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Hospice and End Of Life in Indonesia

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  • Hospice and End Of Life in Indonesia

    I hate to bring up a less-than-positive topic, but I think it's an important one nonetheless. We all want to live a long and healthy life, but at some point we all have to face an end of life situation. This comes to us in many ways, but often it ends in a hospital and can happen quickly without much pain (we hope), or can be an extended experience which unfortunately can be quite painful.

    In my fifteen years of visiting Indonesia, I've known several close friends and family members who have passed away. Each of them had very different experiences. I've also heard stories from my wife on others as well. In general, I witnessed them going to the hospital, and being in severe pain in some cases. In at least two cases, there wasn't any attempt to administer pain medication, or sedatives. In one case, the person refused all medication in the face of great suffering, and just wanted massages, oils, and other hands-on physical treatments. The hospital staff respected that request, and even assisted where they could. In another case, someone had a stroke and the family hired a 24/7 live-in nurse who provided some of the most personalized care I've ever witnessed. There were actually two nurses who alternated, and stayed with this person until the very end. It should be noted that all of these cases were in Solo. The hospital situation in Solo, wasn't really that great in the past decade, but is now improving with new hospitals, and a noticeable trend towards modernization.

    Outside of these cases in Central Java, I haven't really inquired as to what is the typical experience for most people, and specifically for an expatriate who might have to go through this in Indonesia. What is the common philosophy? In most hospitals in the US (for example), there tends to be a focus on expensive technology and sedative drugs. If every alternative has failed, then something like induced coma, or very heavy sedation is used to help the patient pass without experiencing much (or any) pain. Of course this is extremely expensive, but covered by insurance in most cases - at least for now...

    Personally, I'm not fond of the idea of having tubes stuck in me while they try to extend my life for a few more weeks or months. However, I'm not opposed to the idea of so called "pain management" in a hospice arrangement should it come to that. In the US, a typical hospice with pain management (i.e. morphine drip) is much less expensive, and is something being encouraged more and more over time. Does something like this exist in Indonesia? I ask, because the attitudes toward drugs at many levels in Indonesia seems very different than it does in the west or other westernized countries. With specific regard to "hospice care", I'm guessing that the in-home nursing care (described above) is fairly common, but might not include something like pain management if it was needed.

    Interested to hear any experiences or direct knowledge on this topic.

    Thanks.

  • #2
    Originally posted by harvester View Post
    (1) ... In at least two cases, there wasn't any attempt to administer pain medication, or sedatives.

    (2) .. someone had a stroke and the family hired a 24/7 live-in nurse who provided some of the most personalized care I've ever witnessed.

    (3) What is the common philosophy? .. in the US .. there tends to be a focus on expensive technology and sedative drugs... Of course this is extremely expensive, ...

    (4) In the US, a typical hospice with pain management (i.e. morphine drip) is much less expensive, and is something being encouraged more and more over time. Does something like this exist in Indonesia?

    (5) I ask, because the attitudes toward drugs at many levels in Indonesia seems very different than it does in the west or other westernized countries. With specific regard to "hospice care", I'm guessing that the in-home nursing care (described above) is fairly common, but might not include something like pain management if it was needed ...

    (1) Could you tell us if the patients were well financially and which year these events occurred ?
    Some years ago when there was no cheap government health program , most of Indonesians could not afford going to a hospital and I heard that hospitals would not treat a patient without the patient's family paying in advance .

    (2) This is one advantage to live in Indonesia , because nurse's salary is relatively low , it is not that expensive to hire many of them .

    (3) I don't know , but I guess you may find a variety of different philosophies . In relation to religion philosophy , here in Bandung , most of the people are Muslims , but there are at least 2 big Christian hospitals . In Bali it may be different too . In relation to technology , I also guess that we can find well equipped Indonesian hospitals , or just go to Singapore , for example .

    (4) I just checked at MIMS (www.mims.com - Indonesia) and Morphine sulfate is manufactured here by Mahakam Beta Farma , so ...

