• General Practitioner (Medical Doctor)
• ICU Nurses
• Dialysis Nurses
• Chief Engineer
• Asst. Chief Engineer
• Engineer Supervisor
• Physiotherapist
• Patient Relation Officers
• Therapist
• Dental Technician
• Dental Nurse
• Anti-Aging/Cosmetic Nurse
• Reception and Administration Staff
• Health & Travel Insurance Staff
• Health Insurance Claims & Network Staff
• HR Officer/Staff
• Maintenance/Engineering Staff
• IT Staff – IT Coordinator
• Sales Administrator
• Accounts Receivable Staff
• Cashiers
• Ambulance Drivers, Holding SIM B1/B Umum
• Office Boys
• Laundry Attendants

- Graduates from related educational background encouraged to apply
- English competency is a must
- Well groomed and well presented
- Polite and Friendly Disposition

If you are interested in exploring your talent with us, please send your personal resume with cover letter by email to: rai@bimcbali.com
Please note: Only short listed candidates will be notified.

BIMC Hospital
Jl. Bypass Ngurah Rai 100X, Kuta 80361, Bali, Indonesia.
T     (+62 361) 761 263
F     +62 361 764 345
E     info@bimcbali.com
W    www.bimcbali.com

The Importance of a Healthy Blood Pressure

People who do not yet have high blood pressure at age 55 still face a 90% chance of developing high blood pressure during their lifetime. So this is a condition that most people will have at some point in their lives. Here you will read some important advice to lower your blood pressure without any of doctor’s prescriptions needed.

Blood pressure is the force of blood against the walls of arteries. Blood pressure rises and falls throughout the day. When blood pressure stays elevated over time, it’s called high blood pressure.

The medical term for high blood pressure is hypertension. It can be dangerous because it makes the heart work too hard and contributes to atherosclerosis (hardening of the arteries). It increases the risk of heart disease and stroke. High blood pressure also can result in other critical conditions, such as congestive heart failure, kidney disease and/or blindness.

How high is high?

A blood pressure level of 140/90 mmHg or higher is considered high. If your blood pressure is between 120/80 mmHg and 139/89 mmHg, then you have prehypertension. This means that you don’t have high blood pressure now but are likely to develop it in the future unless you adopt a healthier lifestyle.

Both numbers in a blood pressure test result are important, but for people who are of age 50 or older, systolic pressure gives the most accurate diagnosis of high blood pressure. Systolic pressure is the top number in a blood pressure reading. It is high if it is 140 mmHg or above.

Modifications you should do if your blood pressure is high:

• Maintain a healthy body weight

You can calculate your body mass index by dividing your weight in kilograms with your height in metres squared. For example, if you weigh 65 kg, and your height is 1.78 m, your BMI is 65 divided by 2.89m² (from 1.78 x 1.78), which equals 22.49. The recommended BMI is 18.5 – 24.9 kg/m2.

• Follow a healthy eating plan

DASH stands for “Dietary Approaches to Stop Hypertension”. Consume a diet rich in fruits, vegetables, and low fat dairy products with a reduced content of saturated and total fat.

• Eat food with less sodium (salt)

Reduce dietary sodium intake to 100 mmol or less per day (2.4 g sodium or 6 g of sodium chloride).

• Be physically active

Engage in regular aerobic physical activity, such as brisk walking (at least 30 minutes per day, most days of the week).

• Limit your alcohol consumption

Men should limit to two drinks or less per day. While women and lighter weight persons should limit to one drink or less per day.

(1 drink = 0.5 oz or 15 ml of ethanol; e.g. 0.35 l beer, 0.15 l wine, or one double shot (4ml) of whiskey or vodka)

• One other important thing to remember: Stop Smoking!

How low would it go?

You might doubt how effective those modifications are. Here is what studies show how it affects the systolic blood pressure.

