The shape of the world a generation from now will be influenced far more by how we communicate the values of our society to others than by military or diplomatic superiority. William Fulbright, 1964

Thursday, October 01, 2009


Have stethoscope, will travel Duncan Graham 2009

Young Indonesians keen to travel and earn a good salary should consider nursing, providing they have the calling to care, according to Ida Zuraida Falkner-Head

“However you must be able to speak and understand English at a high level, keep studying and be prepared to learn about Western culture,” she said. “This means getting out and mixing with foreigners.

“You’ve got to build your knowledge of medical practices overseas or you won’t get work outside Indonesia. But if you’re good and qualified you can work just about anywhere.”

This is the message that Ms Head, a registered nurse in general nursing and obstetrics, regularly delivers to nursing students on return visits to her homeland from her present base in Hamilton, New Zealand.

NZ relies on overseas labor to maintain its healthcare services more than any other nation in the Organization for Economic Cooperation and Development (OECD). Many caregivers come from the Philippines, South Africa and Fiji – so far few from Indonesia.

This is a situation Ms Head would like to change because she believes Indonesian nurses are good at caring. Qualified nurses have to pass stringent English tests to practise, even if they’ve come from English-speaking countries. (See sidebar.)

Before taking her present job at the Eventhorpe Rest Home and Hospital where she is a ward sister, Ms Head has worked and studied in Europe, the US, the Middle East, Australia and Indonesia.

She was born in Palembang, South Sumatra and wasn’t keen on entering her father’s business as a commodities trader. Her mother wanted her to be a midwife, but the young Ida had broader ambitions and trained in Jakarta in general nursing.

“As a child I really wanted to travel,” she said. “So I used to dig holes in the garden hoping that I might be able to get overseas that way.”

For a while she worked in the private sector, travelling the region with the SOS Indonesia medical care agency specialising in servicing multinational companies. Keen to improve her skills she went to the US where she studied nursing management at California State University in Los Angeles, and later to Austria where she focussed on oncology and emergency medicine.

At SOS she frequently met Westerners working in Indonesia for international companies. One was Welshman Adrian Falkner-Head, a consulting civil engineer whose job meant he was constantly travelling.

The couple married and the energetic Ida, instead of being the passive partner, found her skills much in demand wherever her husband’s career led.

Her husband died 12 years ago and since then Ms Head has spent most of her time in NZ. But she regularly returns to Jakarta where she owns a house, using every opportunity to persuade young Indonesians to set high goals for themselves.

Not all want to hear. A group of nursing students from Brawijaya University in Malang who attended one of her lectures commented afterwards that they liked the idea of high wages and good conditions overseas. However they weren’t so keen on working for the higher qualifications required, particularly building their English skills.

The general attitude seemed to be that a few seminars at university and getting a basic degree was a big enough load to get them into the workforce without undertaking further studies.

Like civil aviation, English is the international language of the top hospitals in the world, including Saudi Arabia. You’re unlikely to last long in an emergency ward if you press the surgeon a scalpel when he or she asks you to dress the scapula.

“Nursing practices in Indonesia can be quite different from those in Western countries,” Ms Head said.

“For example here in NZ we don’t have to worry about the cost of treatment. If we want to order more dressings or drugs the registered nurse’s primary and only considerations are the medical needs of the patient. This makes a nurse’s life much less stressful.

“The other issue is the patient’s ability to pay. In Indonesia one of the first questions asked of an incoming patient is ‘where’s your deposit?’

“In NZ we don’t care if you have money or not, only how we can make you better.”

Like many Western countries NZ has a universal health care scheme funded through taxation. This runs alongside a private medical system catering for people with their own health insurance.

But the level of care is the same whether the hospital is private or government. The main issues are the waiting lists in the government system for patients to see specialists or have non-essential surgery.

Ms Head (“I find the double-barrel surname too awkward for everyday use”) said she preferred to work in small hospitals where there was a more friendly and intimate atmosphere. Although the hospital where she currently works is almost 30 years old it’s been designed to look more like a private home with pictures on the walls, cheerful furnishings, a minimum of signs and few tiled walls.

It specialises in rehabilitation and palliative care and is located in a quiet suburban street to diminish the institutional atmosphere that makes many hospitals intimidating fortresses of doom.

“The other difference is in the culture,” she said. “In Indonesia the doctor is the boss, but elsewhere doctors and nurses work as equals, in partnership to ensure that the one and only issue is the care of the patient.

“Doctors show respect for nurses here and we are given a lot of responsibility. The pay is good and we get extra if we have to come in if there’s an emergency on our days off.”

(A mid range nurse earns about NZ$ 60,000 a year (about Rp 35 million a month) though specialist nurses can receive a third more.)

“However there are no short cuts,” she said. “Apart from high level language we must continuously upgrade our skills. In Western nursing you can’t just depend on your original basic training.

“Every year I have to renew my practising certificate and I’m always undertaking extra training, internally and externally. Even though I’m 55 and have been nursing all my working life I don’t find this a burden. I think it’s essential.”


Check before you fly

Indonesian nurses thinking of working overseas should do their own research to check whether their qualifications are acceptable and do this before applying to migrate.

Most Western nations have their own compulsory national registration systems and websites.

In NZ the authority is the Nursing Council –

People giving migration advice must be registered by the government. See

Overseas trained nurses must have studied for at least four years in an accredited school of nursing and must be able to score 7.0 in each band of the IELTS examination. (International English Language Testing System.) This is a tough test - higher than the university entry requirement of 6.0.

Getting registered doesn’t mean the applicant will automatically get a job.

In some cases overseas-trained nurses have had to work as lower-paid caregivers while they build their skills.

A particular problem facing Indonesian nurses has been the lack of a national registration scheme.

(First published in The Jakarta Post 30 Sept 09)


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