Death by a Thousand Cars
In Jakarta, thousands of lives are lost each year to inadequate emergency response services, bureaucratic bungles, and horrendous traffic. How did it get this bad?
When Aryono Pusponegoro, a prominent trauma surgeon, helped start the Jakarta ambulance division in the late 1970s, the office had only a single ambulance. “It was a joke,” he says with a laugh. Pusponegoro, now a professor and head of the Indonesian Surgeons’ Association, spent years building the capital’s 118 service, which started out as private organization that provided emergency transport for the capital’s residents. He says he was part of a small team of doctors who realized the need for a citywide ambulance service at a medical conference in 1969, after one of his peers lamented that 70 percent of deaths at the time were the result of traffic accidents.
But costs ballooned far beyond his budget: By the time he handed it over to Jakarta’s public health ministry in 2006, it cost some $74,000 a month to operate. Pusponegoro says he was paying to train a large staff, purchase medicine, and provide the kind of street-level emergency care that doesn’t exist today. But few patients could afford to repay the cost of their transport in a country where half the population lives off around $2 a day. The handover was meant to provide additional public funds for the cash-strapped ambulance division. Instead, the funding shortfalls continued, and the service’s fleet fell into serious disrepair.
“When we handed it over, it just collapsed,” he says.
Before the handover, AGD used to respond to emergency calls — delivering an average of 300 patients a year to Cipto Mangunkusumo, the city’s main trauma hospital, he says.
“[Today] if you get in an accident or anything, a heart attack or whatever, it is almost certain you are dead because no one is going to come to give you first aid,” Pusponegoro says. “The ambulance doesn’t go; that is the problem. It is sad, but that is the fact. Last year, only 12 [patients] arrived at Cipto hospital.… The rest are going straight to the morgue.” (Pusponegoro’s numbers couldn’t be verified by official data, but a surgeon at the hospital told me they seemed accurate.)
Pusponegoro is now attempting to start another ambulance service. “I’ve got to do it again because too many people have died,” he offers as a quick explanation before diving into the details. He plans on starting with a small fleet, only five ambulances and five motorcycles, concentrated in Jakarta’s business district during the day before moving to populated neighborhoods at night. He boasts that his ambulances — retrofitted Hyundai and Daihatsu minivans — cost about $25,000 to make; a fraction of the cost of the ambulances operated by AGD.
“I got the experience. I know how to do it. I know how to make it work,” he says. “The problem is I got no money.” The effort has turned Pusponegoro into something of a salesman. He spouts off ideas about services that could eventually subsidize a citywide emergency response. He talks about offering a “red carpet” service for wealthy Indonesians, about transporting blood and organs from hospital to hospital, and about whether he can cut a deal with the country’s public insurance provider.
In his 2011 book, The Silent Disaster: Disasters and Mass Casualties, Pusponegoro estimated that millions of people die nationwide from injury and illness because they can’t reach a hospital in time.
I’ve only seen two such deaths during my time in Indonesia. One was a police officer fatally shot near my apartment during a wave of similar killings back in 2013. The officer was splayed out on his back in the middle of a main road as a small crowd gathered. A few years later, I passed another man lying in the street, this one a motorist knocked off his motorcycle. He was motionless and bloody, and the crowd was directing traffic around the body instead of offering any help. I checked the papers later that week but found nothing about the accident. Such things rarely make the news in Jakarta.
Top image photo credit: BAY ISMOYO/AFP/Getty Images