Indonesia - Bespoke catering offers a shot in the arm for Indonesian diabetics

For 25 years, diabetes slowly eroded the health of retired Indonesian businessman Susanto Salim before he signed up to a catering service last year that provides meals cooked to his specific needs.

"I first started as a customer six months ago and when I compared medical examination results before and after, they were actually better," he told Reuters by telephone.

Salim is one of 10 million people who live with diabetes in southeast Asia's most populous nation, its health ministry estimates. After stroke and heart disease, diabetes ranks among the top three killers in the country.

Diabetes accounted for nearly 100,000 deaths in Indonesia last year, and for 1.5 million deaths globally in 2012, the World Health Organization says. Health experts blame these high rates on poor dietary and lifestyle choices.

One company has seized on this opportunity: MyMeals, a food delivery service that caters to people with clinical conditions, and has about 250 customers a day in places such as Jakarta, the capital, and the East Java city of Surabaya.

"I had hypertension and it was difficult to find any healthy food catering, so I started this business based on my own experience," said founder Ignatius Zaldy, who says a better diet improved his own condition, along with exercise and medicines.

"We want to change people's eating patterns," Zaldy said at the company's headquarters, where a handful of cooks prepare and package small portions of vegetables and meat in its kitchen before a fleet of motorcycles speeds them to customers.

Zaldy, 44, says the company employs nutritionists to ensure meals are appropriate for victims of heart disease, high cholesterol and hypertension, although nearly a third of customers are diabetics.

Still, options such as MyMeals, which costs about 68,000 rupiah ($5.15) for each meal, are a luxury in a country where the World Bank says nearly 40 percent of a population of 250 million lives on around $2 a day.

Indonesia now encourages more people to screen for diabetes, so as to spot, and treat, it earlier, health officials say.

"But remote areas are a concern," said health expert Sidartawan Soegondo. "Even though there is a public health clinic in all areas, diabetes medication is limited."

Yet Salim prefers the expense of catering to the restricted lifestyle his disease forced on him.

"My health has been better so far, and I'm even able to go on holiday with my family again," he said.

($1=13,200 rupiah)

(Writing by Kanupriya Kapoor; Editing by Clarence Fernandez)

By Yuddy Cahya and Atik Kencana Sari

reuters

Indonesia - Indonesia in top five for countries with diabetes: WHO

INDONESIA (REUTERS) - Mr Tonny Soerianto takes a pill every day and gives himself a vitamin injection to help fight the disease he's living with - type-2 diabetes.

Mr Soerianto has been fighting it for nine years, the result of a lifetime of poor dietary decisions.

It's caused by obesity, he says. "It's my bad lifestyle choices and a lack of exercise."

And he's not alone. A report by the World Health Organisation says some ten million Indonesians have diabetes.

Dietary staples like rice and oily fried foods contain high levels of carbohydrates which cause blood sugar levels to skyrocket.

Doctors say medicating patients is not enough. They must be educated about food and lifestyle, Mr Soerianto's doctor said.

Companies like Mymeal are trying to help.

The catering firm delivers precooked, healthy food to customers for about US$5 (S$6.72) per meal.

The service is a luxury however - some 40 per cent of the population live on about US$1 per day.

According to the WHO's report, the world's top five countries suffering from diabetes included Indonesia, China, India, Brazil and the US.

straitstimes

Indonesia - Mental health laws would diminish stigma and improve the lives of millions

I have seen the negative impact of the UN’s failure to incorporate mental health within the millennium development goals (MDGs). Working on various mental health projects in several African countries, I saw how the health budgets of resource-strapped countries were diverted towards MDG projects. Many NGOs providing essential community psychiatric support were near collapse, or forced to alter their objectives to secure sufficient funds.

While almost half of the MDGs focused on physical health, mental health was conspicuously absent even though, at the time, approximately 450 million people worldwide were living with a mental illness. The UN sidelined mental health even though mental impairment falls within its own definition of “disability” in the convention on the rights of persons with disability (CRPD).

