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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!
Q I have been having ongoing issues with diarrhea and gas and pain and discomfort in my stomach, I have had stool samples taken over 4 times to check for intestinal parasites but keeps coming back negative, but I am sure I have worms on my stomach, can you recommend any other testing I could take, like blood tests or such to screen for worms, and recommend medicine.
A Although deworming is not routinely done in adults, deworming medications can be prescribed by GPs and the medication is available in most pharmacies. Common ones available are Albendazole or Mebendazole.
I would not recommend unnecessary additional testing unless you have experienced unexplained weight loss, blood in stools, persistent abdominal pains or there is strong family history of gastro-intestinal conditions.
For milder symptoms of bloating and diarrhea, you can get over-the-counter Attapulgite or activated Charcoal from most pharmacies. You may also want to try supplementation with probiotics see if the symptoms will improve. Just make sure you take the Attapulgite or activated Charcoal as per instruction.
Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.
Q My 11 year old daughter is travelling to Indonesia. She will be in Bali and then drive to Dampar and Surabaya in East Java. What are the Malaria and Cholera risks?
A I have also included some information about recommended vaccinations for Indonesia.
You should check if your daughter’s routine vaccinations are up to date (polio; varicella; measles, mumps and rubella; tetanus, diphtheria and pertussis). If possible, see a travel health practitioner 6 to 8 weeks before departure for destination-specific health advice.
With regards to your daughter’s trip, there is no malaria in:
- Cities of Jakarta and Ubud
- Main resort areas of Bali or the island of Java
Cholera Oral vaccination is recommended for travelers who are likely to encounter unsanitary conditions, or will have limited access to safe water. These are the conditions more commonly associated with cholera outbreaks. Vaccination is not 100% protective, and hygiene, food and water precautions must still be taken.
Hepatitis A is recommended for all travelers and expatriates, especially:
- For long-term or frequent visitors.
- For adventurous travelers who travel to more remote locations or stay in areas with poor sanitation.
Hepatitis B is recommended for all travelers and expatriates.
Rabies should be considered for certain travelers, especially:
- For expatriates and long-term visitors.
- For children who tend to play with animals and may not admit to being bitten or scratched.
- If you are travelling to a location where quality medical care may not be available immediately after being bitten/scratched by an animal. (Unvaccinated people need immunoglobulin within 24 hours of an animal injury, and this medication is scarce in some countries. If you are pre-vaccinated, you do not need immunoglobulin after an injury.)
- If contact with dogs, monkeys or other potentially rabies-carrying animals is likely.
- Jogging increases your risk of dog bite.
Typhoid fever is recommended for all travelers and expatriates.
Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.
Q I recently was scratched by my neighbor’s cat on the hand, the scratch wasn’t particularly deep but did draw blood. I went to the hospital and they gave me a course of anti-rabies vaccines, however they said there was no need for immune globulin. I can’t find any material online to support this decision to hold out on administering IG. What should I do?
A If it was your neighbor’s cat, please check if there are rabies vaccination records for the cat. If yes, there is less of a concern, besides the usual risk of bacterial infections which can result from cat scratches and bites.
If the scratch was a consequence of provocation (playing with cat / rubbing its tummy provoking a normal response of scratching and biting) then this is considered normal behavior and not that of a cat which is behaving aggressively as seen in animals with an active rabies infection.
If you have not been previously vaccinated against rabies and you have sustained a bite or deep scratch then, per protocol (CDC / WHO) Immunoglobulin is recommended and this is what knowledgeable doctors will tell you.
Is there rabies in Jakarta in the first place: No reports of cases in recent past. The rabies risk is much lower in Jakarta, but we can never be certain.
Bali - yes, it is endemic and dozens of cases per year.
What to do: Strictly speaking the lowest risk option is to travel to Singapore to obtain the very expensive IG and before 7 days after the scratch. The IG has not been available in Jakarta for a few years now.
You will need to make the decision. Formally, IG is recommended even though your rabies risk is likely infinitesimally small. You may come to one of SOS MEDIKA clinics to discuss this in further detail.
Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.
Q I want to have a mammogram (+/or ultrasonograph) after finding a lump in my breast. What is available in Indonesia for breast imaging? How up-to-date and reliable are the technology and personnel? Should I go out of the country for this?
A There are a multitude of modern facilities in Jakarta which utilize up to date equipment.
