Salma’s Wound: Dark Portrait of Our Healthcare Services
There is no light in the face of Siti Salma, 8. The condition of her stomach reflects a dark portrait of healthcare in West Java.
By
BENEDIKTUS KRISNA YOGATAMA
·6 minutes read
There is no light in the face of Siti Salma, 8. The child, who lives in Ciemas district, Sukabumi, has lost her smile. Her small body lies in a bed at Sukabumi’s Syamsuddin Regional Hospital. The condition of her stomach reflects a dark portrait of healthcare in the southern part of West Java.
Ten days earlier, Salma had just left the operating room. A stomach infection that developed after her appendectomy needed immediate treatment. The result was said to be good, but she still had a 15-centimeter bandage. Salma was mostly quiet, even when spoken to. She felt pain whenever she changed the position of her body.
“Salma is recovering. The wound is still painful. She wants to eat, but she can’t,” said her mother, Siti Masriva, 33.
Wahyu Handrian, chairman of Syamsuddin Hospital’s information and complaints management team, said that following her operation, Salma needed to remain in intensive care to recover her digestive function. She had initially been treated at Jampang Kulon Regional Hospital (RSUD) in Sukabumi.
Diagnosed with appendicitis at RSUD Jampang Kulon, she had her appendectomy there. Jampang Kulon’s staff and general affairs head, Encang Rukmana, said Salma was treated for 11 days at the hospital. However, the surgery became a trending topic on social media. A photo of her surgical wound went viral. Her treatment at Jampang Kulon Hospital received many negative comments, from the cause of her post-surgery infection to the substandard shape of the suture.
Encang rejected allegations that the hospital had been unprofessional. He said that the surgery had followed correct procedure. The infection was not caused by the shape of the suture, but the follow-up care Salma had received at home.
Victim
Regardless of all debate, Salma is still a victim. At her young age, she was exposed to the impacts of poverty, lack of information and healthcare mismanagement in the country.
Since she was 18 months old, Salma got very little attention from her parents. Her father Rayadi had died, and she lives far from her mother.
Masriva is a factory worker and also runs a small kiosk in Sukabumi, 100 kilometers from Ciemas. She returns to Ciemas only once every 3-6 months. In Sukabumi, she lives with a child from a previous marriage. Unable to support Salma financially, she sent Salma to her 60-year-old father, Aep Saepudin.
Unfortunately, Aep is not wealthy. After divorcing his first wife, he lives with his second wife, Sulastri. He relies on the minimal income he earns as a fisherman. His makes only Rp 300,000 a month. As a result, Salma’s quality of life quality and health began to suffer.
Salma does not get enough nutrition. She lives in an unhealthy environment, including the less-than-ideal sanitary condition of her grandfather’s house, which is far from decent. The bathroom, for example, is outside the house and has a dirt floor. Its wooden walls are worn out. There is no septic tank.
Hari Kurnia, 28, Salma’s uncle, said his niece did not eat regularly. Salma ate once in three days if they made a catch at sea. “We are a poor family. We do not understand healthy foods. We’re grateful just to be able to eat,” said Hari, who is also a fisherman. Hari has not been able to fish for the past month because of bad weather.
It seems the state is absent from the district at the edge of the Indian Ocean. Neither Aep nor Salma have the regional health insurance (Jamkesda) or the national health insurance (JKN). Their house is only 205 km from to Jakarta, or eight hours by land.
The result was nearly fatal. When he needed treatment at Jampang Kulon hospital, Aep had to borrow his neighbor’s Jamkesda card. Although this was a violation, it was the only choice to save Salma’s life. Aep said he registered for the JKN only after Salma had been treated at Syamsuddin hospital.
“With the JKN, Salma can get free medical treatment. Now, however, I am in debt. Going back and forth to the hospital cost Rp 6 million. It’s all debt. I don’t know when I can repay it,” he said.
Salma’s case underlines the serious problem in the health sector. The health service in southern West Java is still dark and underdeveloped, even in today’s millennial era. Jampang Kulon hospital, for example, is 70 km from Salma’s house. It takes four hours for Aep and Salma to get there by ojek, or motorbike taxi, which costs Rp 200,000 for a round trip. The sad tale grows even sadder, as neither are registered with Jamkesda or JKN.
West Java Health Office head Dodo Suhendar acknowledged the limited health facilities in the southern part of the province. Sukabumi currently has three hospitals: Pelabuhanratu, Sekarwangi and Jampang Kulon. Aside from increasing the number of hospitals, an alternative was to upgrade the community health centers (Puskesmas) to hospitals. “We are continuing to add medical facilities and specialist physicians,” Dodo said.
The number of residents participating in the National Healthcare and Social Security Agency (BPJS Kesehatan) program must be increased. Data from the West Java BPJS Kesehatan shows that as of March 2017, 29.1 million people of the province’s 46 million population were registered with the program.
Meanwhile, 4.16 million people in the province live in poverty at a per capita income of less than Rp 344,347 per month. With a monthly income of Rp 300,000, Aep is one of people in the province that works desperately to support his family, including Salma.
The arms of the clock at Syamsuddin hospital pointed to noon. It was time for lunch. Rice porridge, spinach soup, fried chicken, tofu and a banana were on the menu. Salma did not eat much of it, only tofu and a little porridge. “Salma craves steamed rice. She’s bored of porridge. Salma wants to be healthy,” she said, referring to herself in the third person.
It is no use crying over spilled milk. Salma’s health may have improved. But she teaches us a lesson. May others in the country never have to suffer her fate.