The future of Indonesian healthcare

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Taruna Ikrar Chairman of the Medical Council, Indonesian Medical Council 2020-2025

IO – We are now in the clutches of the COVID-19 pandemic, a plague that has spread quickly and massively because of globalization. To be exact, the spread is a direct result of intensive human mobility, all over the world. Rapid, massive human mobility thanks to the development of cheap air transport significantly affects the transfer of the infectant (the SARS-Cov2 virus) from one person to another during their travels, whether they are crossing regions or countries, and whether they go by airplane, rail or ship. Such efficient transport helps communicable diseases like COVID-19 spread quickly across the globe, resulting in a pandemic, with multi-dimensional health, economic, and global security crises.

Meanwhile, disease patterns have dramatically changed, from acute to chronic, and this will impel a shift in health service strategies, from curative to preventive in the past to curative and rehabilitative in the present. The pattern of viral mobility and mortality rates has steadily shifted from infectious diseases such as influenza and smallpox to degenerative diseases (cardio-cerebrovascular diseases such as diabetes and cancer).

The current development of medicine, specifically in the detection and diagnosis of diseases, has reached an understanding of human physiology to both molecular and genetic levels with the completion of the Human Genome Project (HGP). The latest revelations focus on better understanding of pathogenesis, pathophysiology, and on molecular genetics, stem cells and regenerative treatments – these are on their way to becoming trends. Regenerative medicine is the pioneering technique of the future. Our current condition has placed rapid biomedical advances at a peak of an evolutionary explosion.

Global knowledge will be strongly affected by this healthcare revolution. The creation of regenerative drugs will head towards BioHybrid medication, which implies generation of biological tissues and organs meant to regenerate, or even replace, natural tissues and organs that are damaged by illness, injury, or congenital abnormalities.

Regenerative medicine is the future revolution of medical treatment. It is born from the combination of tissue knowledge and multiple disciplines, including biology, biochemistry, and physics. It is a new field that actually and realistically promises

to regenerate damaged tissues and organs in living bodies, using techniques that stimulate the natural, independent self-repair capacities of these organs and tissues. Regenerative medicine is a safe means to grow tissues and organs in vitro for transplant into bodies suffering from abnormalities.

This revolutionary technology has amazing potential new therapeutic applications for diseases that are extremely hard, if not impossible, to cure: cancer, diabetes, heart diseases, kidney failure, osteoporosis & spinal injuries, and retinal blindness. However, the development of treatments like stem cell therapy, gene therapy, etc. that use special tissue culture and transplant systems, means that treatment is possible.

Development of Medical Knowledge and Technology

Science, including medical science, progresses rapidly, day by day. Here are some examples of such progress that are worth noting:

1. Regenerative Medicine

Regenerative medicine can rebuild tissues that are damaged by disease, illness, or injury. It is capable of creating new organs for transplanting and cure genetic diseases. Its progress has been spectacular and promising so far. It generates hope that damaged tissues can be repaired using mechanisms similar to those the body uses by renovating the organs’ cells. It may provide a solution to the inability of organs to be transplanted, which is a serious, persistent global problem. Even better, this can be achieved using the patient’s own cells, which will prevent rejection.

2. Digital Brains

In the future, neuroscience will be able to create digital brains, based on neurological information. This means that humans can upload their minds into a computer and live on as a digital lifeform.

3. Nanotherapy

Nanotherapy is the application and monitoring of treatments using nanotechnology. Its high accuracy greatly reduces the cost of health services. Start-ups have come up with solutions like making pill bottles shine blue when it is time for a dose to be taken, and shine red when there is an overdose or when it is time to refill.

4. New Diseases

With technological development, there is always a risk of new diseases appearing. Nobody knows what will happen.

5. Real-time Diagnosis

Zoltan Takats Imperial College London has developed smart scalpels (iKnife). This is a new application of old technology, using electricity to heat tissues when making incisions, in order to minimize bleeding.

