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THE ORTHOPAEDIC TRAINING PROGRAMME IN INDONESIA1
40
THE AUSTRALIAN JOURNAL OF PHYSIOTHERAPY
THE ORTHOPAEDIC TRAINING PROGRAMME IN INDONESIA x MARION DICK, M.A.P.A, I was fortunate to visit Indonesia in association with the Orthopaedic Training Programme, firstly whilst on holiday in October 1970 and later as a volunteer in an advisory capacity in March 1971 at the request of the Indonesians involved in the Orthopaedic Training Programme. Indonesia is Australia's newest neighbour and has a population of over 120 million people, 70 per cent of whom live on the small fertile island of Java. Since Indonesia's hard-won independence in 1948, many great, but sometimes uneven strides, have been made in the struggle towards achieving the fundamental ideals contained in the new constitution. The former President, Dr. Soekarno was the remarkable figure who enabled Indonesians to be* come united and to feel a pride in their nation which had previously been disparaged as "a nation of coolies and a coolie among nations". After the attempted coup in 1965 the Army took control and more recently, with President Soeharto as Head of Government, there has been a gradual improvement in the economy and the progress of the country. In spite of its rich natural resources, and some areas of abundant fertility, Indonesia is a poor country for many reasons — exploitation by other countries has been marked, inflation, over-population and food shortage in many areas. There is also disparity between the few very rich and the many poor. This is most noticeable in Djakarta, the capital, where one can see many expensive cars and also many people walking and many people who can only move from place to place with bicycles and most primitive forms of transport. There are five million people crowded into what we might call the largest native village in the world. Thus the Government is faced with many problems and health care cannot be given the same high priority as in the more affluent countries. Civil servants are paid so little that it is necessary for them to supplement their official salaries by having two jobs; for doctors, nurses, physiotherapists, etc., running a private practice in the evening is a necessity. There is sometimes the appearance of apathy amongst the staff and patients of hospitals, hut with such obstacles one is continually amazed to find people who are enthusiastic and capable of achieving what seems impossible. Indonesians are charming, polite and cultured people and a visitor is treated with the same hospitality that one finds in most eastern countries. The Orthopaedic Training Programme began following discussion between Orthopaedic Surgeons 1
Delivered at the XIII Biennial Congress of the Australian Physiotherapy Association, Brisbane, August, 1973.
AusLLPhysiother., XX, 1, March, 1974
from Australia, North America and South-East Asia, who made an offer of assistance to the Indonesian Government. The Indonesians then invited the North American-Australian Associations, using the services of CARE (Cooperative for American Relief Everywhere) and in particular the CARE-MEDICO Branch which was originally established by Dr. Thomas Dooley, to set up a training project. This training project was aimed at training Indonesian general surgeons in Djakarta to become orthopaedic surgeons. CARE is a private American-Canadian organisation which raises money through direct contributions, and by using efficient administration ensures that useful assistance is given where it is required without any political involvement. This programme commenced under the auspices of the University of Indonesia and the Ministry of Health. Two Indonesian general surgeons started and were paid a stipend of IU.S.150.00 per month in order that they could work full-time in the programme and at the same time, support their families. The programme was designed to last two years. Finance for these stipends and the running of the programme was provided by the North American Orthopaedic Associations, Rotary, and Community Aid Abroad in Australia. Later the Australian Orthopaedic Association and later still the Australian Government, provided some financial assistance. The volunteer orthopaedic surgeons spent a month in Djakarta, and Mr. W. R. Beetham from Ballarat was the second Australian to go there. He was made Programme Director in early 1969 and since then has been responsible for the coordination of all aspects of the programme. It is anticipated the programme will continue in its present form until early 1975, by which time some 12 orthopaedic surgeons will have graduated in Indonesia, thus forming the nucleus of a Training School for orthopaedic surgeons of the future. In 1970 the first nurses went up to help with the theatre and ward follow-up and since then 16 nurses have worked in various departments of hospitals in Djakarta and Surabaya. The first two orthopaedic surgeons to graduate from the programme and work elsewhere are now well settled in Surabaya. A request came from the Governor of Djakarta for help with the setting up of a Rehabilitation Centre at Fatmawati Hospital. This was the first time that local government had become involved in the programme. Governor Ali Sadikan was extremely interested in this project and put up finance for the first stages of this Rehabilitation Centre, I was privileged to be there at that time and to reinforce the importance of physiotherapy in the overall process of rehabilitation.
