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SURAT TUGAS - DOC - DOC

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									VERSI BAHASA INDONESIA

                                 PRESS RELEASE
                 PELAJARAN DARI BENCANA
         PENGHANCURAN OBAT – OBATAN RUSAK DAN KADALUARSA BANTUAN
         GEMPA BUMI 28 MARET 2005 OLEH BRR NAD NIAS Kantor Perwakilan Nias
        DAN PELAJARAN DALAM PENGELOLAAN OBAT – OBATAN BANTUAN UNTUK
               BENCANA TSUNAMI ACEH DAN GEMPA BUMI JOGJAKARTA


Selama periode darurat (emergency phase) pasca gempa bumi 28 Maret 2005, kabupaten Nias
dan Nias Selatan banyak sekali mendapat bantuan obat-obatan. Sebagian besar obat- obatan
sudah disebarkan ke seluruh Puskesmas dan fasilitas kesehatan lainnya, namun sebagian besar
masih berada di 3 tempat penyimpanan utama di Gunungsitoli, yaitu di Dinas Kesehatan, Gudang
Farmasi dan RSU Gunungsitoli. Tidak diragukan bahwa obat-obatan tersebut banyak bermanfaat,
namun banyak pula yang tidak bisa digunakan karena :
               Rusak akibat tidak ada tempat penyimpanan yang sesuai.
               Expired dan expiring : sebagian besar obat dikirim sudah mendekati masa
                expire dan sebagian besar lagi memang sudah expired.
               Terlabel dalam bahasa asing yang tidak bisa dipahami staf lokal.
               Tidak terdapatnya tempat penyimpanan yang memadai.
               Tidak siapnya sistem kesehatan yang ada untuk mengelola bantuan obat-
                obatan dalam jumlah yang sangat besar.
Berdasarkan assessment dan kegiatan “Pharmaceutical Waste Management” yang dilakukan oleh
WHO, DEPKES dan Dinas Kesehatan Propinsi Sumatera Utara pada bulan Januari – Maret 2006
yang lalu, telah berhasil dikumpulkan dan di inventarisir sejumlah 300 m3 obat – obatan rusak (dari
sekitar perkiraan 1.500 m3 yang tersebar diseluruh pulau). Obat – obatan tersebut dikumpulkan
dalam satu lokasi sementara di Gedung Nasional Gunungsitoli, sebelum dikirim keluar Nias untuk
penghancuran. Secara definitif selama obat – obatan tersebut belum dihancurkan ia akan
mengancam lingkungan hidup di pulau Nias dan juga masyarakat Nias, karena beberapa zat aktif
dari obat – obatan tersebut termasuk dalam bahan berbahaya. Berdasarkan hal – hal itulah
maka BRR NAD Nias mengambil langkah strategis dan taktis untuk terlibat aktif dalam
pemusnahan obat – obatan tersebut, walaupun sebenarnya alokasi dana yang dibutuhkan

