We started our morning with a meeting with Dr. Maxi Rondonuwu, who is the Health Minister of North Sulawesi. It was super positive meeting which basically gave us the green light to proceed with our plans to have our first clinic here in the Summer of 2011. From there we moved on to the village of Likupang. We met with the Regional Health Center Director and toured the new facility, which was very clearly underfunded. We then proceeded to village Likupang Abong which was about a 10 min drive from the center. All the people we we talked to at the village gave us positive feedback for having the clinic there next year. The pastor of the local church offered to house the clinic at the church, which is also the largest building in the village. Very exciting news from our first day!
Check out our Field Notes from the Day after the jump.
Tuesday: 9th August
North Sulawesi –
Meeting with Dr Maxi Rondonuwu (Health Minister of North Sulawesi)
-He had read the proposal, thought it was good for the people of Nth Sulawesi
-Nth Sulawesi healthcare system is socialized. If people ned greater attention they are sent o a more urban hospital, and if they can’t get treatment, they are sent to the main hospital in Manado.
-50% uses government health system (free)
-Island region of Sulawesi Nth and North Minahasa is up to 80% of healthcare system
-The government is trying to have 100% coverage for everyone
-Biggest health issues of the region
1, maternal child health care ( high infant mortality rate)
3, HIV is spreading to rural area’s Bitung, Manado, Tomohon. They have a preventative care plan provided by Global health in place
Re enforced that LTL would be great in rural area’s, particularly early assessment and intervention
H2O- Bunkaken has desalination plant however the upkeep is poor due to the locals have not be taught properly or they may have no interest in maintaining
How people will come to clinic? Nth Sulawesi are attracted to anything new, so he believes the people will come
We spoke about permits being needed by national health minister in Jakarta, however he then thought of the Baptist ministry mission BMMI from Arkansas, had a program on an island nth of Bunaken which went a different route of obtaining a permit. He suggested we do the same. This route is getting a permit and agreement through the regional health minister while they apply for the national level permit, which means we can start LTL immediately!! This agreement is called a MOU ( Memorandum of understanding). He said he would be happy to draw up the MOU for LTL in the next two days.
Medication- Regulation that we use local medications. We can buy the medication through the health office in bulk
(Source price of basic meds from Levy)
Due to it being a short clinic we can come in on tourist visa’s, however if needed he will write a recommendation for special medical visa, however he thinks the 30 day visa will not be a problem.
Sites for the clinic-
Schools and Churches. Churches would be number one, due to availability during the week
TB health management – Trained health providers with necessary drugs in most rural clinics.
National program that vaccinates all standard – Hep A, polio etc… al children vaccinated up until 1 years old.
Child birth – encouraging birth at government health centres, over home birth.
Went to Likupang:
Went to health centre met with director. New facility, 1 year old, however poor upkeep. Equipment is under serviced /not funded. For example: I asked about sterilization techniques or what they use to sterilize apparatus, we went to a poorly managed equipment room with window’s open, rust and not sterile field at all.
Main health issues:
Upper respiratory tract
Dengue fever ( not this year though)
If pts too sick, send to Manado
Increased child death at 1 years old, possibly due to premature birth because of over activity doing physical work. Also women do not seek prenatal care.
Ambulance service – old van, more used to take doc to village
4 doc’s, 3 government one contract on call.
Clinic on call 24hours
Documentation done on scrap papers, and held together with a different colored paper with patients number. All put in different draws according to village. Not a very reliable system.