The Indonesianization of Social Medicine
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The Indonesianization of Social Medicine Vivek Neelakantan PhD student, The University of Sydney, Unit for the History and Philosophy of Science Abstract The purpose of social medicine, which began in Europe as an academic discipline during the Second World War, was to investigate the correlation between specific factors such as age, gender, race, heredity, economic circumstances, domestic environment, occupation and nutrition on health. Almost a decade later, Indonesian physicians applied social medicine ideas to promote public health in a country characterized by weak state intervention. These physicians eschewed the narrow correlation between poverty and ill health but reinterpreted social medicine within the Indonesian social context with its entrenched patriarchal system and cultural preferences. The wider theme explored in this article concerns the emergence of social medicine in twentieth-century Indonesia as a critical reaction to Dutch public health policies. The article examines the partnership between Indonesian physicians and the post-colonial state and their shared vision on state-guided social medicine, but does not explore why social medicine failed to usher in a transformation of the nation’s health system. Keywords: Social medicine, Pembangunan, nutrition, famine Introduction on family stability, a patriarchal system, and cultural choices pertaining to food-affected Social medicine began as an academic health outcomes. This article depicts the discipline in Europe at the time of the Second emergence of social medicine in twentieth- World War with the aim to investigate the century Indonesia as a critical reaction to Dutch correlation between specific factors such as age, public health policies. The article contains three gender, race, heredity, economic circumstances, sections. The first section offers a chronological domestic environment, occupation, nutrition, account of social medicine in the late-colonial and environment on health and disease (Ryle, period and during the Indonesian Revolution. 1948: 9-12). Nearly a decade later, Indonesian The second section surveys the Indonesian physicians such as Raden Mochtar applied discourse in social medicine immediately after social medicine ideas to promote public health independence. The third and final section in a country where the public health system devotes attention to the specific problem of was under-resourced and marked by weak population growth and child health. state intervention. These physicians eschewed the narrow correlation between poverty and ill health and reinterpreted social medicine within the Indonesian context with its emphasis Vivek Neelakantan 75 The Indonesianization of Social Medicine Colonial medicine and decolonization criticize colonial health measures that would later serve as a blueprint for health policies Medical initiatives in the Netherlands during the Soekarno era. A major bone of Indies before the nineteenth century were contention between the Indonesian nationalists limited to curative care, catering primarily and the Health Service in the Volksraad was to the European population in major cities the administration of the anti-plague campaign such as Batavia, Semarang and Surabaya. which involved both puncturing the spleen However by the nineteenth century, the colonial of corpses to detect disease and rat-proofing authorities introduced smallpox vaccination as of houses. The former action was held by a preventive public health measure. The Civil many Muslims to violate Islamic injunctions Medical Service of the Netherlands Indies related to the sanctity of the body after death (renamed Public Health Service in 1925) had (Abeyasekare, in: Chandler & Ricklefs [eds], launched disease eradication campaigns against 1986: 9). The Indonesian members of the malaria, yaws, hookworm and plague and Volksraad campaigned to make the Health was entrusted with the task of implementing Service more responsive to the needs of the quarantine, intensive hygiene schemes, medical colony. I will briefly examine the contribution research, the training of doctors and midwives of Abdul Firman gelar Maharadja Soangkoepon although anti-plague measures were resented (Volksraad delegate from North Sumatra) by the indigenous population. This section and the nationalist physician Abdul Rasjid discusses the dynamic nature of colonial who envisioned an Indonesian alternative to public health policy in the Netherlands Indies, the dominant colonial health model that in the unpopularity of health measures such as the 1930s focused largely on prevention of vaccination, popular resistance, and the way infectious diseases. health became absorbed in the anti-colonial Maharadja Soangkoepon was critical of the struggle. In the process, colonial public health high cost of health care in the Netherlands measures were subject to nationalist criticism. Indies which left the poorer section of the Between 1912 and 1940, the portion of Indies population in the rural areas without the public budget in the Netherlands Indies access to Western medicine (Maharadja allocated to health service ranged between 2.5 Soangkoepon &Abdul Rasjid, 1938: 156- and 5 per cent but showed a declining trend 60). He encouraged individual initiatives to for much of the period as health received only promote hygiene and sanitation in rural areas, about half the amount spent on police and a task which could be well accomplished by less than one-ninth of the expenditure on enlisting Indonesian physicians better placed defence (Abeyasekare, in: Chandler & Ricklefs than their Dutch counterparts in determining [eds], 1986: 4). Health was an issue on the existing health needs. Abdul Rasjid argued nationalist agenda. The Volksraad (People’s that medicine not only affected physical but Council) was created as an advisory body by also spiritual well-being of the person and the colonial government in 1918; it fell under could be studied from scientific, religious and the jurisdiction of the Governor-General and humanist considerations. Rasjid’s view of the Dutch parliament. The Volksraad was not health embraced not only a narrow defence a legislative body and not all members of the against disease but engaged broadly with socio- Volksraad were democratically elected. A few economic aspects affecting overall well-being by prominent Indonesian nationalists, especially emphasizing health conditions of rural areas physicians, were represented in this advisory in medical education. Medicine anchored in body, for instance Abdul Rasjid. The Volksraad Western science but adopted to the way of life served as a platform for the nationalists to 76 Lembaran Sejarah, Vol. 10, No. 1, April 2013 in colonial Indonesia was essential to promote Although medical initiatives in the acceptance of basic hygiene. Nationalist leaders Netherlands Indies before the nineteenth such as Maharaja Soeangkoepon and Abdul century had been largely oriented to curative Rasjid thus used the Volksraad as a political care, such measures proved expensive towards forum to criticize the nature of colonial medicine the end of the nineteenth century as the in the 1920s and 1930s. archipelago suffered a severe shortage of skilled The Bandung Conference in 1937 medical personnel. Given the constraints of the approached the question of rural hygiene from acute shortage of skilled personnel and financial an interdisciplinary perspective involving resources, the Health Service concentrated collaboration of medical professionals with on the control of epidemics while leaving sanitary officers, architects, engineers, individual treatment of the individual to private scientists, and agriculturalists. The conference enterprise, in particular the missionary and acknowledged that preventive medicine was estate hospitals. Such measures did not enlist a cost-effective way of improving health in the co-operation of indigenous people. Asian countries (League of Nations, 1937: 42). Between 1942 and 1949, Indonesian Such an approach implied tracing the socio- public health faced formidable challenges: economic causes of ill health. The conference the Pacific War, including the Japanese recognized that overpopulation was correlated occupation of the archipelago as well as the with a high rate of infant mortality. A poor Indonesian Revolution (1945-49), both causing diet, low standards of living, and oppressive a considerable dislocation of health services. land laws were regarded as causative factors During the Japanese occupation, health was a for malnutrition that raised infant mortality. tool of military propaganda. Public health was Therefore, scientific research on nutrition centralized under Japanese command in Java and demonstration of the nutritive value of whereas the Outer Islands were neglected. certain foodstuffs through village lectures could Indonesian physicians such as Abdul Rasjid help mitigate the problem of malnutrition in and Boentaran Martoatmodjo - now getting Asian countries. The conference acknowledged more responsibility than ever - envisioned an that good health was a part of overall well- Indonesian alternative to Western medicine. being. Decentralized health delivery to rural They began to define what was at stake for the areas (focusing on preventing disease) was health of the Indonesian nation by advocating a cost-effective public health measure for improvements in the standard of living of the which the rural public had to be educated population through a programme of increasing through practical hygiene demonstrations. population,