Health care in Wangkung

The role of postu

The local wards in Flores are called postu, and Wangkung has its own postu. It was built in 1979 and is run by the government. Not all desa have their own postu, in many cases there are three villages sharing one postu. The government decides where the new postu should be located, and private people and institutions are also able to open up postu after sending an application to the government.

According to the nurse we interviewed, 50 people are treated in the local postu in Wangkung each month. Most of them come in with symptoms of flu and are easy to treat. But three to four of them come in with malaria, which is a much more serious diagnosis to get, especially when you are poor, have a weak immune system, and do not live under the best conditions.

40% of the people in Wangkung have some kind of health insurance and get treated for free. But it is not too expensive to get medical treatment if you do not have insurance. If they are not able to pay, the nurse will cover it from his own pocket in special situations. If the sickness cannot be treated by the local nurse, the patient will be sent to the public hospital in Ruteng, or to the private in Chang Chai. According to the nurse, the private hospitals have a better standard on their treatment but they are twice as expensive as the public ones.

The government organized a vaccination program in 1972, and this came to Wangkung some time between its opening in 1979 and 2000. The nurse had worked in Wangkung since 2000, and did not know exactly when it came. In connection with this programme, the postu offers vaccines like BCG, Diphtheria, Tetanus, Polio and Hepatitis B. They are given to every newborn baby.

The postu is also capable of giving blood transfusion and pain killers. When it comes to the level of cleanliness and sterility, the government has introduced a new programme, which says that shots are only to be used once, and other equipment should be put in boiling water before re-use. The nurse also wears gloves when there is blood involved.

When it comes to pregnancy, the women go to the postu for monthly checks to make sure that everything is ok. During delivery, the nurse is assisted by Dukun Bersalin, an elderly woman who has learned to assist through many years of practise. If deliveries are complicated, women are sent to Ruteng. But that is not as easy as it sounds; Wangkung has no normal practicable roads and no cars, so the women have to be taken by a ‘special crew’. They have to be carried to the main road, which is hours away.

The role of the nurse
The health care for the people are mostly taken care of by the nurse, but there is also one doctor coming to the village if it is necessary. To become a nurse in Indonesia, one has to go to school for three years. But to get a job, you have to pay the government for a governmental nurse exam although you have already gone to a public nursery school. If you pass the exam, you can work as a nurse under the government.

The government decides who are going to work where, and we saw that in practice in Wangkung. The nurse was married to another nurse, but she worked in another village. So instead of working nearby each other, they worked far from each other. One reason could be that the government only wants one nurse in each postu in the rural mountain areas in Flores, but we did not follow up on that.

Health care in Indonesia
When it comes to health care in general in Indonesia, the nurse said that there are more female nurses than males, and that the government programmes are better in theory than in practice. The reason is because they are formulated in Jakarta, Java, and are not designed for a village far up in the mountains of Flores. How the programmes work out depends highly on the nurses; if they put a lot of effort in making it work, it will.

There is also much corruption in the health system. One example is related to the governmental exam to become a nurse. If you have good contacts, it is possible to take the exam straight after graduation, but most people have to work several years to be able to pay for the governmental exam.

Another example is that postu and hospitals get money to use on the governmental health programmes but they do not spend all on that. As mentioned before, the government places the nurses where they want them, but it is of course possible to pay for the job you want or pay to avoid certain areas and so on. Money talks.

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