• Weight reduction: 5-20 mmHg / 10 kg weight loss.
• DASH eating plan: 8-14 mmHg
• Dietary sodium reduction: 2-8 mmHg
• Physical activity: 4-9 mmHg
• Moderation of alcohol consumption: 2-4 mmHg

How low should you go?

The target for a healthy blood pressure is

• < 130/80 mmHg for people with hypertension and diabetes and renal disease.
• < 140/90 mmHg for other hypertensive persons.

So, what are the benefits of a healthy lifestyle?

A well maintained blood pressure (with or without medicine) has been associated with:

• 35-40% reduction in stroke incidence
• 20-25% reduction in myocardial infarction
• more than 50% reduction in heart failure

The key of success for maintaining a healthy blood pressure is your own will power to stick to the plan and good teamwork with your doctor. To achieve an optimal blood pressure, your doctor also might prescribe you antihypertensive medicines and suggest you to see a dietitian.

Diabetes among the Elderly

The age factor is very crucial in medicine. The metabolism and physical conditions change with advanced age. The elderly need special attention, especially when there are further critical conditions diagnosed, such as diabetes.

What happens when people get older?

In young adults, the percentage of muscles in the body mass is in general much higher than the percentage of fat. When people grow older, this ratio tends to reverse; the mass portion of fat becomes more than of muscle. The more body fat a person has, the higher the resistance to insulin will become. This insulin resistance causes the body to absorb less sugar from the blood, resulting in a raised sugar content in the blood and the body does not get enough energy. So, as a natural consequence of the advanced age, approximately 10% of elderly people will have glucose (sugar) metabolism problems.

Additional considerations for treating elderly diabetic patients

When treating an elderly diabetic, doctors need to also consider the function of the organs. Even without a disabilitating disease such as diabetes, the organs’ functions decrease with age. When added complexity occurs with diabetes, the functions can decrease significantly.

One of the most common complications with elderly diabetic patients is hypoglycemia, a condition where the blood sugar is below normal, causing the body to not receive enough energy. When the blood sugar level is very low, some body cells can even die. Most importantly, the brain cells are the most sensitive to this hypoglycemia condition. So it reduces the function of the brain and even may cause death.

With a higher insulin resistance and a decreased function of the pancreas, the organ which produces insulin, an elderly diabetic patient needs a higher dose of medicine to reach the required insulin level needed by the body and needs to control the blood sugar. Also with age, the kidney function decreases. The kidney is important to eliminate metabolites (residuals) of chemicals, including drugs. If the metabolites are on a higher level than normal, this may cause serious effects, for example it may contribute to lower the blood sugar level further, as it frequently occurs in diabetic medicine. So with a higher dose of medicine and less elimination by the kidney, hypoglycemia is much more likely to occur.

Another mechanism to result in hypoglycemia is the reduced sensitivity of body responses with the elderly. In a healthy young person, once there is a hypoglycemia condition the body will try to regulate this condition early and try to increase the blood sugar level before permanent damage occurs. With elderly people this mechanism will not work as effectively any more. The body’s response will be too late when the blood sugar level becomes very low, which might already cause damage to the cells.

What is the most suitable therapy of diabetes?

The first and most important is lifestyle modification. All diabetics need to modify their diet and their level of physical activity. If the blood sugar level is still not under control they will need medication. There are many diabetes medicines in the market. The choice of which medicine is to be used depends on many factors, e.g. the individual’s kidney function, patient compliance, and potential side effects.

Insulin Therapy – a brief analysis

Advantages:

• Natural treatment for diabetic patients.
• No side effects.
• Easy to adjust the dosage.

Disadvantages:

• Patients are reluctant to start the ‘injection’ treatment,
• Weight gain,
• Patients fear hypoglycemia, although, with good monitoring and proven from studies, insulin therapy does not have a higher hypoglycemia incidence.

Previously, insulin injection seemed to be the last resort for diabetics, in the case that no oral medication was succeeding in regulating the blood sugar level. This understanding has changed. Insulin is now the “ideal” diabetes medicine, even for early cases.

