ALZHEIMERS IN INDONESIA

WE’RE AS OLD AS WE THINK © Duncan Graham 2006

If you’re planning a long life remember this: It’s quality, not quantity, which counts.

“For healthy ageing keep your body fit and mind active,” advised Singaporean psychologist Dr Ng Li-Ling from Changi General Hospital. “Also avoid head injury by wearing protection on motorcycles and bikes and while playing sport.

“On current projections the number of people who will get Alzheimer’s disease will double in the next 25 years with 4.6 million new cases every year.

“Two thirds of the cases will be in developing countries like Indonesia. The rate of diagnosis is likely to be 300 per cent greater in Asian countries than the West.

“This disease isn’t linked to affluence and at the moment it’s untreatable. But research does show that educated people who stay mentally alert are at less risk.

“The other factor is getting early medical advice. It may not be dementia. It could be delirium and can be treated.”

Alzheimer’s disease was first diagnosed 100 years ago. It’s a progressive dementia (loss of brain power) that attacks the structure and chemistry of the brain.

Sufferers find it increasingly hard to remember things and people, to communicate and reason. The stress on families can be overwhelming

There’s no single gene for the disease and the cause is unknown though age, lifestyle and head injuries are factors. Almost 25 million people worldwide have the disease. The number in Indonesia isn’t known.

Dr Ng, vice president of the Alzheimer’s Association in Singapore has been at the Lawang mental hospital to discuss issues in psycho geriatrics with staff and professionals from other towns in East Java.

Together with another psychologist Dr Donald Yeo, medical social worker Ms Yeo Seok Tin and occupational therapist Ms Koh Hwan Jing the team ran a week of workshops supported by the Singapore International Foundation (SIF).

This is a not-for-profit organisation operating since 1991 that sends volunteers around the world to help developing nations.

Other SIF projects in East Java include training trainers in occupational dermatology in Malang, helping with information technology in Surabaya and neonatal intensive care in Madiun.

Team leader Dr Ng stressed that the Singaporeans’ experiences wouldn’t necessarily translate well into the Indonesian situation. Everything had to be considered and adapted to suit local conditions.

Nor was it a case of outside experts coming in with wise words.

“When I was a young student I got lots of help from many people,” she said. “I volunteered for this assignment because I want to share my knowledge with others. We’re also here to learn how Indonesia is handling mental health.”

Her colleague Dr Yeo said there were many myths about ageing brains. These included the adage ‘you can’t treat an old dog new tricks’, and that new brain cells can’t be created.

“There’s new and growing evidence that adult brains are capable of growing neurons (nerve cells and their appendages),” he said.

“New experiences create new connections between neurons. There’s more transfer of information between the hemispheres of the brain in elderly people. The integration of thought processes increases in the brains of active ageing people.”

Tests for dementia that might work in Singapore could fail in East Java because of different cultural values, he said. Patients with low education may be unfamiliar with testing procedures or be confused by the examiner’s language.

Researchers in Singapore had often found more accurate information on a patient’s behavior from the family’s maid because embarrassed relatives wanted to downplay the problems.

Commented Dr Ng: “There’s still a stigma associated with mental disease and the community needs accurate information. Some countries are launching a Mind Your Brain public health campaign to lift awareness. I think that’s great.

“One day we’ll find a cure and I’ll have no work. I’d love to be out of a job!”


MAD IS NOT BAD

The Lawang Mental Hospital is the biggest in Indonesia and one of four controlled by the central government. Others are either private or run by regional authorities.

The thick walled, high ceiling wards are more than 100 years old and set on a rolling 350-hectare site in the foothills north of Malang. They’re a monument to the ‘ethical’ policy of the Dutch administration, a change of heart towards its colonies in the 19th century.

In 1862 a survey of the district showed 600 people in need of mental care. Three years later a small hospital was built followed by the present complex in 1902.

Just before the war it had 4,200 patients. But with the opening of other facilities the bed number has dropped to 700. The average stay is four months. There are almost as many employees as patients.

Treatment of the mentally ill has changed in recent years. Professionals now have access to a pharmacy of drugs to lift depression, abate anger and stabilise moods. Better understanding of issues such as urban stress, grief and hormonal imbalance have also helped patients recover and return to their jobs.

Except in areas where criminals or dangerous people are held, many bars have been removed from the hospital softening the institutional ambience. Overall the place is therapeutically calm and refreshingly spacious.

Day clinics, therapy, counselling and other non-chemical approaches to mental health have also reduced the need for patients to be kept locked up and out of sight.

But in the community mental illness is often seen as the wrath of God visited on sinful parents. The old attitudes persist: If someone’s mad, they’re bad.

When a sick or injured person is admitted to a hospital there’s usually widespread support for the family. That’s not always the case if the treatment is in an asylum.

Although the practice is less common now, Lawang psychologist I Wayan Gara remembers getting regular calls from the police on the nearby highway. They were reporting mentally sick people who’d been dumped by relatives too shamed to seek help.

“Many families with a mentally ill relative first go to a paranormal,” he said. “Later they might visit a community health centre, and only later a hospital.”

(First published in The Jakarta Post 19 April 06)

##