Abortions, Plastic Surgery, Breastfeeding, and Other Goodies in the Indonesian Health Bill...

No apologies for a really long post...read it if you want to (it is interesting though) :D

The Health Bill which will repeal and replace the current law, Law No. 23 of 1992, has been doing the rounds of the House of Representatives (Dewan Perwakilan Rakyat / DPR) since at least 2003. The passage of the bill was somewhat controversial as it includes clauses that permit abortions to occur under very specific circumstances. Ultimately, these clauses saw one parliamentary faction reject the bill outright and another pass the bill but with notes as to their objections included. These factions were the Prosperous Peace Party (Partai Damai Sejahtera / PDS) and the Star Reform Party (Partai Bintang Reformasi / PBR), respectively.

Nevertheless, PDS did accept the right to an abortion where there was a medical reason detected early in the pregnancy (Art. 75(2)(a)). In contrast, the PBR rejected the clause that permits a rape victim to abort the product of that rape. The PBR rejection is based on the rights to life of the fetus / baby.

However, the bill is so much more than just a few clauses legalizing abortion in certain circumstances or more generally female reproductive rights. The bill also includes provisions on generic medicines and the rights of babies to be breastfed exclusively for the first six months of their young lives, and the amount of the respective government budgets that are to be allocated to health.

The provisions permit abortion within a very narrowly defined set of circumstances. It is important to note that these circumstances do not include abortion as a form of birth control. Abortion is permitted where the pregnant woman is pregnant as a result of a rape. Abortion is also permitted in circumstances where there is a medical reason for the procedure to be conducted. Some of the medical reasons include where there is an identified risk of severe genetic defects in the fetus or where the life of the mother is at risk if she were to carry the fetus / baby to term.

Before an abortion can be performed, counseling must be undertaken by the woman to determine whether she has considered all of the pros and cons of what she is about to do. The bill lists who may provide this counseling.

The bill also requires that the government ensure the availability and supply of generic medicines. This is intended as a measure to ensure that all Indonesians have access to medicines and drugs that they can afford. It is worth noting that the only obligation on the government with respect to generic medicines and drugs relates to those medicines and drugs listed on the essential list.

Interestingly, the bill recognizes the rights of babies to be breastfed exclusively for the first six months of their young lives, and then in combination with other foods up to the age of two. The bill also recognizes that some mothers, even when they want to, for medical reasons are unable to breastfeed. Where this is the case the mother is exempted from the provision. However, it would seem that there would need to be a provable medical reason for this before the exemption would come into effect. It is unclear whether mothers need to have a medical certificate that they must carry with them in order to prove this. The bill is also silent on how this is to be enforced.

More interestingly, the bill requires that the ability to breastfeed be facilitated by not only family members, but also by the central and regional governments, and the broader community. This implies that there is an expectation that employers respect the need for women to breastfeed and provide specialized facilities for this purpose.

Anyone that intentionally interferes with the breastfeeding program is liable for a term of imprisonment up to one year and a fine of IDR 100 million.

Furthermore, the bill sets out provisions that require the central government to set aside at least 5% of the state budget for the health sector. The bill also requires that the regional government set aside a minimum of 10% of their respective budgets for the health sector. There is an important stipulation with these minimum amounts, namely: that they are the minimum amount required to be set aside and these numbers do not include the salaries of any employees. Therefore, in real terms the budget for health related matters is likely to be larger than the amounts noted when salaries are factored in.

The bill also addresses issues such as malpractice, an obligation on health services and providers to provide emergency health care to anyone who requires it irrespective of that person’s ability to pay, traditional healers and therapies, plastic surgery and reconstructive surgery, and expressly prohibits the trafficking in organs.

The provisions relating to malpractice and the obligation to provide treatment are attacked to a criminal sanction that provides that where medical treatment is refused then there is a liability to a term of imprisonment up to two years and a fine of up to IDR 200 million. However, where this refusal results in impairment or death then the penalties are ratcheted up to a maximum of ten years imprisonment and a fine of up to IDR 1 billion.

Traditional healers who use “tools” are required to have those tools registered by the relevant authorities. I would be guessing that this includes Mak Erot and her sons with respect to their noted abilities in fixing male issues like small penis syndrome. If a traditional healer causes injury then they are liable for a term of imprisonment not to exceed one year and a fine of up to IDR 100 million. This is the case even where the injury caused results in death.

So, in that sense it is better to be a traditional healer and kill someone than be a doctor and kill someone. In fact it could be better by about nine years.

The bill explicitly prohibits the commercialization of organ transplants by stipulating that transplantation of organs and body parts can only be done for humanitarian reasons and not for commercial purposes. Therefore, anyone caught trading human organs and body parts are liable for a term of imprisonment up to ten years and a fine of up to IDR 1 billion.

