Health and Medicine in Soekarno Era Indonesia

A review of Health and Medicine in Soekarno Era Indonesia: Social Medicine, Public Health and Medical Education, 1949-1967 by Vivek Neelakantan.

The year 1949 was very significant for Indonesia as it achieved independence after three and a half centuries of Dutch colonial rule and seven years of warfare (the Indonesian Revolution, 1945–1949 and the Japanese occupation, 1942–1945). As in other newly independent Asian and African countries in the 1940s and 1950s, health and medicine became an essential part of the nation-building process (pembangunan) in post-colonial Indonesia. It is not hard to imagine that Indonesia inherited a ruined and devastated health and medical system marked by a severe shortage of medical doctors (1,200 physicians for 70 million people), the scarcity of basic medicine and drugs, and the resurgence of epidemic diseases. Political differences between Java and the Outer Islands and Indonesia’s complicated geography further worsened this woeful situation. In the meantime, post-colonial Indonesia also had to choose an international political strategy during the Cold War, characterized by the military rivalry between the US and the USSR, which also affected the country’s health policy.

Based on rich archival documents, Vivek Neelakantan’s dissertation contextualizes the history of health in post–World War II Indonesia by dividing the period from 1949 to 1965 into four disparate historiographical streams: the political history of Indonesia during the Soekarno era; the history of international aid in the area of health with a focus on the Indonesian context; the history of science, technology, and society in post-colonial Indonesia; and the history of Indonesian public health during the 1950s. His dissertation intends to analyze how health became a component of Indonesian nation building and how Indonesia sought to achieve the equilibrium between accepting international aid and ideas from the WHO while maintaining its hard-won political independence. It also aims to examine how Indonesia positioned itself in terms of health and medicine policies in the context of the Cold War. It further explores how Indonesia developed its unique epidemiological strategies for disease eradication which were appropriate for Indonesia.

The thesis is made up of five main chapters. Chapter 2 traces the genesis of social medicine, which originated in the eighteenth and nineteenth centuries in Europe, specifically during the Industrial Revolution. Social medicine not only contextualized diseases in the immediate environment, but also encompassed social factors, such as economic, nutritional, occupational, and educational variables. With the advent of germ theory at the turn of the twentieth century, two approaches emerged in social medicine: one was a biomedical approach focusing on disease control, and the other was a holistic approach investigating the social-economic causes of illnesses. This chapter analyzes the health programs and efforts of the League of Nations Health Organization and philanthropic organizations such as the Rockefeller Foundation in Indonesia during the inter-war period. It further examines medical initiatives in the Dutch East Indies before the twentieth century, as well as the challenges that Indonesia’s public health system faced following the Japanese occupation up to independence (1942–1949). The chapter also introduces the WHO’s definition of health and approaches for public health in newly-decolonized nations of Asia and analyzes why those key Indonesian social medicine experts interpreted social medicine. It investigates how physicians opted for the holistic approach that took the availability of food, the diversification of the people’s diet, and the affordability of health services into consideration under the influence of President Soekarno’s doctrine of nation-building, within the political philosophy of Pantjasila.

Chapter 3 mainly analyzes how Indonesian health policies were shaped by Johannes Leimena, the country’s most influential minister of health, a post he held between 1947 and 1956. It addresses how Leimena’s political philosophy led him to reconcile Indonesia’s diverse religious beliefs with nation-building, and how he made efforts to establish Indonesia’s pre-eminence in international health within the WHO’s Southeast Asian region of the WHO, cementing cooperation with the Indian Ministry of Health from 1950 onwards. It further discusses the Leimena Plan, also called the “Bandung Plan,” which was based on two principles: integrating preventive and curative public health, and maintaining the balance between rural and urban health facilities. This plan aimed to increase the supply of skilled medical personnel and correct the inequitable distribution of physicians which favored the country’s urban centers. Following these principles, the Bandung Plan established a referral system for the provision of curative care at sub-district and kewedanaan (regency) levels and returned the administration of preventive health measures to the village. However, the Leimena Plan was not successfully implemented because of financial difficulties and political uncertainty by the early 1960s.

Chapter 4 focuses on the campaign against the big four endemic diseases (Penjakit Rakjat), including malaria, tuberculosis, yaws, and leprosy. It first analyzes international political relations between the United States and Indonesia in disease eradication. The US contended that disease caused poverty, and poverty was a breeding ground for communism. Therefore, the eradication of disease would contain the growth of communist ideology and gain the political allegiance of developing countries like Indonesia. However, the Indonesian government adopted its own health policy—the Bandung approach—which was independent of superpower intervention and tried to cautiously balance Indonesia’s sovereignty with increased openness to international health cooperation. Indonesian physicians advocated a holistic perspective that contextualized disease in the light of socio-political factors, the prevailing political conditions, and the environment. It further examines the roles of the WHO and the use of DDT in the transition from control to eradication in the fight against malaria. It also investigates how tuberculosis in post–Word War II Indonesia was framed as both a socio-hygienic and a socio-medical problem and how these two frames had specific control modes. For the eradication of yaws, the government of Indonesia adopted a two-pronged strategy: on Java, it used the Kodijat Method of yaws control, based on the detection and registration of yaws patients and the treatment of infectious cases and their contacts; on the Outer Islands, it carried out mass treatment of the population with penicillin regardless of whether they had been diagnosed as yaws patients or not. In a similar way, Indonesian physicians designed a two-pronged approach to leprosy control according to varying population density across the archipelago: the detection of leprosy cases and breaking the chain of transmission of infection through the treatment of patients.