    (5) I suppose it is difficult to conclude that just from few examples . If you want to know , I think you should talk to some doctors in Indonesia (from different hospitals) . Considering morphine (or at least morphine sulfate - I don't know the difference) is legally available in Indonesia , I don't see why a doctor would not prescribe it when necessary . I had a small surgery in Indonesia recently , and got pain killer even when I was not feeling any pain (but not morphine , off course) .

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    • #3
      There may be imported morphine available in Indonesia too .


      --------------------------------

      from http://www.mims.com/indonesia/drug

      Manufacturer : Mahakam Beta Farma

      Contents : Morphine sulfate

      Indications/Uses Management of chronic pain in patients requiring opioid analgesic.

      Dosage & Administration : W/o prior use of opioid Initially 10-15 mg. Titrate dosage over following days to achieve 12-hr pain relief. Pain uncontrolled by weaker opioids Initially 20-30 mg 12 hrly. Titrate dosage over following days to achieve 12-hr pain relief.

      Contraindications : Resp depression, obstructive airway disease, acute hepatic disease, paralytic ileus; concurrent administration of MAOI (or w/in 2 wk of use) or other CNS drugs.

      Special Precautions : Post-op pain. Pregnancy. Childn.

      Adverse Reactions : Hypoventilation, nausea, vomiting, constipation, somnolence, confusion, hallucination, euphoria.
      View ADR Monitoring Form

      Price :
      MST Continus tab 10 mg , 60's (Rp852,000/pak)
      MST Continus tab 15 mg , 60's (Rp1,254,000/pak)
      MST Continus tab 30 mg , 60's (Rp2,262,000/pak)

      Comment


      • #4
        Hi Marcus,

        Let me try to answer your questions..

        "Could you tell us if the patients were well financially and which year these events occurred ?"

        In the first case, maybe around 2003, and in a lower financial bracket - not exactly poor, but certainly meager Indonesian life. She was in her 80's living life without issue, and within a week had severe cancer-like symptoms, with large swellings. I believe she went to a local family doctor, who basically could not do anything. The pain was extreme for another week or so, and she finally passed away. They found many of her teeth broken from clenching the jaw (I can't fathom how much suffering was experienced). This poor soul would have certainly benefited from a mercy administration of a pain killer like morphine.

        In the second case was around 2009, and in a mid-level financial bracket. She was 83 years old, and suffered from extreme high blood pressure due to calcified (hardened) arteries. Her extended family collectively had whatever money was needed to pay the doctors and hospital. They admitted her to a hospital, with a private room. In essence the doctors and hospital staff did nothing but provide an IV drip with glucose, and checked the blood pressure many times during the day/night. She really didn't want any drugs, but asked for a local massage therapist who came in and performed several coin-scrapping massages (I believe they call it "ka-ro-an"). This really didn't help, and pain increased by the hour. She passed suddenly within that day, once the artery collapsed. Total time from being at home, until passing away was maybe 4 days.

        As for me, I really don't like the effects of morphine. However, it was administered to me for a pericardium (heart lining) infection here in the US. Fortunately for me, I got to the hospital quickly and the symptoms cleared up in less than a day with heavy doses of antibiotics. I received two injections of morphine sulfate, spread about 4 hours apart. They came in to give me a third, and asked if I could just get ibuprofen. After 8 hours of heavy drugging, I was ready to be normal, and just get out of that hospital. Now, if I was in the state of the person in the first case above, they could have just kept it coming and maybe up'd the dose.

        In any case, thanks for all the detailed info - at least we know it exists in Indonesia. If you've got the financial resources it looks like you could get the equivalent of hospice care - high quality nurse and pain killers. The more extreme case of pain killers is what they call induced coma. This is typically performed by administering continual low/moderate dosing of pentobarbital. It's only for more extreme cases, where the condition is so painful that a person would die quickly from the severe reactions of their illness. As a side note, this is also the same drug used for legal euthanasia (in The Netherlands and four different states in the US), but in a very high lethal dose.

        Comment


        • #5
          I think with bpjs , which is inexpensive , proper care will now be administered , for the dying , at least I would hope so .

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