Department of Obstetrics and Gynecology
Fatmawati Hospital, Jakarta, Indonesia

in collaboration with

Indonesian Society for Perinatology

and

National Clinical Training Network in Reproductive Health

Dr. D. Danukusumo, Indonesia
participant at the Geneva Postgraduate Course in Research Methodology and Reproductive Health

 

Fatmawati Hospital

Fatmawati Hospital is a tertiary referral hospital, located in South Jakarta. It is the only state hospital at Southern part of Jakarta, receiving patient from South Jakarta Municipalities, Tangerang District and City of Depok.

The idea of building the hospital was from Mrs. Fatmawati Soekarno (the first Indonesian First Lady) who intent to establish an Infant Tuberculosis Hospital to treat and rehabilitate children suffering from tuberculosis. To realize her idea, in 1953 Mrs. Fatmawati Soekarno established the Ibu Soekarno Foundation, by means of which she stated to collect funds for the establishment of the hospital building.

With the funds plus financial support from the Ministry of Social Affairs on October 24,1954, the establishment of the tuberculosis hospital was initiated using the name Mrs. Soekarno Hospital. The first stone was laid down by Mrs. Fatmawati Soekarno. However, as the foundation was suffering from lack of funds, the erection of the building was discontinued. On December 12,1958 the construction was taken over by the Ministry of Health with the approval from the Ministry of Social Affairs.

Based on the decree of the Minister of Health No. 21286/KEP/121 of April 1,1961, the foundation of the hospital was changed to General Hospital. The management, expenditures and maintenance of the hospital were under the responsibility of the Ministry of Health which was in force starting from April 15,1961. The date was then officially determined as the establishment date of the Fatmawati Hospital.

In the early 1967 the name ‘Mrs. Soekarno General Hospital’ was changed to ‘Fatmawati Central General Hospital’ and was determined as referral hospital in the South Jakarta area. Since May 30,1984 the hospital was determined as ‘B-class General Hospital’ and was put into function as teaching hospital for medical students as well as for future specialist.

In 1995 the Fatmawati Hospital was accredited as Baby Friendly Hospital , and in 1999 as Mother Friendly Hospital.

Based on the decree of Director General of Medical Services No. YM.00.03.2.2.1028 dated September 27,2002, the hospital has got the status of ‘Advanced Fully Accredited’.

The Department of Obstetrics and Gynecology

Department of Obstetrics and Gynecology is one of the 22 Departments at the Hospital. It is divided into 3 Divisions i.e. Division of Maternal Fetal Medicine, Division of Endocrinology / Fertility and Division of Gynecology-Oncology.

The activities at the Department are divided into Services, Education and Clinical/Field Research. As a teaching hospital, the Department arrange internship for undergraduate students from Trisakti University as well as residence of Obstetrics and Gynecology from University of Indonesia. The outpatient departments give services in antenatal care, prenatal diagnostic, fertility examination, general Gynecology and Gynecology-Oncology. In inpatient departments, the activity in operating theatre consists of basic Obstetric and Gynecology operations, laparoscopic & hysteroscopic surgeries and Gynecology-Oncology surgeries.

There are 179 beds in wards, which are divided into pre- and post partum wards, Gynecology-Oncology wards and for infants. There are also level II and level III Neonatal Health Care with Neonatal Intensive Care Unit. In delivery wards there are 5 beds for normal deliveries, 4 beds for treatment of preeclampsia/eclampsia in high care rooms and 1 isolation room.

During the year 2002, there were 1792 live births, 33.9% deliveries with complications, and the Cesarean Section Rate was 29.9%. There were 9 maternal mortalities, consist of 6 cases of Post Partum Hemorrhage, 2 cases of Preeclampsia complicated by HELLP Syndrome and 1 case of congestive heart failure. The Maternal Mortality Ratio was 50.2/1000 live births and the Perinatal Mortality Ratio was 25/1000 births.

The hospital has a Task Force for Proactive Urban Hospital, which carrying out all activities to improve and strengthen the Referral Networks in Maternal and Perinatal Health Care. The Task Force built a referral networks from Health Center and Maternity Clinics to the Hospital in the attempt to reduce maternal and perinatal mortality. The Task Force arranges a Maternal and Perinatal Meeting every 3 months, with all Health Centers and Maternity Clinics around the hospital who referring their patients to the hospital, to make a case review and evaluation.