Any health system in the world should include simple methods for early detection of kidney disease. When indications are that you are at ‘increased risk’ of developing Chronic Kidney Disease (CKD), one simple method to measure your kidney function is to measure albumin in the urine by dipstick that detects protein in urine.

If you are at ‘increased risk’ and tick YES to any of the following:

• Are 60 years or older
• Are of Aboriginal or Torres Strait Islander origin
• Have diabetes
• Have a family history of kidney disease
• Have established heart problems (heart failure or past heart attack) and/or have had a stroke
• Have high blood pressure
• Are obese (Body Mass Index BMI – of 30 or more)
• Are a smoker
• ….. then you should ask your GP for a Kidney Health Check which includes a blood test, a urine test, blood pressure measurement and measurement of your Body Mass Index – BMI including height, weight and waist circumference.

Symptoms of reduced kidney function

• High blood pressure
• Changes in the amount and number of times urine is passed, e.g. at night
• Changes in the appearance of urine
• Blood in the urine
• Puffiness e.g. legs and ankles
• Pain in the kidney area
• Tiredness
• Loss of appetite
• Difficulty sleeping
• Headaches
• Lack of concentration
• Itching
• Shortness of breath
• Nausea and vomiting
• Bad breath and a metallic taste in the mouth

What can you do to keep your kidneys healthy – the golden rules

Keep fit and active
Increase daily physical activity as it helps reduce your blood pressure and reduces your risk of CKD.

Keep regular control of your blood sugar levels, blood lipids and anaemia
About half of people who have diabetes develop kidney damage, so it is important for people with diabetes to have regular tests to check their kidney function. Kidney damage from diabetes can be reduced or prevented if detected early. It is important to keep control of blood sugar levels with the help of doctor.

Monitor blood pressure, reduce if necessary – lower the blood pressure, slower your Glomerular Filtration Rate (GFR) declines
Although many people are aware high blood pressure can lead to a stroke or heart attack, few know it is also the most common cause of kidney damage. High blood pressure is especially likely to cause kidney damage when associated with other factors like diabetes, high cholesterol and cardiovascular disease.

Eat healthy and keep your weight in check
This can help prevent diabetes, heart disease and other conditions associated with CKD. Reduce salt intake – recommended salt intake is 5-6 grams of salt per day (a teaspoon). In order to reduce your salt intake, try to limit the amount of processed and restaurant food and do not add salt to food. It will be easier to control your intake if you prepare the food yourself with fresh ingredients.

Do not smoke
Smoking slows the flow of blood to the kidneys. When less blood reaches the kidneys, smoking limits the kidney’s ability to function properly. Smoking also increases the risk of kidney cancer by about 50%!

Do not take over-the-counter pills on a regular basis
Common drugs such non-steroidal anti-inflammatory drugs like ibuprofen are known to cause kidney damage and disease if taken regularly. Such medications probably do not pose significant danger if your kidneys are relatively healthy and you use them for emergencies only. If you are dealing with chronic pain such as arthritis or back pain, work with your doctor to find a way to control your pain without putting your kidneys at risk.

source: http://www.kidney.org.au

Dialysis Centre at BIMC Hospital, Nusa Dua (Opening soon!)

BIMC Hospital Nusa Dua is located on approximately one hectare of land right amongst luxury 5 star hotels and villas, the Bali Golf and Country Club, a shopping mall, restaurants and secluded beaches, conveniently located just 20 minutes from Bali’s Ngurah Rai International Airport.

BIMC Hospital Nusa Dua will incorporate various Centers of Excellence, firstly the 24 hour Medical and Emergency Centre dealing with all kinds of accidents and other emergency cases as well as with any general medical issue to be addressed to the international team of doctors and specialists. For this the medical team relies on a first-class infrastructure comprising fully equipped ambulances, an Intensive Care Unit, Day Procedure Units, various international standard Operating Theatres, comfortable Ward Rooms and private consultation rooms. Furthermore the new hospital will host new specialty services such as the Dialysis Centre, the CosMedic Centre and the Dental Centre.

