Staying healthy when you visit Indonesia – what are the risks? How good is the care?

Staff of Indonesian medical centre in full PPE during the COVID Pandemic

You probably wouldn’t give too much thought to health issues if planning a holiday in Bali, right? Yet if you are like most people, you might get all get all flustered and worried about health risks if visiting elsewhere in Indonesia. Which is really weird.

HERES A BETTER and a Facts-based way to think about health safety and health facilities if travelling Indonesia.

If you would feel safe enough visiting Singapore, Kuala Lumpur, Phuket – or Bali – then you can also be comfortable about traveling to most of Indonesia’s main centres and popular visitor destinations. The risks are about the same.

That said, there are some health precautions to be considered, depending on which areas of this vast and varied country you plan to explore.

If you will be visiting remote regions in places like Papua, the rivers and jungles of Kalimantan, the coastal lowlands of East Sumatra, or the lesser islands of East Nusa Tenggara, then you may need to take extra precautions and should check.

Elsewhere simply follow the same rules as you would for any mainstream Southeast Asian destination:

Take care with drinking water

It’s always prudent to not drink tap water in Southeast Asia and in Indonesia, even in 5-star hotels.

Safe, good quality bottled water is cheaply and readily available in shops, restaurants, bars and at street stalls. It is preferred by most locals as well as visitors. Your hotel usually will supply free bottled water for you daily.

Generally, you can safely enjoy ice in your drinks. Restaurants, bars, open air food courts and even street vendors typically buy-in their ice from specialist suppliers.

Indonesian food not only tastes great - expect it to be SAFE

BAKSO – meatballs and noodles in a delicious soup. Simple and one of Indonesia’s most popular street foods. Pic- Pixabay.com

Food offered in restaurants and from food market vendors In Indonesia typically is properly and safely prepared.

Those added spices that make Indonesian food taste so great aren’t there just for flavor – they also batter any bugs. Food also is typically slightly over-cooked for good measure.

Food poisoning can happen. But in my experience, with sensible precautions, you would be most unlucky to contract a case of Bali belly. The risk is probably much the same as when you are dining out at home.

I have searched unsuccessfully for data comparing the risks of foodborne illness by country.

However, the British law firm Slater and Gordon has published interesting results from a survey of 2,000 vacationers apparently exploring legal avenues after experiencing food poisoning (1).

The scientific validity may be somewhat questionable, but you may be surprised at the top 10 countries in which people reported becoming ill:

  1. Spain (30 percent) 
  2. Turkey (15 percent)
  3. Egypt (13 percent) 
  4. Greece (12 percent) 
  5. France (12 percent) 
  1. Italy (8 percent)
  2. America (7 percent)
  3. India (7 percent)
  4. Morocco (6 percent)
  5. Thailand (6 percent)

Nary a mention for Indonesia? It could be because fewer people visited or fewer became ill. Regardless, we could reasonably expect Indonesia to rank at least as well as Thailand and India.

After a couple of decades living (and eating lots of local food) in Indonesia, I suggest you need not worry when dining at restaurants and food courts. Indonesian street vendors also take good care in food preparation despite their limited facilities. Ingredients are usually fresh from the markets.

Use your common sense to judge how the stallholder is operating and how the food is being handled and cooked. If concerned move on to another vendor – there are plenty to choose from.

However, be cautious about inflicting too many spicy delights on an unsuspecting Western stomach more accustomed to bland.

The delicious local foods are tempting, but often come with plenty of spicy heat. Your belly may decide to revolt.

The Indonesian phrase you need to memorise is TOLONG TIDAK (pron tee-dah) PEDAS – it translates as ‘please not spicy hot.’

The mosquito-borne disease risk is low, but take care anyway

Take care to avoid mosquito bites while in Indonesia because mosquitoes can carry both Malaria and Dengue Fever.

The risks from these diseases are relatively low in the main visitor destinations. There is virtually no malaria in Jakarta, most of Java, metropolitan Bali, and the urban areas of Sumatra, Kalimantan, and Sulawesi. In total around 55% of Indonesia is considered malaria free.

However, there is some risk if visiting remote regions. Malaria can be present in rural areas of Sumatra, Kalimantan, and Sulawesi and throughout many the islands east of Bali.

Regular fogging is used to control mosquitoes in hotels and resorts and in  suburban neighorhoods across Indonesia – Pic un.org

The debilitating and painful flu-like symptoms of dengue fever can be the more worrying, with periodic outbreaks in major cities and suburban areas.

Fogging programs to combat Dengue

Hotels and resorts routinely use insecticide fogging to combat dengue. Local authorities do the same in neighborhoods prone to outbreaks.

Time is the only cure for dengue fever – recovery usually takers 10 to 15 days. Occasionally it can be fatal.

There is no specific treatment. The medical advice is to rest, take paracetamol to reduce pain and fever, drink plenty of fluids to avoid dehydration, and cease taking blood thinning drugs to avoid any risk of hemorrhage.

Severe cases can result in internal bleeding and damage to organs, but these are rare in adults.