The plastic and reconstructive surgery provisions are interesting. Probably more interesting because the elucidations to the bill only state “self-explanatory” which in essence means that the bill is silent as to how these provisions might be interpreted. This is of concern considering that the penalties are severe, up to ten years in prison and fines of up to IDR 1 billion.

Yet, the provisions prohibit the use of plastic and reconstructive surgery if the objective is to change one’s identity. But, isn’t that the purpose of plastic surgery to change or improve how you look, and consequently change your identity? The bill also prohibits plastic and reconstructive surgery that is against community norms. Unfortunately, the elucidations are silent as to what these community norms (and presumably values) are. So, it is worth wondering out loud whether the provision can be used to prevent gender re-assignment surgeries? I guess that this will all become much clearer when the necessary implementing legislation is enacted. So, until then perhaps this is all much ado about nothing.

It is clear that the bill is a lot more than just a few clauses on abortion and when abortion is permitted. Nevertheless, it is expected that it is the abortion provisions that will dominate news headlines. However, the articles dealing with matters such as generic medicines and drugs, breastfeeding, and minimum budgets are equally as important as these in effect significantly alter the regulatory framework from the current law and also seemingly place additional burdens on both the public and private sectors.

The bill comes into immediate force once it is enacted. Enactment requires the signature of the President. If the President fails to sign the bill into law then the bill will self-enact after 30 days pursuant to the 1945 Constitution.

Pregnant With 12 Babies...

I am all for developments in medicine and science that help us live more fulfilled and healthier lives. However, this story gets one wondering, and wondering big time, about pushing the physical boundaries of what is humanly capable and, perhaps more importantly, what is responsible.

A Tunisian woman is reportedly pregnant with 12 babies, six boys and six girls. The 12 babies are the result, it is thought, of an IVF treatment. The woman and her husband are apparently ecstatic about the pregnancy.

I guess I am wondering what are the implications of trying to carry this many babies to term? Particularly, what are the health implications for the mother and the babies she is expected to give birth to.

The couple have been told that she will be able to give birth to all these babies naturally. However, most experts seem to think that this would be impossible. I suppose we will find out on this one when the time comes.

I truly hope that it all works out for her, her husband, and the 12 babies she is carrying.

Medical Miracles and Some Thoughts on GWB

Here's something I thought was worth sharing.

An Israeli doctor says, "Medicine in my country is so advanced that we can take a kidney out of one man, put it in another, and have him looking for work in six weeks."

A German doctor says, "That is nothing; we can take a lung out of one person, put it in another person, and have them looking for work in four weeks."

A Russian doctor says, "In my country, medicine is so advanced that we can take half a heart out of one person, put it in another person, and have both of them looking for work in two weeks.

The doctor from Texas, not to be outdone, says, "You guys are way behind, we recently took a man with no brains out of Texas, put him in the White House for eight years, and now half of my country is looking for work!"

Pending Fatherhood

This is a personal musing on pending fatherhood.

I have noticed on the telly that Snoop Dogg has a reality show on Global TV (MTV) about fatherhood. It is essentially him doing stuff with his kids. But, the inspiration for the post comes from a conversation I was having with a good friend and a single question that he asked, "are you excited?"

The simple answer is, "Yes!" The complex and long winded answer would include the reasons why. I am looking forward to being responsible for how the little fella turns out as a person. The challenge is both daunting but undoubtedly full of plenty of good times. I look back fondly on my own childhood. If I can be half the parent that my parents were to me then the kid is going to do well in his life.

The pregnancy journey has obviously been more of a burden for the better half than me. Burden in the sense of carrying the kid. For men it is sort of like you do your thing and then you have nine months off from the hard yakka. The biggest demand is satisfying the crazy cravings that the mother has. I am expecting my work load to pick up a little after the little fella pokes his head out into this brave new world.

The fun stuff is the looking at the USG and being able to see the miracle of life in action. Watching your very own flesh and blood grow before your eyes. The Kid is going to be an active bugger if his performances to date are any indication. The way he is banging about with his hands, elbows, arms, feet, knees, and legs, suggests to me that there is a budding UFC star on the way. The next Randy Couture.

The next big thing is to make some recording of the Kid in 3D and 4D. The miracles of modern technology. My parents were going to come over sometime next week and we were going to take them for a look see at the USG. Then yesterday my old lady decided that double bypass heart surgery was more important. In short no air travel for her for a while. Thankfully, the surgery went well and perhaps the folks will be able to fly over later in the year. Hence the idea of getting the recordings in 3D and 4D.

The excitement is also that I am looking forward to playing cricket with the kid as he grows up. Hopefully, at 50 or so I will still be able to waddle around and role the arm over in 4th or 5th grade competitive cricket. I am not so much looking forward to having to get back to primary school maths and science to help with homework...but it should make me good for a shot at the million dollar question on "Are You Smarter than a 5-year-old?"