                                           Badan Rehabilitasi dan Rekonstruksi (BRR) NAD-Nias Perwakilan Nias
                           Jl. Diponegoro No. 439 Desa Sifalaete Tab. Kec. Gunungsitoli Kab. Nias Sumatera Utara
                                                                                           Fax/Telp. 0639-22174
untuk program pemusnahan ini bisa digunakan untuk membangun1 Puskesmas, demikian
umenurut William Sabandar – Kepala Kantor BRR Perwakilan Nias mengungkapkan.
Berdasarkan WHO Guidelines for Safe Disposal metode penghancuran yang TIDAK SESUAI
untuk dilaksanakan di pulau Nias adalah metode Engineered Land Fill (penanaman di dalam
tanah) karena kuantitas yang sangat besar sementara Nias memiliki keterbatasan lahan, kondisi
tanah yang labil dan merupakan pulau yang dekat dengan samudera. Sehingga, metode
penghancuran yang paling tepat adalah mengirimkan obat-obatan tersebut ke luar pulau Nias
untuk dihancurkan dengan incinerator berkapasitas besar dan suhu yang tinggi (di atas 1000 C :
catatan di pulau Nias, termasuk di RSU Gunungsitoli, bahkan tidak memiliki satu
incinerator-pun yang bisa dipakai).
Dengan demikian akhirnya metode pemusnahan yang dipilih adalah co-processing method dengan
cement kiln di Pabrik Semen PT. HOLCIM,tbk, dimana telah mendapatkan lisensi dari Kementerian
Lingkungan Hidup untuk menghancurkan limbah B3.
Diharapkan, setelah kejadian – kejadian ini ada beberapa pembelajaran / lessons learned yang
bisa dipetik bahwa :
    1. Pemerintah Indonesia (Departemen Kesehatan dan BAKORNAS) seharusnya senantiasa
        siap dengan buffer stock obat – obatan bencana, sehingga tidak terlalu tergantung pada
        donasi – donasi dari luar yang pada akhirnya justru menjadi bencana ke dua pada proses
        pemusnahannya.
    2. Pemerintah Indonesia seharusnya tegas dalam menentukan kebijakan donasi obat –
        obatan untuk bencana, jika buffer stock dirasa cukup maka bantuan obat – obatan
        sepatutnya dinyatakan tidak perlu lagi ATAU hanya mengijinkan donasi obat – obatan
        yang sesuai dengan kebutuhan bencana di lapangan setelah assessment dilakukan
        secara memadai. (The recommendation of WHO – FAO South East Asia Regional
        Workshop on Sound Management of Hazardous Waste, 26th – 29th June 2006,
        Jakarta – Indonesia : Direct drug donations in and after emergency situations should be
        discouraged and only take place through specialized agencies such as WHO , in close
        collaboration with national authorities, after adequate assessment of need and
        epidemiological profiling of requirements. Drug donors need to be made aware of the
        significant health risks posed by ill-managed drug donations and implications in terms of
        recurring costs for the safe disposal of the concerned stocks. Willful dumping outdated
                                          Badan Rehabilitasi dan Rekonstruksi (BRR) NAD-Nias Perwakilan Nias
                          Jl. Diponegoro No. 439 Desa Sifalaete Tab. Kec. Gunungsitoli Kab. Nias Sumatera Utara
                                                                                          Fax/Telp. 0639-22174
   drugs need to be considered as a criminal act. Such behavior should be rendered illegal,
   through an internationally binding mechanism)
3. Badan PBB maupun NGO yang bekerja untuk misi kemanusiaan dalam bencana
   seharusnya lebih terlibat aktif dengan pemerintah Indonesia dan komunitas internasional
   untuk mencegah “willful dumping of wasted drugs ” selama bencana.
4. Pemerintah Indonesia beserta departemen terkait agar supaya menyusun langkah –
   langkah yang strategis dan aktif dalam menetukan metode penghancuran obat – obatan
   donasi yang tidak bisa terpakai secara aman dan mencegah akumulasi stok baru yang
   terus bertambah. (The recommendation of WHO – FAO South East Asia Regional
   Workshop on Sound Management of Hazardous Waste, 26th – 29th June 2006,
   Jakarta – Indonesia: National authorities to urgently ensure the safe management,
   disposal and prevention of accumulation of stocks of outdated pharmaceuticals, notably
   those donated internationally, as part of tsunami and emergency relief. To carry out
   detailed national inventories of such stocks. Further to provide adequate safe and secure
   storage to protect them from adverse climatic conditions and from potential looting and
   possible leaking into the black market)




                                      Badan Rehabilitasi dan Rekonstruksi (BRR) NAD-Nias Perwakilan Nias
                      Jl. Diponegoro No. 439 Desa Sifalaete Tab. Kec. Gunungsitoli Kab. Nias Sumatera Utara
                                                                                      Fax/Telp. 0639-22174
ENGLISH VERSION

                                 PRESS RELEASE
      LESSONS LEARNED FROM DISASTER
         DESTRUCTION OF WASTED DONATED DRUGS FROM NIAS EARTHQUAKE -
               28th MARCH 2005 BY BRR NAD NIAS – Kantor Perwakilan Nias
        AND LESSONS LEARNED IN MANAGING DONATED DRUGS OF ACEH TSUNAMI
                           AND JOGJAKARTA EARTHQUAKE

