been tried and failed. The borders are porous.
For the well-off unwell there’s a private health system. Their ads show eager Western-trained staff with clipboards using the latest diagnostic gear.
There’s a government-run universal social health insurance scheme suffering from admin ills as providers lift fees to plunder the purse. As it’s not a tax-embedded levy, families are vulnerable if fees are forgotten. (I pay AUD 15 / month. This isn’t available to tourists who should buy overseas travel cover.)
The cash-deprived have access to puskesmas, community health centres rarely staffed with full-time docs. Hospitals are unfairly tagged as places where the sick are destined to die, so the fearful don’t seek help until the bucket’s about to be kicked. In this highly superstitious and religious country, prayer to invisible deities trumps meeting medics.
As in Australia, the pandemic has exposed flaws in public health systems. Indonesia is way behind its neighbours in total health spending at US$375 per capita, according to the WHO. The figures for Australia are $5,005, Singapore $4,439 and Malaysia $1,194. A WHO review found low government spending and few specialists, particularly in distant islands, meant citizens are getting a raw deal compared to city dwellers.
Accessing adequate treatment can be a problem in all disciplines, but mental health has been measured. According to Sydney Uni medical historian Professor Hans Pols, there are just under 1,000 psychiatrists, 2,000 registered clinical psychologists, and close to 7,000 community mental health nurses across the Republic.
In the journal Inside Indonesia he wrote: “If Indonesia had the same number of psychiatrists per capita as Australia, there would be almost 38,000. Indonesia’s Ministry of Health estimates that about 90 per cent of individuals with mental disorders or psychosocial disabilities do not receive adequate mental health care.”
After second President Soeharto’s 32-years of government-controlled media followed by a growth of blatantly partisan commercial TV stations, consumers prefer info from friends and neighbours, original source unknown. If they haven’t encountered a Covid case or stumbled across corpses in the kampongs, maybe it’s all a beat-up.
Using Indonesian government data, the US Johns Hopkins University has recorded close to 1.8 million cases and 50,000 deaths since the pandemic gripped lungs. The fatalities include more than 650 health workers with around half reported to be doctors.
Indonesian stats can be a dog’s breakfast. As fifth president (2001-04) Megawati Soekarnoputri raged against getting dodgy info from her departments. This year, as chair of Partai Demokrasi Indonesia Perjuangan (Indonesian Democratic Party of Struggle), she beat the same drum reportedly telling supporters:
“After 75 years of independence, government data is still not accurate. Mr President, we have to talk about this matter.” No doubt they will. Whether this results in any change is doubtful.
It’s not just the political leaders showing scepticism. Indonesian epidemiologist Dr Dicky Budiman from the Centre for Environmental and Population Health at Queensland’s Griffith University has been a leading disbeliever, claiming coronavirus casualties could be three times higher.
He’s been advocating “the fundamental pandemic strategy: test, trace and treat and enforcing social distancing.”
Here’s the rub: Figures are flawed because testing isn’t free. Tracing is almost non-existent. Some cinemas are trialling QR code registration for audiences, but there’s no follow-up if an infection is detected.
Social distancing is rare in overcrowded Java with more than 1,000 people per square km. Masking is arbitrarily enforced in shopping malls though not in the street markets which draw thousands daily rubbing shoulders and hips while jostling to buy and sell.
So far about three per cent of the Republic’s 273 million citizens have been jabbed, mainly with the Chinese Sinovac, now being made in Indonesia and free. Big companies are importing stock for employees to bypass the sluggish bureaucracy. President Widodo wants the whole country immunised before Christmas, but at the present rate that ambition looks as distant as the best of PM Scott Morrison’s moveable targets.