serve all of the above institutions, except PHC. In the Indonesian environment, specialists may serve the patient directly and through referral system.
Some general hospital are good hospital for serving TB patients, particularly the teach-ing hospitals. For example is the Persahabatan Hospital (Jakarta), Dr. Sutomo Hospital (Surabaya), and Adam Malik Hospital (Medan). As a general and teaching hospital, pulmonology department in the Persahabatan Hospital is considered tobe the national top referral service. The TB laboratory of persahabatan Hospital, headed by a pulmonogist, is a WHO Collaborating Center. This laboratory is controlling the quality of TB examination done by all laboratories in Indonesia.
Today, general hospital should have general program of the medical services: preventing, promoting, treating, and rehabilitating. Therefore, pulmonologists, who work in these hospital, have the possibility to do all those medical services.
Furthermore ,beside help pre- and post-lung surgeries, they also may be doing some supportive medical services, such as in the service of radiology, laboratory, rehabilitation, etc., as well as in the lung hospitals, and CDC-clinics.
The role on education
Pulmonologists, especially who work in the teaching hospital, have the ability to teach student. The students can be consists of medical doctors (under and post graduate programmes), nurses, or laboratory technicians.
Depend on the objective of the education programme, a pulmonologist may teach and train all aspect of the medical services for TB, either clinical and public health personal. The objectives may consist of prevention and promotion, diagnostic and treatment procedures (chemotherapy and surgery), and rehabilition of TB patients.
The teaching and trainning can be done not only in the formal education programmes, but also in any other opportunities.
They are also may be used to promote public awareness through education.
The role on research
Pulmonologists have the knowledge and skill to make research on every aspect of TB, especially those who work in a teaching institution. The overall objectives of research for TB may be done by pulmonologists, included prevention, promotion, diagnostic and treatment procedures, rehabilitation, and control programme management. Like other specialists, pulmonologists can be trained easily to understand the newest technology of the medical equipments and procedures. Of course, every person has his owned right to select which part of the research he may be decided as his choice. One example of the role of AIP in research is in the Pilot Project for Controlling Pulmonary TB in the DKI Jakarta, headed by Hadiarto Mangunnegoro (former President of AIP). The objectives of the project are:
1. to identify problems related to the integrated effort for controlling TB;
2. to find a better system for controlling TB to be used for NTP.
3. to implement treatment of TB in some selected general hospital in Jakarta with chemotherapy regiment prepared by the programme.
(The result of the program in Indonesian Language is attached)
The role of the pulmonologists association.
The above mentions are related to the role of individual pulmonologist on medical service, education, and research. The association of professional have broaden scope of role than individual pulmonologist. They willing and hunger to do everything on their capacity. They have various human resources. Their burden is only on funding of the activities.
Knowing, that the responsibility of NTP is not only on the government sector, but should be on the shoulder of all citizen, included professional, IAP offer their human resources to support the success of NTP.
According to the WHO Treatment Guidelines for National Programmes (1996's draft), the main reasons forfailure of NTP are:
- inadequate political commitment and funding;
- inadequate organization of services;
- inadequate case management;
- over-reliance on BCC.
IAP may take role on those reasons for failure of NTP. Through official proposal and lobby, IAP and the individual member may propose for political govermment commitment to increase the priority of policy to support and fund NTP. Every proposal will be considered particularly if it supports by reliable data.
Unfortunately, the avaibility of data in the country is a big burden.
A good example of the role IAP in this matter was done through cooperation effort between IAP and Persahabatan Hospital.
In 1994, IAP and Persahabatan Hospital initiated a workshop. The objective of the seminar are two folds: 1, the possibility of declaring Persahabatan Hospital as a
