Transforming Indonesia’s health-care system

McMaster University-affiliated doctors Mark Levitan, left, Ryan Coelho, second from left, Lita Cameron, third from right, and Erin Gallagher, second from right, met with faculty at two universities during an academic exchange to Indonesia in December. 

J.P. Antonacci

Local Journalism Initiative Reporter

Diagnosing and treating thousands of patients right out of medical school would be a daunting task for any family doctor.

But that used to be the norm for rookie doctors in Indonesia, a country of 280 million where primary care is delivered through community health centres called “puskesmas” and a doctor’s roster of patients can run into the thousands.

With help from experts at McMaster University, a pair of Indonesian medical schools developed family medicine residency training programs based on the Canadian system, in which new  doctors complete a two-year residency in family medicine to prepare them for the complexities of caring for patients from birth until death.

The university’s ties to Indonesia date back to 2004, when Dr. Lynda Redwood-Campbell, a professor of family medicine, went to the tsunami-stricken Aceh region as a disaster relief volunteer with the Red Cross.

Numerous academic exchanges followed over the years, with McMaster professors sharing tips on curriculum development, training and supervision while collaborating with their Indonesian counterparts on research projects.

Some Indonesian medical students have come to Canada to complete family medicine residencies through McMaster, with more students expected later this year.

“It’s very much a two-way thing,” said Dr. Mark Levitan, who travelled to Indonesia in December with a four-person McMaster contingent for a weeklong academic exchange.

“As we share how we do things here, it’s also learning about how they do things there, which is super interesting,” Levitan said.

Levitan and Dr. Ryan Coelho mentor medical students from McMaster at their family practice in Norfolk County and at Norfolk General Hospital, where Levitan is an anesthesiologist and Coelho works in the operating room as a surgical assist.

As rural doctors running a busy family practice, Levitan and Coelho felt a kinship with Indonesian doctors who handle all manner of cases.

“A family doctor in Ontario, especially in rural Ontario, has to wear many hats — partially out of necessity,” Coelho said.

While overseas, the four doctors visited medical schools in the regions of Medan and Banda Aceh to lead workshops and give lectures on topics ranging from palliative care to cancer screening.

The group also toured modest village clinics and urban hospitals with state-of-the-art diagnostic suites.

“They’re very proud of what they’re doing,” Coelho said of their “hospitable, lovely” hosts who “wanted to showcase their country (and) pick our brains about family medicine.”

Health-care system reimagined

In 2014, Indonesia took on what Coelho called the “daunting” challenge of devising a “cohesive” mandatory health plan for a populace that speaks hundreds of languages and lives on nearly 1,000 different islands.

“And they did it — and very quickly” he said.

By 2024, Indonesia achieved near-total coverage through a single-payer health insurance system, with a mix of public and private-sector service providers.

The Indonesian philosophy is “everybody’s a patient,” with primary care guaranteed, Coelho said.

“Everybody’s covered. It’s not millions of people without a family doctor. And that’s government-mandated,” he said.

Dr. Lita Cameron, global health lead at McMaster’s Department of Family Medicine, said Canada can learn from the importance Indonesian health officials place on collaboration.

“There is this sense that in order to address the community’s health, many people need to be at the table and their voices need to be represented,” Cameron said.

Reigniting passion for family medicine

When asked the biggest challenge of the weeklong academic exchange, Levitan laughed.

“Trying to survive crossing the street,” he said.

“It’s just pure chaos,” Coelho chuckled, describing traffic-clogged intersections the two visitors from rural Ontario dared not cross on foot.

The Canadians were followed by photographers and feted at formal receptions and university lectures, with their names and faces plastered on banners strung across medical-school entrances.

“It’s a bit overwhelming,” Coelho said. “It was like we were celebrities.”

The group got to Banda Aceh not long after Tropical Cyclone Senyar hit the area, causing major flooding and landslides that left some health centres inaccessible.

Family doctors co-ordinated deliveries of food and supplies to disaster-stricken residents and rolled up their sleeves to clean their health centres so patients could return.

“They travelled by foot, wading through water to visit families. They visited shelters to provide necessities,” Cameron said. “The example of service to their community was really inspiring.”

Meeting the “very passionate” doctors and administrators trying to redefine family medicine “reignited my passion for family medicine,” Coelho added.

“I came away grateful, more than anything,” he said.

“We are very fortunate (in Canada). We can have all these challenges, but in the end, we have a very good (medical) system and we provide really good quality of care. If we didn’t, we wouldn’t be asked to come there.”

Levitan appreciated the chance to chat over meals and on the sidelines of the formal talks and presentations.

“Especially in family medicine, a big part of it is understanding the culture and how people live, because all that affects the relationship and how medical care is delivered,” he said.

The trip, Levitan concluded, “was a good reminder of the possibilities — how things can change, and the meaning we can add to individuals’ lives.”

- J.P. Antonacci is a Local Journalism Initiative Reporter based at the Hamilton Spectator. The initiative is funded by the Government of Canada.