The Development of an A&E Department in Indonesia
Our story began in 1997, when a specialist team from the Singapore International Foundation ( SIF ) came to Malang in East Java, Indonesia.
They conducted Basic Cardiac and Trauma Life Support Courses for us, and we were among the participants. The team actually wanted to develop Saiful Anwar General Hospital into a Trauma Centre because of our high incidence of trauma cases, but it was finally decided that we would set up an Accident & Emergency service. So in October 1999, we came to Singapore for an attachment with the SGH A&E Department.
We started our training in April 2000 and did a 6-month rotation in the Department of Surgery.
A young doctor usually starts with “Theory
and Practice” for 6 months, at the end of which there is an examination.
Candidates who pass then proceed to do attachments in Surgery, Internal
Medicine and the A&E Department, before taking a 2nd exam to go on to the
next phase – Anaesthesia, Cardiology, Paediatrics, Orthopedics and
Neurosurgery ( 3 months each ), then Neurology, Psychiatry, Ophthalmology,
Otolaryngology, Dermatology and Respiratory Medicine ( 1 month each ),
ending off with another 6 months of Emergency Medicine. The final exam
involves all 14 Departments coming together to assess the candidate.
At the time, Emergency Medicine in Indonesia was still quite controversial,
as Emergency Departments were conventionally run by either anaesthetists or
surgeons. So when the idea of Emergency Medicine as a separate specialty was
suggested, it received mixed reactions which still exist to this day.
Before these changes were made, our A&E Department was run by General
Practitioners, while emergency cases were managed by registrars.
In 2003, the Dean of the School of
Medicine at Brawijaya University appointed 28 persons
from various medical disciplines to support our activities. We now have 12
full-time registrars.
Our department is generally quite similar to that at SGH because it was set
up by A/Prof. Anantharaman and his team. They have been visiting us twice a
year for the past 5 years.
During our 2nd attachment period, training activities included clerking
patients and ordering ancillary tests under senior doctors’ supervision. The
first month was also the hardest! But mainly because we were unfamiliar with
certain things such as the computer and referral systems.
The biggest differences between the Emergency Departments in SGH and our
hospital involve patient loads and age groups. SGH sees 300-400 patients
each day, many of whom are in their 70’s and 80’s , whereas we attend
to150-200 patients per day, with only 10% aged 60 and above. This results in
a very different spectrum of diseases.
We notice that SGH has a very good medical records system - we never have
any difficulty tracing the patients’ past medical history. We hope to set up
a similar system in the future, because it is much easier to establish a
diagnosis when there is complete supporting data. We’d also like to equip
our department with ultrasound and CT scan facilities.
We would like to take this opportunity to thank A/Prof. Anantharaman for his
valuable support in the development of Emergency Medicine in Indonesia, as
well as Dr. Lim Swee Han and his colleagues for assisting us and being very
patient.
The MOU between the SIF and Malang Trauma Services / Brawijaya University
ended in 2002, but we still have a long journey ahead. We will continue to
do our best to complete what our seniors began.
Dr. Antonius Freddy and Dr. Ari Prasetyadjati