The Department also has collaboration with Indonesian Society for Perinatology in the Adolescent Health Clinic, because the adolescent pregnancies contribute to maternal mortality. The activity of the clinic is giving services for adolescents who have problems, especially reproductive health or psychological problems, difficulties in learning and drug abuses. It does not only cover the adolescents who came to the hospital, but also gives education at schools.

The other activity of the Department, in cooperation with the National Clinical Training Network in Reproductive Health, is giving clinical trainings of health providers from the primary health center around the hospital, to improve their competency. The training program that had been conducted was post abortion care, and the future programs are normal delivery care, universal precaution, IUD insertion, and insertion and removal of implantable contraceptive.

THE INDONESIAN SOCIETY FOR PERINATOLOGY ( PERINASIA )

Chairman : Imral Chair ,M.D. ( Ped. )

Perinasia (The Indonesian Society for Perinatology) established on the June 13,1981, is an organization for those who concern about perinatal health, which is the health of pregnant mothers from 20 weeks after conception until the baby at the age of 7 days. This is a non-profit organization, independent, and the purpose is to help the effort to decrease mortality and morbidity rate of perinatal and newborn babies and mother in Indonesia. At the province level in Indonesia there are 19 branches. Perinasia has about 1300 members consisting of obstetricians and gynecologists, pediatricians, other specialized physicians, general practitioners, public health, midwives, nurses, psychologist, and other individual interested in mother and new born baby health problem in Indonesia.

The idea to found Perinasia raises from some individuals who felt concerned about the health of pregnant mothers and new born babies. The condition was reflected by the high maternal and baby mortality rate. At present Perinasia works in cooperation with The Indonesian Society of Obstetrics and Gynecologists (POGI), Indonesian Association of Pediatricians (IDAI), Indonesian Midwivery Association (IBI) which are of the same field of services. One of the organizations is more interested in perinatal field, to play the more roles in promoting the quality of human resources from the womb and perinatal period.

Perinasia's activities include research, training, policy, advocacy and distribution of information in the field of Perinatal Health. Perinasia also provides consultation for planning, operational, monitoring, evaluation program, research and training in the field of perinatal health.

THE NATIONAL CLINICAL TRAINING NETWORK IN REPRODUCTIVE HEALTH ( NCTN)

Coordinator : Professor Biran Affandi, M.D., Ph.D.

NCTN is an institute of professional public service which was established on the agreement of its stakeholders (The Indonesian Society of Obstetrics and Gynecologists, Ministry of Health, The National Family Planning Board, and The John Hopkins Program International Education and Training in Reproductive Health/JHPIEGO). The objective of the establishment of NCTN was to create qualified clinic providers. In 1994, it is known that at the early period the organization was established, there were discrepancies in many clinical services stages due to lack or differences in competency of clinic providers. Such a condition can immediately be observed from the evaluation of results of the Family Planning clinics (particularly intrauterine contraceptive device and implant) at various service facilities.

Based on those results, The Indonesian Society of Obstetrics and Gynecologists, The National Family Planning Board, Ministry of Health, The John Hopkins Program International Education and Training in Reproductive Health, and the Heads of Obstetrics and Gynecology Department of certain Medical Faculties were in agreement to establish the NCTN to provide qualified clinic providers who are able to overcome any discrepancies.

One of the factors in making up quality is the presence of standard of various processes, which comes out in the form of satisfaction of clients. It is indeed what the NCTN are professionally going to establish in order to create qualified clinic providers.

The NCTN are carrying out adaptation and adjustments of various techniques and processes which are known to be effective and efficient in making qualified participants. Competency-based Training is one of components used in this method.

The training applied by the NCTN consists of training for qualified future trainers and clinical skill training for clinical providers. The training covers activities within the class rooms and within the clinics on models and patients. The training lasts around 6-10 days in conformity with type of training and progress made by attendants.

Any training center will need a kind of tool to monitor their activities, which is important in making evaluation in their performance and in planning their future training.

TIMS (Training Information Monitoring System) in a computer database program through the application of Microsoft Access 97 to be used to get information and to monitor training activities. It was initially developed by JHPIEGO using the name ‘TIA” (Training Information Application) for the information system on clinical training data in Kenya, in which its ability in keeping data on trainers and trainees was still limited. The program was later on improved such that it can keep information on training and supervision activities and its name was then changed to “Training Information Monitoring system” (TIMS).

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Edited by Aldo Campana,