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Sydney Medical School

Our Indonesia Partnerships APRIL 2010

Indonesia and Sydney Medical School This newsletter provides some insight into the growing relationships across teaching, learning and research that Sydney Medical School and its affiliated research institutes are building with key partners in Indonesia. You will find that our activities and relationships vary enormously in partnerships, themes and in geographic locations across Indonesia from Jakarta to Bali and Lombok. Here we profile just some of these activities and also the voices of some of our Indonesian students. We hope that this publication sets the scene for increased engagement with Indonesian organisations and future students. 1

Avian Influenza – a research collaboration We have all become familiar with the term ‘avian influenza’ or ‘bird flu’. Since December 2003, outbreaks of avian influenza have been reported in poultry populations in South-East Asia and beyond. Within Asia, outbreaks in poultry of highly pathogenic avian influenza (HPAI H5N1 strain) have been reported in Cambodia, China, Indonesia, Japan, the Republic of Korea, the Lao People’s Democratic Republic, Malaysia and Vietnam. These outbreaks have resulted in extensive loss of chickens and ducks due to deaths resulting from HPAI infection and to culling conducted to aid control of disease spread. BY Louise Freckelton Investigation of human cases of this disease that affects both birds and people has found that the majority of infected people report direct contact with poultry. In light of the disturbing spread of the virus to date and its potential as the source of the next pandemic, the World Health Organization (WHO) is working with

governments across Asia to respond. Biosecurity preparedness activity at local, national and international levels has spearheaded strategic planning regarding HPAI for Indonesia. These plans include several strategies which target all sections of the poultry production industry.

In partnership with WHO Indonesia and the Universities of Udayana in Bali and Mataram in Lombok, Sydney academics from the School of Public Health, North Coast Medical Education (Lismore) and the Faculty of Veterinary Science are teaming to investigate HPAI in Indonesia.


“Even though this is an important public health issue, there is still much that we don’t know about how prevention messages are received and acted upon by small-scale poultry raisers.”

“The aim of the study is to evaluate the impact and extent of activities undertaken to date through the National Strategic Plan (NSP) to detect and control HPAI in the small-scale poultry flocks present in village communities in Bali and Lombok, Indonesia”, says Professor Robert Booy, University of Sydney epidemiology team member. “Through current research being undertaken and personal communication with people directly involved, we understand that activities under the National Strategic Plan have not yet rolled out evenly across Indonesia. There is growing evidence that it is within the community-based small scale poultry industry where the most risk lies for transmission of HPAI.” The study will use both quantitative and qualitative methods to explore the biological, socio-cultural, political, economical and environmental phenomena that influence human responses to HPAI at household, village and community levels. The team plans to document HPAI education, control and surveillance activities implemented by human and animal health agencies in Bali and Lombok. “Even though this is an important public health issue, there is still much that we don’t know about how prevention messages are received and acted upon by smallscale poultry raisers,” says Hudson Birden of the North Coast Medical Education Collaboration, who brings over 30 years experience in developing infectious disease control measures to the team, “These people are the key to determining whether a localised focus of infected birds creates a widespread epidemic with transmission to humans”. “The research team is from both Indonesia and Australia and calls on the expertise of animal health, human health, agriculture, epidemiology and medical anthropology researchers from both countries”, says Dr Cynthia Hunter - the medical anthropologist on the team. “It is precisely this type of multidisciplinary approach that will give us a well rounded understanding of what is taking place on the ground and which will enable us to provide solutions that will work for the community”.

to be used to inform future policy and action. “It is likely that some lessons about communication and collaboration with village communities regarding surveillance for and prevention of diseases that seriously affect both animals and people will be relevant to government activities in Bali and Lombok for other such diseases”, says Dr Jenny-Ann Toribio, the Sydney veterinary epidemiologist on the research team.

research team The research team consists of Principle Investigators Professor Dr I Nyoman Adiputra, Fakultas Kedokteran, Universitas Udayana and Ir Muktasam Abdurrahman, Director of Research Center for Rural Development, Fakultas Pertanian, Universitas Mataram. Indonesian co-investigators are Dr I G A A Ambarawati, Senior Lecturer, Department of Agricultural Socio-Economics, Faculty of Agriculture, Fakultas Pertanian, Universitas Udayana and Dr I Komang Gerudug, Lecturer, School of Medicine, Universitas Mataram. The Sydney team of coinvestigators are Dr Cynthia Hunter, Medical Anthropologist and Senior Lecturer in International Public Health, Sydney School of Public Health, Dr Jenny-Ann Toribio, Senior Lecturer in Epidemiology, Faculty of Veterinary Science, Hudson Birden, Senior Lecturer, Public Health and Clinical Leadership, The North Coast Medical Education Collaboration and Professor Robert Booy, Head, Clinical Research, National Centre for Immunisation Research.