By 2030, the final year of the sustainable development goals (SDGs), depression is predicted to be the world’s biggest medical burden, and over the next 20 years the cumulative lost economic output due to mental illness will be $16tn (£11tn). However, only a few countries devote more than 10% of their total health budget to mental health.

Happily, mental health is included in the new SDGs, even if the word “mental” does not actually feature. Goal 3 seeks to “ensure healthy lives and promote wellbeing” for everyone – a significant improvement. Unfortunately, this loose phraseology will inevitably result in competition for international funding between mental health NGOs and other organisations with missions in sport, nutrition or the arts, for example.

It is also disappointing that only two of the 13 targets under SDG3 – 3.4 and 3.5 – relate to mental health, and that in the final global indicators (pdf) relating to the goal, only two of 26 are specific to mental health. One of the provisional indicators which would have required data collation on service use by those with severe mental disorders, mirroring a provision in the WHO mental health action plan (pdf), did not make the final cut. This was hardly the parity those working in mental health had hoped for.

But mental health has never had parity with physical health. Despite compelling economic arguments for investing in mental health, stigma perpetuates the lack of resources allocated.

So what can be done? A mental health law which enshrines the rights of those with a mental illness and gives them the right to treatment could help diminish stigma by educating people about human dignity and rights, in addition to protecting and empowering patients. A law can also frame policy, encourage prevention strategies, and set minimum skills for accreditation of mental health professionals and psychiatric facilities. While the UK’s 1983 Mental Health Act is far from perfect, it has done much to realise the rights of the mentally ill.

Nearly two thirds of the world either has no mental health legislation or has a law more than ten-years-old, and the 2030 agenda does not require the implementation of mental health legislation to enforce obligations, such as the right to access appropriate treatment.

Furthermore, for mental health legislation to have any real effect, there must be the political will to support it. It can be difficult to persuade low-resourced countries to do this, especially when there are many other pressing health problems.

Even where legislation exists, a patient’s ill health may prevent access to legal redress for human rights violations. Healthcare workers should inform patients at regular intervals of their rights under a statute. The procedure for challenging failures in implementation or non-compliance with legislation must be simple and clear, and ideally free legal assistance should be provided. To comply with international treaty obligations and best practice, an independent body to hear inpatients’ appeals against the removal of their liberty must be established.

Naturally, this requires significant funds and the global community can make a huge impact by funding the development or amendment of a law, legal expertise, training for local lawyers, advocates and healthcare workers, as well as independent monitoring and impact evaluation.

The good news is that there is finally a real drive to move mental health from the margins into the mainstream of the global development agenda. This month, the World Bank and the WHO co-hosted a high level meeting on global mental health (pdf) and development priorities, seeking parity between mental and physical health (appropriately headed Out of the Shadows).

If nations comply with the CRPD and other international human rights treaties, we’ll be able to see evidence that SDG3 and SDG16 are being met. Meanwhile, mental health lobbyists should press for additional indicators on SDG3 to measure mental health improvements – in particular an indicator requiring the introduction or updating of mental health legislation.

The global community must ensure that those with mental illness are not left behind. The world has a duty to spearhead positive change, and to prevent the continued marginalisation of the mentally ill. Let’s not miss this opportunity.

Laura Davidson

Laura Davidson is barrister and international development consultant specialising in mental health and mental capacity law.

theguardian

Indonesia - Indonesian Ambassador Furious over Workers Deportation

Seoul - Indonesian Ambassador to South Korea John A. Prasetio said that the issue with fake certificates for Indonesian migrant workers had damaged the country’s reputation.

Following a deportation of an Indonesian worker from Incheon Airport due to suffering tuberculosis, another Indonesian migrant worker from Indramayu, SU, was also deported.

