VZCZCXRO1494
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 
 
SENSITIVE 
SIPDIS 
 
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 
 
 
This Message is Sensitive But Unclassified.  Please Protect 
Accordingly. 
 
¶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 
 
SURABAYA 00000094  002.2 OF 002 
 
 
about breast cancer.  These events garnered significant media 
attention. 
MCCLELLANDCR