ORTHOPAEDIC TRAINING PROGRAMME IN INDONESIA
Following this the Royal Perth Hospital sent up a team to help with the design and fitting up of this centre which was officially opened by Madame Soeharto whilst Mr. Beetham was in Djakarta for the 9th Half-Yearly Evaluation Meeting in May of this year. The next stage which has already been commenced is to include a Paraplegic Ward and teaching facilities. Recently the Committee for Australian-Indonesian Cooperation in Medicine was formed under the Chairmanship of Sir Kenneth Noad of Sydney with representatives from Australian and Indonesian Ministries of Health, Universities and the various Australian Medical Sciences. The Orthopaedic Training Programme is being used as a pilot programme for other medical and ancillary projects in Indonesia. Through the work of the nurses, particularly Sister Margaret Dodds of Melbourne, there has been increasing involvement of the Royal Australian Nursing Association and the International Council of Nurses and the World Health Organisation in assisting with the various problems which face the Indonesian nursing profession. In September of this year, Mr. Beetham accompanied by Dr. Soelarto and Dr. Soekarno, the Indonesian orthopaedic surgeons in charge of training in Djakarta and Surabaya, will go to Oxford to attend a Symposium on Orthopaedic Training in Developing Countries. This has been subsidised by the Commonwealth Foundation and the British Orthopaedic Association and will have world-wide attendance. We are close neighbours to Indonesia, and the Indonesians feel a kinship with Australians which they regard as another, if more advanced developing country, which has also experienced the yoke of colonialism. The success of the Orthopaedic Training Programme has largely been due to the fact that the work has been done in the local conditions with existing facilities, and there is a twoway exchange of knowledge, as visitors have learnt a great deal from the Indonesians who have a genius for improvising; to quote Dr. Soelarto — "what to do with what you have, to get what you want". It is expected that from now on more Indonesian orthopaedic surgeons, doctors and nurses, will visit Australia and it is likely that in the near future, Indonesian physiotherapists will be asking for official contact with their Australian counterparts. Thus it is possible that Australian Physiotherapists could become involved with the development of what is officially a fairly young profession in Indonesia. During my first visitt I followed up a report made by Mr. W. Guiliano of Melbourne in 1969, and on my return in March 1971, I spent 44 months working and observing in three hospitals in Djakarta with some visits for lecturing in Bandung and Solo where the Physiotherapy Academy is situated. By getting to know physiotherapists, and spending time working and talking over their problems, I was able to get an overall picture of the physiotherapy set-up.
41
In 1956 a Training School was started for Assistant Physiotherapists at the existing Rehabilitation Centre at Solo in central Java. This was founded by the late Professor Soeharso. With the help of W.H.O., an English-trained Indonesian physiotherapist, Mrs. Asjad, upgraded the school and in 1968, the Indonesian Physiotherapy Association was formed. The first seminar was held in December 1970 with full recognition by the Ministry of Health, the University and Medical Association. Since then a New Zealand trained Indonesian, Mr. Albert Sirhaan, who was formerly a tutor of the Academy in Solo, has taken up the position of Rehabilitation Officer in the Department of Health. Considering the difficulty in obtaining books, equipment, and other facilities, the training is fair, and some excellent work is being done. Hospital salaries are as low as $5.00 Australian per month and physiotherapists are forced to find extra-mural work in the evenings. They work in the hospitals, in the mornings, and have private work after the afternoon siesta. Unfortunately, many work in massage and sauna bath establishments, and not all doctors understand the value of their work. However, there is increasing understanding particularly from surgeons. The private hospital in Djakarta, St. Carolus, employs full-time physiotherapists on a more reasonable salary, and they are able to make a much more realistic impression as facilities and nursing standards are good. The main teaching hospital has 1,700 beds and the Physiotherapy Department is minute and crowded even by Indonesian standards. The shortage of fully trained staff means that only one physiotherapist spends three mornings a week caring for the orthopaedic patients. The hospital for crippled children J.P.A.T. has a dynamic woman, Mrs. Wirareno in charge. She is trained in both nursing and physiotherapy and was in Perth whilst I was in Djakarta. Since her return she is working as the Nurse in Charge of the Rehabilitation Centre. She is also Acting as the Senior Physiotherapist. The staff at Fatmawati Hospital are very interested in their work and it was here that I was able to be of most use, as the number of patients was more manageable and the language was not such a problem, as the physiotherapists' command of English was much better than my attempt at Bahasa Indonesia. They have since been working with the team from Royal Perth Hospital which included a physiotherapist, Mr. J* Johnson. I also attended several meetings of the Indonesian Physiotherapy Association, and was impressed with the enthusiasm of the members. It was necessary for me to stress frequently, that lack of equipment was not a major drawback to the work of physiotherapy, as unfortunately Indonesians have been given the impression that in the West, fancy gadgets are more important than manpower. It was an honour to attend a meeting of representatives from the various ministries, CARE and the OTPI to discuss plans for the Fatmawati Rehabilitation Centre, and to see how much can be done with cooperation at the international level. AustJ.Physiother„ XX, 1, March, 1974
