Health services: Stools, fools and fungus

Julia Suryakusuma, Jakarta

Earlier this year I took myself and my nasty, persistent tummy problem to the doctor. After listening distractedly to my symptoms for a few minutes, he scribbled on his pad, prescribing antibiotics, without bothering to take any stool samples. Desperate to get better, I didn’t argue and just gulped down the pills as quickly as I could. That night I felt even worse. I sms-ed him to ask what was up? His answer: perhaps I needed psychoanalysis.

Hello? Where did that come from? I agree there was a need for analysis, but at the other end of me, please!

Luckily, I got better on my own, but when my tummy started playing up again recently, I made sure I tried out a new doctor. This one was a big improvement. Much younger, he refused to prescribe antibiotics until all the proper tests were done. In the meantime he gave me medication to alleviate the symptoms and I struggled along until the next day, when the results of the lab tests came back. Turned out the culprit was fungus, and if I had been given antibiotics, it would have reduced the cash in my pocket, but not the bug in my belly.

Later, talking to Dr. Wati from the YOP (Yayasan Orang Tua Peduli, Foundation of Parents who Care — www.sehatgroup.web.id), an NGO dedicated to building a better health community, I discovered that even a stool sample may not have been necessary. Unless there’s blood (a sign that there’s an amoebic infection), diarrhea is often a self-limiting disease, just like flu and cough, sore throat and fever. That means the symptoms need to be alleviated, yes, but the disease itself often doesn’t need treatment. With diarrhea, the most important thing is preventing the patient from becoming dehydrated.

But that doesn’t stop doctors handing out antibiotics like candy, despite effects that are much more dangerous than the original disease! Hadi, my former driver, is a case in point. He regularly pops a few antibiotics before staying up all night to watch a soccer match. This, he used to tell me, was “as prevention, so I don’t get sick”.

I was horrified. I tried to tell him as calmly as I could how ABs should be used, that they should be taken as a cure in fixed dosages over a prescribed number of days, and only when you are already ill enough to need them. “If you fail to do so, you build a resistance, Hadi”, I said, “and then when you really need it, it won’t work for you anymore!”

The truly worrying thing is that there are many more Hadis out there, and their cumulative drug-munching habits are building a community of antibiotic-resistant people who cannot be easily treated when they fall sick, because their bugs are super-resistant. That’s why I called Hadi a krupuk (shrimp or sago cracker): just like crispy, crunchy krupuk that becomes limp when exposed to air and moisture, he wilts easily, falling sick frequently and taking a long time to bounce back. Are we becoming a nation of limp krupuks due to excessive and irresponsible drug-consumption?

Indonesia is now rife with IRUD: Irrational Use of Drugs. Unfortunately, the inappropriate, ineffective and economically inefficient use of pharmaceuticals is more common than not in the world, with between 52 and 62 percent of all antibiotics prescribed in developing countries being unnecessary. And Indonesia is one of the worst culprits: here the percentage is a staggering 87 percent, according to a YOP survey! Yes, 87 percent!

Hardly surprising, though. What, with increasing economic, social and even environmental pressure and the hand-to-mouth existence of the majority of Indonesians, it is little wonder that most resort to shortcuts and take refuge in the belief that “there’s a pill for every ill” so they can get on with the daily business of survival.

Unfortunately, polypharmacy (prescribing several drugs at the same time for conditions that don’t require it) and over-prescribing are also very widespread. One common problem is the practice of powdered drugs (drug compounding) for children with minor health problems like, yes, fever, flu, cough or diarrhea.

In most countries around the world, the administering of poly-pharmacological drugs has been reduced to only 1 percent of all drugs, but in Indonesia levels remain much higher. One example: there is a private hospital in the city of Tangerang (20 kilometers west of Jakarta) that still churns out 130 forms of compound drugs on a daily basis to feed the hungry hordes of Hadis.

Doctors cite three main reasons for over-prescription of antibiotics, lack of confidence being the first. Many doctors feel reluctant to tell a patient that he or she doesn’t need antibiotics, for example when their illness is caused by a virus that antibiotics cannot treat, because most patients just won’t believe them.

The second reason is the passiveness of patients, many of whom unquestioningly believe that the “doctor knows best”. Indonesia is still a largely patriarchal society, and so the “doctor is god” belief remains deep-seated: There are not enough patients who are prepared to assess whether the medication prescribed for them is really what they need.

The third reason is “company pressure”, from pharmaceutical companies and sales staff who ply the doctors with free samples which are then sometimes dispensed to patients. The doctors also get perks in the form of business trips, conferences and even cars from these drug companies! It’s outright bribery!

It boils down to the market right? So, let’s stop being fools about stools and start making sensible decisions about our own health, rather than allowing dopey doctors and money-mongering pharmaceutical companies to drug us until we are sicker — and poorer — than before we went to the doctor!

The writer is the author of Sex, Power and Nation. She can be contacted at jsuryakusuma@gmail.com

source : http://old.thejakartapost.com/

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: