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Ask the Medical Experts in Indonesia

Do you have a medical question pertaining to living in Indonesia? If so, contact us. Medical staff at International SOS have generously agreed to answer your questions!

I had a heart attack several years ago. I am in my early 60s. Before my heart attack I was a regular tourist visitor to Indonesia, Bogor is my base. My medical condition :- 1) Atrial Fibrillation. 2) Ischemic heart disease. 3) CCF. Daily I take medication (pills) 7 in the morning, 1 at 2pm, 3 in evening. I also take Warfarin pills in the evening. All of these pills I can take with me. The pills must be in sealed containers and I need a cover letter from my GP. I must declare this medication to Customs on arrival at Jakarta. That's what the Indonesian Consulate told me. I had a Defibrillator/Pacemaker implanted in my left shoulder this year. My pulse has stabilised. The company that make the pacemaker is "Boston Scientific." They appear to have an office in South Jakarta on Jl. Jenderal Sudirman. This email is forward planning by me. My next visit to Bogor will be "Short and Unadventurous". No treks up Guning Salak. i.e., "A test run". Any advice and/or information you think I need please email to me. I would be very grateful.

You seem well informed and quite correctly you are forward planning. The risk of a problem with the pacemaker is the same here or in any country – it is just that corrective action and indeed diagnostic telemetry may not be available in Indonesia. The key is the pacemaker being in situ for a minimum of 3 month (6 months would be better) to ensure it functions correctly and also to understand how many defibrillator activations you may have. You need to live with the device over a long enough period of time so that you have been exposed to all types of potential triggering events in your lifestyle.

With regard to your overall cardiac condition. Being in a hot climate may alter the effects of your medicine – sweating a lot and being dehydrated is worsened by diuretics. Also certain drugs, like Amiodarone, may cause skin sensitivity in strong sunlight. I appreciate it is sunny at home, but UVB levels are different. The key is to be stable at home. Not stable at home = not stable on holiday. Being stable at home, well informed and well prepared lessens the risk significantly.

What I do think is critical for you is to come with full risk travel health insurance cover (with evacuation rider and assistance) in place. Be very open with the insurer, declare everything. It will cost a lot, but I don’t think you should travel without such insurance.

Travelling with medical conditions such as yours is all about risk. How much you are prepared to accept and what you can do to mitigate the risk, but clearly this is set against the social and psychological benefits of the holiday as a whole. Being well, stable, well prepared with a Plan B ready if things start to go wrong reduce the risk down to likely very acceptable levels. So well done for being prepared! Hope you have a great holiday.

Information contained in this response should be used a general advice and guidelines and should never replace a thorough consultation and examination by a doctor. For further assistance and referrals, International SOS members are advised to call our Assistance Centre at 021-750 6001 (Jakarta) or 0361-710 505 (Bali).

My son and I were vaccinated with Engerix Hepatitis B vaccine. Is this or a compatible vaccine available in Jakarta? We both have had past series, but have proven not to have provided immunization.

In the SOS Medika Klinik in Cipete, Jakarta we have Hevac.B.Engerix Adult and Hevac.B.Engerix Paediatric. I believe these are the same vaccines as you have had previously.

Information contained in this response should be used a general advice and guidelines and should never replace a thorough consultation and examination by a doctor. For further assistance and referrals, International SOS members are advised to call our Assistance Centre at 021-750 6001 (Jakarta) or 0361-710 505 (Bali).

I have questions about malaria in rurals areas of Surabaya and Bromo. I will be conducting hydrogeology work in these areas and will explore the ravines of rivers. I already am already aware of basic protective measures (repellents, long clothes, bednets). What about chemoprophylaxis-prevention for malaria in rural areas of Surabarya and of Bromo? Is there Plasmodium falciparum in those rural areas?

Thank you for your enquiry regarding Malaria risks in Bromo, Surabaya and surrounding areas.

The risk is considered low, however, if your are spending most of your time outdoors and staying in a rural setting for several weeks (and particularly if you are staying overnight in rural areas), it may well be prudent to consider prophylaxis such as doxycycline or Malarone (the latter not available in Indonesia EXCEPT at the SOS Cipete clinic in Jakarta).

If you are only venturing out of the urban environment of Surabaya for daytime trips for work then the need for prophylaxis is doubtful as you would have prompt access to hospitals for blood tests and also the exposure to malaria bearing mosquitos is much less during day time.

You need to be mindful of the potential side effects and also that the medications do not guarantee protection. Also, Dengue (borne by a day-biting mosquito) is rife in Indonesia - throughout the year and the risk of contracting Dengue is far higher in the region you are traveling in.

Prevention is, as you know, key to avoiding malaria:

When outdoors, wear clothing that covers most of your body (long sleeves, long pants, socks). Consider treating clothing with an insecticide. These are available as both soaks and sprays, and usually last through several washings. Always follow the manufacturer's instructions. Use an effective insect repellent that contains DEET, Picaridin, PMD, or IR3535. In general, the higher the concentration of the active ingredient in a product, the longer it lasts and hence the more effective it is. Reapply after swimming or excessive sweating. Ensure windows are covered with fly-wire. Use "knock-down" insect spray to kill mosquitoes in your room. Unless you are staying in air-conditioned, well-screened accommodation, consider using a bed net impregnated with insecticides.

Information contained in this response should be used a general advice and guidelines and should never replace a thorough consultation and examination by a doctor. For further assistance and referrals, International SOS members are advised to call our Assistance Centre at 021-750 6001 (Jakarta) or 0361-710 505 (Bali).^

I moved to indonesia from the U.S. I have been diagnosed with Obsessive Compulsive Disorder, and was prescribed 100mg of fluvoxamine maleate a day. Where can I find this medication in Indonesia? Also, how much will it cost a month at that dose? Will I need to see a psychiatrist to get a prescription?

Thank you very much for contacting International SOS in regards the availability of FLUVOXAMINE (LUVOX).

The medication is not readily available in all parts of Indonesia. We made some enquiries and discovered that some of the major hospitals do not have the medication. It can be purchased in Jakarta, but it does require a prescription by a doctor. Longer duration prescriptions would need to be issued by a Psychiatrist. Only prescriptions issued in Indonesia are valid.

Our SOS Pharmacy in Jakarta advises that the approximate retail price price for LUVOX TAB 100MG is IDR 32,950/tab (excluding VAT)

Most pharmacies (including SOS pharmacies) do not stock Luvox so it needs to be ordered from the local supplier.

You have the option of procuring the medication before your travels to Indonesia, but there are specific requirements for importing medications.

Information contained in this response should be used a general advice and guidelines and should never replace a thorough consultation and examination by a doctor. For further assistance and referrals, International SOS members are advised to call our Assistance Centre at 021-750 6001 (Jakarta) or 0361-710 505 (Bali).

We live in Bali. My wife has type 2 diabetes and has used insulin for almost 10 years. Right now she is experiencing boils. A friend of ours suggested she take cloxacillin. Is this medication available in Bali?

Please find the information below provided by our medical team:

Diabetes Mellitus is a condition with many long term consequences that must be monitored. These include an increased risk of
cardiovascular disease, increased risk of infections, eye problems, neurological problems and sensory problems to the hands and feet. We would recommend that for a stable diabetic patient they are reviewed by a doctor every 6 months.

Boils can certainly be related to diabetes, however the use of antibiotics (‘cloxacillin’) depends very much on the infection and in diabetics the more important issue is to control the blood sugar which would lessen the risk of infections in the first instance.

It is likely the drug mentioned is ‘Flucloxacillin’ which would be a common antibiotic for treating boils, however there are consequences for taking antibiotics in the long term, such as bacterial resistance. These are simple medicines and either this drug or
equivalent other drugs will be held at the SOS Clinic in Bali

In this instance the most recommended plan would be for an appointment with a clinic doctor to assess the boils and also to assess
the overall control of the diabetes as well as look for other diabetic related diseases.

Information contained in this response should be used a general advice and guidelines and should never replace a thorough consultation and examination by a doctor. For further assistance and referrals, International SOS members are advised to call our Assistance Centre at 021-750 6001 (Jakarta) or 0361-710 505 (Bali).

Can I ask for a referral to a good children's gastronologist in Jakarta?

Please find the referral you requested: Dr. Badriul Hegar (gastro paediatrician)

Dr. Hegar practices in Premier Bintaro Hospital and also in Rumah Sakit Cipto Mangunkusumo (RSCM). They have an executive policlinic, named RSCM Kencana).

Information contained in this response should be used a general advice and guidelines and should never replace a thorough consultation and examination by a doctor. For further assistance and referrals, International SOS members are advised to call our Assistance Centre at 021-750 6001 (Jakarta) or 0361-710 505 (Bali).

I'll be moving to Jakarta soon and was wondering if it's possible for a woman in her late 30s, in a case of pregnancy, to do a Down Syndrome or other genetic disease testing (cell free DNA test, ultrasound measurement and possibly amniocentesis) in Jakarta? I've read that abortions, even if clinically motivated, are not allowed. Do you know what the policy is in Singapore?

Regarding your query about Down Syndrom Screening in Indonesia, i would like to inform you that most of the recent screening tests are available in Indonesia There are few OBGYN Specialists working every week at SOS Medika Klinik Cipete and you can discuss anytime with them about the best test to be performed.

Nuchal Tranlucency can be assessed during a routine Fetal USG.

Triple Test, PAPP A test, Free Bhcg can be performed as well. Blood sample can be taken at SOS Medika Klinik and the sample will be sent to our referral labs for analysis.

For Fetal DNA test ( Harmony Test) , blood sample can be taken at SOS Medika and sent to referral labs in US / SIN for analysis. Results available after one month time.

As you correctly mentioned, abortions are illegal in Indonesia. It's quite the same regulation for foreigners in Singapore. The procedure is only for Singaporean citizens or Singaporean residents of more than 4 months. Please find legal advice on the Termination of Pregnancy in Singapore.

Information contained in this response should be used a general advice and guidelines and should never replace a thorough consultation and examination by a doctor. For further assistance and referrals, International SOS members are advised to call our Assistance Centre at 021-750 6001 (Jakarta) or 0361-710 505 (Bali).

I am a senior citizen with severe knee pain. I require what is known as a toilet seat extension. It is an item, usually made of plastic or fibre glass, which fits neatly over a toilet seat, and which is screwed on to each side of the seat in the bathroom. It is usually of 4 cm or 6 cm height, so it facilitates sitting down and getting up from a toilet seat. Request, please let me know where I can buy one from in Indonesia.

Thank you for your enquiry. We're sorry to hear about your severe knee pain. We understand just how debilitating this can be. Please find the following information regarding the purchase of the equipment you requested:

Toilet seat riser availability in Indonesia:

Available in "Arnez De Lourdes" Health Equipment Outlet
Fatmawati : Jl. RS Fatmawati No. 27, Phone 021 765-8081
Pondok Pinang : Jl. Pondok Pinang Raya No. 14B, Phone 021 766-1969

Also, please refer to the below websites to order this item and related items (in Bahasa Indonesia):

Jual Kursi Roda dan Alat Kesehatan and Gesunde Medical

Please let us know if we can be of any further assistance to you with regards to your condition.

Information contained in this response should be used a general advice and guidelines and should never replace a thorough consultation and examination by a doctor. For further assistance and referrals, International SOS members are advised to call our Assistance Centre at 021-750 6001 (Jakarta) or 0361-710 505 (Bali).

I have bipolar disorder and have been on Lithium for many years and it works well for me. Right now I have a 2 years supply of medicine. I really want to stay in Indonesia so I'm trying to think ahead. Is it possible to obtain Lithium in Indonesia?

This email is to try to answer your enquiry and also give some general recommendations. Overall I think you need:

1. Lithium medicine supply
2. A local psychiatrist to oversee and help deal with any urgent issues. We would encourage you to engage with that doctor now and not just if/when an emergency happens – doctor-patient relationships are key and you need to find a local doctor you trust and can work with in the future.
3. 3-monthly blood tests for Lithium levels
4. 6-monthly full blood tests including thyroid function – SOS Clinics in Jakarta (and most other clinics) can do these

I would like to warn you that: The effects of heat or any diarrhoeal or gastrointestinal conditions (which are more common here) may affect your Lithium blood levels, also symptoms of these conditions may mask lithium toxicity.

Lithium can be ordered from the pharmacy at the SOS Clinic at Cipete. We do not stock the drug routinely. But, usually it will be ready in 1-2 days after a prescription has been submitted. Other pharmacies may be able to do the same in Jakarta, but you would have to check with them directly.

We know of a number of psychiatrists in Jakarta who will likely be able to meet your needs. There are very likely other doctors in Jakarta who can support you equally well also. Although patients can refer themselves directly, generally we at International SOS would only make a specific recommendation after seeing the patient at one of our clinics or if the patient was a member.

Your Lithium levels could be the most problematic issue. Our clinics can take the blood sample but we would send it to a laboratory outside Indonesia for testing. The results will only be available after a number of weeks. Other clinics may also be able to do the same, but we do not believe it is likely that the blood test would be processed in Indonesia.

Information contained in this response should be used a general advice and guidelines and should never replace a thorough consultation and examination by a doctor. For further assistance and referrals, International SOS members are advised to call our Assistance Centre at 021-750 6001 (Jakarta) or 0361-710 505 (Bali).

I contracted dengue fever in Thailand in 2005 and it matured when I was in Malaysia. Subsequently, I was hospitalized for 10 days due to low WBC and platelet count. I would like to retire in Indonesia and I wonder if my system is compromised by the first exposure. I should add that I seem to have a weak immune system anyway, I am often tired and run down. I worry that dengue fever could be a problem, if I contracted it again. (January 2016)

As you've already experienced Dengue, it is possible that contracting it again may cause you a similar pattern of illness, or more severe. Studies do show that people who've suffered the condition previously have a higher risk of developing Dengue Haemorrhagic Fever or Dengue Shock Syndrome, these being the more severe manifestations of getting the virus.

This being said, avoiding being bitten, early diagnosis and close monitoring can go some way to reducing the severity of the illness. Vaccines aren't available as yet, though clinical trials are underway. Antiviral medication is only being trialled at present and is yet unproven in any benefit to treat someone with Dengue to prevent the more serious consequences.

To recognise some of the factors that are helpful in determining the severity of the illness:

• Duration of the illness - from day 3 to day 7 would be the higher risk period.
• Haematocrit - if this is rising, then fluid replacement should be given promptly.
• Platelet count - the levels will continue to drop up to day 7, the close monitoring of this allows for early intervention and reduction of risk.
• Liver enzymes - if normal in the first 3 days, the risk of going on to develop serious complications is statistically small (Aspartate Transaminase).
• NS1, a protein found in dengue infection, the rise of this can correlate with severity of infection, but the test is not readily available.
• Other conditions that may complicate the picture such as age, obesity, diabetes, kidney failure and blood disorders may lead to earlier hospitalisation and supportive treatment.
• If the platelets get very low, you can get a transfusion, with its own risks, to supplement your body's own resources. This is an uncommon step in the majority of cases. Certain blood groups such as O negative, aren't readily available in Indonesia and the testing of samples does not always cover the risk of developing a transfusion related illness.

To look after yourself:

The best way to prevent dengue fever is to avoid the mosquitoes that carry it. Not all countries where dengue fever is common control mosquitoes well. But you can lower your chances of getting dengue fever if you live or travel there. You can:

• Stay inside during the day, when the mosquitoes that carry dengue fever are active. Buildings with screens and air conditioning are safest.
• Wear shoes, long-sleeved shirts, and long pants when you go outside.
• Wear bug spray or cream that contains DEET when you are outside. Check the label to make sure.
• Drain any standing water near your home, such as wading pools and buckets. Mosquitoes breed in standing water.

Insofar as you describe your general health, you may be best advised to get a medical assessment relating to your immune systems responsiveness. It is often very difficult to pin point this unless consulting with a doctor who could explore your symptoms in detail

Information contained in this response should be used a general advice and guidelines and should never replace a thorough consultation and examination by a doctor. For further assistance and referrals, International SOS members are advised to call our Assistance Centre at 021-750 6001 (Jakarta) or 0361-710 505 (Bali).

I am moving to Jakarta soon. I am currently using NUVARING (Vaginal ring) for birth control. Do you know if I could get this ring in Jakarta? Or maybe, is there any birth control similar to NUVARING that is available in Jakarta and which you would recommend for use? I have never used birth control pills before, and I don't really want to change to pills. (January 2016)

NUVARING (Vaginal Ring) is not available at SOS MEDIKA clinic. We have also confirmed with our supply chain, that it is unavailable in Indonesia. This leaves you with a few choices to make:

• bring enough supplies to last you until you return to the country you get your usual prescription
• travel to Singapore, where it is available
• request it to be imported through a clinic, however, the lead time for acquisition is a minimum of 2 weeks and can be significantly longer ie a little unpredictable
• as you mentioned, consider changing your contraceptive method

Information contained in this response should be used a general advice and guidelines and should never replace a thorough consultation and examination by a doctor. For further assistance and referrals, International SOS members are advised to call our Assistance Centre at 021-750 6001 (Jakarta) or 0361-710 505 (Bali).

I am currently undergoing ICSI (Intracytoplasmic sperm injection) treatment to conceive. There is a possibility that we might be moving to Jakarta. Before reaching a decision I need to know if ICSI treatment is offered in fertility clinics in Jakarta. (January 2016)

Please find the information below regarding the fertility test provider as you requested.

To undergo this procedure in Jakarta, the patient may go to Morula IVF: Jl. Teuku Cik Ditiro No.12, Menteng, Kota Jakarta Pusat, Daerah Khusus Ibukota Jakarta 10350, Indonesia Phone : +62 21 3926393

The first step would be to have a consultation with an ob/gyn specialist at the Morula IVF Clinic. Please bring any fertility treatment records from your previous doctors with you. It is advisable to come on the second day of your menstruation period. The patient will undergo screening and blood tests that may take up to 6-7 hours to complete. The patient would also be screened for HIV, Hep B, Toxoplasma and Rubella. Requirements for patient registration are: ID / Passport and marriage certificate.

Information contained in this response should be used a general advice and guidelines and should never replace a thorough consultation and examination by a doctor. For further assistance and referrals, International SOS members are advised to call our Assistance Centre at 021-750 6001 (Jakarta) or 0361-710 505 (Bali).

Can you get homeopathy medicines in Jakarta (Tangerang). I have my practioner's prescription, but unable to identify any homeopathy dispensaries here. (January 2016)

Unfortunately we are not able to provide a Homeopathic dispensary details in Jakarta. Generally International SOS don't recommend Homeopathy treatment in Indonesia.

Information contained in this response should be used a general advice and guidelines and should never replace a thorough consultation and examination by a doctor. For further assistance and referrals, International SOS members are advised to call our Assistance Centre at 021-750 6001 (Jakarta) or 0361-710 505 (Bali).

I am in need of hearing aids and I'm thinking what a wonderful opportunity to come back to a place I love to get them! Would any one be able to advise of cost and technology or how to contact the relevant business directly?

For hearing aids, there are several providers but one of the biggest provider in Jakarta is Melawai Hearing Aid (Pusat Alat Bantu Dengar Melawai). Melawai has branches in a lot of cities in Indonesia like Bogor, Bandung, Semarang, Yogyakarta, Bali, Sulawesi, etc.

The contact number for Melawai Hearing Aid (Call Center) is Call Center : +6221 726 9802

There are eight branches in Jakarta region only, but one of the larger brances is:

PABD Melawai Gallery – Jl. Melawai Raya No 192, Blok M, Kebayoran Baru, Jakarta Selatan
Direct contact number : +6221 726-6555 website.

To obtain initial information, patient is to contact the number of the call centre.

To find out the costs (its different for each type – there are a lot of models), they will have to fill a form first. It would be easier to directly visit one of the centers and liaise with the staffs there.

Initially every patient will have examinations, audiometry (this can also be done previously by their own personal ENT specialists), and the measurements for hearing aid may be provided by the ENT. However, it is advisable for them to also come to the hearing center to personally adjust the hearing aid.

Aside from Melawai Hearing Aid, Indonesia also has a branch of Hearing Vision

Indonesia - HEARING VISION
Darmawangsa Square
Jl. Darmawangsa VI Level 3 no. 52
Jakarta Selatan 12160
Tel.: +6221 7278-8370, 7280-1819
Fax: +6221 7280-1819

International SOS can help secure an appointment with an ENT Specialist and help directing the patient to one of the centers for the adjustment and choosing of the hearing aid device.

Information contained in this response should be used a general advice and guidelines and should never replace a thorough consultation and examination by a doctor. For further assistance and referrals, International SOS members are advised to call our Assistance Centre at 021-750 6001 (Jakarta) or 0361-710 505 (Bali).

Does any hospital in Indonesia have specialized equipment and expertise in monitoring and delivery of triplets? Or is Singapore the nearest place where such specialized pregnancy care is available?

As you know triplet pregnancies are much more complicated in terms of risk before and after delivery and also for the mother.

When considering Giving Birth in Indonesia

Delivery in Indonesia:

• There are a number of hospitals in Jakarta which have good facilities for the delivery of babies and which have a certain level of neonatal/postpartum care.
• There are several very experienced OB GYNs in Jakarta and most speak English fluently.
• Most single pregnancy deliveries are uneventful and uncomplicated and as such most foreign ladies who have delivered in Jakarta are generally satisfied.

However:

Communication and Care

• While specialist hospital staff members usually have excellent English skills, many of the nurses and midwives unfortunately do not. Especially for first babies, if mothers have difficulties about caring for the baby there may be a lack of education available (Breastfeeding etc)
• The approach during labour, delivery and postpartum may differ from what most expatriate mothers (and fathers) would expect; the clinical approach is sometimes also different, especially with regard to the availability or sometimes lack of availability of epidural analgesia and also the lack of self-administered inhaled gaseous aneasthesia during labor.

Access and Availability

• Arranging urgent admission especially after hours or during weekends can be difficult, because of the hospital's administrative procedures. Also, given Jakarta’s traffic, a transfer to the hospital can take two or three hours and even if the expectant mother arrives in time, the obstetrician and other members of the delivery team may not all be available at the time of arrival. Due to the very low doctor to population ratio in Indonesia, most specialists work at more than one hospital on any given day and may not be immediately available at the hospital where the mother received her antenatal care.

• Certain blood types are not commonly available in Jakarta even though the hospital may have its own blood bank, or may have access to other blood banks. Provision of “safe” blood in an emergency situation is sometimes difficult as there is a no routine storage of Rhesus negative blood (since less the 1% of the Indonesian population is Rhesus negative) In order to obtain Rhesus negative blood (often needed in NICU) requires the activation of a walking blood bank “expatriate blood donor committee” and delays in getting the rhesus negative blood could be over 24 hours.

• There is no "obstetric flying squad" or equivalent operating in metropolitan Jakarta for rapid movement of difficult labour / delivery of patients to hospital.

Neonatal Care

• The quality of neonatal intensive care (NICU) in Jakarta is not considered on par with Europe or the USA. The nearest centres with comparable NICU are Singapore, Hong Kong and Australia and to a lesser level Bangkok.
• The quality of NICU relies on proper multidisciplinary team efforts; the team being composed of an Obstetrician, neonatalogist and anesthetist supported by suitably qualified and specialized nursing staff. Because of the inherent shortage of specialized staff, gathering such a team at short notice is not always possible.

Evacuation

• If there is a last-minute problem with the infant it is extremely difficult (for clinical as well as bureaucratic and immigration reasons) to quickly move a sick infant to Singapore by air ambulance. There are many reasons for this, including, the lack of a birth certificate, therefore the lack of a passport, therefore the lack of an exit visa; the unavailability of a Singapore public hospital neonatal intensive care team (KK) to travel (the private sector does not carry such a team on standby for very sick infants); unavailability of a large enough aircraft platform to carry the team and the incubator as well as the patient, and of course, above all the clinical instability / unfitness to be transported, of either the baby and/or the mother following a delivery which has unexpectedly become complicated.
  We would recommend as follows:
  
  For any pregnancy which can be considered at risk, or when there may be a need of negative rhesus blood, we strongly recommend that the delivery be done in the home country or one of the regional centres mentioned above. For all high risk pregnancies, ideally the mother should leave Indonesia on or before the stage of foetal viability is reached (approximately week 24).
  
  Any decision of going to Singapore after 35 weeks will most likely mean that an Air Ambulance will be required. Airlines do not permit travel after 35 weeks of pregnancy.
  
  It is always a difficult decision about where to deliver. You may also wish to see the consumer feedback and speak to people at the various advisory institutions and sites for maternity 'consumers' through women's organizations like AWA, or ANZA.

Information contained in this response should be used a general advice and guidelines and should never replace a thorough consultation and examination by a doctor. For further assistance and referrals, International SOS members are advised to call our Assistance Centre at 021-750 6001 (Jakarta) or 0361-710 505 (Bali).

Where can I get the vaccine for Japanese Encephalitis in Indonesia?

Japanese Encephalitis Shots (IMOJEV) are available in Jakarta at the SOS Medika Klinik Cipete. The price is Rp 3.100.000 (Sept 2015), not including doctor consultation costs.

Information contained in this response should be used a general advice and guidelines and should never replace a thorough consultation and examination by a doctor. For further assistance and referrals, International SOS members are advised to call our Assistance Centre at 021-750 6001 (Jakarta) or 0361-710 505 (Bali).

Hello, I moved to Jakarta six weeks ago from Australia. About 10 days ago I started to have severe pain in both legs, from joint and muscle soreness to pins and needles, headaches, eye soreness, nausea and worst of all insomnia due to the pain in my legs. I have been tested for malaria, dengue and chikungunya, All tests returned negative. I have seen a different Dr every time I go back to the hospital, 3 in total. The last occasion I was told to come back in a week if the symptoms persist, There could be a number of causes BUT no one with a diagnosis or help. Is there an international hospital with doctors who speak English near Gading Serpong whom I can consult? I have had 2 hours sleep a night for nearly 2 weeks I'm running on fumes right now.

We understand that the condition is very inconvenient for you right now. If you have membership with International SOS, we suggest that you immediately call our Assistance Centre number. Our team of doctors and staff are well-placed to assist you with the test results and referral for practitioners based on your health condition. Alternatively, you can visit one of our SOS Medika clinics in Cipete or Kuningan, where our English-speaking doctors can assess your condition closely and get referrals to our network assistance, whenever necessary.

Information contained in this response should be used a general advice and guidelines and should never replace a thorough consultation and examination by a doctor. For further assistance and referrals, International SOS members are advised to call our Assistance Centre at 021-750 6001 (Jakarta) or 0361-710 505 (Bali).

I am moving to Indonesia from Belgium and I will arrived in Jakarta in one month. My doctor in Belgium, told me to investigate if it is possible to receive the vaccine for "Japanese encephalitis" in an hospital there. The doctor told me that the normal name of this vaccin is: IMOVEL. Are they doing this vaccine in some hospital?

Yes, it is possible to receive vaccination for Japanese Encephalitis in major hospitals or established private clinics in Jakarta. SOS Medika Klinik provides the Japanese Encephalitis vaccine with the brand name IMOJEV. We suggest to cross check with your provider of choice for stock availability, prior to your visit to get the injection.

Information contained in this response should be used a general advice and guidelines and should never replace a thorough consultation and examination by a doctor. For further assistance and referrals, International SOS members are advised to call our Assistance Centre at 021-750 6001 (Jakarta) or 0361-710 505 (Bali).

I'm staying in Java for 4 months. About 3 and a half weeks ago I hit my lower leg (calf mussel with my surfboard). I was in a lot of pain so the next day went for xray in Banjar and saw an orthopedic doctor. There were no bones brocken and I was told it was a soft tissue injury and to rest for 2 weeks. My foot and ankale were swollen. The swelling has gone down 60% and I can walk now but its still painfull somewhat and I dont have normal use of the leg. Im palaning to go to Bandung to see a doctor. I would be greatful for any suggestions as to who I shoud see and what i may have done to myself.

The information provided by the reader is that of an acute history of an identified incident of direct trauma to a specific area or muscle. No history was given about his pre-injury function and previous injuries that affected the same area. The immediate actions taken by the reader, i.e. visiting a doctor, was correct and the doctor excluded the serious complication of a fracture. You are then left with a likely diagnosis of a muscle tear which can range from a grade 1 to 3 tear. Here I believe we are dealing with at least a grade 2 tear (torn muscle fibers but not a complete muscle tear) but possibly even a grade 3 (complete muscle tear). A diagnosis on the severity or degree of tear needs to made on clinical examination as well as an ultrasound of the area to look for the degree of muscle fiber tear and the integrity of the muscle. The swelling of the leg and ankle with bruising is a common finding as the muscle tear will cause bleeding that migrates downward under the skin from the injured area under the influence of gravity. The importance in confirming the degree of the tear is to help in developing a proper graded rehab program with the help of a good physiotherapist.

Initial management that should have been considered include the standard acute management of muscle injuries using the acronym RICE (Rest, Ice, Compression, Elevation) which had progressed to PRICE (Protection, Rest, Ice, Compression, Elevation) and more recently had a face-lift again to POLICE (Protect, Optimal Loading, Ice, Compression, Elevation). The reason for having added the “Optimal Loading” that complete “Rest” (immobilization), although beneficial in the short term, leads also to a de-conditioning of the muscle (weakness / tightness) and joint stiffness. Optimal loading i.e. not over doing and further injuring the muscle, also stimulates healing and can lead to an earlier return to sport or activity.

Rehab time for a grade 2 tear is anywhere between 2-6 weeks depending on the amount of fibers involved. A grade 3 tear can take up to 3 months of rehab to return to normal activity.

Information contained in this response should be used a general advice and guidelines and should never replace a thorough consultation and examination by a doctor. For further assistance and referrals, International SOS members are advised to call our Assistance Centre at 021-750 6001 (Jakarta) or 0361-710 505 (Bali).

My daughter is currently hospitalized in a small town in Kalimantan with a diagnosis of typhoid. They are awaiting the test results and have been treating her with a drug I'm not familiar with. She contacted typhoid once before in Africa, requiring an airlift and emergency abdominal surgery. I am perhaps too aware of the need to treat quickly to avoid peritonitis. Are effective antibiotics generally used as a first line offensive against the disease without waiting for a culture to return positive? Or might the facility bide its time?

As you may know, a confident diagnosis of typhoid requires a culture which takes several days and suitably equipped and reliable laboratory to perform this test. The region of Kalimantan which you describe has sparse medical resources. They would more likely rely on less accurate blood tests for Typhoid which tends to lead to an over diagnosis of typhoid and therefore over treatment. Suitable antibiotics are likely available in that region, but one must bear in mind the problem of counterfeit medications in this country which adds a further element of concern. All travelers to Indonesia should be vaccinated against Typhoid well before arrival.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I am a foreigner plan to live in Indonesia. If I were HIV positive, could I get treatment of HIV like retrovirus method? If so, how much would it cost?

Antiretroviral medication is not available in Indonesia. The tests that are required for the monitoring of antiretroviral therapy are also not easily available. If you are coming to Indonesia, we recommend that you bring enough medication for the entire duration of your stay here.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

Is it possible to get reliable DNA testing in Indonesia to prove parentage / paternity?

International SOS cannot comment on, recommend or endorse any of the tests currently available by mail order or being carried out in laboratories in Indonesia for DNA testing, as such an inquiry is of a legal nature not a medical nature.

Caution may be in order before going ahead with the DNA testing. In the first place, there are significant quantitative as well as qualitative differences in DNA testing, ranging from the so-called do-it-yourself home testing kits, to forensic DNA testing for the courts. There is a significant difference in the false positive and false negative results of tests across the range of reliability.

Secondly, and of greater concern, is the answer to the question "why am I doing the test?". Is the test being done to "prove something" to the person doing the testing or the person agreeing to be tested, or both... or is the test being done to reject the costs of paternity or impost the costs of paternity upon a thus-far unwilling party. The burden of proof is clearly different, especially if the case goes to court; and it has been noted that test results from one country will not be accepted in the legal jurisdiction of another country.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I have been wanting to find an English and Bahasa speaking doctor for pshychiatric theropy. Any recomendations?

Please be advised that it is very difficult if not impossible to find a psychiatrist in Indonesia with sufficient English language skills for adequate psychotherapy. Foreign doctors are not allowed to register here in Indonesia and cannot practice here. There are a limited number of expatriate psychologists here in Jakarta who could assist with such request if this is needed. They are listed here.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I am going to Indonesia in July/August and need some advice on Malaria tablets. I do want to take them as I get bitten a lot! Our planned itinerary: North Sumatra: 10 days Java and Bali: 12 days Gili Islands (off Lombok): 5 days From what I have read we need Chloroquine taken with Proguanil for Northern Sumatra which we must take for 4 wks after leaving. I also have read we need them for the Gilis as it is Chloroquine resistant. So I was planning on taking Doxi or Malarone. My issue: When I start taking Malarone or Doxi I will still be taking Chloroquine and Proguanil (as I have to continue for 4 weeks). Is it safe to start taking Malarone and Doxi while still taking Chloroquine and Proguanil? What are my options? Does Malarone or Doxi still work in North Sumatra? If yes, then I could do this. Although, I would prefer not to as Malarone is expensive. Hope you can help!

Thank you very much for your query. The principle of preventing malaria, is first to prevent from mosquito bites, using skin repellent, long trousers (instead of shorts), long sleeved shirts, and sleeping under insecticide treated bednets. This is important since this simple measure prevents from other mosquito-born diseases, like dengue fever and Japanese encephalitis.

Concerning the chemoprophylaxis - prevention of the disease by taking oral medication - and regarding the travel you plan to have, and unless you have specific medical contraindication (mainly pregnancy and renal function impairment), MALARONE® is the first option. You have to start 2 days before, continue during exposure and for 7 days thereafter. The usual dosage is 1 tablet daily. Main side effects are: nausea, vomiting, abdominal pain, diarrhea, increased liver enzyme levels; rarely seizures, rash, mouth ulcers.

Second option is Doxycycline 100mg daily. You should start 2 days before, continue during exposure and for 4 weeks thereafter. Main side effects can be: abdominal discomfort, vaginal candidiasis, photosensitivity, worsening of renal function tests in renal diseases, allergic reactions, some blood abnormalities, esophageal ulceration. Doxycycline is contraindicated in persons with an allergy to tetracyclines, during pregnancy, and in infants and children <8 years of age.

Third option is LARIAM® (Mefloquine). Mefloquine prophylaxis should begin at least 2 weeks before travel to malarious areas. The dosage is 250 mg base once weekly. It should be continued once a week, on the same day of the week, during travel in malarious areas and for 4 weeks after a traveler leaves such areas. Few severe side-effects have been reported including psychiatric ones: dizziness, headache, sleep disorders, nightmares, nausea, vomiting, diarrhea, seizures, abnormal coordination, confusion, hallucinations, forgetfulness, emotional problems including anxiety, aggression, agitation, depression, mood changes, panic attacks, psychotic or paranoid reactions, restlessness, suicidal ideation and suicide. Those are more frequent when using mefloquine at treatment dosage - not for prophylaxis

MALARONE® should be considered as the 1st option since it is usually very well tolerated. Another point is that you must choose one and only one medication that will cover all your destinations, and not mix different ones. Since chloroquino-resistance is mentioned in Indonesia, you should avoid any chemoprophylaxis plan including this drug.

Concerning the availability of these medications in North Sumatra, you should be able to find them, but you must be aware of the high proportion of fake medications in Indonesia. This is the reason why I would suggest you to get it before coming in Indonesia, or, once in Indonesia to get it in one of our International SOS clinic in Jakarta if it is possible for you.

For the final choice, I advise you to have a discussion with your treating doctor who will be able to adapt those recommendations to your specific case.

I hope that this information will be of relevant support to prepare your travel in this wonderful country!

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

We are planning to live in Medan with a 3 month old baby. We are wondering whether it is really necessary to give her a TB vaccination and Hep B vaccination at this stage or whether this can also be done when she is a bit older so that vaccinations are a bit more spread out. The risk for a young baby to get Hep B seems low, or is that not correct.

Tuberculosis is common in Indonesia and the BCG vaccine is usually offered to babies and children who will be travelling and living in countries where TB is a problem.

Hepatitis B virus is transmitted between people by contact with the blood or other body fluids (i.e., semen and vaginal fluid) of an infected person.

Children may also be infected by inapparent infection through close interpersonal contact with infected household contacts.

The WHO recommends that children in Hepatitis B endemic countries be immunized in early childhood and in Indonesia, Hepatitis B vaccination is part of the routine schedule for children at given at birth.

May we suggest that you discuss this with your family doctor so that a proper risk assessment could be done and the appropriate vaccinations provided.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I'm planning extended travel through Indonesia and I am a bit worried about being able to refill my narcotic-based prescriptions, should I need to. Can I get vicodine and other prescriptions refilled in Indonesia?

You will find the combination of paracetamol and codeine, and morphine sulphate easily in all central pharmacies in Jakarta and other major urban centres in Indonesia. Please be advised that the distribution and prescription of narcotic drugs is regulated very strictly by the Ministry of Health in Indonesia. For all opiates (codeine and morphine), medical prescription is mandatory.

Prescriptions for both of these substances would only be given for short or very short periods in Indonesia. You would therefore require frequent repeat prescriptions, if the local doctor is convinced of their necessity and willing to prescribe these medicines to you. We suggest you to bring your treating doctor's written recommendation, prescriptions and medical reports. This will facilitate the local doctors to give you appropriate prescription. The doctor would certainly need to know how long you will stay in Indonesia and where, and what dosage of the medication you require.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I was just wondering whether medical abortions were a possibility in Indonesia? I have a serious medical condition and my doctor has strongly advised me that right now is not a good time for me to have children. I would like to know my options, and would be very grateful if you could let me know if there is anywhere that you can go in Bali, or elsewhere in Indonesia, for an abortion.

Please be advised that abortion is illegal in Indonesia. You would need to return to your home country or a third country that allows abortion in order for the procedure to be done legally.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I will move to Jakarta this year. I was wondering if you could let me know where I can purchase birth control. What birth control options do I have in Jakarta?

Birth control methods that are available in Jakarta include: condom, birth control pills, IUD, implants, and the morning after pill. Condoms are recommended as the only protection against HIV and Hep B.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

We just had our son 3 years old vaccinated for BCG but recently we read that if a child is older than 3 months you should make a Mantox-Test first. Now my question is what if he was at the time of the vaccination already TB infected? And what medical steps have to be taken now?

If your son is not sick, you do not need to do anything. The Mantoux Test is a screening test for TB that detects if someone has already been exposed to the TB bacteria and has already build antibodies against it. If there are antibodies in the patient’s system, then the Mantoux Test is often positive. As it is only a screening test (not a diagnostic test) there can be false negatives and false positives. So even if your son had been tested before and the test would have been negative, this would not have been a guarantee that he had not been exposed to the TB bacteria and already had antibodies before.

The BCG vaccine is an attenuated life vaccine using the Bacillus Calmette Guerrain (BCG). This bacillus (or bacteria) has very similar features to the TB bacteria but is not the same.

If your son would have been infected with TB already by the time of receiving the vaccine, this would have not aggravated the disease, but would rather have enhanced his immune response towards the TB.

Please be advised that after haing received the BCG vaccine now, his Mantoux Test will always be positive (so no need to do it again). Also, with the BCG vaccine he will have the best protection against TB that is currently available.

I hope this helps to answer your question and is reassuring for you.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

My 4 month old son has recently spent 7 days in Pondok Indah Hospital and has since been diagnosed with asthma and TB. A Matoux Tuberculin test was done and 24 hours later the results showed an induration of 11-13mm. The pediatrician then suggested an x-ray which showed a build up of mucus in the lungs. The lung specialist then told me that based on the results of the test that my son has TB and will require treatment. It is worth mentioning that my son was admitted to hospital due to a high temperature of 40.2 as well as a cough. Over the time he was in hospital his cough became worse and the wheezing became more pronounced. The result of the blood culture was negative, as was the urine and feces test, although his white blood cell count was very high. Since leaving hospital he has been taken off all medication (on the recommendation of a pediatrian lung specialist practicing in Cinere) his cough has improved along with the wheezing. He continues to put on weight (as he did in hospital) and is very lively. He is certainly much happier than when he was in hospital. The doctor at PI is adamant that he has TB but I am worried that this diagnosis is wrong. I have also been told to allow x-rays for all my wife's family as well as myself. In the meantime I have asked for a re-examination from a qualified lung specialist from another hospital to be performed this friday afternoon at PI Hospital. I would appreciate any expert advice that you could give me concerning my son's case.

Tuberculosis can be very difficult to diagnose. There is no single blood or skin test which provides absolute proof of infection. Chest X-Rays are often helpful for TB of the lungs. Confirmation often rests with the identification of a positive culture of the bacillus or identification microscopically. The blood tests such as Quantiferon and others are not diagnostic and are used in conjunction with other TB tests.

The skin test which your child had can also be problematic. If your child had a BCG vaccination before, then a positive result (induration) can indicate a reaction to the previous vaccination. There is some concern because 10mm or more in a child under 4 can be indicative of TB. To further complicate matters – not everyone who has TB bugs in their bodies has a TB illness.

What should you do?

Ultimately we would have to recommend that you seek opinion in Singapore, which is very highly regarded in the international medical community. You will most likely end up spending less time and effort flying there than seeking suitably qualified paediatric specialists in Jakarta. It may not always be a skills issue, but a matter of communication between the doctor and patient which is sometimes problematic in Indonesia.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

In 1997 we lived in the vicinity of Ragunan, South Jakarta. We had several dogs, which were often bitten by ticks. On one occasion I found myself bitten and I developed a rash on my upper leg. I heard rumors of Lyme disease spreading through Europe, U.S., China, and Russia. Is it possible to get Lyme disease in Jakarta nowadays? Has there been any evidence in Java of ticks with Borrelia Burgdorferi?

We are not aware of any reported cases of Lyme disease in Jakarta, nor of ticks as vectors (carriers) for Borrelia Burgdorfen in this area. Should you have concern of possible previous tick borne infection, it is possible to have serological testing done for some of these infections, although the results may be controversial. These tests could be requested under the care of a physician.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

Do you know if and where they sell (reliable) nicotine patches in Surabaya or Jakarta?

Thank you for your query regarding availability of nicotine patches in Indonesia. Unfortunately, these patches are not available through recommended providers in Jakarta nor Surabaya. It may be possible to source this treatment from Singapore. International SOS procurement department may be able to assist with obtaining this, should you wish to pursue the matter further. The 24 hour contact telephone number is (62-21) 7506001

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I live in Bali and am also interested in having a vasectomy. What are your recommendations?

In general we do not recommend any elective invasive procedure, like a vasectomy, to take place in Indonesia. This is for the reason that Indonesian doctors and hospitals do not always meet international standards of care and of control of infectious disease. Complication rates are also higher in Indonesia. We do usually recommend these procedures to be done in the nearest centre of clinical excellence, in your case that is Singapore. Another option for you is to consider getting it done in your home country on your next visit there.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I would like to ask for the address and telephone number of abortion clinic in Jakarta. Could you reccommend and give me the safest clinic in Jakarta?

Firstly, there are no specific abortion clinics in Jakarta. Secondly, the Indonesian culture is very much against artificial abortions and it is illegal to perform an abortion in Indonesia. This means that you will have some difficulties to have a safe abortion done in Jakarta/Indonesia.

May we suggest you see your obstetrician/gynecologist to advise you according to the individual case/medical situation. They would need to determine the first the week of gestation of your pregnancy and then the further details from your medical history in general. Many issues must be considered when deciding where to send a person in her individual situation to have an operation done in order to be treated in an optimal way and to avoid complications that can be related to abortions. In general, complication rates (infections, bleedings...) are higher in this part of the world than in western countries.

Bring your medical files, medications, to your doctor and ask for a consultation for further information. It is possible that your ob/gyn could then discuss the further options of having it done abroad, e.g., Singapore or in your home country.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

My husband and I work and live in Banda Aceh and I've recently confirmed that I'm 3 months pregnant. I visited the Glen Eagles Hospital in Medan for pre natal care but have been advised by other expats that Singapore or Penang, Malaysia are the best options for delivery. Do you concur with this advice? Do you have any information regarding the pre natal care available in Medan at Glen Eagles? Although this is my first pregnancy, I prefer to stay in the region with my husband, unless complications arise. Thus far the ultrasound and blood test results are normal and fine.

Thanks for your request, we are happy to help you along with these kind of questions. As you understand there are mi lions of women delivering babies in Indonesia and in many cases it all goes fine. However, during pregnancy it is important to detect complications in an early stage and if they do occur that they can be dealt with correctly. Unfortunately it is not always possible to find out if the hospital of your choice has the appropriate standard of care available as you may not know in advance what facilities will be required. Singapore is considered to be the closest centre of clinical excellence, where all appropriate care can be given.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I have a 3-year-old daughter who was diagnosed by the doctor with Positive TB after a Mantoux test. Now she is on treatment for about 2 weeks to 3 months, as suggested. Can the disease infect other members of the family ? She has a 1-year-old brother who she likes to play with and she kisses him a lot. How can we avoid the infection's spread to other family members, especially her brother?

TB is most commonly an infection of the lungs an can potentially be contagious. The Mantoux Test though is a screening test only. It is used for this purpose worldwide. It should not be used as a diagnostic test. It can enhance the suspicion for TB together with other investigations like a chest x-ray and sputum or gastric aspirate analysis. The latter two tests should show a positive result for AFB (Acid Fast Bacillus = TB bacteria) in at least THREE (!) samples. I would not confirm the diagnosis of TB with the Mantoux Test only. If it is positive, it is an indication that the other above mentioned tests should also be done to confirm a TB diagnosis before you start treatment. If you or the doctors are not sure about her diagnosis, I would recommend that you take you daughter to the nearest centre of medical excellence to confirm it.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

Hello, We are currently living in bali for 3 months, and then returning home to New Zealand. We are considering trying to get pregnant while in Bali but are concerned that if I pick up a parasite or suffer form food poisoning it amy harm the fetus. Do you think I should be concerned about this and avoid falling pregnant in Bali and rather waiting until we return home to new Zealand or do you think I can stop worrying and go about conceiving.

Food poisoning or parasites are rather unlikely to cause a lot of problems for a fetus. This does not mean that they couldn’t, but the chances are low. There are plenty of pregnant women in Bali who do not have any problems with their pregnancies and deliveries. If you take general precautions like not drinking tap water and protecting yourself against mosquitoes and apply common sense, I do not see any problem for you and your partner to attempt conception in Bali. The risk for pregnancy problems in Bali is generally not much higher than in NZ. Enjoy your stay in Bali.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

What is the the availability of Insulin in Indonesia? I'm a type 1 diabetic and will require a regular supply.

Most usual insulins are available in Indonesia. If one specific brand is not available, an Indonesian doctor can replace it for an equivalent without difficulties. It is wise upon arrival to have a little stock because you will need time to settle and find yourself a doctor (International SOS has a diabetes clinic in Jakarta Cipete district - Dr Thomas is referent). Be aware when you change food, climate and habits, your insulin requirements may also change and a close monitoring of the capillary blood glucose is necessary until you get adapted to the new place.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

Hello, a close friend was recently diagnosed with "chikungunya" and I am very worried about her! I have read up extensively on this, but I find the info quite lacking! Are there any precautions you could suggest to help recovery, like foods to eat, meds to take, etc.? Thanks!

This disease is not uncommon in South East Asia, often it is misdiagnosed as Dengue fever since it presents similarly.
Body pain, fever, and sometimes abdominal problems are common. However, unlike Dengue fever, the patient does not develop a significant drop of blood platelets, and there is also no risk of a hemorrhagic shock like in Dengue fever.
The outcome is generally very good, symptomatic treatment to reduce fever and body ache is all that can be done. Normally the patient makes an uneventful recovery after 5-7 days, some patients however suffer from a prolonged period of fatigue afterwards. I hope you find this information reassuring; we are not usually concerned about patients with chikungunya in Jakarta, as they always recover with no problems. Unfortunately this cannot be said about patients with Dengue fever.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

Does Jakarta have any western trained psychiatrists or doctors that can effectively deal with mild to moderate depression or anxiety symptoms ?

There are no psychiatrists in Indonesia holding international registration. Mild depression can of course be treated in Indonesia by a psychiatrist or even GP at an International clinic in Jakarta. Outside Jakarta this should be taken with caution, and before agreeing to in-hospital care one need to consider treatment in your home country.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

After a recent visit to Bali I got very ill and I found out I have parasites. I am begriming to search for help in the USA. I'd like to know the name for the type of worm I have. They are in my sinuses and drip down to my intestines, then sometimes I'll pass an adult-sized jelly-like white oval shape with a very long noodle-like skinny tail, along with a rank odor like dead fish. Please help me if you know of a specialist I can consult.

Worms are not uncommon in Indonesia and usually quite successful treated with a medicine called Mebendazole. The description of the worm itself does not allow me to recognize the exact type, however, if you are able to send a digital picture of the worm we could ask a microbiologist from the local university for the name of the parasite. Treatment should start independent of that. What usually happens when you start taking the medication is that the worms will come out through the anus. They will not be dead and the fact that they are alive does not mean the medicine doesn't work. The treatment should be repeated after a week and this should clear up the problem.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

My family is moving to Africa and we need a Yellow Fever shot. Do you know where to get them in Indonesia?

Yellow fever vaccinations can only be given by authorized port health authorities and government authorities. In Jakarta the best place to have this done is at the airports. Here is the address, contact details and opening times for the offices that can administer yellow fever shots. Call first to make sure that they have the medicine in stock.

Cengkareng Airport, Jakarta:

• Port Health Service
  Tel. (021) 550-7989, 550-6068
  Monday-Friday - 09:00-14:00

Halim Airport, Jakarta:

• Port Health Services (ground floor near VIP room)
  Tel. 800-0166
  Monday-Thursday - 09:00 - 14:00

Kantor Kesehatan Pelabuhan:

• Kantor Kesehatan Pelabuhan Bali
  Jl. Pulau Moyo
  Denpasar, Bali
  Tel. 0361-729-287
• Kantor Kesehatan Pelabuhan Mataram
  Jl Adi Sucipto No. 13B Rembiga -
  Kota Mataram, Nusa Tenggara Barat
  Tel. (0370) 616-2145
  
• Kantor Kesehatan Pelabuhan Surabaya
  Jln. Perak Timur
  Perak, Surabaya
  Tel. (031) 329-3231

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I am thinking about a taking a job in Jakarta and I have had skin cancer. Are there dermatologists there that are experienced in this? I have had a malignant melanoma surgery three years ago and a squima cell surgery on my right arm three weeks ago. So I am concerned where would be a good place to go for general checkup.

If you are under surveillance for skin cancer, I would recommend that you keep the contact with your dermatologist back home, and have annual check ups there. This will ensure the highest level of continuity. If you are on any ongoing treatment, it could well be continued in Jakarta under the supervision of a local doctor. It is important to recognize the limitation of the medical system and to always consider second opinions for potentially serious conditions and invasive treatment. Singapore is the regional centre of medical excellence, and is the most common referral point for secondary care and second opinions from Jakarta. Travel from Jakarta to Singapore takes only 1,5 hours, the medical centers there are well prepared for one stop day patients from Indonesia.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I had typhoid 3 months back. Now I underwent Widal test. S typhi O & S typhi H are positive. What is to be done?

Typhoid fever is common in Indonesia, so common in fact that most people have developed antibodies through continuous low grade "background exposure". The test you are referring to is measuring these antibodies, and it could be considered normal in Indonesia to have titers of 1:80 until 1:260 (or even 1:320 in the absence of symptoms).

If you continue to have symptoms you may want to do a stool culture and a blood culture at Gleneagles Hospital in Medan. I would be cautious taking repeated doses of antibiotics, since the presence of antibodies alone does not mean you have an active infection. Persisting lose stools can equally be the result of antibiotic treatment.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

What causes recurrent typhoid? I live in central Java and my housemate has had 4 attacks in 12 months. The last was the most severe, with 40 degree fever and liver involvement. She has been treated by doctors and specialists with antibiotics, but it keeps recurring. She had another blood test last week after her latest course of antibiotics finished and her reading was reduced from 1/1280 to 1/640, so it is still present in her system. She doesn't know where to go from here, as it is getting worse, not better! Any ideas about further treatment or ways to boost her immune system? Doctors here only seem to carry out tests if you request them.

Typhoid is over diagnosed in Indonesia. The diagnose is not easily made, and the figures you referred in you email are those of a Widal test, which only indicates the quantity of antibodies, not the actual typhoid organism.

If a person has had a typhoid infection he/she will build antibodies, and keep a certain level for years after. (1:80, 1:160 and 1:360 would still be considered normal levels even through background exposure). The best way to diagnose typhoid is through blood culture, which will also help to establish sensitivity patterns. There are sub types of typhoid fever, and the infection with one does not necessarily give immunity to the others.

Treatment involves antibiotics, sometimes typhoid organisms are resistant to a number of antibiotics, and in Indonesia older and less effective medications such as Chloramphenicol is still used in some places to treat the disease. I would recommend to have further investigations with a Gastroenterologist in a centre of excellence either in Jakarta (national centre of excellence) or Singapore (regional centre of excellence).

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I will be working in Balikpapan for a short period. Is malaria endemic in the area? Should I arrange a course of malaria tablets?

Balikpapan itself is not Malaria endemic, but surrounding areas in Kalimantan are. It is therefore obviously still possible to get Malaria in Balikpapan. I would not recommend malaria prophylaxis when you are in Balikpapan, but recommend that you carry sufficient supply of ant malaria medications like Malarone for a 3-4 week course of prophylaxis, Equally important is the protection from mosquito bites, there are a number of effective measure, including chemical coils, mosquito nets, and skin repellents.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

How can I find an ob-gyn and specialist for infertility problems?

Fertility treatment in Indonesia can best be done at the Morula Clinic in Bunda hospital in central Jakarta. This has recently been upgraded and is now led by an Obstetrician - Gynecologist who qualified and worked in Australia for a long time.
The address is: Jalan. Teuku Cik Ditiro No. 28, Menteng, Jakarta Pusat

Some patients however, prefer to have fertility treatment in Singapore, where the service is offered at the Mount Elisabeth Hospital and also at the Thompson Medical Centre.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

My diabetic wife just came back from a checkup overseas and had her first of what will be twice daily Insulin injections. We have enough supply for about 30 days. Where is the best place in Jakarta to obtain a regular supply of Insulin?

Most of the larger pharmacies are able to supply the insulin, it is best if this is done on a pre-arranged base to avoid any shortages. In South Jakarta there is Melawi pharmacy in Kemang, but there are many more. Additionally to your wife's need of insulin, she ought to have regular reviews and adjustments of diet, insulin and assessment for possible complications. There is a diabetic clinic at the International SOS clinic in Cipete, run by a Dr. Thomas, that involves a holistic approach and management to diabetic patients. Prescriptions for insulin can be issued there. The address is Jl. Puri Sakti 10, Jakarta Selatan, Tel. 021-750 5980.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

We are moving to Surabaya with a two year old son. My wife is pregnant. We understand that the Surabaya International Hospital may be a good option for us for delivery. Our concern is that this is her second diabetic pregnancy. Her first was well managed with insulin. We hope to have a natural birth rather than a c-section which we have heard is common in Indonesia. Do you have knowledge of any English-speaking expat OBs or endocrinologists that could help us with these issues. I am also in need of information on the out of pocket costs of pregnancy and prenatal care at that hospital. Our international health coverage will not cover pregnancy within the first year of coverage.

Surabaya is the second largest city and the second centre of medical excellence in Indonesia after Jakarta. The International Healthcare of Surabaya hospital is a good facility, which has doctors with English language skills. It would be the best place to have your ongoing ante-natal care, an endocrinologist can be involved at that time by the gynecologist. To arrange an appointment you can contact the appointment desk of the hospital on +62-31-5993211. In regards to the delivery of your baby I would recommend to consider alternative options and to be aware of a few important points.

• Blood transfusions of rare blood groups in Indonesia may not be readily available, most Indonesians have blood group B-pos, A-neg. blood is uncommon. Additionally the screening of blood does not reach the same level as it would in the US. Therefore the remaining risk of disease transmission, esp.. Hep-C, is higher than in a first world medical setting.
• You are expecting a natural birth, as you are aware C-sections are readily performed in Indonesia. It can be difficult to "insist" to continue natural delivery if the Gynecologist is recommending C-section.
• Neonatal ICU care is not well developed in Indonesia, if your baby is in need of support, it may not be readily available and may not be at the standard of a US hospital. This is especially important to consider since your wife has a complicated pregnancy with diabetes.
• Although breast feeding is encouraged by the government and many hospitals, when it comes to support for this at the nursing levee you sometimes need to be rather proactive yourself to make things happen.our wife

With all these points in mind you should be able to make an informed decision as to where you and y wish to deliver. Some expatriates have their babies in Indonesia, but most commonly expatriates decide to have their babies in places like Singapore. This obviously has its own problems, since your wife has to arrive there below 36 weeks of pregnancy. You also need to comply with immigration and visa regulations, this takes around 3-4 weeks. If you deliver in Indonesia, you also need to be aware of the visa and immigration issues, as your baby would be regarded a foreign national and requires a staying permit. This has to be arranged within the first week after delivery, or you may be charged a penalty for illegal stay in the country.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I am a physician traveling with a group of scuba divers to Indonesia. We will be in Bali for several days and at the Wakatobi Dive resort on the island of Onemobaa in SE Sulawesi. Do you know the incidence of typhoid exposure in these areas? Would it be as effective to be aware of symptoms of typhoid illness and bring Ciprofloxacin instead of taking the fairly unreliable vaccine? Thank you for your help.

Thyphoid is ubiqutary around in Indonesia, and the exposure risk is high. Therefore the vaccination against Typhoid (oral or injection) is highly recommended. Although this does not eliminate the risk of an infection, we see that the course of the illness is a lot milder and carries less complications in vaccinated persons. Ciprofloxacin is the recommended treatment, we often see resistance to other antibiotics in Indonesia (Amoxicillin, Bactrim). Although Ciprofloxacin is available in Indonesia, I would recommend to carry a small amount to be able to start treatment without delay.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

My family members just tested positive for HIV+. Since no confidentiality is there in Indonesia, will the person be facing possible deportation? What is the best place to go in Jakarta/Surabaya? We need experienced doctors who can provide advanced medications. We are looking for access to HAART treatments such as those available in the US. Please help us refer to some qualified doctors who are highly experienced in treating HIV/AIDs.

In Indonesia HIV is still very much stigmatized, and virtually all specialized HIV centers have a main focus on risk groups like IV drug users and sex workers. Many Indonesian patients with HIV who do not fall into that group are taken care of by individual doctors, also in order to avoid publicity when going to specialized centers. HAART treatment protocols are not used in Indonesia; many of the medications are not available. We would usually recommend treatment abroad, and for HIV advise Bangkok as the nearest most suitable centre. Singapore has equally strict regulations for reporting positive test results, and coordination between health and immigration authorities is probably more organized there than in Indonesia. There is a theoretical risk that Indonesian immigration officials are becoming aware of the infection and would withhold further visas for expatriates. As per government regulations all laboratories are obliged to report positive cases to the Ministry of Health. However, there are a number of HIV positive expatriates living in Indonesia for many years.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I am coming to Indonesia for a 2-week holidays in Bali and Lombok and, referring in particular to my stay the latter island, I was suggested to start an anti-malaria treatment due to the endemic presence of malaria. What do you suggest?

We recommend Malarone as choice for Malaria prophylaxis. It is not available in Indonesia, and sufficient supply should be brought from your home country. For short term travel we also use Doxycycline oral, which has its limitations as it cannot be used by children and pregnant woman, and also increases a persons sensitivity to light.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I am coming to bali soon and wonder if I can get "Ventolin CFC Free Metered Aerosol 200 Dose 2" and also "Seretide Accuhaler 500/50".

Ventolin inhalers and Serotide inhalers are available in Indonesia, but they are not CFC free. Accuhalers are not available in Indonesia.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

A 27 year old Indonesian friend has just suffered a minor stroke leaving the side of his face paralyzed and his left arm suffering from shakes. He has started attending physiotherapy and massage. I would like to make sure that he gets the best treatment available. What treatments are available in Indonesia?

There is no specific treatment to improve the outcome of a stroke other than physiotherapy and exercise, to allow other parts of the brain to take over function that has been lost. In western countries there re a few rehabilitation centers specialized on this, but there is no such facility in Indonesia. In Jakarta there are rehabilitation specialized doctors, but their focus is not primarily stroke patients.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

We are from Holland and we live now for 7 months in Jakarta, Menteng area. We're expecting our first baby in September. I'd like to deliver the baby in Jakarta. Right now we visit the doctor in SOS in Cipete, but the doctor will not deliver the baby. Which hospital and doctor can you recommend in the Menteng area?

The importance is to select an obstetrician and not so much the actual hospital to deliver your baby. However, expatriates usually seek a doctor in either Pondok Indah hospital, Bintaro International hospital or Medistra hospital. None of these are located in the Menteng area. Also expatriates who consider delivering their baby in Indonesia should be aware of a few important points before hand.

Healthcare in Indonesia is not as patient centered as in the western world, supporting services and curtsey may vary significantly before, during and after the delivery. Medical complications are often not attended to the same way as in your home country. Indonesia has one of the highest rates of cesarean sections in the world, the indication for these are made very liberally, and it can be difficult to refuse the recommendation for cesarean section if you had initially planned to have a normal vaginal delivery. Complications of childbirth include post partum hemorrhage, which may necessitate blood transfusions. In Indonesia the screening of blood products is not done to the same extend as in Singapore or other first world medical settings. Especially the risk of Hepatitis-C transmission is not excluded to the same degree.

Neonatal intensive care in Indonesia is not as developed, and only available in a few hospitals. A transfer from the hospital where you deliver to a neonatal ICU facility can be difficult if the baby has severe problems following delivery.

Expectations in regards to baby care and nursing support after delivery should be discussed with the hospital in advance, especially requests for breast feeding and rooming-in need to be raised beforehand with the pediatrician and the obstetrician.

Apart from these medical considerations, there are a number of other factors to be included into a decision to deliver your baby in Indonesia or abroad.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I'm living on Sumatra. Are there any recommended places to have HIV blood tests in a major city on Sumatra?

It is generally not recommended to have HIV tests done in Indonesia. There is no anonymous testing and all laboratories are obliged to report positive cases to the ministry of health. Therefore the protection of privacy and confidentiality cannot be guaranteed in Indonesia if the test is positive.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

Well I have been taking these pills my doctor told me to take for a burn I had called cloxacillin. My burn wasn't really bad, it was just a little infected. I've been taking these pills, but my burn is healed. Can I stop taking them?

Any burn is at risk of getting infected. This is the case because the barrier function of the skin breaks down, and organisms find easy breading ground on the moist and warm wound surface. Provided there is no sign of infection in the surrounding tissue, treatment with antibiotics can be stopped when the burn wound has dried up and can be left without dressing. If in doubt, please have a doctor review the wound before you stop taking the antibiotics.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I came across this site when i was searching for a hospital in indonesia that is well-known for post acute management of burns. My friend has just had a skin graft on the leg and was discharged a few days ago. He intends to return to Indonesia to seek further treatment. Are there any recommendations on hospitals with specialized, dedicated services in burns area?

The hospital with the largest burn unit in Jakarta is RS Pertamina. That facility is reasonably well equipped, but not the recommended place for expatriate patients who require complicated burn care and skin grafting. The nearest regional center of excellence would be Singapore, which can be reached through a 1,5 hour flight from Jakarta. Uncomplicated wound review and dressing can as well be done in a primary care facility like the International SOS clinic in Cipete.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I plan to move to Indonesia from the US with my husband, and I am supposed to deliver a baby in Jakarta. It is my first delivery, and I would prefer to have painless delivery (I do not know the exact name/This method is common in the US), which use drugs/medicines to hasten labor. I would like to know whether any hospitals in Jakarta have painless delivery system, since in Japan, mothers usually have natural painful delivery. If not, could you recommend other hospitals for me? I am a native speaker of Japanese, and I am also basically comfortable in English.

In general we recommend that expatriates consider having their childbirth in their home country or consider delivery in Singapore. There are however expatriate women who feel very comfortable to have their babies in Indonesia, and if everything goes well, there is no problem with that. These are usually women who live in Indonesia for some time, and know the language as well as the medical system here quite well. Preferred providers are Pondok Indah hospital, Bintaro hospital and Medistra hospital. However, more important than the hospital is the treating doctor, since specialists usually work in more than one hospital. This can also mean that your doctor may not be there when you require his assistance while he is practicing on another clinic. In Indonesia many women receive cesarean section, the indication for this is given very liberal here. Pain relieve through epidural anesthetic or spinal anesthetic is still not very common, but some doctors are offering the service, which will be administered by an anesthetist, who may also not be present at the hospital all the time. If blood transfusions are required, the screening of blood as well as the availability of A-negative blood group donors is not as reliable as in Singapore. International SOS is not an in-patient clinic, and we do not offer delivery of babies here.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

My husband may get a transfer to Bali this year. The thing is, we are also planning to try for a baby later this year, which means we may be in Bali when I am due, which worries me a little. Has anyone, or do you know of anyone who has given birth in Bali? How good are the hospitals? I've also heard that people chose to move to Singapore a few weeks before due date to deliver there, but as husband cannot stay with me for all those weeks, I would be totally alone as I don't know anyone. I also wonder if I need to stay in a hotel in that case until delivery is close, which will cost a fortune.

It is not recommended to have your baby in Bali, since the medical facilities there are to deal with unexpected complications are limited. It is recommended that you either deliver in Singapore as you have mentioned, knowing the downsides of that in terms of accompanying partner. Usually women are traveling to Singapore before 35 weeks of pregnancy, provided all has been uncomplicated up to that time. After 35 weeks commercial airlines will not accept you anymore. This would mean that you stay around 5 weeks in Singapore, a service apartment may be a cheaper and more comfortable alternative to a hotel for that period of time.

Antenatal care can be done in Bali at the International SOS clinic in Kuta, we have also been able to assist couples with their paperwork in order to deliver in Singapore. Alternatively many women decide to deliver their babies in their home country, which allows then to have family support until delivery, and the partner then follows closer to the actual date.
Having said all this, there are some expatriate women who were happy to deliver in Bali, these were all uncomplicated deliveries and with experienced mothers.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

Tonight we discovered what looked like white worms in our eight year old's stool. He has been complaining of itching in that area for the past few days and the feeling of needing to go to the toilet for #2. Referring to a medical book it would appear that Ovex is recommended - is this correct? Is it available in Jakarta? Can this be bought over the counter or do we have to visit a GP? What do you recommend? Does the whole family (parents + 8 year old + 4 year old ) have to be treated, just in case? OK

Worms are a very common finding in children, especially when you are living in the tropics. Some doctors therefore recommend to do regular "de-worming" therapy with all children, using Mebendazole (the active ingredient in OVEX). I recommend that you are seeing a GP for a prescription and treat the whole family, the drug is available in Indonesia under the name VERMOX (syrup and tablets). After you took a single dose, you often see a number of worms leaving the bowel through the stool, this is normal and does not mean the drug hasn't worked. If after 2-3 weeks you still find worms in the stool a second dose is recommended.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

Is there reliable advice available for people with Multiple Sclerosis who wish to move to Bali or other parts of Indonesia (for example, it is advisable to make such a move? I have MS but am relatively symptom-free.

MS is not known very well in Indonesian medical cycles. We have in the past had patients in Jakarta, who managed to keep their condition under control. They also had to travel to Singapore a few times for medical care. It is not necessary to avoid travel in Indonesia, but advisable to keep a small stock of medication with you. Medical facilities in Jakarta are superior to those on Bali, and it is unlikely that any hospital there has any experience to look after MS patients.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

We are a planning to relocate to Jakarta with a 6 months old boy with Down Syndrome. We would appreciate any advice and information regarding the possibilities of finding competent physiotherapist and speech & language therapist. Are there any chances to find good specialists that could help our little boy get the necessary early education?How about mentality on this issue?

Unfortunately Children with special needs do not have access to the same extend and quality of care as in Western countries. Over the past years there has been some development, and a new center for children with special needs has opened. However, these services are aimed at Indonesian children, and the therapists speak mainly Indonesian language. The language issue is often most difficult to overcome for parents.

Below is the contact of a clinic in Jakarta which offers a team approach with a pediatrician, psychiatrist, behavior therapist, psychologist and speech therapist, as well as physiotherapist. Pella Clinic, Jl. Pella Raya No. 09 - Jakarta Selatan, Telp. 021-726-2849.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I have a question about a possible false-positive test for typhoid. I and two Indonesian friends of mine ate at a restaurant in West Jakarta and within hours I developed abdominal gas and bloating which progressed to frequent diarrhea (a few times every hour). I then had a sudden fever and felt very weak and dehydrated despite drinking lots of water. I was hospitalized at RS Permata Hijau for five days and given IV fluids (Ringers injection) and medication (although I refused all meds due to multiple drug allergies and the doctor said I'd recover without the medication, but it would just be worse and take longer). The doctor said it was probably dysentery, although I had no bloody stools or mucus, but the stools were pale. Tests were run and I tested positive for Salmonella Typhi types 0 and H with a 1/160 titer. They took another test the next day and I tested negative for S. Typhi. The diarrhea lasted about five days and I was weak the entire time but I had a good appetite and the fever disappeared after day two or three. My question is: Did I have a false positive result for Salmonella Typhi O and H? This happened in February and since then I cook all foods at home and boil them to be extra safe.

It is possible that a Widal test is false positive, but more likely is that you have a false negative test. A Widal test is testing for a level of antibodies, since we have in Indonesia a continuous "low-grade-exposure" to the Salmonella Typhoid organism, we are all more or less expected to have some antibodies. Therefore the diagnose of Typhoid cannot be made based on one Widal test, unless the titer is very high. To make the diagnose it usually needs repeated tests to demonstrate an increase of the titer, and even that is not 100% proof of the disease. The culture of the organism from a blood sample only can give a 100% confirmed diagnose.

In your case it would not be possible or useful to do a blood culture after you have recovered. It is a good idea to increase the level of food hygiene, but in long terms may be quite difficult to sustain. We usually recommend to do a medical check up with stool tests for all food handlers at home, in order to ensure that none is a carrier of Salmonella Typhoid.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

Our family doctor has recommended that we get immunized against rabies before we move to Indonesia, in addition to Hep. A+B and Typhoid. Is it really necessary to have a rabies vaccination if residing in Jakarta and occasionally traveling across Indonesia?

Vaccination for rabies is not generally recommended, unless you are planning to live in very remote locations, where you don't have any access to a post exposure vaccination. At both International SOS clinics in Jakarta and in Bali Rabies vaccines are available, these can be effectively administered up to 72 hours after exposure. It is important to adhere to general precautions and avoid touching wild animals (i.e. monkeys and stray dogs). Domestic animals should be vaccinated if they are also going outside.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I am temporarily in Australia to give birth. I would like to return to Jakarta as soon as possible after the baby is born. Can you see any problem in returning to Jakarta within 4-6 weeks. I have been told that I may be exposing my baby to tuberculosis ... is this an issue?

There will be no problem for you to return to Indonesia at 4 - 6 weeks post delivery if the baby is fine and there are no medical issues. Babies are fit to fly one week after uncomplicated term deliveries. So if you really wanted to you could return earlier but it would be a good idea if you have the time to get the baby through the first month where you have the backup of very good medical facilities.

If you are living in Indonesia you would be strongly advised to have your baby vaccinated against tuberculosis. This is not done in Australia as there is a very low incidence of TB, but in some developing countries it is compulsory for all newborn babies to have BCG at birth. If you cannot get it done in Australia it is advised that you include this into the baby's vaccination schedule as soon as possible on your return to Indonesia.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I would like to know whether you can recommend a good place in Jakarta for me to undergo diagnostic hysteroscopy and possibly make some tests to check my hormones. I am suffering from primary infertility, and I already made some tests in Europe and am taking progesterone supplements right now. Is there a good infertility specialist available in Jakarta? Thank you so much for your much appreciated help.

Infertility screening can be carried out here in Jakarta, but given the highly technical and scientific details of this rapidly progressing speciality, the success rate may not be the same as it would be in a country where ongoing research and development in this field are carried out.

In addition, as I am sure you are fully aware, this is an emotional and sensitive subject with major psychological impact on an infertile couple, and there will certainly be many cultural and language issues that will need to be dealt with locally.

Ideally it would be good to go to a specialist in a centre that deals with infertility on a regular basis and is involved in latest developments and techniques, particularly if you have already had some investigations done in Europe where this field of medicine is fairly advanced. The higher the success rate of the centre the lower the stress involved for the couple as well. In Jakarta you could contact the Morulla Infertility Clinic.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I spent the summer in Bali and the Eastern Islands of Indonesia and came home on the 5th of August. About 3 weeks ago I began having serious fevers and then took some medicine for the flu, the fevers subsided and returned about 4 days ago. I found out today that I have malaria and was perscribed 5 pills of 250mg each of Larium to take in one day. How long will it take to get well from malaria after taking the medicine and what other effects, if any, should I anticipate for the future? During the healing process should I do abstain from anything in particular like physical activities or anything like that? Thanks!

It will depend entirely on what form of malaria you had, how severe the attack was, and whether you have had sufficient treatment for that particular strain or not. Each person responds differently to the illness process and treatment so it is difficult to say what the

long term effects are going to be and whether or not you will suffer relapses. However, if you have been treated appropriately and you recover sufficiently well the recuperation period may be quick and if the drug is well tolerated there should be no long term problems. It is probably best that you deal with an infectious diseases specialist who is familiar with malaria and its treatment to advise you should you have any side effects or problems related either to the disease itself or the medication.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I will be working on an offshore vessel just off Pagerungan Island in Indonesia during the November- December period and am wondering about the risk of contracting mosquito borne disease and what precautions I can take.

Most of the individuals working offshore on rigs are probably not taking prophylaxis against malaria. Having said that, mosquitoes theoretically can fly for five kilometres and you may also need to transit through an endemic area on the way to your station. So the decision will depend on you personally and also on the company policy with regards to prophylaxis - there are no hard and fast rules.

Most importantly is to avoid getting bitten so ensure that you have insect repellent and you observe all the tips and hints that are available in the article on Dengue and/or malaria on this website.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I have to spend the next two weeks in the Krakatau steel plant in Cilegon. I am a little confused because some people present on site are taking anti-malaria treatment (nivaquine) and others not. We don't have in our company a real politic around medical prevention for people going to this site. Can you please advise me: Is an anti malaria treatment useful in that area?

Most areas in Java are malaria free and if cases do occur in Cilegon then it will usually be due to travel outside of the area to a malarious area - so it may well be that persons on malaria chemoprophylaxis in Cilegon may be using it for travel to other areas.

However, there has been a major resurgence of malaria in areas previously free from the disease, although I do not personally know of any cases in the Cilegon area. It would therefore be recommended to take the necessary precautions to avoid being bitten by mosquitoes. Remember also, on your return to you home country to seek medical advice for any flu like illnesses, and to give your physician a detailed travel history if necessary.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I am looking for information on the brands of low dose combined oral contraceptives (the pill) commonly available in Jakarta, Indonesia. As I know that the pill is not the contraception of choice in Indonesia (but it is mine), I would like to know what brands (with specific estrogen+... composition and dosage level) I will be able to obtain in Jakarta. Also, are the available pills locally produced or imported? If locally produced, are they of good quality? (I remember a recent article claiming that 30% of all drugs available on the Indonesian markets were fake). Are the COC also affected?

There are many oral contraceptive pills available in Indonesia and they are similar to those found in most other countries around the world as they are manufactured by large multinational pharmaceutical companies. As long as you are purchasing products from a well-known pharmacy outlet and the products are manufactured by one of the companies like Schering, Wyeth-Ayerst or Organon then the quality should be good. Remember that no oral contraceptive is completely 100% safe anyway. All of the common brands such as Marvelon, Mercilon 28, Microgynon, Nordette-28, etc. are available locally. It is advised that you consult with a good gynaecologist who is familiar with the needs of expatriates, particularly when it comes to providing contraceptive advice.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

Where, in Jakarta, can you have psittacosis (on a human) diagnosed?

Psittacosis is apparently very rare in Indonesia and the diagnosis is usually made on a good history of contact with birds and on clinical presentation. As it is easily treated I am sure that most cases would be treated here empirically (as elsewhere in the world) without a definite diagnosis being made. Prodia laboratories do not perform the serological tests here and the samples would need to be sent to the USA for analysis. I am sure that arrangements could be made for testing to be done in Singapore but this would need to be verified with the pathologists there beforehand.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

What about Japanese encephalitis in Bali? I'm planning a trip to Bali with my children and I'm worried about because I heard 54 people reported sick with this disease. Should we go or cancel our holiday?

In certain areas of Bali, there is a risk of contracting Japanese encephalitis through mosquito bites, recently there has been a increase in reported infections with the disease.

The risk for travellers depend very much on the kind of activities, and the length of stay. Outdoor activities or camping around remote rivers and lakes at dusk carry the highest risk, whereby walks in the countryside, beach activities and sightseeing in or around more urban areas bare little risk of infection.

For short term holiday travellers, it is not recommended to take Japanese encephalitis vaccine. As the number of JE infections reported are still low, we don't advise to cancel holidays in Bali because of the remaining low risk. However, if you plan to engage in some of the activities associated with higher risk of infection, you need to make a risk benefit analysis for each member of your family.

In any case you need to take common precautions to prevent mosquito bites, as other diseases, such as Malaria and Dengue fever are also transmitted through mosquitoes.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I will need physical therapy after having surgery on my left foot next month. Is there a Registry or Organisation for qualified/accredited physical therapists in Jakarta? Can you recommend one or more physical therapists?

I am not sure of an Accredited Board or Registry for Physical Therapists but we have contacted one of the rehabilitation specialists that we use locally. She advised that there is a physiotherapy clinic at Sasana Husada in Jl. Kyai Maja No 19, Kebayoran Baru. (Phone 7222410 / 7256628). But there is no rehabilation medical doctor there and only the physiotherapist.

Normally in Indonesia patients are assessed first by a Rehab Doctor (Dr. Penny in this case) before they undergo therapy. Dr. Penny practises at Fatmawati hospital, Bintaro International and Mitra Keluarga Jatinegara. Alternatively International SOS has a physiotherapist at their Kuningan Clinic and they also utilise the Department at Medistra hospital that has an excellent rehabilitation physiotherapist.

It is important that you get a detailed report of what physical therapy will be required so that there is no confusion about what needs to be done locally.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

I am moving to Jakarta with my husband and two children aged 5 and 8. My daughter who is 5 suffers from asthma when she has a cold or chest infection. She is also allergic to penicillin. My daughter takes Flixotide Junior Accuhaler (Fluticasone Propionate) as a daily preventor and Ventolin when required. I presume Ventolin is readily available but is the Flixotide available? Also, do asthma sufferers find it difficult living in Jakarta because of the atmosphere? We have had inoculations for Hepatitis A & B and Typhoid. Is immunisation against TB recommended?

In reply to some of the questions relating to asthma and asthma treatment in Jakarta I can provide you with the following information. Certainly pollution does have an effect on children with asthma but this will largely depend on what the causative mechanism is for the asthma. I have found that some children who get asthma from particular allergens such as grass pollens, house dust mite, dust, etc. do better here despite the pollution, because of the lack of the allergen that causes their illness. Other children can have exacerbations because of a combination of factors. So it is difficult to predict whether your child is going to be negatively impacted or not. It is important however, wherever you are, that you keep a constant supply of the medication available at all times.

Although Flixotide is available here, it is only available in aerosol inhaler form and not in Accuhaler form so it is important that you bring sufficient quantities with you in addition to a letter from your treating doctor. Ventolin is freely available. If you would like to use inhalers instead of the Accuhaler, get a spacer device from your doctor as these are just as effective if used correctly. Your doctor or pharmacist will be able to assist you with this. Flixotide inhalers are available in 50 and 125 microgram dosages.

With regards to BCG vaccinations you should discuss this with your family doctor or a travel medicine practitioner. In general, as Indonesia is an area with large numbers of TB cases, it may be advisable to have your children vaccinated particularly if you are going to be living here for an extended period. Alternatively or in addition to that it may be a good idea to have your house staff in Indonesia tested to exclude any active cases of TB that may be in close contact with your children on a regular basis.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

My youngest son (10 years) suffers from mild Cerebral Palsy and requires the use of Crutches and the use of ankle splints to get about. At present his treatment is physiotherapy once a month, and a referral to a orthopedic specialist once a year, or splint clinics as required. My question is It possible to get referral to a local medical centre to get a local orthopedic and is it possible to get ankle splints and physiotherapy in Jakarta. If you could also let me know the likely costs of a consultant and splints if known I would be most grateful. My son does not require any further treatment for his Cerebral Palsy other than his physiotherapy and ankle splints.

It would be best if you arrange to see an orthopedic surgeon in Singapore for your son's ongoing care - so it would be important for you to discuss with the company. This could be done over the weekend so as not to interfere with his schooling. The splints could also be manufactured there and sent through to Jakarta without any problem. There are medical organizations in Jakarta that will be able to recommend and help to make the necessary arrangements for you, and as it is not going to be too regular it would be best to see someone well qualified in pediatric orthopedics in Singapore.

For the physiotherapy, as long as it is not too complicated, there are some good facilities available locally that can be utilized.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

My daughter is 1 year and 3 months old and is suffering from spina bifida and hydrocephalus. She has had 7 operations. Doctors have recommended we give her physiotherapy exercises as she is paralyzed below the waist and cannot sit. To enable her to sit we have to take her to a professional physiotherapist, but I am unable to find one in Jakarta. I would appreciate it if you could give me addresses of a good physiotherapist with all the required equipment. I want to start her therapy immediately.

Although facilities for this type of rehabilitation and ongoing therapy are limited in Jakarta, International SOS has contacted Dr Peni, who is a rehabilitation specialist doctor and have informed her of the background of your case. She says that she is able to manage this type of case at Bintaro International Hospital (021) 745-5500. International SOS refers a number of patients to this specialist for rehabilitation.

Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.

Am moving with family to Java for a least a 6-month stay in the Pelabuhan Ratu area. We will travel through to Jakarta time to time. Is paludrin/progaunil available commonly or only in Jakarta (if at all) and are there generic brands sold. I am opting for chloroquine/paludrin (progaunil) least side effects.

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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 adviser.

Last updated April 8, 2019.