Health Consideration

CONSIDERATIONS:

Lifestyle:
· Expatriates often have an unhealthy lifestyle in Indonesia.
· Many people do not exercise sufficiently because of the heat and pollution.
· Excessive alcohol consumption, smoking and overeating are common.
· Many people gain weight.
· Try to moderate your diet and exercise regularly.

Vaccinations:
· Start all vaccinations well before posting as you may need a course of injections.
· Check with your doctor that all previous vaccinations are up to date.
· All adult and childhood vaccinations can be given in Jakarta, Indonesia

Medications:
· Most medications are available in Indonesia.

Doctors and Clinics:
· Expatriate doctors generally can not practise in Indonesia but there are exceptions.
Contact the International Clinic for assistance if necessary.
· Some local Clinics are well equipped but generally not of Western standard.
· Most clinics other than International Clinics are Indonesian with associate cultural and language problems.
· Ensure disposable needles and syringes and sterile instruments are used.
· Try to avoid any surgical procedures in a small clinics or small hospital.

House and Hotel Calls:
· Home visits are usually not available except International Clinics in Jakarta.
· Hotels have a doctor on call or a hotel clinic. Expect high fees.
· It is often preferable to proceed directly to the clinic or hospital.

Ambulance:
· Ambulance services are usually owned by hospitals or private clinics and are often not of Western standard. Payment before service is normal.
· It may be faster to go by car or taxi to a clinic or hospital.

Blood Bank:
· The Red Cross monitors blood banks. Standards are variable.
Blood supply is not a free service.
· Avoid blood transfusion if possible. Insist blood is re screened by the hospital before transfusion. Contact the Home GP first.
· Rh -ve blood is rare in Asia and difficult to obtain.

Dentists:
· Good quality treatment is available in Jakarta at recommended dental clinics. Request an indication of likely fees before starting treatment.

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A Health Guide For Visitors to Indonesia

GENERAL: Healthy Living in Jakarta,

Air:
- All major Indonesian cities have severe atmospheric pollution. This can be unpleasant but exposure during a normal 2-3 year posting is unlikely to cause new health problems.
- Pre existing respiratory problems may be aggravated but asthma is very common in Indonesia also Hay fever is common.

Water:
Do not drink tap water anywhere in Indonesia.
- Bottled water is widely available and should be used for drinking, tooth brushing and for a final rinse after washing fruit and vegetables.

Food:
· Most foods are available.
· Fruit and vegetables are of reasonable quality.
· Meat and fish from public markets should generally be avoided.
· Supermarkets offer much higher food handling standards.

Restaurants:
· Many restaurants have acceptable hygiene standards. These standards vary daily and with food type irrespective of the quality of the restaurant or hotel.
· Roadside food stalls should be avoided especially Padang food stalls.
· Shellfish, snails and uncooked fish should not be eaten.

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Cause of Malaria

Malaria is caused by a microscopic sized parasite called Plasmodium.

This process involves a very complex mosquito - human being life cycle:
A female Anopheles mosquito itself infested with a Plasmodium parasite bites a human being. This parasite which has multiplied in the mosquito salivary glands is then injected into that person's bloodstream.

The Plasmodium parasite then moves to the human liver where it multiplies again. It is later released into the human blood stream which causes the symptoms of Malaria. The infected human being is subsequently bitten by another mosquito which in turn bites and transmits Malaria to another human being.

The commonest forms of Malaria are Plasmodium vivax which is rarely fatal and Plasmodium falciparum which can be fatal. The other forms, Plasmodium Ovale and Plasmodium Malariae are not so important.

Incidence:
Malaria is one of the 10 most prevalent and fatal diseases worldwide. Approximately 1.5 -2.7 million people die from Malaria each year with 300-500 million people infected at any given time.
About 90% of cases are in sub Sahara Africa with most fatalities in young children in remote rural areas.
About another 6-7% of Malaria cases are from India, Brazil, Sri Lanka, Vietnam, Colombia and the Solomon Islands.
Indonesia has a relatively low incidence of Malaria especially large cities and major tourist areas e.g. Jakarta and Bali. Risks are greater in remote areas.

