Kenapa Dokter Negara Maju “Pelit” Memberikan Obat ke Anak

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Kenapa Dokter Negara Maju “Pelit” Memberikan Obat ke Anak

ghgjhBELUM sebulan aku tinggal di Belanda, dan putraku Malik terkena demam tinggi. Setelah tiga hari tak ada perbaikan aku membawanya ke huisart (dokter keluarga) kami, dr. Knol.

“Just wait and see. Don’t forget to drink a lot. Mostly this is a viral infection,” kata dokter tua itu.

“Ha? Just wait and see?” batinku meradang.

Ya, aku tahu sih masih sulit untuk menentukan diagnosa pada kasus demam tiga hari tanpa ada gejala lain. Tapi masak sih nggak diapa-apain.

“Obat penurun panas Dok?” tanyaku lagi.

“Actually that is not necessary if the fever below 40 C.”

Sebetulnya di rumah aku sudah memberi Malik obat penurun panas, tapi aku ingin dokter itu memberi obat lain. Sudah lama kudengar bahwa dokter di sini pelit obat. Karena itu, aku membawa obat dari Indonesia.

Dua hari kemudian, demam Malik tak kunjung turun dan frekuensi muntahnya bertambah. Aku kembali ke dokter. Dia tetap menyuruhku wait and see. Pemeriksaan laboratorium akan dilakukan bila panas anakku menetap hingga hari ke tujuh.

“Anakku ini suka muntah-muntah juga Dok,” kataku.

Lalu si dokter menekan-nekan perut anakku. “Apakah dia sudah minum suatu obat?”

Eh tak tahunya mendengar jawabanku, si dokter malah ngomel-ngomel,

“Kenapa kamu kasih syrup Ibuprofen? Pantas saja dia muntah-muntah. Ibuprofen itu sebaiknya tidak diberikan untuk anak-anak, karena efeknya bisa mengiritasi lambung. Untuk anak-anak lebih baik beri paracetamol saja.”

Huuh! Walaupun dokter itu mengomel sambil tersenyum ramah, tapi aku jengkel dibuatnya. Jelek-jelek begini gue lulusan fakultas kedokteran tau!

Setibanya di rumah, suamiku langsung menjadi korban kekesalanku.

“Lha wong di Indonesia, dosenku aja ngasih obat penurun panas nggak pake diukur suhunya. Mau 37, 38 apa 39 derajat, tiap ke dokter dan bilang anakku sakit panas, penurun panas ya pasti dikasih. Masa dia bilang ibuprofen nggak baik buat anak!”

Sewaktu praktik menjadi dokter dulu, aku lebih banyak mencontek yang dilakukan senior. Tiga bulan menjadi co-asisten di bagian anak memang membuatku kelimpungan dan belajar banyak hal, tapi secuil-secuil ilmu kudapat. Seperti orang travelling Eropa dalam dua minggu. Menclok sebentar di Paris, dua hari ke Roma. Dua hari di Amsterdam, kemudian tiga hari mengunjungi Vienna. Puas berdiam di Berlin dan Swiss, waktu habis. Tibalah saat pulang ke Indonesia. Tampaknya orang itu sudah keliling Eropa, padahal ia hanya mengunjungi ibukota utama. Banyak negara dan kota di Eropa belum disambangi. Itulah kami, pemuda-pemudi fresh graduate from the oven Fakultas Kedokteran. Malah yang kami pelajari dulu, kasusnya tak pernah kami jumpai dalam praktek sehari-hari. Berharap bisa memberikan resep cespleng, kami mengintip resep ajian senior!

Setelah Malik sembuh, Lala, putri pertamaku sakit. Kuberikan obat batuk yang kubawa dari Indonesia. Batuknya tak hilang dan ingusnya masih meler. Lima hari kemudian, Lala kubawa ke huisart.

“Just drink a lot,” katanya ringan.

“Apa nggak perlu dikasih antibiotik, Dok?” tanyaku tak puas.

“This is mostly a viral infection, no need for an antibiotik,” jawabnya lagi.