42
THE AUSTRALIAN JOURNAL OF PHYSIOTHERAPY
Since then I have been able to follow progress through contact with the various Australians and Indonesians involved and I look forward to returning some time in the future. Physiotherapists I met in Singapore are also interested in the programme through contact with their orthopaedic surgeons who have acted as consultants in Djakarta. There are many ways in which I feel that they and members of the A.P.A, can help. It is imperative that Australian physiotherapists become involved in the overall scene in Indonesia. As indicated, the Indonesian Physiotherapy Association is most desirous of developing communication and major involvement with Australian Physiotherapists. The pressing problem is the establishment of a Physiotherapy Training School in Djakarta. This will then inevitably lead to the development of at least partially adequate physiotherapy services for the major hospitals in Djakarta, in particular those that are involved with the University of Indonesia. Australian physiotherapists must go up as consultants in various fields, many of which have not been even developed at this stage. Provision of much needed text books and journals is certainly an urgent necessity. We must work to organise post-graduate experience in Australia for Indonesian trained physio-
AustJ.Physiother.,
XX, 1, March, 1974
therapists. ting up of Indonesian Committee
For the present I would suggest the seta fund to provide official contact with the Physiotherapy Association and with the in Australia. SUMMARY
The Orthopaedic Training Programme in Indonesia has made it possible for Australian and Indonesian physiotherapists to meet on their common ground, with greater involvement likely in the near future. The Committee for Australian-Indonesian Cooperation in Medicine would be an effective guide in coordinating further developments. My sincere thanks go to Mr. W. R. Beetham, Director of the Programme, Mr. Peter Rice and Mr. Frank Guymer, partners of the Ballarat Physiotherapy Group without whose help and encouragement I would not have been able to visit Indonesia. To the Ballarat Branch of Community Aid Abroad and the Vikings Ballarat who gave support and financial help to aid my visit, I also give thanks. Finally, I would like to thank the Indonesians who were so hospitable and helpful during my visit. I acknowledge using the article by Mr. Albert Sirhaan "Physiotherapy in Indonesia", New Horizons, viii: 27, January 1971.
THE AUSTRALIAN JOURNAL OF PHYSIOTHERAPY
THE ORTHOPAEDIC TRAINING PROGRAMME IN INDONESIA x MARION DICK, M.A.P.A, I was fortunate to visit Indonesia in association with the Orthopaedic Training Programme, firstly whilst on holiday in October 1970 and later as a volunteer in an advisory capacity in March 1971 at the request of the Indonesians involved in the Orthopaedic Training Programme. Indonesia is Australia's newest neighbour and has a population of over 120 million people, 70 per cent of whom live on the small fertile island of Java. Since Indonesia's hard-won independence in 1948, many great, but sometimes uneven strides, have been made in the struggle towards achieving the fundamental ideals contained in the new constitution. The former President, Dr. Soekarno was the remarkable figure who enabled Indonesians to be* come united and to feel a pride in their nation which had previously been disparaged as "a nation of coolies and a coolie among nations". After the attempted coup in 1965 the Army took control and more recently, with President Soeharto as Head of Government, there has been a gradual improvement in the economy and the progress of the country. In spite of its rich natural resources, and some areas of abundant fertility, Indonesia is a poor country for many reasons — exploitation by other countries has been marked, inflation, over-population and food shortage in many areas. There is also disparity between the few very rich and the many poor. This is most noticeable in Djakarta, the capital, where one can see many expensive cars and also many people walking and many people who can only move from place to place with bicycles and most primitive forms of transport. There are five million people crowded into what we might call the largest native village in the world. Thus the Government is faced with many problems and health care cannot be given the same high priority as in the more affluent countries. Civil servants are paid so little that it is necessary for them to supplement their official salaries by having two jobs; for doctors, nurses, physiotherapists, etc., running a private practice in the evening is a necessity. There is sometimes the appearance of apathy amongst the staff and patients of hospitals, hut with such obstacles one is continually amazed to find people who are enthusiastic and capable of achieving what seems impossible. Indonesians are charming, polite and cultured people and a visitor is treated with the same hospitality that one finds in most eastern countries. The Orthopaedic Training Programme began following discussion between Orthopaedic Surgeons 1
Delivered at the XIII Biennial Congress of the Australian Physiotherapy Association, Brisbane, August, 1973.