Option 1) Many expatriates elect to have imaging done locally for screening mammography or ultrasound and then decide to go abroad for further evaluation by a breast specialist if an abnormality is identified. This a practical option.
There remains an element of inconsistency locally in terms of the quality of radiological interpretation, but this is more evident in complex cases.
Option 2) The lowest risk option is for you to consult a breast specialist for a physical examination followed by imaging based on the clinical findings. There is a higher degree of reassurance by having such evaluation done in Singapore.
Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.
Q My husband and I moved to Bangka Island with our son, now 7 months old. The vaccination schedule for our home country and Indonesia is not exactly the same and especially the BCG vaccine is worrying me. Should we have our son vaccinated or not? I am not sure how big the risk is and/or whether or not the vaccine has any negative impact on him. Can you please advise us on what to do? It would be a very big help!
A As per my understanding, the baby has never been vaccinated for BCG and he should have got it after birth, per CDC guidelines. So we recommend to have him vaccinated, at earliest convenience.
Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.
Q I am probably going to be moving to Indonesia soon. I have type II diabetes, but not on insulin. I need to take Metformin regularly. Is that medication readily available in Bandung? I also take a couple of natural supplements that help with regulating blood sugar levels. Are there any good vitamin & supplement stores in Bandung?
A Metformin is available in Indonesia, mostly on 500 mg strength presentation. Regarding natural supplements, there are many chains of pharmacies where you may find them.
Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.
Q Most dermatologists seem to be associated with beauty/gender clinics. My daughter has severe acne, and I want to see a doctor, not a quack pushing various lotions. A recommendation would be much appreciated!
A We have Dermatologist services at the SOS Medika Clinic. Please feel free to contact SOS Medika Cipete Clinic for our Dermatologist's availability. You can reach the Clinic on +62 21 7505980
Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.
Q I was in Borneo about ten days ago. While hiking through the jungle, what I thought was a leech got onto my lower leg. As I quickly moved to knock it off, I thought I saw the creature go right through my skin and disappear inside. I had no cut before and there is absolutely no mark where it happened. I probably knocked it off onto the ground, but the memory is still bothering me, thinking I may have something parasitic inside me now. So, is it possible that something passes right through my skin without leaving a mark? I have no symptoms and feel healthy, but the lingering image of what I thought I saw is disturbing.
A I have read the description of your incident and would like to give you some feedback to reassure you that nothing serious may happen.
Leeches are not dangerous. They do not cause serious physical harm to people as they really don't take much blood from their host, and it has been reported that they do not transmit human diseases.
Because they are blood sucking creatures, they attach themselves to your skin and will attempt to burrow into the tissue beneath to feed off your blood. Although unpleasant, a leech attaching itself to an arm or leg is not going to do much more damage than cause a puncture wound.
The biggest dangers from leeches are if they enter your body via your nose or mouth - the most common way they can do this is if you’ve drunk infected water.
Although sometimes blood may be visible at the site of the wound, leeches do not generally transmit blood parasites to humans.
Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.
I have been told by some people not to eat lettuce and leafy vegetables raw because of the possibility of amoebic parasites. Others say it is okay. I wonder if a light chlorine soak would rid the vegetables of this problem? If so, what would be the quantity per water. Also, someone mentioned Milton sterilization tablets and I wondered if that would kill these parasites? (1/2017)
Please consult these Medical Notes on Amoebic Dysentery for further information on best practices.
Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.
Our son was bitten by a monkey in Java, at G-land Surf Camp. The monkey has bitten several people in the last two months. Someone killed its baby and it has been attacking staff and surfers. Are there known cases of rabies in Java? (8/2016)
Whilst we understand the risk of Rabies in Bali is high, we do not have precise understanding of Rabies in the wider Java region. We believe the risk to be lower (than Bali) but still qualifies as ‘High Risk’ in world terms according to the World Health Organization. We would recommend reading the WHO guidelines .
In addition, we know that monkey bites in Bali carry a risk of Herpes Virus transmission also and in such cases we usually recommend administration of anti-viral medicines as well as anti-rabies.
Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.
I have had the first tranch of post bite rabies jabs, and have been told I need a follow up in one week and then three weeks later. I shall be in Lombok a week after the first injection and hope that there is a medical fascility there that can provide the injection? We plan to be in Lombok and Flores for 12 days so would only be able to get the second one in Bali 2 weeks after the first. Would really appreciate your advise. (8/2016)
I understand you already received the first twi injections of rabies vaccine, and you were not vaccinated before the exposure. Did you also get Immunoglobulines? It could be indicated. The recommendation are: to get rabies vaccine at first day, day 3, day 7, day 14, and day 28.