During Nias earthquake disaster, large amount of pharmaceutical were donated as part of the
humanitarian assistance. Undoubtedly many of the pharmaceutical was useful to save lives, but
unfortunately most of it also could not be optimally utilized and then became wasted due to :
               Damaged because improper stored.
               Expired and expiring : most of the drugs arrived past or near their expire
                date.
               Labeled in foreign language.
               No proper storage room or facility.
               Our current health system is not ready to handle huge amount of donated
                drugs.
According to the World Health Organization (WHO), Ministry of Health and The Provincial Health
Office of North Sumatera who has had a “Pharmaceutical Waste Management” program during
January – March 2006 in Nias, there are more than 1500 m3 of unusable drugs in Nias. So far this
program has already re-collected around 300m3 from 3 main places: Gunungsitoli Hospital, District
Health Office Building, and Pharmacy Warehouse. Those re-collected drugs have been stored in
temporary storage in Gedung Nasional, Gunungsitoli while waiting for the destruction process.
Definitely, these wasted drugs are hazardous substances that can absolutely threatened the
environment and community in Nias. Based on those situations, BRR NAD Nias has actively
involved on the wasted drugs destruction, even though with that allocated budget for drugs
destruction we can build one Puskesmas (public health center), noted by William Sabandar,
Head of BRR Nias Regional Office.
Based on the discussion of WHO Guidelines for Safe Disposal, we could not implement the
“Engineered Land Fill Method” in Nias due to the limited land availability on the island and also
limited capacity while the number of drugs is significantly huge. Therefore the most easiest and
                                           Badan Rehabilitasi dan Rekonstruksi (BRR) NAD-Nias Perwakilan Nias
                           Jl. Diponegoro No. 439 Desa Sifalaete Tab. Kec. Gunungsitoli Kab. Nias Sumatera Utara
                                                                                           Fax/Telp. 0639-22174
proper method is to send the drugs out of Nias and destroy them in high temperature incinerator.
Based on the assessment in Aceh and North Sumatera (Nias does not even have any single
incinerator), no incinerator with that qualification is available. Therefore we finally decided to
destroy the drugs with Co-Processing Methods by Cement Kiln in HOLCIM cement factory, which
has a license from the Ministry of Enviroment to destroy the hazardous wastes.
LESSONS LEARNED :
    1. Government of Indonesia (Ministry of Health and BAKORNAS) will always have to be well
        prepared with buffer stocks of drugs for disaster, therefore not relying on donations from
        outside the country.
    2. Government of Indonesia should be decisive in their drugs donation policy during
        emergency, if the buffer stocks are          sufficient then the government should declare
        temporary restriction to drugs donation OR allows only drugs donation which is suitable
        with the need on the field after an adequate assessment have been carried out. (The
        recommendation of WHO – FAO South East Asia Regional Workshop on Sound
        Management of Hazardous Waste, 26th – 29th June 2006, Jakarta – Indonesia : Direct
        drug donations in and after emergency situations should be discouraged and only take
        place through specialized agencies such as WHO , in close collaboration with national
        authorities, after adequate assessment of need and epidemiological profiling of
        requirements. Drug donors need to be made aware of the significant health risks posed by
        ill-managed drug donations and implications in terms of recurring costs for the safe
        disposal of the concerned stocks. Willful dumping outdated drugs need to be considered
        as a criminal act. Such behavior should be rendered illegal, through an internationally
        binding mechanism)
    3. UN Agencies and NGOs which are working for humanitarian actions should more actively
        involved with the Government of Indonesia and international community in preventing the
        willful dumping of wasted drugs during a disaster.
    4. Government of Indonesia to urgently ensure the safe management, disposal and
        prevention of accumulation of stocks of outdated pharmaceuticals, notably those donated
        internationally, as part of tsunami and emergency relief (The recommendation of WHO –
        FAO South East Asia Regional Workshop on Sound Management of Hazardous
        Waste, 26th – 29th June 2006, Jakarta – Indonesia National authorities to urgently ensure
                                           Badan Rehabilitasi dan Rekonstruksi (BRR) NAD-Nias Perwakilan Nias
                           Jl. Diponegoro No. 439 Desa Sifalaete Tab. Kec. Gunungsitoli Kab. Nias Sumatera Utara
                                                                                           Fax/Telp. 0639-22174
the safe management, disposal and prevention of accumulation of stocks of outdated
pharmaceuticals, notably those donated internationally, as part of tsunami and emergency
relief. To carry out detailed national inventories of such stocks. Further to provide
adequate safe and secure storage to protect them from adverse climatic conditions and
from potential looting and possible leaking into the black market)




                                   Badan Rehabilitasi dan Rekonstruksi (BRR) NAD-Nias Perwakilan Nias
                   Jl. Diponegoro No. 439 Desa Sifalaete Tab. Kec. Gunungsitoli Kab. Nias Sumatera Utara
                                                                                   Fax/Telp. 0639-22174

								
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