Sandra Funke famulated in Indonesia in summer 2009. The special highlight during her work in gynecology was that she was allowed to deliver a baby by herself. In her report Sandra describes how she organized the internship in advance, how the journey was organized and which experiences she was able to gather in Indonesia.
Motivation
At my university suddenly each from "abroad" spoken , so I also decided to take the risk and go abroad for a clinical traineeship. Because Asia has fascinated me for a long time, I decided to go to this continent. After this decision I looked at what AMSA has to offer.
Finally I decided for Indonesia, because in this country Internship and vacation, so the info, well can connect.
Application
I study at the Medical University of Vienna, so that my application via the Austrian AMSA . Here I had to apply for a place in November 2008. The Ranking the AMSA goes by completed clinical clerkships, electives and study progress.
At the end of December it was decided that I would get my desired place in Malang.
Now I had to submit some documents like a collective certificate, letter of recommendation, language certificate, and some more, but AMSA helped me a lot. In addition, I had to Placement fee of just under 390 € transfer the money to AMSA. AMSA’s services include the placement, accommodation, food and social program on site.
Formalities
Although it was clear that I would get the famulatur place, the AMSA partner organization in Indonesia (MSCIA) quite a long time no feedback, whether they can take me at my desired time. Then finally, five weeks before the start of the internship, the confirmation was in my mailbox.
Thereupon I have directly Visa at the Indonesian embassy applied for in Vienna. Since I am originally from Germany, I also called the Indonesian embassy in Germany to ask how the procedure works; but it was so complicated that I decided to go personally to the embassy in Vienna, where I got a 60-day social visa for 35 € (in Germany it costs 45 €) without complications.
I have then still with the alliance one International insurance with all the trimmings completed. This cost me about 50 € – in my opinion a good investment.
Travel and accommodation
I flew with Etihad Airways from Munich via Abu Dhabi to Jakarta. The flight cost 760 €. In Jakarta I had one night stay, and the next morning I flew further from Jakarta to Malang (flight with Domestic Airline: approx. 35 €).
In Malang, I was warmly welcomed by a couple of girls from AMSA and brought to my host family.
I was with two other female exchange students at a very nice Hindu family in a very big house accommodated. From the first day I felt comfortable. The family consisted of mother, father, two daughters and a housekeeper who was always in the house during the day.
I had my own big room and shared the bathroom with the daughters and the other two exchange students. Fortunately, our bathroom had a normal toilet and a shower with hot water, which is considered an absolute luxury. Other families had only a standing toilet and a mandi for a shower. A mandi is a tiled basin of water from which cold water is poured over the head with a ladle.
My clothes were washed and ironed by the housekeeper, except for my underwear.
There was plenty of food on the dining table all day and everyone could eat when they liked. The basis of the meals is always rice, and in addition there were between two and four dishes a day, which usually tasted fantastic. Indonesians eat the same thing at any time of the day. Unfortunately, it was very difficult for me to eat rice with vegetables at 6 o’clock in the morning – so I finally bought some muesli for breakfast.
Hospital
My training center was General Hospital Dr. Saiful Anwar in Malang. In this hospital all students of the medical faculty in Malang spend most of their last two years of study. This hospital is the largest in Malang and has all specialties of medicine.
All photos: Sandra Funke
I spent 4 weeks in Department of Gynecology and Obstetrics famuliert. This department is divided into gynecological oncology, postpartum observation, delivery room and polyclinic (outpatient clinic), which in turn consists of reproductive outpatient clinic, antenatal outpatient clinic and gynecological outpatient clinic.
From home you should bring enough disinfectant in a smock pocket, your own smock, stethoscope, lamp and disposable gloves.
All female students must have a Top with collar (blouse or polo shirt) wear and an over-the-knee skirt. The male students suit pants and shirt with collar! The colors of the clothes are not given.
Required language skills
Since both the students and the doctors speak relatively good English, you can get along very well with English alone well to do.
However, my recommendation for anyone wanting to go to Indonesia is: Learn before you go a few words of Bahasa Indonesia! The Indonesians are very happy when foreigners speak some Indonesian, you get a lot of sympathy and it makes things easier for you; this is true for the clinical traineeship as well as for the possible vacation afterwards in Bali and Co. And most importantly: You can at least talk a little bit with the patients, who usually don’t speak English at all.
Contents of the clinical traineeship
My working day began punctually at 7 o’clock in the morning with the Morning Report, where the doctors on duty the previous night presented in English the new cases. Afterwards, one of the doctors usually gave a lecture on a selected topic in Bahasa Indonesia. The Morning Report usually lasts one hour.
Afterwards I could choose where I wanted to spend my day. Most of the time I am in the Delivery room went where it was most interesting for me personally.
I did not have a supervisor in charge, so I asked as many questions as possible right at the beginning. So many doctors showed and explained the essential things to me. I had the opportunity to draw blood in the delivery room, perform vaginal examinations, practice the Leopold maneuver and I was even allowed to deliver a baby once, which was the absolute highlight for me.
In the polyclinic I was allowed to perform some vaginal examinations, where I was able to feel far advanced cervical and ovarian carcinomas.
I also went to the operating room a few times when a cesarean section was scheduled. But of course I only watched.
Otherwise, the main task was observation, which could be a bit boring if there was no birth and not too much going on in the outpatient clinic. When this was the case I went to the emergency room where I saw some interesting cases.
Between 1 p.m. and 2 p.m., I always went home. We did not have to work on weekends. However, those who wanted to were welcome to do night duty.