Lalu ngapain dong aku ke dokter,tiap ke dokter pulang nggak pernah dikasih obat. Paling enggak kasih vitamin keq!

“Ya udah beli aja obat batuk Thyme syrop. Di toko obat juga banyak.”

Ternyata isi obat Thyme itu hanya ekstrak daun thyme dan madu.

Saat itu aku memang belum memiliki waktu untuk berintim-intim dengan internet. Di kepalaku, cara berobat yang betul adalah seperti di Indonesia.

Putriku sembuh. Sebulan kemudian sakit lagi. Batuk pilek putriku kali ini ringan, tapi hampir dua bulan sekali ia sakit. Dua bulan sekali memang lebih mendingan karena di Indonesia dulu, hampir tiap dua minggu ia sakit.

“Dok anak ini koq sakit batuk pilek melulu ya?”

Setelah mendengarkan dada putriku dengan stetoskop, melihat tonsilnya, dan lubang hidungnya,huisart-ku menjawab,”Nothing to worry. Just a viral infection.”

“Tapi Dok, dia sering banget sakit, hampir tiap sebulan atau dua bulan Dok,”

Dokter tua yang sebetulnya baik dan ramah itu tersenyum. “Do you know how many times normally children get sick every year?”

“Twelve time in a year, researcher said,” katanya sambil tersenyum lebar. “Sebetulnya kamu tak perlu ke dokter kalau penyakit anakmu tak terlalu berat,” sambungnya.

Aku pulang dengan perasaan malu. Barangkali si dokter benar, aku selama ini kurang belajar.

Setelah aku beradaptasi dengan kehidupan di Belanda, aku berinteraksi dengan internet. Aku menemukan artikel Prof. Iwan Darmansjah, ahli obat-obatan Fakultas Kedokteran UI.

“Batuk – pilek beserta demam yang terjadi 6 – 12 bulan masih wajar. Observasi menunjukkan kunjungan ke dokter terjadi 2 – 3 minggu selama bertahun-tahun.”

“Bila ini yang terjadi, maka ada dua kemungkinan kesalahkaprahan penanganannya, Pertama, obat diberikan selalu mengandung antibiotik. Padahal 95% serangan batuk pilek dengan atau tanpa demam disebabkan oleh virus, dan antibiotik tidak dapat membunuh virus. Di lain pihak, antibiotik malah membunuh kuman baik dalam tubuh, yang berfungsi menjaga keseimbangan dan menghindarkan kuman jahat menyerang tubuh. Ia juga mengurangi imunitas si anak, sehingga daya tahannya menurun. Akibatnya anak jatuh sakit setiap 2 – 3 minggu dan perlu berobat lagi.

Duuh…kemana saja aku selama ini. Eh..sebetulnya..bukan salahku dong. Aku kan sudah membawa mereka ke dokter spesialis anak. Sekali lagi, mereka itu dosenku lho!.

Di Belanda ‘dipaksa’ tak pernah mendapat antibiotik untuk penyakit khas anak-anak, kondisi anakku jauh lebih baik. Mereka jarang sakit.

Aku tercenung mengingat ‘pengobatan rasional’. Hey! Lalu kemana perginya ingatan itu? Jadi, apa yg kulakukan, tidak meneliti baik-baik obat yang kuberikan, sedikit-sedikit memberi obat penurun panas, sedikit-sedikit memberi antibiotik, baru sehari atau dua hari anak mengalami sakit ringan aku panik dan membawa ke dokter, sedikit-sedikit memberi vitamin. Rupanya adalah tindakan yang sama sekali tidak rasional!

Sistem kesehatan Belanda menerapkan betul apa itu pengobatan rasional.

Aku baru mengetahui ibuprofen memang lebih efektif menurunkan demam pada anak, sehingga banyak negara termasuk Amerika Serikat, dipakai secara luas untuk anak-anak. Tetapi resiko efek sampingnya lebih besar, Belgia dan Belanda menetapkan kebijakan lain. Walaupun obat ibuprofen tersedia di apotek dan boleh digunakan usia anak diatas 6 bulan, di kedua negara ini, parasetamol tetap dinyatakan sebagai obat pilihan pertama anak demam.