My visiting daughter and son-in-law contracted Dengue and spent about a week in hospital where they received excellent care and recovered fully.

Prevention is the answer. Wear appropriate clothing, especially, in the early evening. If there are mosquitoes around then apply a repellent. Use a knock-down spray if there is any hint of mosquitoes in your hotel room.

Many hotels will leave a pressure pack of insect spray in your room. If not, then buy a small pack for yourself or ask the hotel staff to spray the room for you.

Inoculations for Indonesia - What shots do I really need?

if you have recently visited Africa or some areas of South America, you must have a Yellow Fever vaccination certificate This is to protect the Indonesian community.

Any other inoculations are optional and most experienced visitors dispense with them completely.

Internet country advisories will often recommend Hepatitis A and Typhoid inoculations, yet reputable Travel Health clinics do not recommend them for nearby Singapore and Malaysia.

Why the difference? – Because country recommendations from health authorities are for the WHOLE country and therefore must take account of any risk within the national boundaries, even if confined to limited or remote areas.

Indonesia, as the world’s longest archipelago, is vast and has many different regions. A health risk in one location, like Papua, influences the advisory for the whole country.

Indonesian hospitals - what if I become sick or I'm injured?

Most of Indonesia has extensive medical facilities and services ranging from basic to state-of-the-art. However, quality care and facilities can be limited in rural regions

The cost of medical care is much lower than in Western developed countries. In some modern private hospitals, a private room and care can be cheaper than a night in a good hotel.

Regardless of where or how your illness or accident happens, unless you (or your friends, your family, or sponsors) can pay or guarantee payment, then you may not be treated.

It is therefore essential you have reliable TRAVEL INSURANCE. Ideally the policy should cover evacuation costs. Most responsible tour operators make travel insurance mandatory. It is a firm requirement for Better Tours packages.

TOP:Awal Brothers hospital Batam (Pic Yunianti Jannatun Naim – antaranews.com). ABOVE LEFT: Pondok Indah Hospital in Bintaro Jaya, Greater Jakarta (Pic kfmap.asia), and RIGHT: Doctor viewing computer diagnostics. (Pic irwan-iwe unsplash.com)

How is the Indonesian medical system set up - is it any good?

Basic health care in Indonesia begins at clinics in local communities and rural areas. Called Puskesmas, they are staffed by nurses and midwives (Bidan).

It seems that a midwife is part of the team at every community clinic and you will often hear locals refer to their consultations as a visit to the Bidan regardless of whether it has anything to do with a pregnancy or childbirth.

The care provided is usually good and incredibly cheap. A consultation and medication can cost as little as five Australian dollars.

Some years ago, an American friend and I were visiting one of the Riau Islands when he suffered a nasty gash to his head. A minibus delivered us to the nearest community health clinic where a nurse and her assistant cleaned, treated, sutured, and dressed his wound.

The fee asked was only around AUD $6. My friend was so impressed with the care that he immediately reached into his wallet and handed over the equivalent of USD$100 as a donation to the clinic.

In the towns and cities care is provided by more than 2,800 large public and private hospitals, many with state-of-the-art equipment and facilities.

About 65% are private sector with the rest funded by Government or operated by charitable or religious organizations. Larger hospitals also operate ambulance services.

A Puskesmas or Community Health Clinic in Benkulu Province, West Sumatra. You will find centres like this in regional communities throughout Indonesia.

One of 12 national in-service training centres being established for health professionals and workers. This one is located in Tanjung Uncang, Batam

General Practitioner doctors (Dokter Umum) are widely available, usually in group practices and often conjointly with pharmacies (known as apoteks).

Larger centres have efficient and well-equipped pathology labs. Some GPs offer a choice of modern Western medicines or traditional cures.

Medical services are often stretched

Unless you are in a very remote region and provided you can guarantee payment, you will have ready access to quite good medical care.

However, services are often stretched. Unless you arrive at a hospital as an emergency, you can expect crowds and extended waiting times.

Indonesia is a caring society, and you will find nursing staff to be helpful and attentive, if a little shy when dealing with Westerners.

The quality of doctors varies. Many are well trained and excellent, but the abilities of others are open to question.

The Government has established a national network of sophisticated in-service regional training centres aimed at lifting standards for doctors, nurses, and ancillary staff.

Remember too that in the event of a truly serious medical issue in Indonesia, the world-class facilities of Singapore and Malaysia are close by.

How can I get my medications in Indonesia?

Pharmacies in Indonesia are called Apoteks – this one is in Jakarta

Indonesian pharmacies or drug stores (Apoteks) are well stocked. And you can obtain most common medications without a doctor’s prescription.

If a branded medication is not available, the pharmacist will usually offer a generic substitute – an identical medicine but at a much lower price.

The Indonesian government is encouraging the supply of low-cost generic preparations. So much so, that regular visitors to Indonesia with chronic conditions save money by routinely stocking up on medications to take home. A no-brainer if you are from a country with expensive health care.

Rather than complete packages of medications you will usually be offered blister-pack strips. But you can buy full packs, depending on the pharmacy’s stocks. You may have to order and wait a day or so.