When SU arrived at Incheon Airport on April 19, 2016, the 24-year old man had to be deported when he was found suffering from TB during a medical checkup. SU’s situation added to the long list of deported Indonesians due to health reasons and reflected collusion practices among clinics and migrant workers.

“Indonesia is one of the countries with the most deported workers,” said an airport staff as quoted from a press release issued by the Indonesian Embassy in Seoul on Friday, 22 April 2016.

Ambassador John said that he had sent a complaint letter to the government, however the deportation incident recurred that it would harm the reputation of Indonesian workers in general.

“The practice of providing fake certificates cannot be justified under any reasons. Indonesia is a great country that must show discipline before other countries,” John added in a furious tone.

SU was reportedly aware of his disease before he went to South Korea. He also admitted that he had an agreement with the clinic releasing the clinic from any responsibilities, should any unfavorable situations occur.

Maria Rita

http://en.tempo.co/read/news/2016/04/22/074764982/Indonesian-Ambassador-Furious-over-Workers-Deportation

Indonesia - Bali governor says stray dogs must be killed

Bali Governor Made Mangku Pastika said Thursday that the provincial husbandry agency’s rabies team must implement the 2009 rabies prevention bylaw firmly in an attempt to curb rabies on the island.

Pastika also said stray dogs should be killed immediately to prevent people from being bitten.

“If any stray dogs are found, feel free to eliminate them. It has been stipulated in the bylaw that dog owners have to confine their pets at home,” Pastika said during a meeting at the governor’s office in Denpasar.

Pastika said the implementation of the rabies prevention bylaw must be firm, as stray rabid dogs were the main cause of rabies in humans. “It is more dangerous if we let the stray dogs roam,” he said.

“There is no need to catch them, put them in a shelter or something. Just cull them. It is the dog owners’ fault for letting their dogs stray,” Pastika said.

If needed, he suggested the team work with the police. “If any dog owners protest, just show them the bylaw. It is their fault. They should keep their dogs at home,” he added.

Enacted in 2009, the rabies prevention bylaw stipulates that dog owners have to keep their pets at home and have them vaccinated regularly. Anyone in violation of the bylaw faces a maximum of six months in prison or a fine of 50 million rupiah (US$4,100).

However, many dog owners are still unaware of the bylaw and let their dogs roam free.

Since rabies first broke out on the island in November 2008, 147 people have died from the disease. This comprises four deaths in 2008, 28 deaths in 2009, 82 in 2010, 23 in 2011, eight in 2012, one in 2013 and one in 2014.

The administration had set an ambitious target of freeing Bali from rabies by 2015, but will fail to reach this as cases of rabies still occurred in 2013. Bali can only declare itself rabies-free if there are no cases of rabies found in humans or animals within a two-year period.

Bali has now pledged to be a rabies-free island by 2020.

Pastika said that the work to free the island from rabies had been hampered by dog owners who were unaware of the rules. This had resulted in a high cost for rabies prevention.

The epidemic led the Bali administration to provide free vaccines for dogs and affected humans. For 2009, the administration allocated 600 million rupiah from its provincial budget to distribute free vaccines to all regional hospitals on the island. This increased to 3.5 billion rupiah in 2010, 6.4 billion rupiah in 2011, falling slightly to 6 billion rupiah in 2012, then 4.3 billion rupiah in 2013 and rising again to 4.7 billion rupiah in 2014.

“The cost to be rabies-free is really high,” Pastika said.

Mass vaccinations have also been held, targeting more than 300,000 dogs each time. But the number of dog bite cases is still high and rabies cases are still found.

The provincial husbandry agency had found seven rabid dogs in five regencies by mid-June this year in Jembrana, Bangli, Buleleng, Klungkung and Karangasem.

US$1:12,106 rupiah.

Ni Komang Erviani

The Jakarta Post

Indonesia - Indonesia To Tackle The Shackling Of The Mentally Ill

Indonesia is seeking to end the lockdown and shackling of thousands of mental health patients.

