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11
HYPERBARIC MEDICINE ACTIVITIES IN INDONESIA
Indonesian Maritime Specialist Society
Mahdi.H, Susanto.A, Undari.J, Mahdi.DDecember 7th. 2009LAKESLA, SURABAYA
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INDONESIA
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Introduction
Indonesia: Archipelago country, >> 17.000 islands, 2/3 seas enriched with marine’s biota, minerals and mining's, shipwreck’s treasures, beautiful fish and sea coral.
The needs of undersea operation activities is very important:• Combat driver, underwater demolition,
underwater construction, off shore drilling.
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Recreational diving sites:
- Manado / Bunaken, Maluku / Banda Island, Bali, Lombok, Derawan Islands, Raja Ampat Island
Supported by:• 17 hospitals with Hyperbaric Chamber• 3 naval ships with HC
…introduction
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Hyperbaric Medicinein Indonesia
• 1962 –1964 study to Poland and Japan• 1962 Diving Center for Indonesian Navy Surabaya• 1962 Graving dock and Hyperbaric Chamber (HC)
Installation Surabaya• 1964 Multiplace HC “Kurimoto” operational • End of 1970 Indonesian Naval Health Institute
(LAKESLA), Surabaya for Center of Excellence, east of Indonesia
• End of 1980 improvement for hyperbaric facilities at Dr.Mintohardjo Naval Hospital, Jakarta for Center of Excellence, west of Indonesia
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• Installation operating HC: Navy, Oil Company Pertamina, Dept of Health and Private Hospitals.
• Advance study: USA, Russia, Yugoslavia, Australia, France, Germany: deep diving and submarine medicine.
• 1980 decade, Indonesian Naval Health Institute started Hyperbaric Medicine course.
Hyperbaric Medicine in Indonesia
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• Ongoing process:Diving and Hyperbaric medicine service
standardization for medical doctor and paramedic.
Standardization and competence for divers and underwater workers.
Hyperbaric Medicine in Indonesia
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Hyperbaric facilities in IndonesiaNo Nama R S Kota Jml Kondisi
1 RS PT Arun Lhoksumawe 2 Operasional
2 RSAL dr,Midiyato S Tanjung Pinang 1 Operasional
3 RSAL dr Mintohardjo Jakarta 4 Operasional = 3
4 Klinik Spesialis Armabar Jakarta 1 Operasional
5 RS Jakarta Jakarta 1 Operasional
6 P. Pramuka Kep.Seribu Jakarta 1 Operasional
7 RS Pertamina Cilacap Cilacap 1 Operasional
8 LAKESLA Surabaya 3 Operasional
9 RSUD Sanglah Denpasar 1 Operasional
10 RS Pertamina Balikpapan Balikpapan 1 Operasional
11 RSUD Makasar. Makasar 1 Operasional
12 RSUD Gunung Wenang. Menado 1 Operasional
13 RSAL Halong. Ambon 1 Operasional
14 RSUD Biak. Biak (monoplace) 1 Tidak operasional
15 RS China Oil Co. Kasim, Sorong 1 Tidak operasional
16 RS Panti Waluyo Solo 1 Rekonstruksi
17 Puskesmas Serang Serang (monopl ) 1 Operasional
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JakartaSurabaya
Tj. Pinang Ambon
KRI Rupat
Lumba2
Distribution of HC
Indonesian Navy
1010
Distribution of HC
Biak
Denpasar
P. PramukaSerang Makassar
Manado
Dept of Health
1111
Distribution of Hyperbaric Chamber in IndonesiaDistribution of HC
Cilacap
Aceh
Balik papan
Sorong
Oil Company PERTAMINA
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Distribution of HC
SOLO
JAKARTA
Private
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Center of Excellence
West Indonesia
HYPERBARIC CENTER
Dr.MINTOHARDJO NAVAL HOSPITAL, JAKARTA
East Indonesia
INDONESIAN NAVAL HEALTH INSTITUTE (LAKESLA), SURABAYA
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HYPERBARIC CENTERDr. MINTOHARDJO
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Indonesian Naval Health Institute(LAKESLA)
Experimental HC (animal)
Transport Monoplace Chamber
Locking
1616
LAKESLA
1717
Indonesian Navy
Monoplace HC
KRI. P. RUPAT
Lumba2 Barge
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HC Sanglah Denpasar, Bali
Frequency HBOT for DCS is high Patients: Fisherman and recreational diver
Hyperbaric Chamber
Support diving activities in Indonesia and Asean countries
T/ OHB : “ DCS “ and Cilical case Preventive and Promoting Research and Training
2020
Personel for HC Medical doctor consultant Maritime medicine specialist Doctor + hyperbaric medicine course Inside Tender Outside Tender Technicians / operator
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Education and Hyperbaric course
Naval officer: underwater medicine (Lakesla) Hyperbaric course: doctor, paramedic, operator and
HC technicians Hyperbaric introduction for Medical student, Professional divers (Mintohardjo Naval Hospital) Continuing degree environmental medicine majoring
Hyperbaric (Mintohardjo Naval Hospital)
Maritime medicine specialist (Faculty of Medicine University of Indonesia)
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Number of patients and visits : LAKESLA, 2006 and 2007
NoCases 2006 2007
Patients Visit Patients Visit
a Divers check up / OTT
b DCS tipe II 3 15 1 5
