11 HYPERBARIC MEDICINE ACTIVITIES IN INDONESIA Indonesian Maritime Specialist Society Mahdi.H, Susanto.A, Undari.J, Mahdi.D December 7 th. 2009 LAKESLA,

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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

1212

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

1818

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

2121

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


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


2 DM: complication* 140 1743 109 1005

3 Neurology * 88 1171 74 665

4 Post stroke rehabilitation 45 532 57 664


6 DM 27 234 29 117


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






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


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






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

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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

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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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Documents

11 HYPERBARIC MEDICINE ACTIVITIES IN INDONESIA Indonesian Maritime Specialist Society Mahdi.H, Susanto.A, Undari.J, Mahdi.D December 7 th. 2009 LAKESLA,