Prevention of Malaria-
1. Be aware of the local incidence of Malaria:
Not always easy to get this information.
Overall risk in Indonesia is about 1:50,000 but varies greatly with location eg risk much higher in Irian Jaya than Bali.
Likelihood of contracting Malaria increases with time spent in the area.

2. Reduce exposure to Mosquitoes:
Obsessive prevention of mosquito bites reduces the risk of contracting Malaria about ten -fold.
Use mosquito nets preferably treated with permethrin unless in reasonable standard accommodation in a low risk area.
Spray an aerosol insecticide in your room before retiring.
Use mosquito coils or vapourising mats containing pyrethoid.
Cover arms and legs from dusk to dawn – the time when the female Malaria mosquito bites.
Avoid dark areas or garden areas from dusk to dawn.
Use mosquito repellents preferably those containing DEET eg “RID”, “Tropical Strength AeroGard”, “Autan” (a local brand).
Wear light coloured clothing.
Scent attracts mosquitoes –avoid perfumes and after shaves.

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Final Stage Of Adjustment Begins

 Final Stage Of Adjustment Begins

At about the eleventh month, the final stage of adjustment begins.  You may have learned a more functional way to deal with your stress.  You are more adept at communicating both verbally and non-verbally, giving you instant feelings of success.  You have learned to be more assertive in identifying what your wants and needs are and seeking out those things when appropriate.  You utilise withdrawal more for a time to retreat, rest and recoup rather than as a way to isolate yourself. As you look back to earlier months you feel a sense of achievement in all that you have accomplished. 

Full integration into the host country may only begin at the end of the second year.  You see yourself and your family as both participants and active members of your community with a sense of comfort and affection for your lifestyle.  Moments of sadness and feelings of loss may still be some thing that you experience, however, the frequency is less and you have the ability to grieve and then get on with your life. 

The above stages of adjustment are based on general experiences of a person's inter-cultural adaptation.  Each individual may experience some uniqueness in the  amount of time they find themselves in each of the stages and some persons may even find themselves 'stuck' and unable to progress onto a different level. 

There are many resources available for assisting in your cultural adjustment.  ICAC's Newcomers support groups.  ICAC Family Counselling Services and Orientation Program as well as orientation services of women's organisations, to name a few, can shed a little light on your feelings of despair and provide some real practical strategies for successful adjustment. 

The good news is that nearly everyone lives to tell about their international living experience and many of us even talk fondly about it.

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Culture Shock Part 2

Major Problems That You Feel
You Need To Cope With

There are three major problems that you feel you need to cope with.
They are:

1. Other people's behaviour does not make any sense. Host country, colleagues, neighbours and staff do things that baffle you and confuse you about their intended goal.

2. What you know about your own behaviour and reactions do not produce the expected results with persons from the host country and

3. It becomes more difficult to find ready-made answers or solutions to the new demands of your day-to-day existence. ii

As this period continues,
You wonder how you were so blind as to not see the problems that occur in the host country. You experience a real sapping of your energy from just daily existence. Goals and hopes for the future become less clear. You begin to grieve the loss of the familiar comforts of home, especially the social interaction of friends and family. Individuals in the family may react differently to this stage. Those fortunate enough to have a routine of work or school may have an easier transition. Unresolved marital and relationship issues may resurface during this stage as the family experiences more and more stress. Adolescents may 'act-out' their frustrations in anti-social ways.

