Development of pain management in indonesia


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Development of pain management in indonesia

  1. 1. Dr. A. Husni Tanra
  2. 2. There are certain barriers : 1. 2. 3. Patient barrier Doctor Barrier Government Barrier
  3. 3. 1. PATIENT BARRIERS Some patients are reluctant to report their pain  Some due to the culture & religion  Mostly due to the socio-economic status 
  4. 4. 2.DOCTORS / HEALTH PROVIDER BARRIERS    No pain specialist doctors in Indonesia In medical college, very little time is spent to teach about pain & pain syndromes Shortage in number of Specialist Doctors of : SPECIALIST DOCTOR Anesthesiologists Neurologists Neurosurgeons Orthopedics Rehabilitation Medicine Rheumatologists NUMBER 650 doctors 715 doctors 103 doctors 306 doctors 272 doctors 56 doctors
  5. 5. 3.GOVERMENT BARRIER S  There are 53 medical schools in Indonesia • 22 government medical schools • 31 private medical schools  Only 15 medical schools has post graduate for specialist doctors  Immediate release opioids are only available in 3 top referral hospitals. (now MS contin is available in big city)  Pain management is still not the priority.  Pain management is still considered not economically beneficial for the government, because it might need a big budget.
  6. 6.  Total Government Hospitals  163 units*  Total private Hospitals  960 units*  Total Primary Health Care  5614 unit*  Total General Physicians  50.000 doctors 1  doctor for 5000 people *Biro Pusat Statistik (2006)
  7. 7. Pain Management In Indonesia Acute Pain Postop Pain Shortage in Anesthesiologist (650 doctors) APS (Acute Pain Service) only in some teaching hosp. 3hospitas Chronic / Neurophatic Pain Shortage in Neurologist No Pain Specialist Only Few Pain Clinics Only 3 pain clinic Cancer & AIDS Pain Shortage in Palliative Doctors Only 5 hospitals Have Palliative care
  8. 8. In many parts of Indonesia : Many people may die of pain Many more people dying in pain Even many more people living in pain This is our task to help them.
  9. 9.        Was established in 1993, after the 1st Pain Meeting at Makassar in February 1993 Professor Karjadi was elected as the 1st Chairman Dr. A. Husni as the Vice Chairman Dr. Idrus Paturussi as the Secretary Dr. Assadul as the Treasurer However, not many activities concerning pain and pain management were done. Indonesia was not yet registered as IASP member.
  10. 10. 1. 2. 3. 4. 5. Pain relief should be considered as a basic human right Pain should be the fifth vital signs in all hospitals Pain should be included in medical curriculum, as early as possible Development of pain specialists doctor as a new discipline Promoting the establishment of Acute Pain Service, multi disciplinary pain clinic, and Palliative care.
  11. 11.      Was conducted at Makassar in April 2002 Dr. Husni was elected as the Chairman Annual Scientific Meeting since 2002. Global Day Against Pain was held in Surabaya 2004 Promoting establishment of IPS branches in big cities (Yogyakarta, Jakarta, Surabaya, Makassar, Bandung, Medan, Solo, Padang, and Denpasar)  Two books were published : 1. Guidelines on Acute Pain Management by IASP (translated to Indonesia) 2. Guidelines on Neuropathic Pain Management  Promoting the establishment of pain clinic
  12. 12.  2nd National Congress was conducted in 2005 at Surabaya  Dr. Idrus Paturussi (Orthopedic Surgeon) was elected as Chairman.  3rd National Congress was conducted in 2009 at Bali  Dr. Lukas Meliala (Neurologist) was elected as Chairman.
  13. 13.    The main idea of establishment of ASEA-PS is not only to build closer relationships among ASEAN doctors, but also to bring together pain specialists from developed countries and ASEAN doctors, including Indonesian doctors. In other words, ASEA-PS was established to improve and to share the knowledge about pain management in ASEAN countries. To help each other, and work together to promote pain management.
  14. 14.  Joint Meeting with NeuPSIG (Neuropathic Pain Special Interest Group)
  15. 15. Indonesian Society of Anesthesiology for Pain Management 1st Meeting at Makassar, South Sulawesi in 2011 2nd Meeting at Makassar, South Sulawesi in 2012
  16. 16.  Dr. Soetomo General Hospital in Surabaya, the capital city of East Java, was the pioneer in pain service in Indonesia, focusing to the palliative pain care.  Pain service in Surabaya was initiated in 1991.
  17. 17.  In Makassar, the capital city of South Sulawesi, Acute Pain Service for post-operative patients was initiated in 2005, using mainly epidural analgesia as the modality.  Now, in 2013, only some leading hospitals in big cities in Indonesia (Jakarta, Bandung, Bali), both government and private, have pain services.