Busy Chinese medicine outlet in the city of Bandung

Apoteks stock traditional remedies along with Western medicines. There also are specialist Chinese medicine outlets who also dispense and sell pills, potions, lotions, and remedies from Indonesian and other Asian traditions.

Supermarkets and convenience stores stock sunscreens, insect repellents, lotions, elastic strip bandages, toiletries and more at low prices.

TOILETS in Indonesia - Dirty, smelly, squats or what?

There are plenty of horror stories about the toilets of Asia – and the bad news is that many of them are true.

But toilet facilities in Indonesian hotels, bars, better restaurants, shopping centres, airports and public buildings typically will be clean and well maintained with Western style pedestal pans and hand wash basins.

There is often a choice of cubicles with pedestal toilets, or the squat pans preferred by Asians.

Usually there is a spray washer or hand bidet on a hose adjacent to Western or Asian toilets for cleaning yourself (Expats variously call them ‘bum guns, bum washers or butt blasters’).

The Asian squat toilet and the ‘bum gun’ hand bidet can be a challenge for Westerners. But there are plenty of regular Western pedestals. 

Don’t worry – you will become accustomed to this hand-held-bidet way of completing your toilet. You might even start thinking of installing them in your bathrooms at home.

PRO TIP

The trick with bum guns is to try them out with a squirt into the toilet BEFORE you use them. The water pressure is often very strong. The unwary will wet much more of themselves than intended, together with their clothing!

The definitive article on bum blasters has been written by backpacker Samantha Lego. You can read her tongue in cheek account here South East Asia Backpacker Bum-gun Beginners Guide. I strongly recommend you check it out, because it is hilarious as well as instructional.

Other than in your hotel, there often will be no toilet tissue provided. So, if you need it, you should carry your own. It is available from Indonesian supermarkets and convenience stores (The Paseo 3-ply is good).

Remember, toilet paper can gum up the works

Where there is toilet paper provided, you may also see signs asking you not to flush it down the toilet but instead place it in a provided receptacle.

Toilet discharge in Indonesia typically goes to septic tanks and excess toilet tissue can reduce the efficiency of the system. The idea is to use the bum-washer for cleansing and the toilet paper to dry-off.

In markets and open-air food courts toilets are likely to be smelly, possibly dirty and have only Asian style squat pans and basic urinals.

There will be no toilet tissue and often no spray washer, but rather a container of water and a dipper. You are expected to use dippers of water to clean yourself and flush the toilet.

All this can represent a hygiene challenge for Western visitors. However, you will find that most of these places have separate hand-wash basins away from the toilets with liquid soap supplied. Look for them.

Expect to find squat toilet arrangements if you are invited into Indonesian homes, particularly in rural areas.

It may take a little while to become accustomed to them, but people who ought to know maintain they are healthier than Western pedestals.

Perhaps so, but for the not-so-fit or flexible they can be quite a test on knees and legs – maybe a few pre-travels squat exercises are in order?

STDs - Dangers from local liaisons in Indonesia?

The mantra of ALWAYS practicing safe sex applies just as much in Indonesia as elsewhere, though there is evidence that many visitors and locals routinely don’t do so.

As in the rest of the world, HIV is a fact of life in Indonesia. As of 2019 official figures put the number of people living with the condition at just over 640,00, about 0.04% of the population. You will not hear much about HIV as it remains a largely taboo subject in Indonesian society, which is a pity.

However, the rate of new infections has been declining and the Government is quietly supporting enlightened prevention and treatment programs, including clinics offering free or low-cost testing, anti-retroviral therapies, and counselling for those infected.

Though not a major issue, Indonesia also is by no means immune from the usual run of sexually transmitted diseases (STDs), like gonorrhoea, genital herpes, chlamydia and so on.

In the event you contract a nasty STD, there are efficient testing and treatment facilities at medical clinics and hospitals where you can be treated efficiently, inexpensively, and discreetly. There will be doctors or staff who can speak English.

IN SUMMARY ...

Overall, health services in Indonesia are not as sophisticated as in Western countries or in nearby countries like Singapore, Malaysia, and Thailand (where first rate facilities attract medical tourism).

But good, inexpensive medical treatment is available, especially in Indonesia’s big towns and cities. And it is constantly improving.

Rural areas can be more problematic, and this is a powerful reason why travel insurance with medical repatriation benefits should be part of your visit preparations.

Indonesia also has its share of folk cures. MASSAGE is one of them and is considered a potential cure for just about everything. The massages are excellent and cost amazingly little.

To learn more, check out these articles:

The marvellous magic of traditional massage in Indonesia 

What to expect in an Indonesian massage salon

In Indonesia you can be deliciously pampered for ridiculously little

References
  1. Spain is FOOD POISONING capital of the world –  EXPRESS Travel News, UK 

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Douglas Cole

Doug is a former journalist and broadcaster who lived and travelled in Indonesia and Southeast Asia from 2002 to 2018. He returned to Indonesia in mid-2022 after being stranded in Australia by COVID border closures. He is completing a book under the working title ‘INDONESIA – Safely, Easily, and in Comfort.’

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