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Open book of medicine.

History of medicine helps to inform health reform

Making improvements to mental health care in Indonesia

The history of medicine is Indonesia is interesting and unique, however recently mental health resources have been limited. In looking back, new strategies are helping the system to move forward.

Associate Professor Hans Pols

Associate Professor Hans Pols, has been investigating the history of medicine in the Dutch East Indies and Indonesia for several years as part of his research within the School of History and Philosophy of Science. He has a special interest in the history of psychiatry that dates back to his childhood.

“I grew up near a mental hospital in the Netherlands where my father worked,” said Pols.

“My friends and I used to play in the area around it, so I was aware of mental illness from a young age. I was never fearful of mental illness or anyone at the hospital.”

Pols spent a lot of time learning about the history of psychiatry around the world before becoming particularly interested in mental health care in Indonesia after moving to Australia.

“My mother's family lived in Indonesia for many generations so when I accepted my position at the University of Sydney in 2002 I thought I might finally have an opportunity to visit Indonesia and see where they lived.”

After completing several field trips to Indonesia, Pols quickly realised the healthcare system there was very unique. In looking back, he discovered that doctors had been active participants in the Indonesian nationalist movement and the revolution. This type of social and political engagement was not often observed in western physicians.

He also found that the mental healthcare system was struggling, despite the fact that it was considered exemplary in colonial times.

Indonesia has two hundred and sixty million people and just over 1000 psychiatrists
Associate Professor Hans Pols

Determined to do something about it, he and two colleagues, Byron Good and Mary-Jo DelVecchio Good, from Harvard, teamed up and applied for research funding to investigate the problem further.

Five years ago, they received an ARC grant to examine Indonesian psychiatry, looking at the past, present and the future.

 “In order to understand what was happening, I interviewed hundreds of mental health personnel and asked them what their vision was for mental health.”

 “There was and still is an obvious shortage of manpower, so extreme that we need to be extremely creative in finding a solution that raises awareness, expands educational opportunities and increases avenues to treatment,” Pols explained.

In 2016, a Human Rights Watch report, entitled Living in Hell, appeared detailing the many abuses individuals with mental illness experience in Indonesia. Sadly, nothing in the report was new.  

 “It was clear that families didn’t know how to care for loved ones with mental illnesses, in particular schizophrenia. Unpredictable and violent outbursts are very hard to manage, so in the countryside individuals with schizophrenia are often locked in wooden blocks or chained.”


A patient with a mental illness is chained up

Most Indonesians do not know about mental illness, its symptoms, and available treatments. Access to mental health care professionals is difficult, in particular outside major urban centres.

“On remote islands like Flores, there is just one psychiatrist. People would have to travel up to ten hours to another island for treatment because the roads are so bad, however Catholic priests and other community members have started stepping in to help which is encouraging,” said Pols.

Another positive development is the increasing presence of patient and volunteer groups.

“What’s unique about these groups is that they are led by educated patients who are confronted by the same problems.”

Because of this, participants in these groups can easily relate to their group leader and in turn it empowers everyone in the session.

Patient groups also significantly reduce the strain on the health care system as it diminishes the reliance on physicians.

“We now have over 1000 participants in these groups dealing with a range of mental health issues including schizophrenia, bi-polar, depression, post-partem depression, Alzheimer’s and autism.”

“These groups are also important for carers, parents and spouses, who can find it difficult to get access to information because doctors and other healthcare practitioners simply don’t have the time to communicate with everyone.”

In recent times, interest for psychiatry is increasing, and education and treatment is improving.

“The provisions of the new universal health insurance scheme require that mental health care is delivered at primary health clinics by GPs. In principle, this makes mental health much more accessible, but most doctors still don’t know enough about it.”

 “There are also plans to develop of a centre to provide primary health care professionals with better education about mental health.

“The problem in Indonesia and in many countries is that psychiatry itself needs to change. While most professionals prefer a one-to-one treatment model, we actually need to have psychiatrists who think at the community level,” explained Pols.

Culminating ten years of work, Pols has just written a book, ‘Nurturing Indonesia: Medicine and Decolonisation in the Dutch East Indies’. It’s set to be released in August 2018 and will then be translated into Indonesian.

Pols also recently spearheaded a conference on the history of medicine in Indonesia.

“Hosted in Jakarta, in collaboration with the Indonesian Academy of Sciences (AIPI), it was the largest conference in the history of medicine in Indonesia thus far. There were 75 speakers, more than half of which were from Indonesia.”

With initiatives like this, Pols aims to nurture research in the history of medicine and is encouraging community efforts to improve the lives of thousands of people who struggle with mental health disorders every day.