Adi Heru Sutomo

Are patient-centered care values as reflected in teaching scenarios really being taught when implemented by teaching faculty? A discourse analysis on an Indonesian medical school's curriculum.

BackgroundAccording to The Indonesian Medical Council, 2006, Indonesian competence-based medical curriculum should be oriented towards family medicine. We aimed to find out if the educational goal of patient-centered care within family medicine (comprehensive care and continuous care) were adequately transferred from the expected curriculum to implemented curriculum and teaching process.MethodsDiscourse analysis was done by 3 general practitioners of scenarios and learning objectives of an Indonesian undergraduate medical curriculum. The coders categorized those sentences into two groups: met or unmet the educational goal of patient-centered care.ResultsText analysis showed gaps in patient-centered care training between the scenarios and the learning objectives which were developed by both curriculum committee and the block planning groups and the way in which the material was taught. Most sentences in the scenarios were more relevant to patient-centered care while most sentences in the learning objectives were more inclined towards disease-perspectives.ConclusionsThere is currently a discrepancy between expected patient-centered care values in the scenario and instructional materials that are being used.

Physician's self-perceived abilities at primary care settings in Indonesia

Background: Southeast Asian countries with better-skilled primary care physicians have been shown to have better health outcomes. However, in Indonesia, there has been a large number of inappropriate referrals, leading to suboptimal health outcomes. This study aimed to examine the reasons underlying the unnecessary referrals as related to Indonesian physicians’ standard of abilities. Materials and Methods: This was a multiple-case study that explored physicians’ self-evaluation of their abilities. Self-evaluation questionnaires were constructed from the Indonesian Standards of Physicians Competences of 2006-2012 (ISPC), which is a list of 155 diseases. This study was undertaken in three cities, three towns, and one “border-less developed” area during 2011-2014. The study involved 184 physicians in those seven districts. Data were collected using one-on-one, in-depth interviews, focus group discussions (FGDs), and clinical observations. Results: This study found that primary care physicians in Indonesia felt that they were competent to handle less than one-third of “typical” primary care cases. The reasons were limited understanding of person-centered care principles and limited patient care services to diagnosis and treatment of common biomedical problems. Additionally, physical facilities in primary care settings are lacking. Discussions and Conclusions: Strengthening primary health care in Indonesia requires upscaling doctors’ abilities in managing health problems through more structured graduate education in family medicine, which emphasizes the bio-psycho-socio-cultural background of persons; secondly, standardizing primary care facilities to support physicians’ performance is critical. Finally, a strong national health policy that recognizes the essential role of primary care physicians in health outcomes is an urgent need.

Microbiological Quality Assessment of Drinking Water in Teros Village, East Lombok District, West Nusa Tenggara Province, Indonesia

Although the source of drinking water is abundantly available in East Lombok District, its quality raises a public health concern. The East Lombok District, especially Teros Village at Labuhan Haji District is mainly characterized by several springs and very shallow water levels. Teros village communities regularly use water from springs or from dug wells to meet their daily needs. The springs are scattered and located in the middle of densely populated settlements. This results in the high possibility of groundwater contamination or pollution by human activities. This research primarily aims at studying the microbiological water quality of drinking water at Teros Village, and to review household water treatments methods employed by the local population and also the sanitation condition. Eight water samples were taken from six dug wells and two springs and were analyzed with measured microbiological parameters namely coliform and fecal coli. It is revealed that there is a significant degree of microbiological pollution of drinking water in this area owing to domestic wastewater and poor sanitation condition. By using purposive sampling technique, 100 respondents (Head of Family) were selected to collect qualitative data regarding local household water treatment methods. This amount based on the reason that one house with one water source is usually inhabited and used by some families so that the number of respondents is considered enough to represent the existing conditions. Field observation was conducted to find out the sanitation condition. Local residents were familiar with several household water treatments methods, although they only knew about limited physical characteristics of water improvement.