AusLLPhysiother., XX, 1, March, 1974
from Australia, North America and South-East Asia, who made an offer of assistance to the Indonesian Government. The Indonesians then invited the North American-Australian Associations, using the services of CARE (Cooperative for American Relief Everywhere) and in particular the CARE-MEDICO Branch which was originally established by Dr. Thomas Dooley, to set up a training project. This training project was aimed at training Indonesian general surgeons in Djakarta to become orthopaedic surgeons. CARE is a private American-Canadian organisation which raises money through direct contributions, and by using efficient administration ensures that useful assistance is given where it is required without any political involvement. This programme commenced under the auspices of the University of Indonesia and the Ministry of Health. Two Indonesian general surgeons started and were paid a stipend of IU.S.150.00 per month in order that they could work full-time in the programme and at the same time, support their families. The programme was designed to last two years. Finance for these stipends and the running of the programme was provided by the North American Orthopaedic Associations, Rotary, and Community Aid Abroad in Australia. Later the Australian Orthopaedic Association and later still the Australian Government, provided some financial assistance. The volunteer orthopaedic surgeons spent a month in Djakarta, and Mr. W. R. Beetham from Ballarat was the second Australian to go there. He was made Programme Director in early 1969 and since then has been responsible for the coordination of all aspects of the programme. It is anticipated the programme will continue in its present form until early 1975, by which time some 12 orthopaedic surgeons will have graduated in Indonesia, thus forming the nucleus of a Training School for orthopaedic surgeons of the future. In 1970 the first nurses went up to help with the theatre and ward follow-up and since then 16 nurses have worked in various departments of hospitals in Djakarta and Surabaya. The first two orthopaedic surgeons to graduate from the programme and work elsewhere are now well settled in Surabaya. A request came from the Governor of Djakarta for help with the setting up of a Rehabilitation Centre at Fatmawati Hospital. This was the first time that local government had become involved in the programme. Governor Ali Sadikan was extremely interested in this project and put up finance for the first stages of this Rehabilitation Centre, I was privileged to be there at that time and to reinforce the importance of physiotherapy in the overall process of rehabilitation.
ORTHOPAEDIC TRAINING PROGRAMME IN INDONESIA
Following this the Royal Perth Hospital sent up a team to help with the design and fitting up of this centre which was officially opened by Madame Soeharto whilst Mr. Beetham was in Djakarta for the 9th Half-Yearly Evaluation Meeting in May of this year. The next stage which has already been commenced is to include a Paraplegic Ward and teaching facilities. Recently the Committee for Australian-Indonesian Cooperation in Medicine was formed under the Chairmanship of Sir Kenneth Noad of Sydney with representatives from Australian and Indonesian Ministries of Health, Universities and the various Australian Medical Sciences. The Orthopaedic Training Programme is being used as a pilot programme for other medical and ancillary projects in Indonesia. Through the work of the nurses, particularly Sister Margaret Dodds of Melbourne, there has been increasing involvement of the Royal Australian Nursing Association and the International Council of Nurses and the World Health Organisation in assisting with the various problems which face the Indonesian nursing profession. In September of this year, Mr. Beetham accompanied by Dr. Soelarto and Dr. Soekarno, the Indonesian orthopaedic surgeons in charge of training in Djakarta and Surabaya, will go to Oxford to attend a Symposium on Orthopaedic Training in Developing Countries. This has been subsidised by the Commonwealth Foundation and the British Orthopaedic Association and will have world-wide attendance. We are close neighbours to Indonesia, and the Indonesians feel a kinship with Australians which they regard as another, if more advanced developing country, which has also experienced the yoke of colonialism. The success of the Orthopaedic Training Programme has largely been due to the fact that the work has been done in the local conditions with existing facilities, and there is a twoway exchange of knowledge, as visitors have learnt a great deal from the Indonesians who have a genius for improvising; to quote Dr. Soelarto — "what to do with what you have, to get what you want". It is expected that from now on more Indonesian orthopaedic surgeons, doctors and nurses, will visit Australia and it is likely that in the near future, Indonesian physiotherapists will be asking for official contact with their Australian counterparts. Thus it is possible that Australian Physiotherapists could become involved with the development of what is officially a fairly young profession in Indonesia. During my first visitt I followed up a report made by Mr. W. Guiliano of Melbourne in 1969, and on my return in March 1971, I spent 44 months working and observing in three hospitals in Djakarta with some visits for lecturing in Bandung and Solo where the Physiotherapy Academy is situated. By getting to know physiotherapists, and spending time working and talking over their problems, I was able to get an overall picture of the physiotherapy set-up.
