FIENS - Foundation for International Education in Neurological Surgery

FIENS has been active in the following countries (click for more on any location):

Belize
Ecuador
Ethiopia
Ghana
Guatemala
Honduras
India
Indonesia
Kenya
Korea, DPR
Nepal
Nigeria
Peru
Philippines
Taiwan
Tanzania
Thailand
Uganda
Vietnam
Zimbabwe

This immense country of 13,000 islands and 210 million people is full of great contrasts. Primary health care is delivered throughout the country through health clinics staffed by physicians and nurses. Regional hospitals are scattered throughout the country and are staffed by general physicians and the four basic specialties. One physician provides health care to about 20,000 people. Most secondary and tertiary health care is delivered through B and A level institutions. Neurosurgery is provided through several B level hospitals and the four A level institutions, which provide tertiary and quaternary care. There are a large number of private hospitals, which now deliver approximately 75% of the health care to the country's population.

The recent economic crisis has hit Indonesia hard. Where basic emergency health care and many public health
care was provided previously, almost all subsidies have disappeared and everyone must pay for care. This has had serious adverse consequences on provision of such basic care as birth control, immunizations and trauma care. Supplies of foreign goods have dwindled or become unobtainable because of the severe devaluation of currency. Maintenance of technology is often beyond the budgets of hospitals and health care institutions. Consequently equipment such as respirators, CT scanners, laboratory equipment and instruments lie idle for want of routine maintenance.

Health care and medicine in Indonesia is practiced through a combination of public and private institutions where approximately 75 percent of all institutional health care is delivered through private institutions. The government provides primary health care throughout the nation through small regional hospitals and clinics. Previously, the public institutions were subsidized for basic care such as acute trauma, maternal fetal health, family planning and immunizations, however these subsidies have been discontinued because of the current economic crisis. Public institutions are now required to charge patients in order to survive and because of many factors the costs are often higher than those charged by private institutions. Private institutions are often well managed and well equipped and generally provide a much higher standard of health care.

There are now about 75 registered neurosurgeons in the country to serve the population of 210 million. Most live on Java and combine government service with a private practice. Those in government service are expected to serve ‘in house’ until about 1400 hrs, following which they engage in private practice throughout the afternoon and evenings. Most have appointments in several private hospitals.

Indonesian neurosurgical leaders recognize the need for training increased numbers and welcome cooperation
in neurosurgical education. There is hope to increase the number of neurosurgeons in the early years of this
century to 100.