Tuesday, January 30, 2007

Just a Spoonful of Sugar…

The rains may be sneaking in late this year but last week I succumbed to the usual seasonal malaise and was laid low by a mega bout of flu. After a night creating an entire mini Matterhorn of used tissues, I toddled off to the chemists to purchase a shed load of tablets. After buying about five different types of flu pills, I retired to my boudoir to make horrible noises and randomly select the first medicine from my bag of Apotik Melawai goodies.

Most Indonesians love their drugs of course and need very little encouragement to take pills by the bucketful. There is a bewildering array of popular medicines at your local pharmacy for all the usual gastric and common cold type ailments, as well as plenty of pills for those local sicknesses that don't precisely correspond to biomedical categories. I'm referring of course to those twin scourges of Indonesian health, Masuk Angin (Enter Wind) and Panas Dalam (Hot Inside). What these two names actually designate has always been a bit of a mystery to me. Personally, I've always found wind more likely to exit, as opposed to enter, my body. I was once on an intercity bus that broke down and the word being spread among the passengers that had assembled around the back of the ailing coach was that the engine was suffering from Masuk Angin, so clearly this is a pandemic that affects organic and inorganic objects alike. As for feeling hot inside, well that covers just about everything from indigestion to pancreatic cancer.

Local television is full of commercials for these rather non-specific medicines. My favorite product though would have to be Pil Kita (Our Pills). Apparently the whole family can stay in the pink with these things but what they actually do remains a complete mystery. You can imagine the conversation can't you?
-Shall we take Our Pills son?
-But I feel fine dad
-You take your pills now! I don't want to be dragging you down to the hospital tomorrow.
-But what exactly are these pills for dad?
-Well.... they're for us.

Products such as this are, of course, the tip of a very large traditional medicines iceberg. Jamu, those local potions sold in roadside stalls and by ladies carrying baskets full of bottles on their backs, are as popular as they ever were. Sales have increased greatly since the economic crisis in fact and these drinks have become a multi-million dollar industry. Such traditional remedies are seemingly a panacea for almost all human illnesses. There are Jamu for menstruation pain, acne, kidney stones, weight loss, bust enlargement (?!), diabetes, sexual virility and just about anything else you can think of. Some Jamu may be genuinely effective and many are based on ancient Chinese remedies. Many others, however, are no doubt nothing but snake oil (the possibility of bust enlargement, for example, seems to be stretching credulity somewhat).

More seriously though, the popularity of these potions is indicative of the majority of Indonesians' inability to afford prescription medicines. Local doctors will often prescribe extremely expensive brand-name pharmaceuticals when cheaper generics are available, raising suspicions about their possible collusion with drug companies. Doctors here are also given to polypharmacy, namely prescribing a list of six or so drugs to patients, many of which are non-essential but expensive (if you're poor) items such as vitamins. Thus, cheap and traditional herbal remedies remain popular and are perhaps actually effective on occasions; after all, the placebo effect is a well-known scientific phenomenon. If you believe you're getting better, you will get better. The fact that most Jamu drinks taste absolutely revolting only adds to their medicinal credibility in this respect.

On the other hand, perhaps such psychological placebo trickery is a dangerous delusion. The booming sales of the new generation of sickly sweet energy drinks reflect this. Packed full of such health giving compounds as caffeine, taurine and sugar, these ghastly drinks offer an illusory quick fix of instant strength to Indonesia's impoverished masses, a fix which can only temporarily mask the effects of poverty, poor diet, lack of sleep, pollution, disease and parasites.

Perhaps though we shouldn't blame the malingering masses for choosing the quick fix option. Allegedly, between 30 and 40% of medicines on sale in Indonesia are fake (especially those famous little blue pills that have revolutionized male droop). In addition, the quality of health care available can often leave a lot to be desired. One credible report I found on the Internet pointed to the overuse of antibiotics and injections, wrong prescriptions and short three-minute consultations with doctors as all endangering Indonesian health. With bird flu hovering ominously around the headlines perhaps we should all be a bit worried.

Why fret though? Why not forget all of these worries with some recreational drugs? Want to get wasted but are too scared of the stiff sentences dished out for possession of ecstasy, marijuana, etc? Simply drag yourself down to the chemist (or even supermarket) and buy yourself a strip of ephedrine filled asthma relief tablets. Ephedrine is an amphetamine derivative that you certainly won't find in western over-the-counter medicines, or even in prescription ones. Neck three pills down and head to the disco, you'll soon be speeding your head off and, as a bonus, you'll be reducing your unsightly tummy bulge and also be in no danger of an asthma attack either. Rock on man!


Simon Pitchforth