No One Gets Left Behind

KOMPAS/ADITYA PUTRA PERDANA

Several elderly people at the Wisma Lansia Harapan Asri retirement home in Banyumanik, Semarang City, Central Java, perform physical exercises on Aug. 9 (9/8/2019). The retirement home was inhabited by 68 elderly people from Semarang and surroundings, as well as from Jakarta, Surabaya and Palembang.

Sukinem, 65, had been waiting for two hours at the geriatrics clinic of the puskesmas (community health center) in Kebon Jeruk district, Jakarta, on Thursday (15/8/2019). She was accompanied by her husband and grandchild for a medical checkup for her diabetes.

“I have routinely visited the doctor for the past three years,” she said while holding a small piece of paper with her queue number: 32. In the consultation room, the doctor was still serving patient No. 25.

Sukinem is registered as a non-salaried participant of the National Health Insurance-Indonesian Health Card (JKN-KIS) program. She pays a premium of Rp 80,000 (US$5.63). As a housewife of a former security officer, she depended on her son for income.

The program helps her obtain health care for her condition and for her husband’s heart disease. “Paying between Rp 300,000 and Rp 400,000 for a one-time medical check is too hard for us. However, we still need to queue for two to three hours, excluding the time needed to queue for medicines,” she said.

Harto, 70, a disabled patient who requires a wheelchair to get around, also needed to wait for a few hours at the puskesmas with his daughter. “This is hard for him. We bring a meal from home, just in case he gets hungry,” Harto’s daughter Sari said.

Due to a lack of puskesmas offering geriatric care, those offering the service are overwhelmed with patients. The Kebon Jeruk Puskesmas, for instance, has to serve 60 to 100 patients a day. “One time, we served 120 patients a day, with only two doctors available. We try to provide all services on one floor, in line with the Jakarta administration’s Pokemonss program,” the Kebon Jeruk Puskesmas’ geriatrics clinic coordinator, Melani Suhestian, said.

Pokemonss, short for poli kesehatan manula one-stop service (one-stop-service geriatrics clinic), is an innovation to facilitate the elderly in puskesmas. All services are provided on one floor, including the registration booth, lab and pharmacy.

Accompanying patients

The Banyuwangi regency administration has also launched innovative geriatric care. In the regency’s Blambangan General Hospital, the elderly, like 72-year-old Siti Jubaidah, are prioritized in outpatient care.

That morning, Jubaidah was greeted by transporter Bagus Dwi Cahyo, 24, who had a wheelchair prepared. Jubaidah usually came to the hospital with her son. However, because of her son’s busy work schedule, the grandmother of two visited the hospital alone. At the registration booth, Bagus helped her. “Nuwun sewu, saged ngampil kartu Gandrungi pun, Bu (Excuse me, can I have your Gandrung card, Ma’am?),” Bagus said.

Without having to queue, Jubaidah, who suffers from stroke, was taken by Bayu to the internal diseases clinic. Bayuhad also prepared Jubaidah’s medical records. Jubaidah had undergone therapy three times a week since 2007, not including routine medical check-ups. At the clinic, Bagus placed Jubaidah’s Gandrung card and medical records in the “Gandrung Patient” box.

In less than five minutes, a medical officer called Jubaidah’s name. Helped by Bagus, Jubaidah entered the consultation room in her wheelchair. She was prioritized over several younger patients who were queueing.

Bagus then took the doctor’s prescription and Jubaidah’s Gandrung card to the pharmaceutical officer, who prioritized preparing Jubaidah’s medicines. After obtaining the medicines, Jubaidah was taken by Bagus to the waiting room, where they waited for Jubaidah’s son to pick her up. “Matur sembah nuwun, nggih, Cah Bagus (Thank you very much, son),” Jubaidah told Bagus.

She needed less than one hour for her hospital trip. Since the Gandrung service was launched in 2018, Jubaidah has been registered as a beneficiary.

As a transporter, Bagus sees all elderly patients as his own parents. “It’s not tiring to take them around and wait for them. I just need to be really patient as many elderly patients are fussy and insistent,” he said.

The Gandrung priority service program was enjoyed by about 6,000 cardholders. The Blambangan hospital’s program provides priority service for vulnerable groups and complements the JKN-KIS program.

Blambangan General Hospital director Siti Aisyah Anggraeni explained that Gandrung was chosen as the program’s name as it was Banyuwangi’s iconic traditional dance. Furthermore, Gandrung is an abbreviation of Gerakan Asuhan Nyatapada Disabilitas, Risiko Tinggi, Usia Lanjut, Veteran, Pensiunandan Gravida (Concrete Care for the Disabled, High-Risk, Elderly, Veterans, Retirees and Pregnant Women). The program aims to provide medical services for patients without them having to queue.

Now, Blambangan General Hospital has six transporters trained to serve vulnerable groups and those needing special care.

Other healthcare facilities need to take example from these innovative healthcare programs, considering the lack of attention to geriatric care in Indonesia. Data from the Health Ministry’s directorate of family health from 2018 showed that only 4,835 out of 9,993 puskesmas in Indonesia provide proper geriatric care. Of the 2,813 hospitals in the country, only 88 have integrated teams for geriatric care.

Health Minister Nila Farid Moeloek said that she hoped integrated care would be available for the elderly to help them access health care.