The Dialysis Centre is designed to provide dialysis service using the latest Nipro’s high-tech instruments, all to be experienced in a dedicated Spa-style comfort environment, leaving no room for any concerns for quality or safety. The whole process is supervised by an Australian nurse with long-term experience in dialysis procedures.

For more information and reservation, please contact us:

BIMC Hospital, Nusa Dua
Blok D Kawasan BTDC, Nusa Dua, Benoa, Kuta Selatan 80363, Bali, Indonesia
Email: nusadua@bimcbali.com

What is a Swimmer’s Itch?

Other names

Swimmer’s itch has various other names. In eastern nations, it is often named in reference to the rice paddies where it is contracted, producing names which translate to “rice paddy itch”. For example, in Japan it is called “kubure” or “kobanyo”, in Malaysia, “sawah”, and in Thailand, “hoi con”. In the United States it is known to some as “duckworms” (in coastal New Jersey) or “clam digger’s itch”.

In certain parts of Canada, mainly Ontario, it is known as “Duck Lice” and “Beaver Lice”. In Australia it is known as “pelican itch”. In Western Minnesota, particularly on Lake Minnewaska, it is known as “Lake Itch.”

Who gets Swimmer’s Itch?
Only about one third of the people who come in contact with the parasite develop Swimmer’s Itch. People who swim or wade in infested water may experience this itchy rash. All age groups and both sexes can be involved, but children are most often infected due to their habits of swimming or wading in shallow water and playing on the beach as the water evaporates from the skin.

How is Swimmer’s Itch spread?
An individual may get the infection by swimming or wading in infested water and then allowing water to evaporate off the skin rather than drying the skin with a towel. Person-to- person spread does not occur.

What are the symptoms of swimmer’s itch?
Whenever infected water is allowed to evaporate off the skin, an initial tingling sensation may be felt associated with the penetration of the parasite into the skin. The irritated spot reaches its maximum size after about 24 hours; the itching may continue for several days. The symptoms should disappear within a week.

How soon do the symptoms begin?
A person’s first exposure to infected water may not result in the itchy rash. Repeated exposure increases a person’s allergic sensitivity to the parasite and increases the likelihood of rash development. Symptoms may appear within 1 to 2 hours of exposure.

What is the treatment for Swimmer’s Itch?
There is no treatment necessary for Swimmer’s Itch. Some people may get relief from the itching by applying skin lotions or creams to the infected site.

What can be done to reduce the chances of getting swimmer’s itch?

• Toweling off immediately after swimming or wading in infested water can be very helpful in preventing rash development.
• Swim in water away from the shore.
• Avoid swimming in areas where snails have accumulated.
• Don’t encourage birds to stay near swimming areas by feeding them.

The critical care team consists of a diverse group of highly trained professionals. The head of the team, the critical care physician, also known as an Intensivist, is specially trained to care for critically ill patients who may require organ support, life support or intensive monitoring. These physicians are board certified in a medical specialty such as anesthesiology, internal medicine, surgery and pursue subspecialty board certification in critical care.

There are many reasons a person may need care in an ICU, the following are the most common reasons :

• Shock, a condition when the organs of the body do not get enough oxygen and blood pressure for them to function normally.
• Respiratory failure, when the lungs do not work sufficiently.
• Infections.
• Renal failure, when the kidneys fail to work.
• Neurological conditions.
• Bleeding and clotting problems.
• Multiple Organ Dysfunction Syndrome (MODS).

When a patient is in the ICU, many people are involved in making decisions about that person’s care. Doctors, nurses and other healthcare workers make choices about how to care for patients throughout the day. In certain conditions the doctor will involve the patient’s family in the decision making process. These decisions can be very difficult ones to make which an ICU team is prepared to deal with professionally.