  18. 18.  Acute Pain Service (APS) for post-operative patients is organized as a resident-based service with anesthesiology residents as service providers, under supervision of senior anesthesiologist pain consultants.  In Makassar, Pain Clinic was opened in 2006, with integrated modalities of pharmacologic therapy, acupuncture, and interventional therapy.
  19. 19. Male, 70 y.o. Fracture Femur, with continuous epidural analgesia Male, 52 y.o. Post laparatomy, with Patient Controlled Epidural Analgesia F, 32 yr. Haemorrhoidectomy , 5 days after SC, with cont epidural analgesia Anesthesiologist-supervised APS
  20. 20. Surgical Procedures Digestive Obgyn Orthopaedic Urology n 1356 1308 800 921 % 30.77 29.53 13.40 22.08 Thorax, Oncology, Plastic Surgery 201 2.48 Total Patients 4586
  21. 21. Percentage of Pain Intensity 90.00 80.00 70.00 60.00 50.00 81.39 40.00 30.00 20.00 10.00 15.88 2.73 0.00 0 1-3 4-6 0.00 7 - 10
  22. 22. Pain Clinic & Acupuncture
  23. 23. Why Acupuncture??? 1. It has been used for more than 2000 years for treatment 2. Eastern method 3. Promoting self-healing 4. Almost no side-effect 5. Is used in more than100 countries 6. Is a treasury of KNOWLEDGE
  24. 24. Epidural steroid injection STELLATE GANGLION BLOCK
  25. 25.  Pain used to be just a part of lecture in Medical Student Curriculum  Since 2007, Acupuncture and TCM have been taught as a subject for undergraduate medical stundents.  Collaboration with Xiamen University, China  Since 2011, pain has become an individual subject for undergraduate medical students.
  26. 26.  Nurse Education for Pain Management  Nurses have important roles in pain management and pain services, because nurses have continuous encounters with the patients  Nurses are the first persons to hear patients complaints and the ones who communicate patients’ complaints to the doctors.
  27. 27. 2nd ISAPM Workshop Pain for Nurse_2012
  28. 28.  Short course of Basic Acupuncture skill for Pain Management  Collaboration with Xiamen University, China  Collaboration with Onomichi Hospital, Japan  Role of anesthesiology residents in Acute Pain Service and pain management in Pain Clinic
  29. 29. Doctors from Xiamen University taught acupuncture for anesthesiology residents in Makassar, 2006
  30. 30. MOU Dept. of Anesthesiology Fac. of Medicine Hasanuddin Univ. and Dept. of Anesthesiology and Pain Clinic Onomichi Hospital May 2006
  31. 31.  Many specialists are interested to learn more about pain and pain management  Anesthesiologists are the ones who daily deal with pain and pain-relieving drugs, mainly opioids  Fellow on Pain Management started on 2012 in Our Department under collaborate with Anesthesiology Collegium, Faculty of Medicine UNHAS and Teaching Hospital ( RSWS and RSP UNHAS )
  32. 32. Pain Management Education Committee in Anesthesiology Collegium  Several Meetings for prepare the formal subspecialist education in Pain Management  MOU agreement between Anesthesiology Collegium, Faculty of Medicine and Anesthesiology Department  MOU agreement between Anesthesiology collegium, Anesthesiology Department and Teaching Hospitals  Fellow has been run on 2012 
  33. 33. Fellowship training of pain management for anesthesiologists was opened, and the first lecture was conducted in January 2012, after the signing of the MOU between : • Indonesian Collegium of Anesthesiology and Intensive Therapy • Department of Anesthesiology, Intensive Therapy and Pain Management of Hasanuddin University Medical Faculty • Teaching Hospitals : Wahidin Sudirohusodo General Hospital and Unhas Hospital
  34. 34.  1st Lecture in January 2012  Nine anesthesiologists from all over Indonesia were accepted as the first fellows.  At 2013, 10 anesthesiologists were accepted as fellows.
  35. 35. Hands on manniquine session workshop under c-arm
  36. 36. Hands on manniquine session workshop under c-arm
  37. 37. 1st IPM Workshop and has been held for 5 times till now
  38. 38. 5th IPM Workshop (Basic)
  39. 39. IPM Workshop (2nd Advanced)
  40. 40. 2nd ISAPM Workshop Pain for Nurse_2012
  41. 41. 2nd ISAPM Pain Symposium for Doctor_2012
  42. 42.   Many studies about pain as a topic have been conducted for Magister Thesis for Residents and Doctoral Dissertation Oral and Poster Presentations in National and International Meeting of Anesthesiology and Pain
  43. 43. Poster presentation about APS RSWS-FKUH in World Congress of Pain, Milan 2012
  45. 45. San Diego, 2002