Role of the Role of the Physician in Physician in Indonesian Indonesian

SocietySociety

THE PHYSICIAN is a PROFESSIONAL THE PHYSICIAN is a PROFESSIONAL with special skills who is able to with special skills who is able to SERVE his fellow human only SERVE his fellow human only through a relationship of TRUSTthrough a relationship of TRUST

We will look at the general We will look at the general competenciescompetencies, , rolesroles and and responsibilitiesresponsibilities of physicians in of physicians in modern Indonesian societymodern Indonesian society

First defined by WHOFirst defined by WHO

Adapted by most national societiesAdapted by most national societies

(Canada) (Canada)

You graduated from UPH last year and You graduated from UPH last year and have just accepted a position to do have just accepted a position to do your PTT in Halilulik, West Timor.your PTT in Halilulik, West Timor.

Describe the responsibilities as a Describe the responsibilities as a physician in this small community. physician in this small community.

Physician CompetenciesPhysician Competencies Medical Expert – Health Care Medical Expert – Health Care

ProviderProvider CommunicatorCommunicator Collaborator Collaborator Health Advocate / Social ActivistHealth Advocate / Social Activist ManagerManager ProfessionalProfessional ScholarScholar

Health Care Provider

Primacy of Patient Welfare = Looking after patients is always our primary responsibility

Patient Centered Care We must become COMPETENT

We must MAINTAIN COMPETENCE

AND Even though we are health care

providers,

We have a diversity of roles and responsibilities to the society we serve

Collaborator Collaborator

Group Practice vs Solo Practice Inter Professional Teamwork

NursesBidanPharmacists PhysiotherapistsOther health professions

ManagerManager

Manage your Practice as a business Allocate health resources

Influence Access to health care

ManagerManager

Manage your Practice as a business Allocate health resources

Influence Access to health care

Professional

Is a Medical Professional Primacy of Patient

Patient is first above all else Practices Social Justice

A Duty to ALL Race - Gender Religion - Age Economics - Other

Respects patient Choice Decision making and Autonomy

Professional “Promise” Standards of Professional Behavior Code of Conduct Profession Renewal – teaching and

education (it is a professional responsibility)

Advocate / Social Activist Advocate / Social Activist

To act on behalf on anotherTo act on behalf on another

Address issues of Social Injustice and

The “Sociopolitical” Face of Compassion

Burden of disease (infectious diseases, trauma)

Population and Health

Community Leader

Social Activist Status and Power in Community -

is based on trust

TRAUMA and HEALTH TRAUMA and HEALTH

TRAFFIC and MVATRAFFIC and MVA

MVA (RTA) Trauma

Helmets for MC

Speed control for MC and MV

A Taiwan example

POPULATION AND HEALTHPOPULATION AND HEALTH

Growth rates (% Increase - 2009)Philippines 1.72India 1.46Indonesia 1.49World 1.17

China 0.6Canada 0.9

(immigration)Taiwan 0.36Scandinavia 0.2

Growth rates in past decade (%)Asia

Indonesia 2.1Philippines 2.3Malaysia 1.72Thailand 0.5Taiwan 0.41

Effects of population growth

Population

Poverty

Poor Health

Effects of population growth Increased Consumption

Food Water Fossil fuels Forests Livable land

Effects of population growth Environmental destruction

Forests Water

Toxic contaminants Sanitation Safe drinking water

Sanitation Traffic / Air pollution

Effects of population growth Increased poverty

Increasing unemployment Increased consumption demand Poor housing and clothing Decreased Food growing,

availability and purchase Decreased education Cumulative decreased health

Effects of population growth Decreasing Education

Decreased school entry (96%) Decreased school completion

(81%) - girls Decreased literacy (96%) Female children always first

affected

Effects of population growth Decreasing Health

Decreased life expectancy Increased MMR, IMR and CMR(U5)

Increased fertility rates family size Increased adolescent pregnancies Respiratory illnesses Diarrheas Nutrition

Effects of population growth Indonesia

Life Expectancy (70.7) Family Size 4.2 MMR 228/ 100,000 births U5MR 41/ 1000 births

Common illness Nutrition - 19% undernourished Diarrheas - 21% of all child deaths Respiratory - 12% of all child deaths

IMR (46%) 31/ 1000 births Increased fertility rates family

size Increased adolescent pregnancies –

52/1000 women

Solutions Family planning and contraception

Cultural and religious values Thailand (3.0 0.5) stable population Philippines (3.0 3+) incr 20+ millions Indonesia

Pre 1997 Economic recession Post 2006 2010 (61%)

Availability of contraception Costs of contraception Methods of contraception

Solutions

Improve IMR and U5 MR

Solutions

Termination of pregnancies Unwanted child Indonesia

Last decade - 24 million

SO WHAT IS OUR RESPONSIBILITY AS YOUNG INDONESIAN

PHYSICIANS

ITS OUR PROBLEM

THE “NOW” GENERATION MUST SOLVE IT

WHAT OPPORTUNITIES for

US EDUCATE OURSELVES

EDUCATE OUR PEOPLE

TELUK NAGA – H.E.L.P Project

Volunteer at Puskesmas in Summer

INTERNSHIP

PTTWORK in a Puskesmas