BIMC Hospital has a fully equipped ICU which is prepared to handle even most severe medical condition. The ICU area at BIMC Hospital includes 4 fully equipped bed units and an isolation ICU bed with a separate air filtration system where patients with highly contagious infections can  be closely monitored and treated at all times without risking the infection to spread further.

• Hotel or home visit by a clinic, hospital or doctor
• General practitioner consultation
• Specialist consultation
• Emergency consultation
• Emergency service

Hotel or home visit

Most clinics and private hospitals provide hotel and home visit service. A doctor will come to your address for examination and treatment. This is indicated for less serious ailments. It may take time for the doctor to arrive to your address. In some cases, you can call your insurance company to arrange a doctor’s visit. When necessary, the doctor will arrange a patient transfer to the hospital.

General practitioner consultation

Most clinics have general practitioners on standby. You can find many clinics available giving 24-hour service in major tourist areas. Some hospitals like the BIMC Hospital also provide in-house clinics. They also provide medications.

Specialist consultation

When you visit a hospital, you can request to directly have consultation to a specialist, i.e. internist,surgeon, ENT specialist, dermatologist, etc. You should contact the hospital for the time of consultation. Most specialists also run their own private practice and are not available full-time at the hospital.

Emergency consultation

If you are in an acute condition, but able to get to a medical centre, you will be escorted to the emergency room. Most major hospitals like the BIMC Hospital and some clinics have a 24-hour emergency room service. The attending usually is a general practitioner who will perform initial examination and tests, then advise for further treatment or referral. When a specialist referral is needed, they may not be immediately available, usually the attending doctor will discuss the treatment until the specialist’s evaluation.

When you need immediate emergency treatment, you can call an emergency ambulance service. Although many hospitals boast to provide 24-hour ambulance service, in practice these services are very limited and not readily available. The only reliable emergency service with international standard equipment and quick ambulance dispatch is at the BIMC Hospital. However, you must know there will be a charge for the service. At BIMC Hospital, the ambulance team always consists of a doctor and a nurse, unlike in most western countries, where paramedics will be the first responders. When the ambulance returns to BIMC Hospital, the emergency room is prepared to provide professional service immediately from minor injuries to more complex procedures.

Medical Evacuations

When medical treatment in Bali is not sufficient, medical evacuation to a higher care facility is needed. The nearest higher care facilities are in Singapore, Perth or Jakarta. Should medical evacuation be necessary, BIMC Hospital will handle all arrangements either by commercial airline carrier, helicopter or private air ambulance charter. Working closely with aircraft operators and insurance companies worldwide, BIMC Hospital fully facilitates the process to place the patient in the safest hands.

These evacuations are expensive, therefore should include assistance from your insurance company. If the insurance company has agreed to cover the cost, the company will be able to make any necessary evacuation arrangements. Such arrangements include settling the hospital account, hiring an ambulance to the airport, check-in procedures, immigration processing and tarmac clearance for the ambulance.

Travel Insurance

Not only for severe cases but also for simpler treatments every traveler is advised to have organized coverage with travel insurance. In some facilities, medical assistance and treatment can be expensive. And most importantly, due to some diagnostic or therapeutic facility limitations in the island, some patients need to be transfered to another city, even to another country.

The patient, family member or travelling companion should contact the insurance company as soon as possible after admission to hospital. Insurance companies usually have 24-hour contact numbers for emergency assistance. The insurance company will be able to advise on medical coverage, assess the treatment and give consideration to medical evacuation after liasing with the treating doctor. They can also assist with changing bookings and ticket arrangement.

In non-severe medical cases, usually you will have to pay the medical bill in advance, then reimburse the cost when you arrive back in your country.

A note on the Doctors’ education in Indonesia

In Indonesia, once medical students finsh their hospital internship, they get their medical degree as general practitioners. If they continue their 3 to 5 year residency, they get a specialistic degree, i.e. becoming surgeons, neurologists, dermatologists, etc.  Doctors in Indonesia who practice in the public health system also have private practices or lecture at universities.  At present foreign doctors and nurses are not permitted to practice in Indonesia.

