Health care in Indonesia

While in Indonesia, you should be mindful of your health and take a few precautions, but there is no need to panic. While standards of sanitation may be poor and students do occasionally get sick, Indonesia has good health care facilities and basic hospital facilities in-country are adequate for standard operations, such as appendectomies. A trip to the rumah sakit (hospital) in Indonesia can actually be quite a pleasant, restful experience. While health is the sole responsibility of the student, ACICIS staff on the ground in Indonesia are there to help you if you get sick. ACICIS also requires all participants to have medical insurance - with specific coverage for medical repatriation - in case of emergencies. Be sensible about your health, but make sure you still fully experience Indonesia. Just remember to be aware, not alarmed. Almost everyone gets the runs once, but it is rare for students to get seriously ill.

Preparation

Before you leave for Indonesia it is very worthwhile to look at the factors that contribute to your physical and emotional well-being, as the state of your health will affect the success of your trip. ACICIS does not advise you on what measures to take before your departure, as these decisions are very individual. Everybody is different - some people get all of the immunisations available and some people get none. What we do advise you to do is to:

• Seek out all relevant information about health matters in Indonesia.
• Talk to your doctor
• Understand any health problems that you may have.
• Prepare any medications that you take regularly.

For information on diseases and disease prevention for travellers see the great website of the American Centers for Disease Control and Prevention. They also have great Indonesia specific information.

It’s a good idea to consult your doctor as early as possible to discuss vaccination requirements. If you choose to be inoculated against hepatitis and other diseases, keep in mind that you may need to have a series of shots over a period of several weeks. It’s also wise to have a general medical and dental health check (especially wisdom teeth), before departure.

If you require medication for any personal condition in Indonesia, make sure you take an adequate supply with you. Bringing a signed medical statement from your doctor confirming the medicine is prescribed can help you through Indonesian customs if necessary. Before you leave, you should make sure that you’re physically fit so you can better cope with any illness. You will be knocked around initially by the sudden climate change and change in diet, so it’s best to start off fit and healthy.

Pollution

Students also need to understand how polluted Indonesia can be. Anyone with asthma or any other respiratory illness must see their doctor before leaving home and come armed with a peak flow metre, an asthma management plan, preventers, brochiodilators and preferably emergency supplies of Prednisone.

Mosquito-borne disease

The main hazard travellers come across in Indonesia is diseases carried by nyamuk (mosquitoes), like malaria, dengue fever and Japanese encephalitis. While hepatitis, tuberculosis and AIDS are much more serious and you’re more likely to suffer from diarrhoea and other food or water-borne infections - mosquito-borne diseases can be easily avoided with some simple steps:

• Cover up with long, loose-fitting clothes, including trousers and socks (light-coloured cotton clothing seems to be more effective as well as cooler).
• Wash and use good quality mosquito repellents regularly, and avoid wearing perfume or scented body lotion as these attract mosquitoes.
• Consider using a specialised mosquito net or sleeping under a sheet (Indonesians typically don’t use a selimut unless in cold areas). You can also buy a sarong for the same purpose although the sheet gives you better protection for your feet.
• Mosquito coils and other anti-mosquito methods are readily available in Indonesia, as are insect sprays.
• You can also try sleeping with a fan on full-blast to blow the mosquitoes off course or spray your room a couple of hours before sleeping.

It’s important to be aware that mosquitoes are not only active at dusk, they can be active for most of the day and night in heavily infested areas as well. The small grey mosquito which carries dengue is active during the day and, since there is no cure for it, using a repellent is strongly recommended. Malaria and dengue fever can be contracted in cities, but are mainly found in the outlying and remote parts of the Indonesia.

You should check with your doctor about the worth of using anti-malarial medication as it can mask symptoms if you do contract the disease (although they are not fool-proof). Most students decide not to take anti-malarials during the study program, preferring other precautions instead, and only take medication when they are in an isolated or remote area. You should make this choice carefully in consultation with your doctor.