The Hygiene in the hospital leaves a lot to be desired compared to Germany: Doctors and students hardly ever use disinfectants, for example. Disposable gloves are disinfected, dried on a clothes rack, then powdered and used again. Should not "hit" when drawing blood another site is punctured with the same needle. There is no such thing as a puncture-proof drop container and "recapping" is on the agenda.
Gloves while drying
At emergency room the incoming patients are treated according to urgency. Acutely life-threatening cases are attended to immediately, all patients who do not have a potentially life-threatening outcome are first sequestered in the Emergency Room until a doctor has time to attend to them. This can take a whole day. Painkillers are used very sparingly, as they are very expensive and have to be paid for by the patients themselves.
In Delivery room there are about eight beds next to each other, only separated with curtains. According to this, fathers are also not allowed to come into the delivery room, as there is simply not enough space. The women lie from the time of arrival in the hospital until the birth of her child on her back. When I told the doctors that women in Western Europe can choose in which position they want to go through labor and in which position they want to deliver their baby, they just looked at me with wide eyes.
The Indonesians show no big emotions. therefore it is not surprising that pain is experienced rather quietly. I have hardly heard a woman scream or wail during a birth.
Because doctors in Indonesia do not have the wide range of diagnostics available to them as in our latitudes, they have to focus primarily on the following areas Rely on their hands, eyes and professional knowledge. However, as a result, the doctors are practically very competent and have a wide range of expertise.
Both the doctors and the students work every day from 7 to 15 o’clock and have to have a 36-hour duty perform.
Address of the hospital
Rumah Sakit Umum Dr. Saiful Anwar
Jl. JA. Suprapto 2
Malang, Jawa Timur, Indonesia
Important internet addresses
All Indonesians, especially doctors and students, use Facebook. I have also administrative things via Facebook done, because the given e-mail address of the Indonesian MSCIA did not work.
Country and culture
The state of Indonesia is the largest island state in the world. It was opened on 17. August 1945 proclaimed and on 27. December 1949 independent from the Netherlands. The Capital Jakarta has about 18 million inhabitants and is located on the island of Java, where more than half of the country’s inhabitants live. The equatorial island chain is the largest state in Southeast Asia in terms of area and population, the world’s largest island nation, as well as with about 241 million inhabitants the fourth largest nation in the world. According to Indonesian data, the land area of Indonesia is distributed over 17.508 islands.
With the independence movement in Indonesia in the late 1920s, there was also a call for a common, uniform state language loud: "A country. One people. One Language!" was a widespread slogan, in the wake of which a "Bahasa Indonesia" was first heard ( language Indonesia ) was the speech.
But it should still be possible until 27.12.In 1949, the Republic of Indonesia was able to proclaim its independence and declare the Jakarta dialect (Omong Jakarta) as Bahasa Indonesia (BI), the state language. Since then, BI has been the official language of Indonesians. It should be noted that many are only confronted with the BI in school, and otherwise maintain their regional languages, so that it is safe to assume that there is not even close to the number of native speakers of BI.
88% of Indonesians are Muslim. With over 191 million Muslims, Indonesia is the country with the largest Muslim population in the world. 9 % of the population are Christians (ca. 6 % Protestant and 3 % Roman Catholic), 1.8 % of the population are Hindus (Bali, Lombok) and 1 % Buddhists (mostly members of the Chinese minority). Most Indonesians live very religious, praying an integral part of the daily routine, both among Muslims and Christians, Hindus and Buddhists.
Over 27% of the total 241 million. Indonesians live in Poverty, whereby strong regional differences there. While in Java, the main island of the country, about 23% of the people live in poverty, there are some provinces, especially in the east, where the percentage of poor people is 44.
Especially in big cities like Jakarta there are extensive slums. There are about 1.7 million street children in Java.
The Studying medicine at the Fakultas Kedokteran Universitas Brawijaya in Malang comprises twelve semesters. The first eight semesters are "preclinical", the last four semesters are clinical, where the students, called "Co-Ass in the Rumah Sakit Umum Dr. Rotating through all the medical specialties at Saiful Anwar (Malang City General Hospital) and working in the different wards under the supervision of the residents.
Free time
In the afternoons, I either went home and met with my host sister or the other exchange students, or we strolled through the city or went shopping.
On the weekends we had a extended social program. Together with our host brothers and sisters and the MSCIA staff, we went to the beach, went rafting, and climbed the Bromo volcano. We also visited a waterfall and hot springs. Once we exchange students went on our own to Yogyakarta.
Impressive events and conditions
It was one of the best decisions of my life, going to Indonesia and doing a clinical elective here. Because I lived with an Indonesian family and made friends with many Indonesians, I got to know the whole culture and way of life of Indonesians from a completely different perspective than a "normal" Indonesian Tourist.
There are so many similarities, but also just as many differences between our Western culture and the Asian culture.
Besides, it is only in such a country that one realizes how glad we can actually be in our western world. Having such a good social system and access to the best medical care at all times is not a given for most of the world’s population.
That probably most impressive personal experience was being allowed to bring a baby into the world.
But also the new friendships I made with Indonesians are of great importance to me.
My host sister once took me to a Hindu temple, where I had a Hindu ceremony was allowed to follow and was even involved himself – dressed in traditional clothes. The sister of my host mother also taught me Legong Keraton Dance, the traditional Balinese dance, which enriched me especially for my following stay in Bali.
Altogether this stay was a great thing and I would go there again at any time. The following vacation on Bali and Lombok has made the Summer perfect for me made.