Chapter 5 analyzes the expansion and transformation of medical education in Indonesia after its independence. Indonesia faced a serious shortage of medical doctors due to the departure of most Dutch physicians and the low number of physicians graduated from medical schools before 1949. In order to remedy this shortage, the government of Indonesia changed the medical curricula from the Dutch model to the American model in Jakarta, Surabaya, and Yogyakarta, which fostered problem solving and critical thinking and introduced cohort-based rather than individual examination. In the meantime, the government of Indonesia established new medical schools at Medan, Bukittinggi, and Makassar. However, the implementation of the American model encountered the problems like the shortage of medical school faculty members and the lack of infrastructure. These factors made the government resort to external aid from institutions that included the University of California, the WHO, and the University of Melbourne.

Chapter 6 focuses on Indonesian scientific thinking. President Soekarno maintained that science could help support the cause of the Indonesian Revolution and realize the nationalist ideal of achieving a just and prosperous society by discovering new solutions to existing problems such as food shortages. Indonesian physicians such as M. Sardjito, Sarwono Prawirohardjo, and Soedjono Djoened Poesponegoro contributed to Indonesian scientific strategies and institutionalization. According to M. Sardjito, the “Bandung spirit” of Indonesian science was to minimize the country’s technological dependence on either the US or the USSR as a non-aligned nation. In Sarwono Prawirohardjo’s view, science should serve as a means to combat Indonesia’s national problems like nutrition and food and therefore contribute to nation building. However, the materialization of these goals was impeded by the emphasis on applying overly basic sciences, the weak foundation of most undergraduate students in basic science, and a shortage of scientific manpower.

This dissertation furthers our understanding of the history of medicine and health in post-colonial Indonesia from 1949 to 1965 and addresses key issues in the field of the history of medicine in Southeast Asia, such as the relationships between newly independent countries and major powers like the US and the WHO, strategies for health and medicine, the eradication of endemic diseases, the transition of medical education from the Dutch model to the American model, as well as the role and significance of science in nation-building.

The area of the dissertation that interests me most is the similarities and differences between Indonesia and China in 1949–1965. For China, the seventeen-year period from the founding of the People’s Republic of China in 1949 to the outbreak of the Cultural Revolution in 1965 was very crucial as China started nation-building from scratch, too. Health and medicine were an essential part of this process. China faced the same problems as Indonesia in terms of its shortage of physicians and medicine, the absence of a medical system, and the resurgence of epidemic and endemic diseases. The differences between the two countries lay in their relationships with major powers like the US, the USSR, and the WHO. The US was China’s adversary, and China was not a member state of the WHO until 1972. The USSR impacted on China’s medical science research and medical system to some extent. However, relations between the two countries fell apart by the late 1950s. China was therefore relatively independent of foreign influence. Under this circumstance, the establishment of a top-down medicine and health system, which was affiliated with the administrative system, contributed to the implementation of medicine and health policies and campaigns without too much resistance. Other areas of similarity between China and Indonesia include the rural medical system (the three-tier system for China and the desa hygiene service for Indonesia), the role of vaccines and antibiotics like penicillin in disease eradication campaigns and treatment of common rural diseases, as well as the regulation and mobilization of urban medical doctors to serve in rural areas. In this sense, this dissertation also contributes to the study of the history of medicine and health in newly independent African and Asian countries in the context of the Cold War during the 1950s.

Xiaoping Fang
Assistant Professor of Chinese History
Division of Chinese
School of Humanities and Social Sciences
Nanyang Technological University, Singapore
XPFang@ntu.edu.sg

Primary Sources
Archives and Special Collections
Indonesian Medical Biographies, Autobiographies and Novels
Official Publications, Commemorative Volumes and Yearbooks
Speeches
Indonesian Parliamentary Proceedings

Dissertation Information
University of Sydney. 2014. 299 pp. Primary Advisor: Hans Pols

Image: President Soekarno supervises the spraying of DDT (used in anti-malarial operations) in a central Javanese village, c.a. 1959.  From Satrio and Mona Lohanda, “Perjuangan dan Pengabdian: Mosaik Kenangan Prof. Dr. Satrio,1916-1986,” Penerbitan Sejarah Lisan Nomor 3 (Jakarta: Arsip Nasional Republik Indonesia, 1986), 193.

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