Dehydration

Drink constantly when you first arrive. You might feel like you’re over doing it but thirst is your body’s way of telling you that you need to replenish your liquids. Dehydration can leave you feeling lethargic, dizzy, nauseous, and with acute headaches. It‘s also important to keep your blood-sugar levels high, so sugar-heavy drinks such as teh manis, es jeruk, and soft drinks are important. Please note that caffeinated beverages and alcohol will increase dehydration. In the event of excessive sweating, you may suffer from muscle cramps due to loss of salt. It may be an idea therefore to supplement your salt intake to avoid this.
If you suffer from a bout of diarrhoea or vomiting, you should take care to replenish both water and electrolytes (salt). Rehydration formulas are best for this - usually in the form of an orange/lemon flavoured powder which you mix with a glass of bottled water. Antimotility drugs such as Imodium can give relief from symptoms but seek the advice of your doctor on the use of these.

Food and water

Do not drink straight out of the tap in Indonesia. You should at least make sure that any drinking water has been boiled for 10 minutes, or use bottled water which is safe and readily available.If you heed everything the travel guides and “so-called” knowledgeable friends tell you, you won’t eat or drink anything except rice and pure water. Some books say things like: “no ice, no fish, no meat that hasn’t been freshly cooked, no fruit with skin on, no fruit that’s been washed in anything other than Evian, ditto for vegetables, only eat at western places, etc” and, granted, some of this has been relevant at some stage. But most people can’t tell exactly how they got sick and will therefore blame some well-known causative such as ice. Generally, there isn’t a problem with ice in many areas of Indonesia any more. It’s bought from sterile factories as enormous clean blocks and then chopped up for use - it’s actually the chopping up and the place that it’s done (on the footpath outside the warung!) that could cause a problem. So be selective.

Any fruit you might be served would generally be the skinless variety (papaya, pineapple and banana) and is relatively safe unless it’s been washed. If you buy apples or fruit with edible skin, it’s best to wash it yourself. And as for only eating at western places, it’s far safer eating from a warung where they know how to cook the local dishes than going somewhere where they Western food is served without the knowledge or hygiene required. Warung food may not look so nice sitting there with flies hovering but you’re less likely to get food poisoning there than at some of the western hang-outs. However, approach the little warungs and road-side stalls / street-side tents with caution. Try to get an idea of how clean the people running the place are before you buy. Try to avoid the friendly men and women who push supplies of hot and cold food on wheelbarrow-style boxes. They can’t wash their dishes, so hygiene is poor. Those selling ice-cream on the street also can’t guarantee the coldness of their iceboxes, so occasionally their products will be off or have very strong preservatives.

Insurance

Health and Travel Insurance cover is obligatory on all ACICIS programs. As some applicants will be covered by policies in operation at their home university or industry organisation, advice and assistance should be requested from relevant staff on these matters. If you are searching for your own insurance, we recommend you look for one which has no excess when it comes to making a claim. Students who have unfortunately been hospitalised in the past have had to pay excesses up to $500. This is the last thing you want to be worrying about when you're sick and trying to understand hospital bureaucracy in a foreign country!

Prior to departure for Indonesia, ACICIS will require proof of adequate cover, including a copy of the policy, the policy number, and the 24 hour emergency number. Routine medical care is available in Indonesia. However, medical insurance with coverage for medical evacuation and repatriation is compulsory. ACICIS is not liable for personal loss, injury, theft, damage, travel cancellations, etc. These are all the responsibility of each individual participant. It is the participant’s responsibility to obtain and take with them a copy of their Insurance Policy and any documentation, (for example, insurance card) that is required for utilisation of the cover.

Rabies

Bali has historically been rabies free, however, in late 2008 a rabies outbreak was reported by the Indonesian Ministry for Agriculture. While there are currently no ACICIS programs in Bali, if students decide to travel to the island they should take the necessary precautions, such as avoiding contacts with animals (for example, monkeys and stray dogs). Vaccines are available to prevent rabies before and after suspected exposure. According to the World Health Organisation (WHO), ‘wound cleaning and immunizations done as soon as possible after suspect contact with an animal and following WHO recommendations, can prevent the onset of rabies in virtually 100% of exposures’.  The Centre for Disease Control and Prevention and the WHO websites are useful if you want to find out more about rabies in Indonesia.

Other tips

Another simple preventative measure is the treatment of bites and scratches (especially coral scratches). In the tropics, these can rapidly become septic, so it’s wise to thoroughly clean the lesion with soapy water and apply an antiseptic solution.