As part of its series exploring infection control around the globe, Eschmann Direct examines standards in Indonesia
The beautiful face of Indonesia hides some ugly facts. The year is 2011 and Indonesian dentist Edi Herman has just been banned from practising dentistry from his tiny shop in the country’s capital of Jakarta. Were it a developed country, the low and often unacceptable standards of care provided by unlicensed dentists such as Herman would not have been tolerated for that long, so when the law was passed forbidding the practice of any dental treatment by an unlicensed dental professional, it appeared that sense had prevailed at last.
Unfortunately it was short-lived, and by 2013 the ban had been overturned. Cue the reintroduction of unsanitary makeshift surgeries, unapproved, unsafe tools and substandard dental care. The horror stories began rolling in. A well publicised case was that of Fitri Hayati, whose unlicensed comprehensive orthodontic treatment resulted in patients suffering intense pain and a disproportionate smile. Additional risks posed by illegal dentistry can be severe, especially when it comes to poor infection control.
For the Indonesian Medical Council (Konsil Kedokteran Indonesia/KKI), which is ultimately responsible for providing and enforcing the competence standards for dentists, the continued use of unlicensed dental professionals is a constant threat. Incidences of communicable disease are still rife throughout Indonesia. Tuberculosis is a particular concern, with an estimated 6,800 new cases diagnosed each year.
Work continues behind the scenes to minimise risks, particularly by the Ministry of Health, which is responsible for the management of all programmes. There’s an active surveillance and outbreak response system in place, with regular national surveys carried out to measure and monitor prevalence. But is that enough to remedy the chaos being caused by unlicensed dentists like Herman? Probably not, but it’s a start.
The fact is that regional disparities between the richer western islands of Java, Sumatra and Bali, and the poorer, less developed east in the quality, availability and capacity of services, has taken its toll on Indonesian residents. Many simply cannot afford to visit their dentist.
To tackle the problem Indonesia’s universal social health insurance scheme was introduced in 2014, and there are plans for universal health coverage by 2019. A lot of work has been done through government-run hospitals and the School Health Programme, which provides dental and oral health screening and advice about toothbrushing for schoolchildren throughout Indonesia.
The dentist to patient ratio is heavily unbalanced, which could be attributed to the limited number of dental schools available. Indeed, such is the problem that around half of Indonesia’s puskesmas – the government-mandated community health clinics – did not have a dentist on their books in 2012, with the distribution of dentists heavily skewed towards the more populated urban areas.
So what has this got to do with you? While the problem might be thousands of miles away and the UK will never know what it is like to come up against illegal dentistry on such a large scale, it serves as a reminder to us all that substandard dentistry and unsafe conditions are still a very real risk.
It’s 2017 and Indonesia’s problem is still not under control. Luckily, it's a different story here in the UK, for the most part at least, and we have the government and regulatory bodies to thank for that. Unlike the Indonesians you are a valuable part of a system that helps keep our standards high; don't forget that.
About Eschmann Direct:
EschmannDirect has been setting the standards in infection control since 1966, when it introduced its first Little Sister autoclave. Today, the team works closely with industry professionals at the forefront of design, producing market-leading dental products and offering customer service and support all over the world. For more information about decontamination equipment and products from EschmannDirect visit www.eschmann.co.uk or call 01903 753322