So, yeah, I am excited at the prospect of being a father. Probably no more so than my better half is looking forward to being a mother. We already have a running bet on what the kid's first word is going to be.

Multiple Orgasms & The Australian Parliament

This gripping headline is not as gripping as it might seem! This is in spite of the fun that can be had with multiple orgasms in general. It appears there is a direct relationship between these multiple orgasms and genetically modified organisms. It appears that at least one of Australia's Federal politicians cannot quite tell the difference yet between a genetically modified organism and a genetically modified orgasm.

The mind boggles at the miracles of modern medicine and modern science. However, the ability to genetically modify an orgasm sounds just too good to be true. Think about it for a second or two, longer if you want! For those that have never had an orgasm, your problems are solved (if indeed it is a problem), you can now be genetically modified to orgasm till your heart is content. On the flip side, so to speak, presumably if you orgasm too often then you can get yourself genetically modified to orgasm on a less frequent basis.

Seriously folks the story is not really one of orgasms at all but organisms and whether or not the government should permit them to be genetically modified. Anyways, it would seem that the Liberal Member for La Trobe, Mr. Jason Wood, still has a little ways to go on working out what constitutes a genetically modified organism and a genetically modified orgasm!

Keep your eyes peeled and your legs crossed because there might just be a genetically modified orgasm coming your way!

Down Syndrome & Medical Science

This is something I cut and pasted from somewhere else, a site called "Bad Science". The site has been set up to debunk myths and the link is one provided to me by a blog colleague, Jakartass.

It is a follow on from my recent posting on Down Syndrome. The picture is of John Langdon Down.

"Ben Goldacre The Guardian

Every now and then something comes along which is so bonkers and so unhinged that it unmoors itself from all cultural anchoring points, and floats off into a baffling universe all of its own. I am a connoisseur of freaky ideas, but nothing prepared me for this gem from the academic journal Medical Hypotheses: an article called “Down subjects and Oriental population share several specific attitudes and characteristics”.

You’d be right to experience a shudder of nervousness at the title alone, since this is an academic journal, from 2007, and not 1866 when John Langdon Down wrote his classic “Observations on the Ethnic Classification of Idiots”. This paper was the first to describe Down syndrome (which Down called “mongolism”) and in it, the author explained that different forms of genetic disorder were, in fact, evolutionary regressions to what he viewed as the less advanced, non-white forms of humanity. He described an Ethiopian form of “idiot”, a mongoloid form, and so on. Looking back, it reads as spectacularly offensive.

Now. People with Down syndrome - who have three copies of chromosome 21, learning difficulties, and other congenital health problems - do indeed look a tiny bit like people from east Asia, to westerners. This is because they have something called an “epicanthic fold”, a piece of skin that joins the upper part of the nose to the inner part of the eyebrow. It makes the eyes almond shaped. You’ll find epicanthic folds on faces from east Asia, south-east Asia, and some west Africans and Native Americans. People with Down syndrome have various other incidental anatomical differences too, if you’re interested, such as a single crease in their palm.

Flash forward to 2007 - I think that’s where we are - to two Italian doctors. They offer their theory that the parallels between Down syndrome and “oriental” people go beyond this fleeting facial similarity. What is the evidence they have amassed? I offer it almost in its totality.

One aspect, they say, is alimentary characteristics. “Down subjects adore having several dishes displayed on the table, and have a propensity for food which is rich in monosodium glutamate.”

... “The tendencies of Down subjects to carry out recreative-rehabilitative activities, such as embroidery, wicker-working, ceramics, book-binding, etc., that is renowned, remind [us of] the Chinese hand-crafts, which need a notable ability, such as Chinese vases, or the use of chopsticks employed for eating by Asiatic populations.”

Perhaps you can think of cultural rather than genetic explanations for these observations. There’s more. “Down persons during waiting periods, when they get tired of standing up straight, crouch, squatting down, reminding us of the ’squatting’ position … They remain in this position for several minutes and only to rest themselves.” Amazing. “This position is the same taken by the Vietnamese, the Thai, the Cambodian, the Chinese, while they are waiting at a bus stop, for instance, or while they are chatting.”

And that’s not all. “There is another pose taken by Down subjects while they are sitting on a chair: they sit with their legs crossed while they are eating, writing, watching TV, as the Oriental peoples do.”

To me, and I may be wrong, this article is so fantastical and so thoughtlessly crass that it’s impossible to experience anything like outrage. But this is a proper academic journal, published by Elsevier, with a respectable “impact factor” - a measure of how frequently a journal is cited - of 1.299. I contacted the editor. He told me this paper was a very short, discursive and preliminary communication, floating a general idea for discussion and debate, and that taking scientific ideas out of their context could be misleading."

As I said, I do not often cut and paste others work but this I found interesting. My thanks to Jakartass for pointing it out!