c Fitness 153 649 221 947
d Clinical cases 738 8254 927 9224
1 DM complication* 191 3074 208 3340
2 DM 51 455 26 230
3 Neurology * 48 1057 66 1456
4 Orthopedic post op 45 718 52 820
5 Sudden deafness 36 397 48 505
6 Osteoarthritis 30 61 40 83
7 Allergy 24 137 22 126
8 Post Stroke rehabilitation 21 119 35 210
9 Osteomyelitis 16 575 17 630
10 Combustion 16 262 20 327
Others 260 1399 393 1497
∑ 1208 9232 1971 10998
*DM complication : gangrene, ulcus, cellulites, post amputation*Neurology : cephalgia,neuropathy, vertigo, tinnitus, bell’s palsy, etc
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Number of patients and visit, RSMTH: 2006 and 2007
NoCases 2006 2007
Patients Visit Patients Visit
a Divers check up / OTT 390 390 335 335
b DCS tipe II 35 94 22 128
c Fitness 300 1143 181 718
d Clinical case 785 8430 699 5475
1 Sudden deafness 323 2483 236 2010
2 DM: complication* 140 1743 109 1005
3 Neurology * 88 1171 74 665
4 Post stroke rehabilitation 45 532 57 664
5 Orthopedic post op 31 529 15 149
6 DM 27 234 29 117
7 Osteomyelitis 15 324 39 81
8 Ophthalmologic case 10 136 12 177
9 Neuro surgery post op 5 95 8 69
10 Combustion 5 98 6 82
Others 96 1085 114 456
∑ 1510 10057 1237 6656
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Number of patients and visits, LAKESLA and RSMTH 2006
NoCases LAKESLA RSMTH
Visitors Visit Visitors Visit
a Divers check up 390 390
b DCS 3 15 35 94
c Fitness 153 649 300 1143
d Clinical case 738 8254 785 8430
1 DM: complication 191 3074 140 1743
2 DM 51 455 27 234
3 Neurology 48 1057 88 1171
4 Orthopedic post op 45 718 31 529
5 Sudden deafness 36 397 323 2483
6 Post stroke rehabilitation 21 119 45 532
7 Osteomyelitis 16 575 15 324
8 Combustion 16 262 5 98
9 Others 314 1597 111 1316
∑ 1208 9232 1510 10057
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Number of patients and visits, LAKESLA and RSMTH 2007
No
Cases LAKESLA RSMTH
Patients Visit Patients Visit
a Divers check up 335 335
b DCS 1 5 22 128
c Fitness 221 947 181 718
d Clinical case 927 9224 699 5475
1 DM: complications 208 3340 109 1005
2 DM 26 230 29 117
3 Neurology 66 1456 74 665
4 Orthopedic post op 52 820 15 149
5 Sudden deafness 48 505 236 2010
6 Post stroke rehabilitation 35 210 57 664
7 Osteomyelitis 17 630 39 81
8 Combustion 20 327 6 82
9 Others 455 1706 134 702
∑ 1971 10998 1237 6656
Audiogram : Ny.N; 30..thn. Audiogram : Ny.N; 30..thn.
OHB ke …0.. OHB ke …0..
ISO ASA ISO ASA
125
250
500
750
1000
2000
3000
4000
6000
8000
125
250
500
750
1000
2000
3000
4000
6000
8000
10 10
5 5
0 10 0 10
5 3 5
10 o 0 10 0
15 o 15
20 o o 10 20 10
25 25
30 o 20 30 20
35 35
40 o 30 40 30
45 45
50 40 50 40
55 55
60 50 60 50
65 2 65
70 o 60 70 60
75 o o o 75
80 o o 70 80 70
85 85
90 80 90 80
95 95
100 90 100 90
105 Ka Ki 105 Ka Ki
110 Ka Ki …. …. 100 110 Ka Ki …. …. 100
115 …. …. …. …. 115 …. …. …. ….
120 …. …. 110 120 …. …. 110
Hantaran : Udara Tulang Hantaran : Udara Tulang
Tulang : - - - - - Kiri : Biru x < Tulang : - - - - - Kiri : Biru x < Udara : Kanan : Merah o > Udara : Kanan : Merah o >
I> Masking I> Masking
1000 1000
2000 2000
Rinne Weber
500 500
Rinne Weber
Pra OHB
OHB 10 x
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Discussion Case :o Decompression Sickness: >> fisherman
divers, recreational divers.o Military and professional divers ↓o Routine medical check up for military divers,
underwater professional worker, dive guides o Traditional and fisherman divers : +
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o Sudden deafness highest case in RSMTH Jakarta
o The patient treated within golden period (2 x 24 hours), the improvement: 75-90%
o DM case to avoid amputation o Orthopedic post op, neuro surgery post op,
and general surgeryo Post stroke rehabilitation, neurological
symptoms (headache)
…discussions
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o Ophthalmologic case: A. Centralis Retinae occlusion
o Most of adjuvant therapy:o Good results
o Kindwall oxygen treatment table
…discussions
30
There are 17 hospitals with HC. Two diving centers:
- Mintoharjo Naval hospital Jakarta
- LAKESLA, Surabaya Indonesian Navy: diving school and
ships
Conclusions
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Improvement hyperbaric and diving medicine education / course for medical doctor, paramedics and medical/paramedic student
Clinical application: ↑ ↑ The need of more specialist in
Maritime medicine and also Hyperbaric Chamber
…conclusions
3232
Maritime medicine specialist In University of Indonesia, Jakarta Students: general medicine Six semesters Diving, hyperbaric medicine, port
health authority, quarantine procedures, ships hygiene, mental and health ships personnel
We have Maritime Medicine Specialist Society
Guinness of World record, Bunaken, Manado Indonesia 2009:• August 16th, The Largest Scuba Diving
Lessons, 2465 divers• August 17th, The Most Scuba Diving
Simultaneously, 2486 divers • Divers from Indonesia, Singapore,
Thailand, Australia, USA, New Zealand Lead by First Adm. Iskandar Sitompul,
Indonesian Navy.
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