We checked for rabies vaccine availability: at the time we called, we were told that there is one vaccine in Lombok, at Islam Hospital Jatiwarga, MALARAM. There is no other place where vaccine could be available in Lombok, and no place in Flores. I would advise you to secure this vaccine as this is the only one: please liaise directly with this hospital to be sure you will can receive it. The phone number is 0819-07522525. If I may assist you better, please let me know.
Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.
My daughter in law was in a serious motorcycle accident and had several tendons in her foot repaired by surgery. The hospital is suggesting a week long stay will be necessary to ward off infection. This seems longer than the US but is that standard protocol for Indonesia? Are oral antibiotics effective enough for her to travel home? (8/2016)
It is very common to have much longer hospitalizations in Indonesia. The duration of inpatient stay is determined by the treating doctor. For injuries as you described it would be common practice to give intravenous antibiotics initially, followed by oral antibiotics a few days later. For a long transcontinental flight it would be ideal if she could keep her foot elevated for most of the flight, if travel is planned within the first week or so after surgery.
Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.
I will in Bali next month and want to have a back up plan if my pacemaker has problems, its nearly at its end of life. Can you tell me if there is anywhere that can check a Medtronic pacemaker in Bali? (7/2016)
We have checked with our referrals staff in our Bali Clinic, and please be advised that Doctor Gunadi, a cardiologist at Sanglah Hospital, Denpasar, can deal with Medtronic pacemakers. We hope you won't hae the need to see him during your visit, and wish you a nice stay in Bali.
Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.
I see a lot of queries about malaria and pills, however will really appreciate it if you help me on these questions: 1) Can I just not take Malaria pills at all if I go to Bali 8 days, Gilis 8 days and Lombok 8 days (3 days of trecking to the volcano). What do people who live there do? Some pills cannot be taken for more than 28 days and my trip is more or less that many. 2) Do I need a japanese encephalitis vaccine at all for these areas - lots of contradictive opinions on that, and 3) Can I go without hepatits A vaccine? I live in Spain and just realized that although it is a month before the trip I cannot get a doctor's advice ASAP and need to wait until the end of the month. Vaccines are hard to find and some of them are not supplied in the country. I have my trip booked but no specialized doctor can meet me. Would really appreciate your opinion on if I can just travel to Indonesia without any vaccines? Thank you in advance for your help.
For your trip in Indonesia, please be advised as follows:
- Hepatitis A - vaccination is recommended for most travellers, including those with standard itineraries and accommodations.
- Malaria - There is a low risk of transmission in Lombok and Gilis islands. The malaria species are plasmodium falciparum and plasmodium vivax, with a drug resistance to chloroquine. The international recommendations are to use a chemoprophylaxis: atovaquone-proguanil, doxycycline or mefloquine.
- Japanese encephalitis - recommendations are as followed: Vaccination is recommended for the following groups:
- Long-term travelers (i.e., trips lasting a month or more) to endemic areas;
- Short-term (<1 month) travelers to endemic areas during Japanese encephalitis virus transmission season if their itinerary or activities will increase their risk (e.g., spending substantial time outdoors in rural or agricultural areas; staying in accommodations without air conditioning, screens, or bed nets.);
- Travelers to an area with an ongoing outbreak of Japanese encephalitis.
- Travelers to endemic areas who are uncertain of specific activities or duration of travel. Indonesia is an endemic area, and in Indonesia transmission can occur year-round, often with a peak during the rainy season. Please note that Japanese Encephalitis is a rare event among travellers, but that does not mean there is no risk at all.
Please also let me give you some more advice: in any tropical region, preventing insect bites is vital - especially as malaria, dengue fever, Chikungunya fever, and other insect-borne diseases are even more likely to be present. Please use adequate mosquito repellent, wear protective clothing, with long sleeves and pants, stay indoors at twilight and after dark, and sleep under insecticide-treated mosquito net.
I hope this information will help you to make the best decisions for yourself. I wish you a nice trip in Indonesia.
Declaration of interest: medical adviser to International SOS, an AEA Company, Jakarta, Indonesia.
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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 for this forum.
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 July 31, 2020