This piece was written by Ricky Gunawan and was published in Asia Catalyst on 12 February 2010.
The story of Rose – the first drug user sentenced by Indonesian courts to rehabilitation instead of prison – continued this month, with some dramatic twists and turns that highlight obstacles to implementing Indonesia’s newly improved policy.
Rose was transferred from Pondok Bambu Detention Center to Cibubur Drug Dependence Hospital (RSKO Cibubur), on Monday, February 8, 2010. As I wrote in December, it took months after her July sentence for the corrupt detention system to actually move her to the hospital. During that time, Rose suffered from withdrawal symptoms without any medication. But even once the transfer was finally completed, it seemed the drama had only begun.
Rose was transferred to RSKO Cibubur using a hospital vehicle, and accompanied by staff of our organization, LBH Masyarakat. Once she arrived, hospital staff examined Rose regarding her addiction history, and gave her some medicine. They then charged a fee of around US$42.
In response to the medical fee, we argued that Rose was transferred to the hospital as ordered by the court, and also that she comes from poor family. Therefore, she should be released from any fees.
The administration officer at the RSKO Cibubur informed us that in order to get free drug treatment there, a civil health insurance card (jamkesmas – insurance for poor people) would be required. Otherwise, Rose would be liable for the fees of about US$270/month for six months – an astronomical sum for an impoverished Indonesian family.
Actually, we suspected this might happen. Rose’s mother had already begun the process of applying for a jamkesmas card in Bandung, West Java, where Rose is a resident. However, Rose’s mother found herself trapped in Indonesia’s rotten bureaucracy, ping-pong-ed from one unit to another unit.
Eventually, she was informed by the first officer who assisted her at the regional health agency that jamkesmas has a quota system. In other words, the government can only cover a limited number of poor people. If a poor person wants to apply for jamkesmas, s/he has to wait until someone from that quota dies.
This information was conveyed to RSKO Cibubur, but the administrative officer still refused to treat Rose without a jamkesmas card. Knowing Rose’s condition in Jakarta, Rose’s mother became seriously distressed about the bureaucracy in Bandung.
We were asked to deposit a large amount of money and sign a guarantee letter saying that if by Wednesday, February 10, Rose’s jamkesmas card is not submitted, we agree to cover all the medical expenses. We did so, and then we asked Rose’s auntie in Jakarta to sign the guarantee. But, she would only guarantee the costs until Wednesday. If on Wednesday Rose’s jamkesmas is not ready, Rose’s family has to pay all the medical expenses. Of course, as an underprivileged family, this is impossible for them.
And if Rose’s family can’t afford to pay the expenses, and the hospital can’t receive her, what’s the point of sending Rose to a drug treatment hospital for rehabilitation?
The hospital’s standpoint — that they want to treat Rose but need some guarantee of payment — is understandable. Since it is the state’s responsibility to pay the expenses, the state should provide a jamkesmas card. But the jamkesmas system, in which an impoverished person can join only if another jamkesmas holder dies, is completely ridiculous.
Luckily, we learned that in December 2009 the Ministry of Health had introduced a new program called “Jamkesmas for Newly Impoverished Persons”. This new program is available for impoverished people who are in correctional facilities, detention centers, social shelters or who are victims of natural disasters. Fortunately, Rose qualifies for this program.
On Tuesday afternoon, Rose prepared all the documents needed and on the next day her application was approved. At first, the administration officer at the hospital refused her application, because the program is so new that detention facilities don’t even know about it yet. Finally, Rose was accepted for treatment at the hospital.
Rose’s dreadful experience once again reflects the fragility of Indonesia’s legal system when it addresses drug users and the issue of addiction. Indonesia’s Narcotics Law clearly states that the state will pay the treatment costs for drug addicts who are found guilty of committing drug offenses, as this is considered part of the punishment period. But as the first person to be so sentenced, Rose had to work hard to convince the hospital that she is impoverished, and that her rehabilitation is a court’s order.
Rose’s case shows that Indonesia does not yet have a system in place ready to serve convicted drug users who need rehabilitation. Had the whole system been set up, it would be obvious that Rose had to go to rehab first, treat her addiction and then serve her prison sentence. It would also be clear who is responsible for transferring Rose from detention center to the hospital, and what procedures to follow when arranging for treatment costs. Instead, Rose and her supporters have had to advocate to create such a system at every step of the way.
One thing is for sure: Indonesia needs to develop a good system that can address the above issues very quickly. If a drug user needs to be imprisoned, it is far better for her or him to go to rehab first to treat the addiction, instead of prolonging her or his suffering and creating new health crises for prisons.