Different organizations provide guidelines on cancer screening tests. Recommendations vary on which cancers people should have screening tests for, which screening tests should be used to screen for a particular cancer, and when and how often those tests should be done. It’s important for people to talk to their doctors to determine which tests are appropriate for their age and medical history.

Currently, screening tests are used widely to check for cancers of the breast, cervix, colon, and rectum:

Breast: A mammogram is the best tool doctors have to find breast cancer early. A mammogram is a picture of the breast made with x-rays. The NCI recommends that women in their forties and older have mammograms every 1 to 2 years. Women who are at higher-than-average risk of breast cancer should talk with their health care provider about whether to have mammograms before age 40 and how often to have them.

Cervix: The Pap test (sometimes called Pap smear) is used to check cells from the cervix. The doctor scrapes a sample of cells from the cervix. A lab checks the cells for cancer or changes that may lead to cancer (including changes caused by human papillomavirus, the most important risk factor for cancer of the cervix). Women should begin having Pap tests 3 years after they begin having sexual intercourse, or when they reach age 21 (whichever comes first). Most women should have a Pap test at least once every 3 years.

Colon and rectum: A number of screening tests are used to detect polyps (growths), cancer, or other problems in the colon and rectum. People aged 50 and older should be screened. People who have a higher-than-average risk of cancer of the colon or rectum should talk with their doctor about whether to have screening tests before age 50 and how often to have them.

• Fecal occult blood test: Sometimes cancer or polyps bleed. This test can detect tiny amounts of blood in the stool.
• Sigmoidoscopy: The doctor checks inside the rectum and lower part of the colon with a lighted tube called a sigmoidoscope. The doctor can usually remove polyps through the tube.
• Colonoscopy: The doctor examines inside the rectum and entire colon using a long, lighted tube called a colonoscope. The doctor can usually remove polyps through the tube.
• Double-contrast barium enema: This procedure involves several x-rays of the colon and rectum. The patient is given an enema with a barium solution, and air is pumped into the rectum. The barium and air improve the x-ray images of the colon and rectum.
• Digital rectal exam: A rectal exam is often part of a routine physical exam. The health care provider inserts a lubricated, gloved finger into the rectum to feel for abnormal areas. A digital rectal exam allows for examination of only the lowest part of the rectum.

Doctors consider many factors before they suggest a screening test. They weigh factors related to the test and to the cancer that the test can detect. They also pay special attention to a person’s risk for developing certain types of cancer. For example, doctors think about the person’s age, medical history, general health, family history, and lifestyle. They consider how accurate the test is. In addition, doctors keep in mind the possible harms of the screening test itself. They also look at the risk of follow-up tests or surgery that the person might need to see if an abnormal test result means cancer. Doctors also think about the risks and benefits of treatment if testing finds cancer. They consider how well the treatment works and what side effects it causes.

Screening benefits and risks

Deciding whether to have a screening test is not always as straight forward as it may seem. Screening has potential risks and benefits that a person should talk about with his or her doctor, especially in the context of his or her personal and family medical history. The benefits include a potential decrease in the number of deaths from cancer. The risks include:

• Overdiagnosis. Cancer screening tests may find slow-growing cancers that otherwise would not have been found or caused harm in a person’s lifetime. The result is that a person may receive potentially harmful, painful, stressful, and/or expensive treatment that the person didn’t need.
• False positives. Sometimes a cancer screening test will suggest that a person has cancer when they do not.
• Increased testing. Both overdiagnosis and false positives can lead to additional tests that a person may not need. These tests can be physically invasive, costly, and cause a person unnecessary stress and worry.
• False reassurance. Sometimes a cancer screening test will suggest a person does not have cancer when they actually do. As a result, a person may not get needed treatment.

You may want to talk with your doctor about the possible benefits and harms of being checked for cancer. The decision to be screened, like many other medical decisions, is a personal one. Each person should decide after learning about the pros and cons of screening.