Jadi, bagaimana dengan para orangtua di Indonesia? Aku tak ingin berbicara terlalu jauh soal mereka-mereka yang tinggal di desa atau orang-orang yang terpinggirkan. Karena kekurangan dan ketidakmampuan penyakit anak sehari-hari, orang desa relatif ‘terlindungi’ dari paparan obat-obatan yang tak perlu. Sementara kita yang tinggal di kota besar, cukup berduit, melek sekolah, internet dan pengetahuan, malah kebanyakan selalu dokter-minded dan gampang dijadikan sasaran oleh perusahaan obat dan media. Kalau pergi ke dokter lalu tak diberi obat, biasanya kita malah ngomel-ngomel, ‘memaksa’ agar si dokter memberikan obat. Iklan-iklan obat pun bertebaran di media, bahkan tak jarang dokter-dokter ‘menjual’ obat tertentu melalui media. Padahal mestinya dokter dilarang mengiklankan suatu produk obat.

Dan bagaimana pula dengan teman-teman sejawatku dan dosen-dosenku yang kerap memberikan antibiotik dan obat-obatan yang tidak perlu pada pasien batuk, pilek, demam, mencret? Malah aku sendiri dulu pun melakukannya karena nyontek senior. Apakah manfaatnya lebih besar dibandingkan resikonya? Tentu saja tidak. Biaya pengobatan membengkak, anak malah gampang sakit dan terpapar obat yang tak perlu. Belum lagi bahaya besar jelas mengancam seluruh umat manusia: superbug, resitensi antibiotik! Tapi mengapa semua itu terjadi?

Duuh Tuhan, aku tahu sesungguhnya Engkau tak menyukai sesuatu yang sia-sia dan tak ada manfaatnya. Namun selama ini aku telah alpa. Sebagai orangtua, bahkan aku sendiri yang mengaku lulusan fakultas kedokteran ini, telah terlena dan tak menyadari semuanya. Aku tak akan eling kalau aku tidak menyaksikan sendiri dan tidak tinggal di negeri kompeni ini. Apalagi dengan masyarakat awam, para orangtua baru yang memiliki anak-anak kecil itu. Jadi bagaimana mengurai keruwetan ini seharusnya? Memikirkannya aku seperti terperosok ke lubang raksasa hitam. Aku tak tahu, sungguh!

Aku sadar. Telah terjadi kesalahan paradigma pada kebanyakan kita di Indonesia dalam menghadapi anak sakit. Disini aku sering pulang dari dokter tanpa membawa obat. Aku ke dokter biasanya ‘hanya’ konsultasi, memastikan diagnosa penyakit dan penanganan terbaiknya, serta meyakinkan diriku bahwa anakku baik-baik saja.

Di Indonesia, ke dokter = dapat obat?

Sistem kesehatan di Indonesia memang masih ruwet. Kebijakan obat nasional belum berpihak pada rakyat. Perusahaan obat bebas beraksi‘ tanpa ada peraturan dan hukum yang tegas dari pemerintah. Dokter pun bebas meresepkan obat apa saja tanpa ngeri mendapat sangsi.

Lalu dimana ujung pangkal salahnya? Percuma mencari-cari ujung pangkal salahnya. Kondisi tersebut jelas tak bisa dibiarkan. Siapa yang harus memulai perubahan? Pemerintah, dokter, petugas kesehatan, perusahaan obat, tentu semua harus berubah. Namun, dalam kondisi seperti ini, mengharapkan perubahan kebijakan pemerintah dalam waktu dekat sungguh seperti pungguk merindukan bulan. Sebagai pasien kita pun tak bisa tinggal diam. Setidaknya, bila pasien ‘bergerak’, masalah kesehatan di Indonesia, utamanya kejadian pemakaian obat yang tidak rasional dan kesalahan medis tentu bisa diturunkan. []

Dikutip dari buku “Smart Patient” karya dr. Agnes Tri Harjaningrum, http://ibuhamil.com/

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