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Indonesia: mutual enthusiam about working together
Indonesia is the third most densely populated country in the world with 
more than 200 million inhabitants. The Indonesian Archipelago consists of 13,000 islands and has a wide range of ethnic groups and cultures. As in many other asian countries, cervical cancer is the most common type of cancer. Problems with infrastructure, lack of resources, lifestyle factors and insufficient awareness amongst the population are the main reason for a very high mortality rate in women with cervical cancer. Eighty percent of all patients die from the disease. At the same, Indonesia has excellent institutions for medical research.
Indonesia is a former colony of the Netherlands, just like Surinam is. The comparison ends there though. Indonesia is a vast country that consists of a large number of islands, with an ancient cultural heritage. The country became independent in 1949 after a severe struggle against the Dutch. Even though the relationship between the Netherlands and Indonesia has improved a great deal since then, the ties are not as close as those between Surinam and the Netherlands. Indonesia is a country with many contradictions. A modern industry has developed over the last few decades that measures up to economies og other countries in East Asia. However, only a few Indonesians benefit from this development. The majority of the nation works in farming, which is very labor intensive, or they are unskilled laborers. Over 80% of the Indonesians live in rural areas. The average annual income is approximately $750
dollars. Most Indonesians live on the island of Java: some 160 million people, whilst the other 40 million live on Sumatra, Kalimantan, Sulawesi, Irian Jaya (Papa New Guinae), Bali, Lombok and many other small islands.
Tragically, the country is suffering from a deep political and economic crisis, of which the end is not yet in sight. Ethnic tensions add to a sense of instability, which is a hindrance for economic recovery. In spite of these problems, Indonesians are generally optimistic, hospitable people who are clearly open to new ideas. At universities and private institutions, top quality scientific research is conducted. In other words: there are plenty of opportunities to work together on a basis of equality.
Cervical cancer in Indonesia
Every year 200,000 Indonesians are diagnosed with cancer; 20% of them (40,000 people) are women with cervical cancer. 
Cervical cancer is the most common type of cancer in Indonesia. This disease is especially widespread in traditional communities in rural areas, where several risk factors contribute to an increased chance of cervical cancer. Women get cancer and preventing death. First of all, it is crucial to increase the awareness of both doctors and women. This was a starting point for early detection and for further advice related to life style risks. In the meantime, the cooperation has expanded to all University Hospitals in Indonesia. The Joint Indonesian Study group on Cervical Cancer (JISGCC) has been established under the coordination of the University Indonesia (Jakarta) and the LUMC.
Prevention: screening
A screening program is being set up to enable early detection of cervical cancer. When cervical cancer is diagnosed early, a relatively minor operation not affecting fertility, can cure the patient. This would improve the quality of life of the women suffering cervical cancer, in a culture where having children is highly valued. However, it won't be easy to set up an adequate screening program in such a vast area with a scattered population, with only very limited access to health facilities. If there was a preventive vaccine available, it would be manageable to vaccinate large numbers of women and girls.
The Eijkman Institute: High Quality Research
The Eijkman institute in the Indonesian capital Jakarta is part of the Leiden-Indonesia cooperation. The institute is named after Dutch nobel prize winner Christiaan Eijkman who discovered vitamin BI. This institute is one of the most renowned biomedical research institutions in Asia. Modern molecular biological technology is used to try and find solutions and cures for diseases that are mainly common in the tropics. In the past this institute contributed to an evaluation of a vaccine against the Hepatitis B virus that plays a role in causing cancer of the liver. vaccines that were developed for western countries were not always found to be effective in a country like Indonesia. Evidently, this expertise can be extremely useful in the quest to find a preventive vaccine against cervical cancer in Indonesia and other Asian countries. They have close links with other Indonesian laboratories like the one in Mataram (Lombok). These laboratories have all been approved by the WHO (World Health Organization).
Exchange with the LUMC
The enthusiasm for Bandung and Leiden to work together has grown in the meantime. Gynecologists from Indonesia visit the LUMC regularly, research staff from Leiden conduct field work on West Java. Information is gathered about the course of cervical cancer in Indonesia and the related subtypes of HPV are recorded. An initial analysis shows that several types of HPV are involved in causing cervical cancer on West Java. This is essential information when developing vaccines.