Cablegate: Breast Cancer Awareness, but Diagnosis and Treatment Options

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RR RUEHCHI RUEHCN RUEHDT RUEHHM
DE RUEHJS #0094/01 2890509
ZNR UUUUU ZZH
R 160509Z OCT 09
FM AMCONSUL SURABAYA
TO RUEHC/SECSTATE WASHDC 0472
RUEHJA/AMEMBASSY JAKARTA 0461
INFO RHHMUNA/HQ USPACOM HONOLULU HI
RUEHZS/ASSOCIATION OF SOUTHEAST ASIAN NATIONS
RUEHBY/AMEMBASSY CANBERRA 0211
RUEHWL/AMEMBASSY WELLINGTON 0178
RUEHJS/AMCONSUL SURABAYA 0484

UNCLAS SECTION 01 OF 02 SURABAYA 000094

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DEPT FOR EAP/MTS AND EAP/PD
JAKARTA FOR ECON AND USAID

E.O. 12958: N/A
TAGS: EAID ECON KWMN KPAO PGOV SOCI ID
SUBJECT: BREAST CANCER AWARENESS, BUT DIAGNOSIS AND TREATMENT OPTIONS
ARE LIMITED

REF: SURABAYA 73 (DECENTRALIZATION BRINGS LOCAL SOLUTIONS TO HEALTH SERVICES)

SURABAYA 00000094 001.2 OF 002

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1. (U) SUMMARY: Breast cancer diagnostic facilities are
difficult to access in Indonesia, especially outside provincial
capitals. Once a case of cancer is diagnosed, treatment is too
expensive for all but the wealthiest individuals. In honor of
Breast Cancer Awareness month, ConGen Surabaya is working with a
local survior group to shine a light on the issue. According
to local oncologists, while cervical cancer kills more women in
Surabaya each year, the incidence of breast cancer is increasing
rapidly as awareness grows. END SUMMARY

Detection and Diagnosis
-----------------------

2. (U) Proper breast cancer diagnostic facilities are not
available to many Indonesians, who visit their local clinic
(Puskesmas) for health services (reftel). According to Doctor
Wiwei Ristanto of the Surabaya Oncology Hospital, mammogram
tests are typically not available outside of the public hospital
located in each provincial capital. This is particularly
problematic in wide-spread provinces such as Nusa Tenggara Timur
(NTT) where inhabitants of remote islands may never have the
means necessary to travel to the capital city for an
examination. Another barrier to women having regular mammograms
is that they cost approximately $40, a prohibitively large
amount for the vast majority of Indonesians without access to
health insurance.

3. (U) Public provincial hospitals are able to perform the
biopsies necessary to properly diagnose the presence of cancer.
Because none have the capacity to analyze the biopsy, they must
send the samples to one of three diagnosis labs in hospitals in
Jakarta, Surabaya, or Denpasar for examination and diagnosis.
The biopsy results are typically available in three days.

Prohibitive Costs of Treatment
------------------------------

4. (U) Once the cancer is detected and diagnosed, the patient
faces prohibitive problems when seeking treatment. Doctor Wiwei
explained that hormone therapy is the only type of treatment
available at the Puskesmas. Hormone therapy is not only the
most expensive treatment, it is only an option for patients with
a type of cancer that will respond to the therapy. For
pre-menopausal women, hormone therapy costs approximately $15
per month for a five-year treatment regime. However, if the
patient is post-menopausal, then the hormone therapy's cost
jumps to $200 per month for a five-year period. Chemotherapy is
available at provincial hospitals, but costs as much as $180 per
session. Surgery is also available at provincial hospitals, but
costs up to $2,000 to perform. Radiation therapy is only
available at hospitals in Jakarta, Surabaya, and Bandung, all on
the island of Java, and has a total cost of up to $300.

5. (U) Poverty is a major impediment to cancer diagnosis and
treatment in Indonesia. Public health insurance is limited to
government employees, and private insurance is too expensive for
all but the wealthiest Indonesians to afford. As a result, the
vast majority of the population must pay for medical treatment
themselves. With nearly 54% of the population living on less
than $2 a day, the costs associated with cancer treatments, and
even detection, are prohibitive. As a result, Indonesia's
fledgling cancer detection and treatment facilities are out of
reach of the majority of the population.

Partnering With Survivors to Raise Awareness
--------------------------------------------

6. (U) ConGen Surabaya partnered with the non-profit
organization Reach to Recovery Surabaya (RRS) to promote breast
cancer awareness activities throughout the month of October.
RRS is a group of breast cancer survivors and oncologists who
promote early detection and awareness, as well as provide
support for women with breast cancer. This month's activities
include two prominent billboards promoting October as breast
cancer awareness month, appearances on six radio talk shows, a
public workshop at the Oncology Hospital in Surabaya, and a
public "Breast Talk" event at a major local shopping mall. On
October 13th, the Consulate hosted a "Pink Ribbon Luncheon, "
attended by the Mayor and Vice-Mayor's wives, members of RRS,
and prominent women in the community, to raise public awareness

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about breast cancer. These events garnered significant media
attention.
MCCLELLANDCR

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