The dissemination of research findings to all levels of the government agencies responsible for human health and animal health will permit the results


“This project is a tangible demonstration of our desire to forge a closer relationship with Universitas Indonesia.”


Dr Cynthia Hunter with colleagues from RSCM

Collaborating on Communication in Indonesian Hospitals BY Louise Freckelton

A research collaboration with Universitas Indonesia is exploring the communication strategies used within a major teaching hospital in Jakarta. This joint project is supported by Sydney Medical School experience in major tertiary hospitals in Australia in the area and the Office of the Deputy Vice-Chancellor (International) of quality care and communication. She has spent several via the International Project Development Fund (IPDF) years in medical anthropological research in Indonesia. grants. “The project has two main aims”, says Cynthia. “The first is The project is led on the Sydney side by Dr Cynthia Hunter, to share our expertise and information on the interactional Medical Anthropologist and Senior Lecturer in the Sydney and intercommunicative skills used between clinicians and School Public Health and on the Indonesian side by their teams while providing quality care to patients. The Professor Ratna Sitompul, Dean of the Faculty of Medicine second aim is to provide a platform whereby Universitas at Indonesia’s prestigious Universitas Indonesia, Dr Nurjati Indonesia and the University of Sydney Faculties of Siregar of UI Medical Faculty and Dr Julianto Witjaksono Medicine might develop the relationship.” and Dr Dini Widiarni Widodo of Rumah Sakit Dr Cipto The research focuses on three departments in Rumah Sakit Mangunkusumo (RSCM). Dr Hunter has ethnographic Dr Cipto Mangunkusumo (RSCM); surgery, adult intensive 4

care and the children’s infectious and non-infectious disease department. The main data collection period was conducted in November and December 2009. “As part of the project, Indonesian research staff were trained in qualitative fieldwork techniques such as observation and interviewing. Considerable time was also spent in ensuring that we had the consent of all staff”, says Dr Hunter. Each day our research assistants spent time in the wards recording ward rounds, the interactivity between nurses and between consultants, nurses, doctors, residents and students—it was quite intense work. Following the analysis the results will be disseminated through reports to the hospital and joint conference presentations and research papers. We hope to start on this phase of the project in February 2010.” The involvement of key personnel at UI and RSCM were fundamental to the success of the project, says Dr Hunter. Some initial findings were shared by the research team with the Head of the Research Division, Dini Widiarni Widodo, Dr Julianto Witjaksono, the Director of Nursing and Medical Services and Dr Nurjati Siregar of the UI Faculty of Medicine. “This project is a tangible demonstration of our desire to forge a closer relationship with Universitas Indonesia”, says Louise Freckelton, Manager, International Relations with Indonesia from the Office for Global Health, “and the results

Intensive Care at RSCM

of the research will provide a tangible benefit to hospital communications and patient care.”

