HYPERBARIC MEDICINE ACTIVITIES IN INDONESIA

1. HYPERBARIC MEDICINE ACTIVITIES IN INDONESIA Mahdi.H, Susanto.A, Undari.J, Mahdi.D December 7th. 2009 LAKESLA, SURABAYA Indonesian Maritime Specialist Society 1

2. INDONESIA 2

3. Introduction Indonesia: Archipelago country, >> 17.000 islands, 2/3 seas enriched with marine’s biota, minerals and mining's, shipwreck’s treasures, beautiful fish and sea coral. The needs of undersea operation activities is very important: Combat driver, underwater demolition, underwater construction, off shore drilling. 3

4. Recreational diving sites: - Manado / Bunaken, Maluku / Banda Island, Bali, Lombok, Derawan Islands, Raja Ampat Island Supported by: 17 hospitals with Hyperbaric Chamber 3 naval ships with HC …introduction 4

5. Hyperbaric Medicine in Indonesia • 1962 –1964 study to Poland and Japan • 1962 Diving Center for Indonesian Navy Surabaya • 1962 Graving dock and Hyperbaric Chamber (HC) Installation Surabaya • 1964 Multiplace HC “Kurimoto” operational • End of 1970 Indonesian Naval Health Institute (LAKESLA), Surabaya for Center of Excellence, east of Indonesia • End of 1980 improvement for hyperbaric facilities at Dr.Mintohardjo Naval Hospital, Jakarta for Center of Excellence, west of Indonesia 5

6. Installation operating HC: Navy, Oil Company Pertamina, Dept of Health and Private Hospitals. Advance study: USA, Russia, Yugoslavia, Australia, France, Germany: deep diving and submarine medicine. 1980 decade, Indonesian Naval Health Institute started Hyperbaric Medicine course. Hyperbaric Medicine in Indonesia 6

7. Ongoing process: Diving and Hyperbaric medicine service standardization for medical doctor and paramedic. Standardization and competence for divers and underwater workers. Hyperbaric Medicine in Indonesia 7

8. Hyperbaric facilities in Indonesia 8

9. Distribution of HC Indonesian Navy Lumba2 Tj. Pinang Ambon KRI Rupat Jakarta Surabaya 9

10. Distribution of HC Dept of Health Biak Manado P. Pramuka Serang Makassar 10 Denpasar

11. Distribution of Hyperbaric Chamber in Indonesia Distribution of HC Oil Company PERTAMINA Aceh Sorong Balik papan Cilacap 11

12. Distribution of HC Private JAKARTA SOLO 12

13. Center of Excellence West Indonesia HYPERBARIC CENTER Dr.MINTOHARDJO NAVAL HOSPITAL, JAKARTA East Indonesia INDONESIAN NAVAL HEALTH INSTITUTE (LAKESLA), SURABAYA 13

14. HYPERBARIC CENTERDr. MINTOHARDJO 14

15. Indonesian Naval Health Institute(LAKESLA) Experimental HC (animal) Transport Monoplace Chamber Locking 15

16. LAKESLA 16

17. Indonesian Navy KRI. P. RUPAT Monoplace HC Lumba2 Barge 17

18. HC Sanglah Denpasar, Bali Frequency HBOT for DCS is high Patients: Fisherman and recreational diver 18

19. Hyperbaric Chamber • Support diving activities in Indonesia and Asean countries • T/ OHB : “ DCS “ and Cilical case • Preventive and Promoting • Research and Training

20. Personel for HC Medical doctor consultant Maritime medicine specialist Doctor + hyperbaric medicine course Inside Tender Outside Tender Technicians / operator 20

21. Education and Hyperbaric course Naval officer: underwater medicine (Lakesla) Hyperbaric course: doctor, paramedic, operator and HC technicians Hyperbaric introduction for Medical student, Professional divers (Mintohardjo Naval Hospital) Continuing degree environmental medicine majoring Hyperbaric (Mintohardjo Naval Hospital) Maritime medicine specialist (Faculty of Medicine University of Indonesia) 21

22. Number of patients and visits : LAKESLA, 2006 and 2007 *DM complication : gangrene, ulcus, cellulites, post amputation *Neurology : cephalgia,neuropathy, vertigo, tinnitus, bell’s palsy, etc

23. Number of patients and visit, RSMTH: 2006 and 2007

24. Number of patients and visits, LAKESLA and RSMTH 2006

25. Number of patients and visits, LAKESLA and RSMTH 2007

26. OHB 10 x Pra OHB

27. Discussion Case : • Decompression Sickness: >> fisherman divers, recreational divers. • Military and professional divers ↓ • Routine medical check up for military divers, underwater professional worker, dive guides • Traditional and fisherman divers : + 27

28. Sudden deafness  highest case in RSMTH Jakarta The patient treated within golden period (2 x 24 hours), the improvement: 75-90% DM case  to avoid amputation Orthopedic post op, neuro surgery post op, and general surgery Post stroke rehabilitation, neurological symptoms (headache) …discussions

29. Ophthalmologic case: A. Centralis Retinae occlusion Most of adjuvant therapy: Good results Kindwall oxygen treatment table …discussions

30. There are 17 hospitals with HC. Two diving centers: - Mintoharjo Naval hospital Jakarta - LAKESLA, Surabaya Indonesian Navy: diving school and ships Conclusions

31. Improvement hyperbaric and diving medicine education / course for medical doctor, paramedics and medical/paramedic student Clinical application: ↑ ↑ The need of more specialist in Maritime medicine and also Hyperbaric Chamber …conclusions

32. Maritime medicine specialist In University of Indonesia, Jakarta Students: general medicine Six semesters Diving, hyperbaric medicine, port health authority, quarantine procedures, ships hygiene, mental and health ships personnel We have Maritime Medicine Specialist Society 32 32

33. Guinness of World record, Bunaken, Manado Indonesia 2009: • August 16th, The Largest Scuba Diving Lessons, 2465 divers • August 17th, The Most Scuba Diving Simultaneously, 2486 divers • Divers from Indonesia, Singapore, Thailand, Australia, USA, New Zealand Lead by First Adm. Iskandar Sitompul, Indonesian Navy.

34. Thank You 34