The hospitals that were founded in this period or existed before 1890 are subject of study. Their background and activities were followed during the period 1890-1910. These years are grouped around the turn of the century, a period that may be characterized by the notion of revolutionary changes. The way in which changes took place was disclosed in the first few paragraphs. They formed the introduction to the real issue: what happened in the field of health care and more specific in the field of hospital care.
A few significant developments may be mentioned. The most important is the change in relations and power between the two big players in the field of health care, the BGD (Civil Medical Service) and the MGD (Military Medical Service). Next to the two public health services, two new large players presented themselves in the field of hospital care: companies and missionary organizations.
A few essential questions may be put in this period of transition: why did new actors appear on the stage of hospital care? What caused their drive to surmount the problems of starting new hospitals?
A variety of motives is known, mostly depending on the kind of initiating organization. The motive may be charity, self-interest or a mixture of these.
About the use of the hospitals during this period: after a hesitant start, patients began to consult the new provisions. At first, for getting medicaments, being treated for minor health problems or looking for help in last resort. Later on, also for being hospitalized, although at first hospital admissions were avoided or refused most persistently. The success of hospital services with the population depended upon the attitude of the doctors, the reputation of the hospital and the tariffs charged. As the patients generally were poor and had no means for paying health visits, the hospital bill could become an important issue. However, for quite a number of the new hospitals the treatment and nursing was for free. This was the case for employees who visited their company hospital and for civil servants below a certain income. And also for the patients who could prove that they were poor and had no means to pay.
As far as the type of hospitals concerns: a division may be made in general hospitals and specialized hospitals. Within the first group we looked into the developments of governmental hospitals, which benefited from the newly announced ethical politics and which grew in number and quality. However, the two new groups of general hospitals (Company and Missionary) did show more innovations than the governmental hospitals could demonstrate. The Djokja system was described, a network system of hospitals, auxiliary hospitals and policlinics. This system made school and got many followers. The other major innovation came from the Deaconess hospitals which put much effort in the training of a professional nursing staff. The third group of general hospitals that was described was the group that started company hospitals. Alongside a lot of criticism that this group met from outside because of their dependence on the much detested Coolie Ordinance, they earned credits for their role in the improvement of hospital care by organizing patient files and statistics and by making use of analytical and research laboratories.
Then a number of specialized hospitals for leprosy, venereal diseases, health resorts, infectious diseases, beriberi and psychiatry were discussed. The future of this type of hospitals partly depended on the health policy the authorities pursued (leprosy, syphilis) and partly on the outcome and application of scientific research (beriberi and infectious disease).
The tour was closed by looking into the daily life of one of the pilot hospitals. This time the estate hospital of Tandjong Morawa (East Coast Sumatra) was described extensively.
What may be learnt from the experiences encountered?
First of all, that the focus of colonial healthcare before had been on European VOC servants or European military with some exceptions, mostly due to preventive actions in the interest of the same Europeans.
From the end of the 19th century this focus was shifted to the indigenous people of the Netherlands Indies.
Secondly, that the private initiatives in the field of hospital establishments gradually gained the upper hand, compared to the initiatives of the military and of the government. Together with this development the monopoly situation of Java changed: by 1910 the num-ber of general hospitals in the Outer Provinces surpassed that of Java.
In the third place, that the influence of the ethical movement made it felt. More funds became available for government hospitals and missionary hospitals. For the last category this occurred by way of financing lands and buildings and subsidies for running costs.
Finally, that training facilities booked results: the number of trained indigenous doctors reached almost the same level as the staff of European doctors, at least when counting exclusively the civil doctors. Besides, there were some preliminary start-ups of training facilities for indigenous nurses and midwives. Still, the situation in the field of professional nursing remained worrisome, like the story of the company hospital showed.
Not much can be said about the influence of Western hospitals and doctors on the health situation of the population, but then this is also true for the hospitals in the Western hemisphere. During the period discussed, the health situation remained unstable and deteriorated, especially on Java, but this was as much due to the food situation and hygienic circumstances as to shortcomings in medical knowledge and health provisions.