What is healthcare in Indonesia like?

Facilities and Health Information

The general level of sanitation and health care in Indonesia is far below U.S. standards. Some routine medical care is available in all major cities, although most expatriates leave the country for all but the simplest medical procedures. Psychological and psychiatric services are limited throughout Indonesia. Medical procedures requiring hospitalization and/or medical evacuation to locations with acceptable medical care, such as Singapore, Australia, or the United States can cost thousands of dollars. Physicians and hospitals often expect immediate cash payment or sizable deposits before offering medical care. A non-exhaustive list of English-speaking doctors and hospitals is accessible via the U.S. Embassy Jakarta's website. Many places in Indonesia are inaccessible to the physically handicapped. Sidewalks tend to be uneven and difficult to navigate, and many buildings do not have elevators.

Ambulance services are individually run by hospitals and clinics. Indonesian ambulance attendants lack paramedical training equivalent to U.S. standards, and there is no reliable emergency ambulance service in Indonesia. If you are staying in Indonesia for an extended period, especially if you have known health problems, you are advised to investigate private ambulance services in your area, and to provide family and close contacts with the direct telephone number(s) of the preferred service. Traffic congestion is a significant problem in urban Indonesia and roads are generally in poor condition in rural Indonesia, so ambulance transport, if it exists at all, even over short distances can take hours.

Community sanitation and public health programs are inadequate throughout Indonesia and subject to frequent breakdowns. Water and air pollution and traffic congestion have rapidly increased with the unstructured growth of major cities. Almost all maladies of the developing world are endemic to Indonesia, and immediate treatment is problematic. Residents are subject to water- and food-borne illnesses such as typhoid, hepatitis, cholera, worms, amebiasis, giardia, cyclospora, and bacterial dysentery.

Mosquito-borne dengue fever and tuberculosis exist throughout Indonesia and have been serious in Jakarta. Indonesia has the highest incidence of dengue fever in Asia, which is caused by several species of mosquitoes biting during the day. Multiple drug-resistant strains of malaria are endemic in some parts of Indonesia but not in metropolitan Jakarta, Medan, Surabaya, and Bali; even short stays can be disastrous without malaria prophylaxis. Precautions against being bitten – such as mosquito repellent, wearing long sleeves, and sleeping under a bed net are all recommended. Malaria prophylaxis is highly recommended for travel to malaria-endemic areas outside major cities. Travelers to Sulawesi should be tested for schistosomiasis.

Asthma and other respiratory difficulties are common and generally worse in Jakarta than in other areas, exacerbated by the high pollution levels. Indonesia has one of the highest prevalence of tuberculosis, which is transmitted through the air, shared smoking devices, and particularly in densely crowded areas. Precautions include wearing a face mask when in crowded areas, and having a PPD test after departure. Skin allergies are also common. Avian (H5N1), swine (H1N1) influenza, and seasonal influenza (H2N3) are endemic in Indonesia all year with peaks during the rainy season (November- April). Influenza vaccination may be helpful to reduce instances of seasonal flu (H2N3). High risk areas for highly pathogenic avian influenza (H5N1) are live-bird markets around the greater Jakarta area. Current information about influenza in Indonesia can be found on Flu Net ( http://www.who.int/influenza/gisrs_laboratory/flunet/en/ ). Rabies is endemic in Indonesia, but extensive dog vaccination has reduced cases in Bali by almost 80% with a possibility for elimination by the end of 2012; other islands in East Nusa Tenggara (NTT) and Sumatra still pose risks for rabies. Rabies is a highly fatal disease and treatment availability is very limited. If bitten, immediately seek treatment at a reputable medical clinic or hospital. If you will spend time in rural areas while in Indonesia the CDC recommends rabies vaccination. Indonesia has been polio-free since 2007. Travelers are urged to consult with their personal physicians and to get updated information on prevalent diseases before traveling to Indonesia. Travelers should be current on all recommended immunizations; those planning on traveling extensively should consider the series of three pre-exposure inoculations against rabies. Local pharmacies carry a range of products of variable quality, availability, and cost. Counterfeit pharmaceuticals are a significant risk and U.S. citizens should patronize only reputable pharmacies.

Tap water is not potable. In 2008, Indonesian authorities found that 100 percent of tap water samples from the Jakarta area tested positive for coliform bacteria, as well as high concentrations of toxic chemicals, including lead and mercury. Bottled water should be used for consumption, including for cooking. Factory bottled soft drinks, and juices and milk sold in sealed containers are generally safe. Take extra care preparing fresh fruits, vegetables, and meats. If you cannot see refrigerators, expect that any food, especially street food, is preserved with high concentrations of formaldehyde derivatives. Consider that unprocessed or raw food may be unsafe even in higher end establishments. Washing, soaking, peeling, and/or thoroughly cooking food are mandatory procedures to minimize insecticide, bacterial, and parasitic contamination. Gastrointestinal disorders are common. A wide variety of foods are available in local markets and supermarkets, and with some care and effort, it is possible to eat a well-balanced diet.

Frequent hand washing, using hand sanitizer, wearing mosquito repellent, not eating street food, and drinking only bottled beverages are some ways to stay healthy while traveling.

Car and motorcycle accidents are the primary causes of severe injury to foreigners living and traveling in Indonesia. Defensive driving and use of seatbelts are encouraged. Use of motorcycles and bicycling in traffic are both discouraged. Rh negative blood may be difficult to obtain in an area with very few Westerners. Therefore, it is important to know your blood type and recognize that scarcity may be a problem.

Updated information and links to the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) are posted on the U.S. Embassy Jakarta's website.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention's (CDC) hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC website.

Drinking Water Source - % of rural population improved

76.4%

Drinking Water Source - % of total population unimproved

15.1%

Drinking Water Source - % of urban population improved

93.000000

HIV/AIDS - adult prevalence rate

0.2%

Hospital Bed Density - beds/1,000 population

.6

People Living with HIV/AIDS

310,000

Physicians Density - physicians/1,000 population

.2

Diseases - note

highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds

Sanitation Facility Access - % of total population unimproved

41.2%

Sanitation Facility Access - % of urban population improved

71.400000

Sanitation Facility Access - % of rural population improved

45.5%

Infectious Diseases - degree of risk

very high

Food or Waterborne Disease (s)

bacterial diarrhea, hepatitis A, and typhoid fever

Vectorborne Disease (s)

dengue fever and malaria