41
In 1956 a Training School was started for Assistant Physiotherapists at the existing Rehabilitation Centre at Solo in central Java. This was founded by the late Professor Soeharso. With the help of W.H.O., an English-trained Indonesian physiotherapist, Mrs. Asjad, upgraded the school and in 1968, the Indonesian Physiotherapy Association was formed. The first seminar was held in December 1970 with full recognition by the Ministry of Health, the University and Medical Association. Since then a New Zealand trained Indonesian, Mr. Albert Sirhaan, who was formerly a tutor of the Academy in Solo, has taken up the position of Rehabilitation Officer in the Department of Health. Considering the difficulty in obtaining books, equipment, and other facilities, the training is fair, and some excellent work is being done. Hospital salaries are as low as $5.00 Australian per month and physiotherapists are forced to find extra-mural work in the evenings. They work in the hospitals, in the mornings, and have private work after the afternoon siesta. Unfortunately, many work in massage and sauna bath establishments, and not all doctors understand the value of their work. However, there is increasing understanding particularly from surgeons. The private hospital in Djakarta, St. Carolus, employs full-time physiotherapists on a more reasonable salary, and they are able to make a much more realistic impression as facilities and nursing standards are good. The main teaching hospital has 1,700 beds and the Physiotherapy Department is minute and crowded even by Indonesian standards. The shortage of fully trained staff means that only one physiotherapist spends three mornings a week caring for the orthopaedic patients. The hospital for crippled children J.P.A.T. has a dynamic woman, Mrs. Wirareno in charge. She is trained in both nursing and physiotherapy and was in Perth whilst I was in Djakarta. Since her return she is working as the Nurse in Charge of the Rehabilitation Centre. She is also Acting as the Senior Physiotherapist. The staff at Fatmawati Hospital are very interested in their work and it was here that I was able to be of most use, as the number of patients was more manageable and the language was not such a problem, as the physiotherapists' command of English was much better than my attempt at Bahasa Indonesia. They have since been working with the team from Royal Perth Hospital which included a physiotherapist, Mr. J* Johnson. I also attended several meetings of the Indonesian Physiotherapy Association, and was impressed with the enthusiasm of the members. It was necessary for me to stress frequently, that lack of equipment was not a major drawback to the work of physiotherapy, as unfortunately Indonesians have been given the impression that in the West, fancy gadgets are more important than manpower. It was an honour to attend a meeting of representatives from the various ministries, CARE and the OTPI to discuss plans for the Fatmawati Rehabilitation Centre, and to see how much can be done with cooperation at the international level. AustJ.Physiother„ XX, 1, March, 1974
42
THE AUSTRALIAN JOURNAL OF PHYSIOTHERAPY
Since then I have been able to follow progress through contact with the various Australians and Indonesians involved and I look forward to returning some time in the future. Physiotherapists I met in Singapore are also interested in the programme through contact with their orthopaedic surgeons who have acted as consultants in Djakarta. There are many ways in which I feel that they and members of the A.P.A, can help. It is imperative that Australian physiotherapists become involved in the overall scene in Indonesia. As indicated, the Indonesian Physiotherapy Association is most desirous of developing communication and major involvement with Australian Physiotherapists. The pressing problem is the establishment of a Physiotherapy Training School in Djakarta. This will then inevitably lead to the development of at least partially adequate physiotherapy services for the major hospitals in Djakarta, in particular those that are involved with the University of Indonesia. Australian physiotherapists must go up as consultants in various fields, many of which have not been even developed at this stage. Provision of much needed text books and journals is certainly an urgent necessity. We must work to organise post-graduate experience in Australia for Indonesian trained physio-
AustJ.Physiother.,
XX, 1, March, 1974
therapists. ting up of Indonesian Committee
For the present I would suggest the seta fund to provide official contact with the Physiotherapy Association and with the in Australia. SUMMARY
The Orthopaedic Training Programme in Indonesia has made it possible for Australian and Indonesian physiotherapists to meet on their common ground, with greater involvement likely in the near future. The Committee for Australian-Indonesian Cooperation in Medicine would be an effective guide in coordinating further developments. My sincere thanks go to Mr. W. R. Beetham, Director of the Programme, Mr. Peter Rice and Mr. Frank Guymer, partners of the Ballarat Physiotherapy Group without whose help and encouragement I would not have been able to visit Indonesia. To the Ballarat Branch of Community Aid Abroad and the Vikings Ballarat who gave support and financial help to aid my visit, I also give thanks. Finally, I would like to thank the Indonesians who were so hospitable and helpful during my visit. I acknowledge using the article by Mr. Albert Sirhaan "Physiotherapy in Indonesia", New Horizons, viii: 27, January 1971.