For some, a real crisis can occur.
Strong emotions can take over such as anger towards the perceived irrational, behaviour of the host country inhabitants; depression at finding yourself unable to complete simple or routine tasks and panic at the prospect of the ruin of your sanity, health, career and family. This stage, the very bottom of the adaptation curve, may be accompanied by symptoms of ill-health, overindulgence in alcohol or food, conflict with family, peers and nationals, withdrawal, overspending and many tears. iii

The third stage is when you find,
Yourself in direct confrontation with the host country culture. Sometimes the options seem scarce. You can wait it out until things start to get better of their own accord, or you can take evasive action. Unfortunately, for some, evasive action means just that - taking the first flight home. Others find a congenial retreat of like-minded souls and spend the rest of their stay as far as possible from inhabitants of the host country. Those who make the most complete and successful adaptation, however, are the people who find ways to communicate across cultural barriers. iv
Other dysfunctional reaction to

Cultural adjustment are aggressiveness and dependence. Aggressive behaviour portrayed not only towards members of the host country, but also towards family members and other expatriate peers. Aggressive behaviour may get someone's attention and quick results, but at the expense of the long-term benefit of developing communication skills which foster trust and mutual respect.

Regression into dependent behaviour may feel safe and secure, however, this posture can increase the burden on the family member or friend. When significant persons feel overwhelmed with responsibility, they begin to resent the dependent person and shy away from contact. The strategy of depending on others for assistance in adjusting can back fire, leaving the person feeling even more isolated.

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Culture Shock

CULTURE SHOCK:

The STAGES of ADJUSTMENT Culture Shock has been described as “an emotional and psychological reaction to the confusion, ambiguity, value conflicts and hidden clashes that occur as a result of the fundamentally different ways of perceiving the world and interacting socially between cultures”.

The term 'culture shock' may be a new addition to your vocabulary if you are having your first taste of overseas living. The concept is something we should neither fear nor dread. The process of adjustment is practically inevitable and happens to all of us, even the most seasoned -international expatriates. Cultural shock is also not limited to a 'foreign country or culture'.
For those long-term overseas dwellers eventually returning to their home country, the re-entry process can also be 'shocking'. requiring time for adjustment and recovery.

The Culture Shock Process is an attempt to conceptualise the adjustment process as it relates to cultural adjustment. Depending on which author you read, there are a series of stages (from four to ten) which you may experience as you cope with the new situations in which you live and work.

If you were fortunate to have had ample time to contemplate your move to Indonesia, you might have had an opportunity to study the environment in which you and your family would be living. Pre-departure planning can assist greatly in a family's transition, however it cannot eliminate the inevitable – your personal and family's reaction to change.

With or without pre-departure orientation, you create for yourself preconceived ideas and expectations about the new culture. This helps you navigate in unfamiliar territory with a kind of road map. You may find yourself fascinated with your new surroundings, confident about your future and excited about the new possibilities for professional and leisure pursuits. This is the first stage of adjustment. Some authors refer to it as the 'honeymoon period'.

Personal reactions to this first stage may include astonishment, wonder, elation and excitement. You become intense in your desire to comprehend the differences in the host culture. Your communications home go on endlessly about all the novel experiences you encounter. There is drama in almost every activity, even the most mundane.

As with most honeymoons, the rose-coloured glasses come off after two or three months when the romance and novelty no longer exist. Frustration ushers in the second stage that can last six to eight months. The mood is more of confusion and surprise.

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Common Sense Suggestions Will Help To Stay Healthy

Common Sense Suggestions Will Help To Stay Healthy
Common Sense Suggestions Will Help You
Have A Healthy Stay In Indonesia:

• Keep all vaccinations up to date.
• Exercise at least three times per week.
• Maintain a light diet with plenty of fruit and vegetables.
• Avoid raw fish and shellfish.
• Drink alcohol in moderation.
• Do not smoke.
• Drink at least 2 litres of water per day.
• Drink only bottled water.
• Generally avoid ice.
• Do not eat at road side stalls.
• Be more careful than usual with personal hygiene and food preparation.
• Ensure your domestic staff are aware of and follow good hygiene practices.
• If you cannot “cook it, peel it or boil it” avoid it when eating out.
• Have at least one day per week away from work.
• Utilise your leave provisions to have a break from your post.
• Practise safe sex.
• Avoid mosquito bites.
• Contact the Clinic or Hospital or your GP at home for any other medical advice.

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