Recent visits Professor Laksono Trisnantoro (UGM) May ‘09 Professor Laksono delivered a talk entitled ‘Indonesian Health System Reform’ to an audience of interested participants. Professor Bruce Robinson, Dean and Mr Tom Rubin (Sydney Medical School) May ‘09 Dean of Sydney Medical School, Professor Bruce Robinson lead a visit to University of Indonesia, The Eijkman Institute for Molecular Biology, University Airlangga, University of Gadjah Mada and Dharmais Cancer Hospital to explore potential collaborations. Professor Ali Ghufron Mukti, Professor Abu Tholib, Professor Sofia Mubarika , Dr Ahmad Hamin Sadewa and Dr Tri Wibawa (UGM) Aug ‘09 Lead by Dean Professor Ali Ghufron Mukti, the UGM team visited Sydney Medical School to learn about each others medical schools, and to discuss research and education collaborations. Professor Alison Kesson (Children’s Hospital Westmead), Dr Belinda Herring (Sydney Medical School) and Ms Louise Freckelton (Office for Global Health, Sydney Medical School) Oct ‘09 This delegation visited the Universitas Indonesia to take part in their Biosafety and Biosecuirty Symposium and also visited The Eijkman Institute for Molecular Research and Dharmais Cancer Hospital. Dr Tiana Subagyo (UI and Rumah Sakit Dr Cipto Mangunkusumo) Oct ‘09 Dr Tiana Subagyo visited the University of Sydney for 1 week to meet colleagues and discuss her participation in the IPDF funded project, ‘An evaluation of the communication strategies used between health practitioners and teams in Rumah Sakit Dr Cipto Mangunkusumo’. Dr Anis Karuniawati and Dr Fera Ibrahim (UI) Feb ‘10 Following on from the Biosafety and Biosecurity IPDF project, Dr Fera and Dr Anis spent 1 week visiting laboratories and research facilities on the Westmead campus. University of Sydney delegation to Indonesia Apr ‘10 Sydney Medical School will be represented as part of the University of Sydney’s major delegation to Indonesia in April ’10.


Ms Fiona Thien, Dr Fera Ibrahim, Dr Anis Karuniawati and Ms Louise Freckelton

Collaborating on Biosafety and Biosecurity BY Louise Freckelton

The emergence of new infectious diseases such as SARS, H5N1 or bird flu and H1N1 or swine flu has become an increasing concern particularly in the region and consequently issues of biosafety and biosecurity have come into focus. As a result it was timely that in October 2009, Associate Professor Alison Kesson, Head of Infectious Diseases and Microbiology at the Children’s Hospital Westmead and member of Sydney Medical School’s Discipline of Paediatrics and Child Health and Dr Belinda Herring, Lecturer in Medical Microbiology and a member of the Department of Infectious Diseases and Immunology at Sydney Medical School were invited to take part in the Universitas Indonesia’s Biosafety and Biosecurity Symposium.

The symposium was an initiative of the Universitas Indonesia (UI) which provided a day-long forum where researchers and academics from Rumah Sakit Dr Cipto Mangunkusumo (RSCM) and UI could exchange the latest information on laboratory safety and dealing with highly pathogenic material. “The symposium was extremely informative”, says Dr Belinda Herring, “of particular relevance and importance was a presentation by the Director General of Indonesia’s National Institute of Health Research and Development, Professor


“Closer interaction with our near neighbours and an understanding of each others systems will be imperative for the development of robust research, surveillance and biosecurity efforts across the region in preparedness for the next emerging infection.”

Agus Purwadianto on the ethics of using biomaterial and also a presentation by UI’s Vice-Dean, Professor Pratiwi Sudarmono on the new Materials Transfer Agreement that governs the exchange of materials between international research partners.” Dr Belinda Herring spoke on ‘The Principles of Biosecurity’ and Associate Professor Alison Kesson spoke on ‘Managing Biological Risks’. The afternoon consisted of a number of case-studies on biosafety principles in action in various labs and facilities across UI and RSCM.

and Chair of Clinical Microbiology program and Director for Virology, Institute of Human Virology and Cancer Biology, undertook a one-week visit to the Sydney Medical School laboratories in February 2010 to gain an understanding of the University of Sydney’s and affiliated hospitals’ clinical microbiology and virology services, infection control and immunisation research. “The solid program of visits to the University of Sydney and particularly the facilities at Westmead were very fruitful”, said Dr Fera Ibrahim. “Visits to the facilities at the University of Sydney and Westmead gave us a comparison to improve education and services at our hospital in terms of infectious diseases. At the Children’s Hospital at Westmead, we saw the interaction between experts in medical microbiology and infectious diseases specialists in management of infectious diseases patients, as well as the interaction between the laboratory and patient services. It could be a model for the new hospitals that we are planning to build and development of our clinical microbiology program. Discussions with the experts in the field of infectious diseases and review of the research laboratory facilities gave us a horizon to think of the two universities cooperating in research and education, especially related to infectious diseases. We hope that the continuation of these efforts will be realized in the near future.”