6. Artificial Intelligence Applications in Medical Service Artificial Intelligence is a transformative technology that touches on nearly all aspects of human life, especially in the current, all-digital modern lifestyle. The use of AI in medicine will affect all clinical applications in healthcare and health services, including prevention of illness and treatment of patients.

7. Gene Therapy

Gene therapy modifies a person’s genes in order to treat or cure an illness. Some of its mechanisms include replacing the gene that causes a condition with a healthy copy, deactivating genes that function badly and cause illness, and introducing new or modified genes into the body to treat illness.

8. Advanced Medicine

The latest medication techniques developed by advanced modern medical technology; five primary medical treatments include: 1) cellular therapy (using stem cells), 2) growth factor stimulation, 3) particle therapy (the use of biological particles to build the body’s primary structures), 4) nanotherapy (the use of nanotechnology in treatment), 5) gene therapy (the use of genetic technology to stimulate and reprogram the body’s genetics). Advanced medical methods will be able to cure various degenerative diseases, wherein both patients and doctors have lost hope of healing, especially chronic illnesses due to old age and degeneration, such as cerebral palsy, Parkinson’s disorder, post-stroke rehabilitation, emphysema, ejection fractions, cardiac infarctions, cardiovascular and other heart diseases, diabetes mellitus, autism, erectile dysfunction, amyotrophic lateral sclerosis (ALS), kidney failure, and other regenerative and geriatric illnesses.

The Impact of Medical Technological Advances

Medical advances will allow people to become healthier and live better and longer, be more efficient and more productive. Increased life expectancy is a good thing, as it means a later retirement age. Therefore, the elderly and retirees can remain healthy and productive, as they are

no longer sickly. This means that they can make a positive contribution to the people. Research published in the Journal of the American Medical Association shows that 52% of people older than 65, as well as 53% of respondents 18-24 years old, consider living longer to be “positive” and “extremely good for the community”.

Future Medical Service Strategies in Indonesia

The above shifts require specific strategies that will allow Indonesia to provide comprehensive health protection, services, and care. Similarly, the Indonesian government and citizens will need special efforts to catch up to the level of science and technology in the future. Everyone needs to take charge of their joint responsibility and achieve the founding fathers’ dream of Indonesia becoming an advanced, civilized, fair, and prosperous nation, respected by other countries on the international stage.

In view of great future health challenges, Indonesia needs to prepare itself. To make ultimate health of Indonesian citizens a reality, all components and elements of the people must prepare by strengthening basic health, whether in the context of the individual, community groups, community or the Indonesian nation. To be more specific, health strategies should be focused on promotive and preventive health measures. Ensuring basic health and preventing diseases will reduce health costs, which are today mostly spent on curative and rehabilitative efforts.

Economic awareness is a necessity in managing healthcare. Maintaining overall health among the people is in turn necessary to ensure a good economy. Health levels depend on economic soundness, robust health system, and an overall healthy lifestyle. Good health service is a priority for all citizens. With manifold, complex challenges, wise health investments and health policies consider intricate interactions between health and the economy.

Health expenditures must be made with due consideration of technological benefits. Calculations must be made in how to obtain advanced equipment, for example instruments for non-invasive surgeries, and how to ensure that competent healthcare professionals are trained properly on how to use them. This will generate higher better – more efficient and effective – disease treatments and preventive methods.

Efficient health systems strongly affect Indonesia’s readiness to deal with future health issues. Health conditions (deaths, morbidity, disabilities) depend on individual lifestyles and the strong performance of existing health systems. Similarly, the efficiency of our economic system is the result of a properly functioning economic system, which includes regulatory frameworks, trade policies, social capital, the job market, etc.

The intersection between the economy and health is people. Ensuring everyone stays healthy and productive requires competent health HR – ones who are able to deal with the various rapid developments in medical technology. We need as many of these qualified HR as possible. Therefore, it is time for the Government to start developing proper health research and training centers, to provide medical skills and knowledge, from basic to advanced levels. This will help us innovate more for better health overall.