2. There are certain barriers : 1. 2. 3.Patient barrier Doctor
Barrier Government Barrier 3. 1. PATIENT BARRIERS Some patients are
reluctant to report their pain Some due to the culture &
religion Mostly due to the socio-economic status 4. 2.DOCTORS /
HEALTH PROVIDER BARRIERS No pain specialist doctors in Indonesia In
medical college, very little time is spent to teach about pain
& pain syndromes Shortage in number of Specialist Doctors of :
SPECIALIST DOCTORAnesthesiologists Neurologists Neurosurgeons
Orthopedics Rehabilitation Medicine RheumatologistsNUMBER 650
doctors 715 doctors 103 doctors 306 doctors272 doctors 56 doctors
5. 3.GOVERMENT BARRIER S There are 53 medical schools in Indonesia
22 government medical schools 31 private medical schools Only 15
medical schools has post graduatefor specialist doctors Immediate
release opioids are only available in 3 top referral hospitals.
(now MS contin is available in big city) Pain management is still
not the priority. Pain management is still considered not
economically beneficial for the government, because it might need a
big budget. 6. TotalGovernment Hospitals 163 units* Totalprivate
Hospitals 960 units* TotalPrimary Health Care 5614 unit*
TotalGeneral Physicians 50.000 doctors1doctor for 5000 people*Biro
Pusat Statistik (2006) 7. Pain Management In Indonesia Acute Pain
Postop PainShortage in Anesthesiologist (650 doctors)APS (Acute
Pain Service) only in some teaching hosp. 3hospitasChronic /
Neurophatic PainShortage in Neurologist No Pain SpecialistOnly Few
Pain Clinics Only 3 pain clinicCancer & AIDS PainShortage in
Palliative DoctorsOnly 5 hospitals Have Palliative care 8. In many
parts of Indonesia : Many people may die of pain Many more people
dying in pain Even many more people living in painThis is our task
to help them. 9. Was established in 1993, after the 1st Pain
Meeting at Makassar in February 1993 Professor Karjadi was elected
as the 1st Chairman Dr. A. Husni as the Vice Chairman Dr. Idrus
Paturussi as the Secretary Dr. Assadul as the Treasurer However,
not many activities concerning pain and pain management were done.
Indonesia was not yet registered as IASP member. 10. 1. 2. 3. 4.
5.Pain relief should be considered as a basic human right Pain
should be the fifth vital signs in all hospitals Pain should be
included in medical curriculum, as early as possible Development of
pain specialists doctor as a new discipline Promoting the
establishment of Acute Pain Service, multi disciplinary pain
clinic, and Palliative care. 11. Was conducted at Makassar in April
2002 Dr. Husni was elected as the Chairman Annual Scientific
Meeting since 2002. Global Day Against Pain was held in Surabaya
2004 Promoting establishment of IPS branches in big cities
(Yogyakarta, Jakarta, Surabaya, Makassar, Bandung, Medan, Solo,
Padang, and Denpasar)Two books were published : 1. Guidelines on
Acute Pain Management by IASP (translated to Indonesia) 2.
Guidelines on Neuropathic Pain ManagementPromoting the
establishment of pain clinic 12. 2ndNational Congress was conducted
in 2005 at Surabaya Dr. Idrus Paturussi (Orthopedic Surgeon) was
elected as Chairman. 3rd National Congress was conducted in 2009 at
Bali Dr. Lukas Meliala (Neurologist) was elected as Chairman. 13.
The main idea of establishment of ASEA-PS is not only to build
closer relationships among ASEAN doctors, but also to bring
together pain specialists from developed countries and ASEAN
doctors, including Indonesian doctors. In other words, ASEA-PS was
established to improve and to share the knowledge about pain
management in ASEAN countries. To help each other, and work
together to promote pain management. 14. JointMeeting with NeuPSIG
(NeuropathicPain Special Interest Group) 15. IndonesianSociety of
Anesthesiology for Pain Management 1st Meeting at Makassar, South
Sulawesi in 2011 2nd Meeting at Makassar, South Sulawesi in 2012
16. Dr.Soetomo General Hospital in Surabaya, the capital city of
East Java, was the pioneer in pain service in Indonesia, focusing
to the palliative pain care. Painservice in Surabaya was initiated
in 1991. 17. InMakassar, the capital city of South Sulawesi, Acute
Pain Service for post-operative patients was initiated in 2005,
using mainly epidural analgesia as the modality. Now, in 2013, only
some leading hospitals in big cities in Indonesia (Jakarta,
Bandung, Bali), both government and private, have pain services.
