Indonesian government official health requirements
Proof of yellow fever vaccination for all travelers over 1 year of age
who have traveled through infected areas.
In this country, the availability and uptake of immunizations is so dismal such
that epidemic diseases have not yet been controlled and periodic outbreaks
continue to threaten the lives and health of Indonesian citizens on a regular
basis. Other diseases remain endemic due to natural or manmade environmental
factors. Therefore specific precautions, including but not limited to
immunizations, are necessary to reduce the substantial health risks.
Recommended Vaccinations/Immunizations
All standard immunizations should be current, including MMR (measles,
mumps and rubella) and DT (diphtheria and tetanus). In addition, the following
are recommended:
- Hepatitis A
- Tetanus
- Hepatitis B
- Typhoid
- Rabies (depending on location and occupational risk)
- Adult polio booster
- Japanese B encephalitis (in certain areas)
- Malaria prophylaxis
One of the most important things that a parent can do for their child is to make sure that they have all their routine childhood vaccinations. It's the most effective way of keeping them protected against a range of serious and potentially fatal infectious diseases. In a country such as Indonesia where access to international standard of healthcare can be limited the importance of immunizations cannot be overstated. Tragically children who do not have access to immunization programs still die or suffer from chronic illness from vaccine preventable diseases.
Schedules for routine vaccinations vary slightly in timing between different countries, and we suggest following the schedule from your country of origin (which can usually be found on that countries health ministry website) or on the websites below. Additional vaccinations that are recommended for patients residing in Indonesia include: Hepatitis A (can be given from 12 months of age), typhoid, Japanese Encephalitis and Rabies. BCG is included in most routine schedules for at risk children, and certainly residing in Indonesia where tuberculosis is endemic would be considered an indication for this vaccination.
For further reliable and detailed information about immunizations, vaccination schedules and vaccine preventable diseases please refer to the following websites:
Center for Disease Control
Immunise Australia Program
World Health Organization
Potential diseases
Insect-borne illnesses that must be considered include:
Loose, light clothing protects against insects. When in long grass, tuck
trousers into socks. Avoid wading through swamps and brushing against jungle flora. Liberal use of insect repellent on your ankles, cuffs, collar and waist will help reduce bites.
Ticks (small, eight-legged insects which feed off blood) are an increasing
source of infection worldwide. Some transmit serious infections, but all leave
a bite which can easily be infected by other micro-organisms. When
forcibly or incompletely removed, remnants of the tick's mouthparts are prone to causing infection in the bite. Backpackers and
campers should exercise additional caution in tick-infested
areas such as forests.
Prevent Mosquito Bites
Simple personal protective measures can
greatly reduce the risk of being bitten by the anopheles (malaria-carrying)
mosquito. Because of its nighttime feeding habits, malaria transmission
occurs primarily between dusk and dawn (whereas the dengue-carrying mosquito
tends to bite in daylight).
Mosquitoes are found worldwide, as all varieties breed in or near water
that is stagnant or slow-moving. The female mosquito is the only one that bites, as she requires a blood
meal in order to be able to lay her eggs. Furthermore, she may acquire new disease
organisms through biting which may be transmitted to subsequent bite victims. The importance of mosquitoes in the transmission
of disease is illustrated by the fact that there are over 50 important
diseases transmitted by female mosquito bites, including
malaria, dengue fever, Japanese B encephalitis, yellow fever, and a variety
of forest and jungle fevers.
Urban mosquitoes breed in pools of standing water such as empty tin
cans, old tires and water-filled tire tracks, coconut shells, and saucers under domestic pot plants. Rural mosquitoes breed in rice paddies,
stagnant ponds and slow-moving streams. Control of mosquito-breeding sites
is very important, especially those close to human habitation as mosquitoes
usually have a flight range of less than one kilometer from where they hatched.
Other useful precautions include:
- changing the water in flower pots once
a week after a thorough washing
- avoiding trays with standing water for plants
- scrubbing plant trays weekly to get rid of any mosquito eggs
- cover all water
containers and any objects that can trap rain water
- ensure that roof gutters are not
clogged
- filling or draining
areas of impounded water, except for aerated swimming pools and ornamental pools
- using larvicides or mosquito larvae-eating fish in waters that cannot be drained
- applying screens on doors and windows as well as mosquito nets on beds
Food and water borne illnesses in Indonesia
These diseases are very common in Indonesia and include:
Indonesian public health controls are not effective. The overall
incidence of food- and water-borne disease is very high; clean water, modern
sanitation, and safe food storage and processing facilities are rarely
available. Travelers need to take great care and maintain personal
responsibility for a supply of safe food and drink due to
the wide variety of possible contaminants in Indonesia. Drink
only water known to be safe; in some cases even bottled or carbonated
water and other processed beverages may not have been prepared
to safe standards. Avoid ice, salads, uncooked
seafood and peeled fruit. All tap water should be briskly boiled for a minimum of twenty minutes with even longer periods recommended to destroy any heat-resistant cysts formed by amoebae.
For information on HIV/AIDS in Indonesia, please visit the STDs page.
Other diseases that you may encounter/experience include:
Other hazards
Industrial plants and high pollution levels in urban areas may cause problems for asthmatics.
