It is still very early in the morning when Amirul Mukminin kisses his wife goodbye and leaves the house. The newly married couple moved into their first shared home a few weeks ago. The streets of Banda Aceh are just coming to life. Cars, pickup trucks and the ubiquitous mopeds provide the soundtrack to the city.
(Published: October 2016)
Carrying a box full of spare parts and a small collection of tools, Amirul looks for the bus that will take him to Blang Pidie in Aceh Barat Daya. Minibuses, designed for around ten passengers, are the vehicle of choice for long-distance travel in this remote region of Indonesia. This particular morning, the bus is full. But Amirul is not in a rush. He knows that sitting in the bus in the tropical heat for ten hours or more will be tough. That’s how long the 350-kilometer journey to the hospital in Blang Pidie takes. The evening before, the hospital had called to say there were technical problems with one of the dialysis machines. For Amirul, this meant off to work.
The technician has sole responsibility for the maintenance of 120 dialysis machines throughout the Aceh region. In total, Amirul covers eight hospitals, some of which are in extremely remote towns.
The journey to Blang Pidie takes Amirul through the tropical landscape of the Indonesian island of Sumatra. He undertakes lengthy journeys like this several times a month. For trips to hospitals closer to home, he uses his motorbike. “Not long ago, I had a lucky escape when a vehicle ran into the back of my moped,” Amirul recalls. He got away with a few scratches.
Indonesia’s healthcare system is less developed than those of other emerging market countries in Asia, such as neighboring Malaysia. It is projected that some 100,000 end stage renal disease patients in Indonesia will need dialysis treatment in 2019. 30,000 are currently being treated.
Since the turn of the millennium, Indonesia has been trying to improve health care provision for its 250 million inhabitants. In 2014, the country took a huge step forward by introducing a health insurance program for all Indonesians. In the next few years, the country aims to open up medical care to all inhabitants of the island nation – a gigantic project for this multiethnic state. This requires expanding the infrastructure, particularly in rural areas. One of the biggest challenges is Indonesia’s geography: The country comprises 17,500 islands, more than 6,000 of which are inhabited. Whereas 60 percent of Indonesians live on the relatively small main island of Java with its capital city Jakarta, many other islands are very sparsely populated – and isolated.
Kundur Island in the Strait of Malacca is one of these remote islands. Two or three times a week, Husin Maidin waits outside his house in the early morning, standing under palm trees by the roadside, just a few meters from the beach. The dialysis patient is on the lookout for his neighbor, who comes to pick him up with his motor scooter. Their journey to the harbor takes 45 minutes. From here, Husin has to catch the ferry to the neighboring island of Karimun, where the nearest dialysis clinic is located. In stormy and choppy conditions, the ferry doesn’t run, and he has to wait a day or two before he can go to the clinic again.
When he gets back home after a long day of treatment, he is tired and exhausted. “I would love to spend more time at home, as my wife needs help since she had a stroke,” says Husin Maidin. Fresenius Medical Care has been active in Indonesia since 2000 and is now the market leader for dialysis products in the country. The company has installed over a thousand modern hemodialysis systems there to date as well as dialyzers, water treatment systems and accessories.
The company supplies around half of all the clinics. In the Greater Jakarta area, Fresenius Medical Care runs a dialysis center as part of a public-private partnership. The Indonesian government has decided to significantly increase the capacity of its hospitals and to make it easier to build private clinics. Dialysis patients are also set to benefit from this. The number of patients being treated is already rising sharply each year.
In view of this situation, a major task for Fresenius Medical Care is training clinic staff to handle dialysis technology. That’s why Triningsih is on the dialysis ward at the hospital on the island of Karimun at the same time as Husin Maidin. The nurse, who everyone calls Tri, has been working for Fresenius Medical Care since 2007. She became a clinical manager in 2012 and is now responsible for teaching employees how to perform dialysis and passing on the practical skills needed to handle the machines.
Tri is a core member of Fresenius Medical Care’s team in Jakarta, where she is mainly based. However, her job also involves regular visits to other clinics, such as Karimun Island, where she is now. She covers almost the whole of Indonesia, by airplane, bus, car or ship, depending on where she is needed. This isn’t always easy for her, as she discovered just the day before when she set out on her journey to the island. One of the ferries was late, so she missed the last connecting boat. Late in the evening, she managed to organize a private crossing. But Tri has long become an old hand at dealing with day-today travel problems like this in Indonesia.
In addition to her job, Tri is also very socially committed. When the tsunami struck in 2006, she traveled to the badly affected city of Padang to work as a volunteer. As a member of the Taiwanese aid organization Tsu Chi International Medical Association, she has also helped out in the aftermath of several severe earthquakes. In 2014, she gained another nursing qualification to enable her to advance her career.
Amirul has similar ambitions for the future. Through his hard work, he has long finished repairing the dialysis machine in Blang Pidie. An electronic component had to be replaced, but that posed no problem for the young technician. With great dedication, he has familiarized himself with the workings of the high-tech machines. “But I still don’t know enough. I want to learn much more about them,” he says, describing his ambition to be involved in developing a better health care system – also to give his wife and himself better prospects in life.