Basic Health Care Information - Indonesia

Here is some basic health care information for living in or traveling to Indonesia.  More detailed information can be found from numerous sites on the Internet such as the World Health Organization (WHO), the United States (or other country) Embassy website, etc.

             

Food and water precautions

Do not drink tap water unless it has been boiled, filtered, or chemically disinfected. Do not drink unbottled beverages or drinks with ice. Do not eat fruits or vegetables unless they have been peeled or cooked. Avoid cooked foods that are no longer piping hot. Cooked foods that have been left at room temperature are particularly hazardous. Avoid unpasteurized milk and any products that might have been made from unpasteurized milk, such as ice cream. Avoid food and beverages obtained from street vendors. Do not eat raw or undercooked meat or fish. Some types of fish may contain poisonous biotoxins even when cooked. Barracuda in particular should never be eaten. Other fish that may contain toxins include red snapper, grouper, amberjack, sea bass, and a large number of tropical reef fish.

Ambulance

Indonesia does not have a nationwide emergency phone number, such as "911" in the United States. Many hospitals have their own ambulances, but staffing and equipment may not be comparable to that in Western nations and response time may be slow. The following hospitals offer ambulance service:

• R.S. MMC Kuningan: call 527-3473
• R.S. Medistra: call 521-0200
• R.S. Pondok Indah: call 750-2322
• R.S. Graha Medika: call 530-0887-9

Those staying in Indonesia for prolonged periods should identify private ambulance services in their area.

Medical Facilities

Medical services are limited. Most expatriates go to either International SOS or Global Doctor, which offer 24-hour emergency as well as routine care. International SOS has locations in; Jakarta, Balikpapan, and Bali: JL Puri Sakti No. 10 Cipete, Jakarta Selatan, Jakarta, ph. 62 21 750 5980, 750 6001; PKT Office, Jalan Pupuk Raya 54, Balikpapan, ph. 62 542 765966; Pt. Abhaya Eka Astiti, Klinik SOS Medika, Jalan Bypass Ngurah Rai 505 X, Kuta 80361, Bali, Indonesia 80361, ph. 62 361 710 544.
 
Global Doctor is located in South Jakarta at Jl. Patimura 15 Kebayoran Baru, South Jakarta; ph. 021-723-1121. Only Indonesian doctors are allowed to treat patients in Indonesian medical facilities. However, International SOS has an expatriate consultant physician on the premises most of the time and Global Doctor offers telemedicine appointments with a consultant in Perth.


For a cardiac emergency, go to Pusat Jantung Nasional (National Cardiac Center) (Jl. Letjen S. Parman Kav. 87; Jakarta Barat; ph. 568-4085, 568-4093). If hospital admission is necessary for non-cardiac problems, options include R.S. MMC Kuningan (Jl. H.R. Rasuna Said Kav. C21, Kuningan, South Jakarta; ph.021 520-3435/45) and R.S. Medistra (Jl. Jend. Gatot Subroto Kav. 59, South Jakarta, ph. 021 5210200), both of which have 24-hour emergency rooms and their own ambulance services. However, most expatriates prefer to be transferred to a country with state-of-the-art medical facilities, usually Singapore or Australia, for serious medical problems.

For a guide to other physicians and health facilities in Indonesia, go to the U.S. Embassy website. Routine medical care is available in major cities, but not elsewhere. Many doctors and hospitals will expect payment in cash, regardless of whether you have travel health insurance.

Immunizations

The following are the recommended vaccinations for Indonesia:

Hepatitis A vaccine is recommended for all travelers over one year of age. It should be given at least two weeks (preferably four weeks or more) before departure. A booster should be given 6-12 months later to confer long-term immunity. Two vaccines are currently available in the United States: VAQTA (Merck and Co., Inc.) (PDF) and Havrix (GlaxoSmithKline) (PDF). Both are well-tolerated. Side-effects, which are generally mild, may include soreness at the injection site, headache, and malaise.

Older adults, immunocompromised persons, and those with chronic liver disease or other chronic medical conditions who have less than two weeks before departure should receive a single intramuscular dose of immune globulin (0.02 mL/kg) at a separate anatomic injection site in addition to the initial dose of vaccine. Travelers who are less than one year of age or allergic to a vaccine component should receive a single intramuscular dose of immune globulin (see hepatitis A for dosage) in the place of vaccine.

Hepatitis B vaccine is recommended for all travelers if not previously vaccinated. Two vaccines are currently licensed in the United States: Recombivax HB (Merck and Co., Inc.) (PDF) and Engerix-B (GlaxoSmithKline) (PDF). A full series consists of three intramuscular doses given at 0, 1 and 6 months. Engerix-B is also approved for administration at 0, 1, 2, and 12 months, which may be appropriate for travelers departing in less than 6 months. Side-effects are generally mild and may include discomfort at the injection site and low-grade fever. Severe allergic reactions (anaphylaxis) occur rarely.