Local medical facilities
The standard of care given by most Indonesian medical facilities is not up to international standards. Not all drugs are available, and certain
medical techniques are generally unknown
or cannot be safely practiced.
The national blood supply is reportedly screened for HIV and Hepatitis B (but not
Hepatitis C). The usual international standards of sterile supply are
not always adhered to, especially outside centers in urban areas. Needles, syringes and gloves which should
be single-use are often reused due to economic necessity.
Standards of medical and nursing care can fall below internationally acceptable
guidelines. Ambulances may be poorly equipped,
are not always staffed by paramedics, and in a medical emergency response
times may leave something to be desired. Unless
in an emergency, comprehensive medical care should be deferred until after exiting the country, if at all possible.
Most doctors and medical facilities will expect immediate payment for
their services, perhaps suspecting that most travelers will ignore invoices sent after discharge. This
often extends to a request for guarantee of payment before treatment starts. Indonesian service providers
do not usually accept a guarantee of payment from overseas
insurance or medical assistance agencies unless they have a local presence. It is wise to have sufficient funds
in cash to meet predicted medical expenses, as few medical service providers will agree to take credit cards. Therefore, as
well as adequate insurance protection, a traveler should carry or have
rapid access to sufficient funds to pay for emergency and initial medical
costs.
There are no reciprocal medical arrangements between the government of
Indonesia and other countries.
Note: When in pain or apprehensive about the cause of mysterious symptoms,
miscommunications and misunderstandings can greatly magnify concerns. If you
are not reasonably adept in the language the doctor or nurse speaks, try
to have an interpreter present. If this is not possible, you'll need a
dictionary as well as a phrasebook; tourist-orientated language guides
are fine for “where is the toilet?”, but lack the substance to
describe pain and bodily functions adequately. If at all possible, while
waiting or traveling to see the doctor work with your friends or an interpreter
to compose a written summary of your symptoms in the local language.
Indonesian physicians communicate less with patients than expats are accustomed
to, and may be insulted when patients ask questions about treatments or
express a need for a second opinion.
There is a metropolitan ambulance service said to be operating in most
Indonesian cities (the telephone number is 118). Do NOT rely only on this
service in case of an emergency.
Foreign doctors are NOT allowed to practice in Indonesia. Some
Indonesian doctors have pursued postgraduate training
overseas.
More inforamton on medical facilities in Indonesia
Avian flu
All persons travelers to Indonesia should consult their health
care providers about avoiding and treating avian influenza. Of particular importance is avoiding
contact with sick or dead poultry, which goes double for children.
Most human cases of H5N1 have occurred due to direct contact with sick/dead poultry. Be vigilant about
food preparation and handling involving chicken or eggs, and wash
hands thoroughly afterwards.
Food preparation tips
- Separate raw meat from cooked or ready-to-eat foods. Do not use the
same chopping board or knife for preparing both raw meat and cooked
food.
- Do not handle raw and cooked foods back-to-back without washing your hands
in-between.
- Do not place cooked meat back on the same plate or surface it was
on before cooking.
- Poultry products, including eggs and blood, should be
cooked thoroughly. Egg yolks should not be runny or liquid. Influenza viruses are destroyed by heat, so cooking temperatures for
poultry meat should be a minimum of 70°C (158° F).
- Wash egg shells in soapy water before handling and cooking and wash
your hands afterwards.
- Do not use raw or soft-boiled eggs in foods that will not be cooked.
- After handling raw poultry or eggs, wash your hands and all surfaces
and utensils thoroughly with soap and water.
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Kebersihan Makanan
- Pisahkan daging mentah dari makanan yang telah dimasak atau siap
untuk dimakan. Jangan gunakan talenan atau pisau yang sama untuk memotong
daging mentah dan makanan yang telah dimasak atau siap untuk dimakan.
- Jangan mengolah daging mentah maupun makanan yang telah dimasak tanpa
mencuci tangan terlebih dahulu.
- Jangan meletakkan daging yang telah dimasak ke wadah atau piring tempat
daging tersebut diletakkan waktu sebelum dimasak.
- Semua makanan dari produk unggas, termasuk telur dan darah unggas,
harus dimasak sampai matang. Kuning telur tidak boleh dibiarkan cair.
Oleh karena virus influenza akan mati pada suhu yang panas, daging unggas
harus dimasak hingga mencapai 70ºC (158ºF).
- Cucilah kulit telur dalam air sabun sebelum diolah dan dimasak, kemudian
cucilah tangan sesudahnya.
- Jangan mencampurkan telur mentah atau setengah-matang ke dalam makanan
yang tidak untuk dimasak.
- Setelah selesai mengolah daging unggas atau telur mentah, cucilah
tangan serta seluruh peralatan masak sampai bersih dengan sabun dan
air.
If you have any further questions about medical concerns in Indonesia, see the Ask the
Experts.
We trust this information will assist you in making correct choices regarding your health and welfare. However, it is not intended to be
a substitute for personalized advice from your medical advisor.
Our appreciation to Dr. Rene de Jongh of International
SOS, an AEA Company who has contributed this article in response to
a growing need for medical advice for expatriates in Indonesia.
We also extend our thanks to the US Embassy which provided the information
for the Avian Flu update in a warden alert.
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