18. AcutePain Service (APS) for post-operative patients is
organized as a resident-based service with anesthesiology residents
as service providers, under supervision of senior anesthesiologist
pain consultants. In Makassar, Pain Clinic was opened in 2006, with
integrated modalities of pharmacologic therapy, acupuncture, and
interventional therapy. 19. Male, 70 y.o. Fracture Femur, with
continuous epidural analgesiaMale, 52 y.o. Post laparatomy, with
Patient Controlled Epidural AnalgesiaF, 32 yr. Haemorrhoidectomy ,
5 days after SC, with cont epidural
analgesiaAnesthesiologist-supervised APS 20. Surgical Procedures
Digestive Obgyn Orthopaedic Urologyn 1356 1308 800 921%30.77 29.53
13.40 22.08Thorax, Oncology, Plastic Surgery2012.48Total
Patients4586 21. Percentage of Pain Intensity 90.0080.00 70.00
60.00 50.00 81.3940.00 30.00 20.00 10.0015.88 2.730.00 01-34-60.00
7 - 10 22. Pain Clinic & Acupuncture 23. Why Acupuncture??? 1.
It has been used for more than 2000 years for treatment 2. Eastern
method 3. Promoting self-healing 4. Almost no side-effect 5. Is
used in more than100 countries 6. Is a treasury of KNOWLEDGE 24.
Epidural steroid injectionSTELLATE GANGLION BLOCK 25. Painused to
be just a part of lecture in Medical Student Curriculum Since 2007,
Acupuncture and TCM have been taught as a subject for undergraduate
medical stundents. Collaboration with Xiamen University, China
Since 2011, pain has become an individual subject for undergraduate
medical students. 26. NurseEducation for Pain Management Nurses
have important roles in pain management and pain services, because
nurses have continuous encounters with the patients Nurses are the
first persons to hear patients complaints and the ones who
communicate patients complaints to the doctors. 27. 2nd ISAPM
Workshop Pain for Nurse_2012 28. Shortcourse of Basic Acupuncture
skill for Pain Management Collaboration with Xiamen University,
China Collaboration with Onomichi Hospital, Japan Role of
anesthesiology residents in Acute Pain Service and pain management
in Pain Clinic 29. Doctors from Xiamen University taught
acupuncture for anesthesiology residents in Makassar, 2006 30. MOU
Dept. of Anesthesiology Fac. of Medicine Hasanuddin Univ. and Dept.
of Anesthesiology and Pain Clinic Onomichi Hospital May 2006 31.
Manyspecialists are interested to learn more about pain and pain
management Anesthesiologists are the ones who daily deal with pain
and pain-relieving drugs, mainly opioids Fellow on Pain Management
started on 2012 in Our Department under collaborate with
Anesthesiology Collegium, Faculty of Medicine UNHAS and Teaching
Hospital ( RSWS and RSP UNHAS ) 32. Pain Management Education
Committee in Anesthesiology Collegium Several Meetings for prepare
the formal subspecialist education in Pain Management MOU agreement
between Anesthesiology Collegium, Faculty of Medicine and
Anesthesiology Department MOU agreement between Anesthesiology
collegium, Anesthesiology Department and Teaching Hospitals Fellow
has been run on 2012 33. Fellowship training of pain management for
anesthesiologists was opened, and the first lecture was conducted
in January 2012, after the signing of the MOU between : Indonesian
Collegium of Anesthesiology and Intensive Therapy Department of
Anesthesiology, Intensive Therapy and Pain Management of Hasanuddin
University Medical Faculty Teaching Hospitals : Wahidin
Sudirohusodo General Hospital and Unhas Hospital 34. 1stLecture in
January 2012 Nineanesthesiologists from all overIndonesia were
accepted as the firstfellows. At2013, 10 anesthesiologists
wereaccepted as fellows. 35. Hands on manniquine session workshop
under c-arm 36. Hands on manniquine session workshop under c-arm
37. 1st IPM Workshop and has been held for 5 times till now 38. 5th
IPM Workshop (Basic) 39. IPM Workshop (2nd Advanced) 40. 2nd ISAPM
Workshop Pain for Nurse_2012 41. 2nd ISAPM Pain Symposium for
Doctor_2012 42. Many studies about pain as a topic have been
conducted for Magister Thesis for Residents and Doctoral
Dissertation Oral and Poster Presentations in National and
International Meeting of Anesthesiology and Pain 43. Poster
presentation about APS RSWS-FKUH in World Congress of Pain, Milan
2012 44. TO CURE IS SOMETIMESTO TREAT IS OFTENTO COMFORT IS ALWAYS
A. Pare (1598) 45. San Diego, 2002