Indonesia is seeking to boost its community mental health services in an effort to end the lockdown and shackling of thousands of mental health patients.

“The practice of shackling mentally-ill people still exists and eliminating it is one of our priorities for 2013,” Diah Setia Utami, director of mental health at the Health Ministry, told IRIN, noting that the country’s “serious” shortage of mental health professionals has been one of the biggest obstacles.

The government aims to provide 30 percent of the country’s 9,000 community health clinics and 1,700 general hospitals with staff to provide basic mental health care by 2014, Utami said.

The Health Ministry estimates 19 million people nationwide have various mental health disorders, including anxiety and depression, and another one million have severe psychoses.

Currently, 33 specialized mental health hospitals and 600 psychiatrists offer public mental health care.

“These hospitals are adequately equipped to treat mental patients, but in the future, patients will be encouraged to have treatment outside [the] hospital under the care of families and community caregivers,” Utami added.

The Health Ministry estimates some 18,000 people with mental disorders, mostly in rural areas and bereft of any mental health services, are still subjected to ‘pasung’ (shackling) to prevent them from attacking others. In villages, people with mental disorders are typically chained behind their homes, while in cities, limited space and stigma confine a number of them to small rooms.

Opposition to the practice has grown along with local media reports of people – at times undiagnosed – wasting away after years in chains.

Yusuf said people still resort to ‘pasung’ – banned since 1977 – because they cannot afford mental health care and to escape stigma associated with mental illness.

A psychiatric consultation costs on average US$25, not including drugs. The government plans to implement nationwide universal health coverage in 2014, which is expected to cover most mental health costs.

Government initiative

In 2011 the Health Ministry launched the ‘Menuju Indonesia Bebas Pasung’ program (Towards a Shackle-Free Indonesia), but lack of trained health professionals and funding have stalled progress, say officials.

Nova Rianti Yusuf, a member of a parliamentary health commission, noted the lack of data and research on ‘pasung,’ with the exception of two recent studies of 49 shackled mental health patients that showed 90 percent of them had schizophrenia and 70 percent were receiving improper treatment.

The country’s decentralized health care system accounts for uneven attention to mental health care across the country’s 34 provinces, said Utami. “There are some regional governments that pay little or no attention to mental health and, therefore, allocate little or no budget.”

But, in some places, there are signs of improvement.

Asmarahadi (one name), a psychiatrist at the state-run Soeharto Heerdjan mental hospital in Jakarta, said mental health care has improved there “significantly” over the past 10 years. “People used to call the place a prison, but now it’s like a hotel – at least a one-star hotel.”

The hospital receives 150 patients daily and has a policy of not turning anyone away even if they cannot pay, he said.

“People in Jakarta and its surrounding areas are increasingly aware of mental problems,” he said. “Mental health care is not expensive and even atypical, third-generation anti-psychotic drugs are accessible at affordable prices,” he said.

“Treatment failure is usually caused by a lack of patients’ compliance and family support,” he said.

This is if someone seeks formal medical treatment at all. Large pockets of the country still believe magic spells cause mental illness, with families turning to shamans and religious leaders for cures.

WHO plan

Under the 2013-2020 World Health Organization (WHO) global mental health action plan, 80 percent of member countries are expected to update their mental health policies and laws by 2016, while allocating at least 5 percent of public health expenses to mental health care by 2020.

It also seeks to decrease the number of beds used for long-term stays in mental hospitals (which medical studies link to poor treatment and human rights abuses) by 20 percent by 2020, and increase the availability of places for community-based residential care and supported housing.

“The government has the responsibility to provide mental health care for the poor and it should do so by involving local communities,” said Yusuf.

The WHO plan also calls for doubling the treatment of severe mental disorders. Up to 85 percent of such disorders are not currently treated in low- and middle-income countries,WHO estimates.

Source: IRIN.