“This increased interaction with the UI on the theme of infectious disease control comes at an excellent time”, says Professor Tania Sorrell, Director of the University of Sydney’s newest research centre, the Sydney Institute for Emerging Infectious Diseases and Biosecurity. “As a direct result of this visit, in early 2010 Sydney Medical “Closer interaction with our near neighbours and an School hosted a visit by two medical microbiologists from UI who are working in the areas of microbiology and virology understanding of each others systems will be imperative for the development of robust research, surveillance and on a week-long research fellowship to view our facilities, biosecurity efforts across the region in preparedness for the exchange information and to establish closer contact”, says next emerging infection”. Louise Freckelton, Manager - International Relations with the Office for Global Health, Sydney Medical School. Dr Anis Karuniawati, researcher and lecturer in medical microbiology and Head, Department of Microbiology, Faculty of Medicine, UI and Dr Fera Ibrahim researcher and lecturer in medical microbiology, Faculty of Medicine, UI

Some of the participants in the Biosafety and Biosecurity Symposium

Faculty of Medicine, Universitas Indonesia


Christiana Titaley with her PhD supervisor, Associate Professor Michael Dibley

Students & graduates of Sydney medical School in their own words Christiana Titaley - PhD candidate What is your PhD on? My PhD is on determinants of neonatal death in Indonesia, specifically on the role of antenatal, delivery and postnatal services. Why did this topic interest you? Child mortality remains an enormous challenge in developing countries, including Indonesia. Interventions to decrease child mortality rates have been conducted worldwide; as a result under-five and infant mortality rates have dropped considerably. Unfortunately, this remarkable decrease is not occurring for neonatal deaths (deaths occurring in the first 28 days after delivery). In fact, the proportion of infant deaths occurring in the neonatal period has been increasing over time. These are some basic ideas behind this research topic.

To some extent, this is also related to the project I worked in, five years back, when I was still working in the WHOIndonesia as we attempted to build the mortality registration system in some districts. Why did you come to Sydney to undertake this research? I did my Master in International Public Health in 2003 with an Australian Development Scholarships from the AusAID. In 2007, AusAID rewarded me another scholarship under the scheme of the Australian Leadership Awards to do my PhD. I realized that pursuing a PhD would be one of the biggest challenges; so maybe going back to an environment I’m already familiar with would help me to hit the ground running. What advice would you have for future students wanting to do a PhD in Sydney?

I spent almost 6 months deciding what I really wanted to do for my PhD. It was the hardest 6 months, I should say, of my entire time here in Sydney. If I had spent more time thinking about it or talking about it, it would have been better; but no regrets at all. Maybe another thing I can suggest for future students is to have an open mind and embrace things you can learn from people around you, including your peers and supervisors. Eventually you will select what to bring and what to leave behind. Another important thing is not be afraid to make mistakes. At least, don’t feel bad too long. It is something I keep on telling myself. I try to value the learning process and believe that everything happens for a purpose. All we need to do is to enjoy the ride, the PhD journey with its ups and downs!


Jane Zahiri – Medical Student Indonesian by birth, Jane completed her high school education in Singapore and her first degree in the United States. “I was interested in medicine at school, but I wasn’t confident that my chemistry was good enough so I decided to do take a sciencetype degree and chose Electrical Engineering instead.” Following her first degree, she worked in a car company for three years but medicine was still on her mind. She decided to move to Los Angeles and pursue it. Jane prepared for her medical school entrance test by taking preparatory courses at the University of California Los Angeles in chemistry, biology, biochemistry and physics. During her time there, she also volunteered at a cancer hospital for a year. “I talked to doctors and they invited me to operations and other sessions and it was then I knew - chemistry or no chemistry – medicine was for me.”

graduate-entry program and because it was close to Indonesia. I applied to three Australian universities, but Sydney was my first preference.”

“I chose Sydney because it had a long and prestigious history, it was a 4-year

Jane is still considering her options but is drawn to emergency medicine. “My

Clinical School is Nepean and they allowed me to shadow an Emergency Medicine team and the bug has bitten.” Jane’s ambition has been a long time coming and taken her all over the world to get here - soon she’ll be back in Indonesia practicing as a doctor.