Typhoid vaccine is recommended for all travelers, with the exception of short-term visitors who restrict their meals to major restaurants and hotels, such as business travelers and cruise passengers. It is generally given in an oral form (Vivotif Berna) consisting of four capsules taken on alternate days until completed. The capsules should be kept refrigerated and taken with cool liquid. Side-effects are uncommon and may include abdominal discomfort, nausea, rash or hives. The alternative is an injectable polysaccharide vaccine (Typhim Vi; Aventis Pasteur Inc.) (PDF), given as a single dose. Adverse reactions, which are uncommon, may include discomfort at the injection site, fever and headache. The oral vaccine is approved for travelers at least six years old, whereas the injectable vaccine is approved for those over age two. There are no data concerning the safety of typhoid vaccine during pregnancy. The injectable vaccine (Typhim Vi) is probably preferable to the oral vaccine in pregnant and immunocompromised travelers.

Polio immunization is recommended, due recent reports of polio in Indonesia (see "Recent outbreaks" below). Any adult who received the recommended childhood immunizations but never had a booster as an adult should be given a single dose of inactivated polio vaccine. All children should be up-to-date in their polio immunizations and any adult who never completed the initial series of immunizations should do so before departure. Side-effects are uncommon and may include pain at the injection site. Since inactivated polio vaccine includes trace amounts of streptomycin, neomycin and polymyxin B, individuals allergic to these antibiotics should not receive the vaccine.

Japanese encephalitis vaccine is recommended for those who expect to spend a month or more in rural areas and for short-term travelers who may spend substantial time outdoors or engage in extensive outdoor activities in rural or agricultural areas, especially in the evening. Japanese encephalitis has been reported in animals from Kalimantan, Bali, Nusa Tenggara, Sulawesi, Mollucas, and West Papua, Lombok. Human cases have been identified on Bali, Java, East Timor, and possibly Lombok. Transmission is by mosquito bites and probably occurs year-round, with peak risk usually from November to March, sometimes in June and July. Increased risk is associated with rainfall, rice cultivation and the presence of pigs.

For those age 17 or older, the recommended vaccine is IXIARO, given 0.5 cc intramuscularly, followed by a second dose 28 days later. The series should be completed at least one week before travel. The most common side effects are headaches, muscle aches, and pain and tenderness at the injection site. Safety has not been established in pregnant women, nursing mothers, or children under the age of 17. An older vaccine (JE-VAX; Aventis Pasteur Inc.) (PDF) is recommended for those younger than age 17. JE-VAX is given as a series of three injections on days 0, 7 and 30. Mild side effects including fever, headache, muscle aches, malaise and soreness at the injection site occur in about 20% of those vaccinated. Serious allergic reactions including urticaria, angioedema, respiratory distress and anaphylaxis occur in approximately 0.6% of vaccinees and may occur as long as one week after vaccination. Any person who receives the vaccine should be observed in the doctor's office for at least 30 minutes following the injection and should complete the full series at least 10 days before departure. In addition to vaccination, strict attention to insect protection measures is essential for anyone at risk.

Rabies vaccine is recommended for travelers spending a lot of time outdoors, for travelers at high risk for animal bites, such as veterinarians and animal handlers, for long-term travelers and expatriates, and for travelers involved in any activities that might bring them into direct contact with bats. Children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites. In Indonesia, rabies is most often transmitted by stray dogs, though cats and monkeys may also be responsible.

A complete preexposure series consists of three doses of vaccine injected into the deltoid muscle on days 0, 7, and 21 or 28. Side-effects may include pain at the injection site, headache, nausea, abdominal pain, muscle aches, dizziness, or allergic reactions.

Any animal bite or scratch should be thoroughly cleaned with large amounts of soap and water and local health authorities should be contacted immediately for possible post-exposure treatment, whether or not the person has been immunized against rabies.

Tetanus-diphtheria vaccine is recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.

Measles-mumps-rubella vaccine: two doses are recommended (if not previously given) for all travelers born after 1956, unless blood tests show immunity. Many adults born after 1956 and before 1970 received only one vaccination against measles, mumps, and rubella as children and should be given a second dose before travel. MMR vaccine should not be given to pregnant or severely immunocompromised individuals.

Cholera vaccine is not generally recommended, except for relief workers, because most travelers are at low risk for infection. Two oral vaccines have recently been developed: Orochol (Mutacol), licensed in Canada and Australia, and Dukoral, licensed in Canada, Australia, and the European Union. These vaccines, where available, are recommended only for high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care. The only cholera vaccine approved for use in the United States is no longer manufactured or sold, due to low efficacy and frequent side-effects.

Yellow fever vaccine is required for all travelers arriving from a yellow-fever-infected country in Africa or the Americas or from a country in the endemic zones, but is not recommended or required otherwise. Yellow fever vaccine (YF-VAX; Aventis Pasteur Inc.) (PDF) must be administered at an approved yellow fever vaccination center, which will give each vaccinee a fully validated International Certificate of Vaccination. Yellow fever vaccine should not in general be given to those who are younger than nine months of age, pregnant, immunocompromised, or allergic to eggs. It should also not be given to those with a history of thymus disease or thymectomy.