IRIN News | Health & Medicine

http://www.asianscientist.com

Indonesia - Indonesian Bird Flu Outbreak “Has Only Infected Ducks”

Indonesian health officials have downplayed concerns over a fresh outbreak of avian influenza which has killed some 160,000 reared ducks since September 2012.

Indonesian health officials have downplayed concerns over a fresh outbreak of avian influenza which has killed some 160,000 reared ducks since September 2012.

“So far no Indonesians have been infected by the new clade [virus group] of the H5N1 virus,” Tjandra Yoga Aditama, the director of disease control and public health at the Health Ministry, told IRIN.

“The outbreak has only affected ducks. There have been no known cases in humans,” said Muhammad Azhar, coordinator of the Avian Influenza Disease Control Unit. “We have taken necessary measures to control the outbreak.”

More than a dozen subsets of the H5N1 virus have been identified – with numerous variants within each clade. Although new to Indonesia, clade 2.3.2 H5N1 has been circulating across Asia for several years, say experts.

Reared ducks began dying on Indonesia’s populous Java Island in September, with the disease spreading to 80 villages in 12 of Indonesia’s 34 provinces. Affected ducks show clinical symptoms such as torticollis, paralysis, seizures, incoordination, and sudden death.

Most poultry kept by Indonesians are chickens; only a small minority keep ducks.

“The origin of the infection was apparently uncertified imported ducks,” said Emil Agustiono, head of the National Commission on Zoonosis. “But luckily we have discovered the vaccine [for poultry] and will start production in February. For now we’re using the old vaccine and it’s still effective.”

The government needs at least another 25 million doses of the H5N1 clade 2.3.2 vaccine, and will compensate farmers affected by the outbreak, though the amount of compensation has not been decided, he added.

The Health Ministry’s Aditama said many countries had reported the presence of clade 2.3 and there had been eight known bird flu cases in humans caused by the strain – three in Bangladesh and five in China.

“So far Indonesia has not seen infection from ducks to humans or bird flu cases in humans caused by clade 2.3, but I expect that generally the medium of infection is similar to that of clade 2.1,” he said.

Health officials have advised that control activities in humans had not changed with the new clade, he said.

“Data on antiviral sensitivity is limited from the human cases, but there is no reason to expect a change.”

Government response

In response to the outbreak, Agustiono said the government was strengthening surveillance and tightening the movement of poultry between provinces to stem the outbreak.

“The spread of the virus is epidemiologically controllable and we’re doing what we can to stop it,” he said, adding: “This outbreak has disrupted the animal husbandry sector and more importantly, is a public health issue.”

Indonesia stopped importing poultry from Australia in December following a bird flu outbreak there, he said. However, there has been no ban on imports of certified ducks from other countries.

About 60 million Indonesians keep poultry, including ducks, in their homesteads. Indonesia’s animal husbandry sector is worth US$2 billion, government statistics show.

Agriculture Minister Suswono, who like many Indonesians goes by only one name, said the outbreak was not yet an emergency.

“According to our data, 160,000 ducks have died and compared to the population of 50 million reared ducks that’s a small number,” he told reporters.

Indonesians wary

Humans in Indonesia have been more affected by avian influenza than in any other country: Of the 189 confirmed bird flu cases since 2005, 157 were fatal.

On December 20, the World Health Organization (WHO) said sporadic human cases reported that month in countries with known H5N1 virus activity in poultry were within the expected range.

“No onward sustained human-to-human transmission was reported,” it said.

Since the H5N1 virus first appeared in 2003, there have been 610 laboratory-confirmed human cases globally – 363 of them fatal – with Indonesia seeing the largest number of deaths, according to WHO.

Globally, H5N1 has killed or forced the culling of more than 400 million domestic chickens and ducks, and caused an estimated $20 billion of economic damage. It was eliminated from most of the 63 countries infected at its peak in 2006, the UN Food and Agriculture Organization reports.

Source: IRIN;

IRIN News | Health & Medicine

http://www.asianscientist.com