Sydney Medical School senior lecturer awarded Endeavour Executive Award to Indonesia Dr Bing Yu, senior lecturer in molecular genetics at the University of Sydney Medical School, has been awarded a prestigious Endeavour Executive Award by the Australian Government for 2010. An experienced researcher, Dr Yu will travel to Jakarta to learn about mitochondrial (mt)DNA technology for forensic testing at the prestigious Eijkman Institute for Molecular Biology, with a view to establishing a State-wide mtDNA laboratory here in Sydney. It is expected that this new initiative will be used for forensic DNA testing as well as population genetic research. “Mitochondrial DNA techniques can be important for identification of individuals in certain scenarios” Dr Yu said. “Unlike nuclear DNA, mtDNA can tolerate some extreme conditions such as burning or long-term UV exposure. As such, the facility to identify people using mtDNA can be critical following natural disasters or terrorist attacks, as well as for identifying perpetrators of attacks like suicide bombings.” At present NSW does not have facilities for forensic mtDNA services and all such work is outsourced to the USA. “NSW Police and other organisations have already expressed their interest to collaborate with the forensic laboratory once it is established” said Dr Yu. He hopes to see the Sydney

Forensic Medicine and Science Network, of which he is a member, establish the laboratory to provide services not only in forensic testing but also population genetic research. “There are a wide range of uses for this technology, for example mtDNA analysis can be invaluable in population studies to identify relationships, population structures or evolutionary movements of people. Determination of population structures in which a disease is more or less likely to occur will also be important for disease-related gene identification.” The Endeavour Executive Awards, provided by the Department of Education, Employment and Workplace Relations, provide professional development opportunities for high achievers in business, industry, education or government from participating countries. The award focusses on building skills and knowledge through a host work environment rather than through formal enrolment in a study program at a host institution. In addition to learning mtDNA techniques for use here in Australia, Dr Yu’s trip to Jakarta will also serve to strengthen the growing collaborative ties between Sydney Medical School and the Eijkman Institute. Dr Bing Yu will undertake his placement at the Eijkman in May 2010. 9

Studying at Sydney Medical School Sydney Medical School is Australia’s largest and oldest. At Sydney Medical School our aim is to develop caring, clear-thinking, clinically outstanding, research capable and globally engaged graduates who have the capabilities to become leaders in medicine, public health and research. Ranked by the Times Higher Education Supplement as 15th in the world for Life and Biosciences, you can be sure that our programs are world-class. Sydney Medical School offers programs in a large number of disciplines critical to contemporary health care. These include: Graduate-entry studies in: • Medicine (MBBS) Postgraduate study in: • Biostatistics • Brain and Mind Sciences • Clinical Epidemiology

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Health Policy Indigenous Health Promotion Indigenous Health (Substance Use) Infection and Immunity International Ophthalmology International Public Health Medical Education Medical Humanities Ophthalmic Science Paediatric Medicine Pain Management Psychotherapy Public Health Qualitative Health Research Refractive Surgery Reproductive Health Sciences and Human Genetics • Sexually Transmitted Diseases/HIV • Sleep Medicine • Surgery And research programs in any medical field.

Office for Global Health The Office for Global Health works closely with the University’s Office of the Deputy Vice-Chancellor (International). The Office for Global Health is part of Sydney Medical School and aims to internationalise the research we undertake, the experience of our students and staff, and our approaches to learning and teaching. We also aim to contribute to the health and wellbeing of our region by engaging in health projects with some of our nearest neighbours. Find out more about the activities of our office by visiting our website: Join our Indonesia Interest Group: international-networks/interest-groups.php

Sydney Medical School

CREDITS Copy: Louise Freckelton Editor: Louise Freckelton Layout: Philippa d’Halluin

LOUISE FRECKELTON Louise Freckelton is the Manager – International Relations with responsibility for Indonesia. Louise’s first trip to the country was only in 2009 having avoided the Australian rite de passage - the beaches of Bali. Determined to make up time without heading to the beach, Louise is looking forward to getting to know Indonesia through the growing connections between the University of Sydney’s Sydney Medical School and the best academic and health institutions that Indonesia has to offer. Louise provides advice to the Sydney Medical School in relations with Indonesia including information on our current partners and potential ones, funding and research opportunities.

for more information contact T +61 2 9036 7578 F +61 2 9036 3343 E