By Budhiana Kartawijaya
Two volunteers from Odesa, Andini Putri and Didin Sudeni were trekking through the road of Cimenyan area, in the eastern part of North Bandung, some seven kilometers from Bandung city. Having escaped from the rocky and muddy path, they took a break at a small and gloomy warung (stall) in Mekarmanik Village. Close to the warung, they came across an old woman who had been long time paralyzed by high blood. For six years, she had only been to see a doctor. It was a hidden kampong (village) behind the mountain, with poor quality of the turn and twist road. Having no cash in the pocket, she is unable to access the health services.
March 2015, the government launched Kartu Indonesia Sehat (KIS) or Healthy Card Indonesia program in which the people with community-related or social problems (Penyandang Masalah Kesejahteraan Sosial-PMKS) that have not yet been registered as participants of the National Health Insurance Beneficiary (Penerima Bantuan Iuran-PBI) can get free health care. But not all poor people can take advantage of KIS due to the expensive transportation cost. The Community Health Center (puskesmas) is over the mountain, so it is difficult to bring sick villagers there unless by car.
“How can I go to puskesmas? By what? We only have a bike!” She said.
Rarely an officer of the District Health Office touches the isolated village. In Kampung Cikawari there is a clinic of Saint Joseph. Younger medical teams are diligent to pick up the ball. They periodically go to people’s homes and check the family health. “They check the health and give free medicine,” said Edi, a resident of Cikawari.
Another example, Idam (it is common in Indonesia to have a name without surname). The old man of the Pondok Buahbatu village had been disabled for eight years since falling from a 16-meter-high tree. He had his ribs broken and did not get a good treatment for eight years. Poor road access, as well as having no money causes him to be reluctant to seek treatment. He has KIS, but he could not use it because of transport and other expenses. Finally, now he stays in the mosque Nurul Iman Pondok Buahbatu and relies his life on the generousity Nanang Muhammad Yusuf, a local religious leader or ustadz.
Sad story also happened to Amah, an old resident of Cadas Gantung village. She had cancer for years and could only stay in his rickety shack. Her husband, Damim, was a stone-breaking worker with uncertain income. Incidentally Amah was discovered by Odesa volunteers. So Odesa took the ailing old lady to the Hasan Sadikin Hospital. Unfortunately, due to late treatment, Amah died. Ignorance of the benefits of KIS as well as having no fare led them to give up.
Not until the KIS program, most of these PMKS society was practically unable to get health care because they did not have enough money to pay doctors and medicines. But having KIS on hand does not mean the problem is resolved. KIS covers the medical costs, not societal costs. The societal cost items include transportation cost, meal expenses of the family members who keep in touch of the patient at the hospital. Most of them are laborers with daily wage. So when he or she is being hospitalized, or stay at the hospital to keep up with his ailing family, he misses his job and consequently cannot feed the family.
KIS facilities also often cannot be used because sometimes the name written on the card does not match what is written on the identity card (KTP) or family card. For example, in the ID Card it is written “Enda”, but in the KIS card it is “Endak”. Many adults are illiterate so they cannot fill in the health registration forms rightly.
As a result the puskesmas or hospital cannot proceed the registrations. Lack of direction from the government apparatus cause the public not to get good information about KIS benefits. Let alone understand the rights of patients. Moreover, the hospital is an alien thing. The lift doors to the medical equipments make them jittery and nervous.
Accustomed to living without health services and guidance of government officials, they don’t not aware the importance of preventing disease. To them, health care means only curing the sickness.(Budhiana Kartawijaya)