Limited access to health and trauma to the plague made conditions for the people of Papua difficult during the Covid-19 pandemic. The lack of development in health services in the last five years will make Papua and West Papua confused if they have to face an uncontrolled increase in the number of patients.
Andreas Wahyu (31) and his parish priest, Vince Cole, rode the motorized boat on the Pomats River, about 20 kilometers from where he lives in Kampung Er. On Saturday afternoon, March 28, 2020, the volunteer handling covid-19 from the Christ Amore Parish Church moved to Agani Village, Sawa Erma District, Asmat Regency, Papua. Both of them want to provide counseling and socialize what can and cannot be done during the corona pandemic. He also wanted to ask residents not to gather to celebrate Easter which fell on Sunday, April 12.
Their visit found no results. The village, which is inhabited by around 1500 people, is almost empty. In fact, two weeks ago, when Andreas last stepped aside, he was still seeing residents passing by. While the parents catch fish, the children cheerfully punt and play volleyball when the sun starts to drift.
"They went to the forest," said Andreas when contacted by Jaring.id, Friday, April 9, 2020.
The forest that Andreas refers to is about 30 kilometers from the residents' village. In the observation of the volunteer team, around 90 percent of the 7,198 population in Sawa Erma often go to the forest. Even in Esmapan Village, Pulau Tiga District, the houses are no longer inhabited.
They have been vacating the village since Wednesday, April 1, 2020. District officials (Tripides) and religious leaders have appealed to residents to stay in their respective bivouacs during the corona pandemic.
"The Covid-19 team appealed to the public to go to their respective bivouacs because it is relatively safer," he said.
For the people of Kampung Agani, living in a bivouac located in the middle of a forest is nothing new. Gaharu seekers often use temporary shelters during the search for high-value timber.
According to Andreas, people in Asmat Regency are still traumatized by the tragedy that killed dozens of children in January 2018. At that time, Asmat District was hit by an epidemic of malnutrition and measles. Of the hundreds of cases identified, 72 children were killed.
This condition is exacerbated by inadequate health facilities. Let alone dealing with covid-19, basic health services only take place at the auxiliary Puskesmas where health workers only come once a month.
"They are safer living in the forest than in the village. Dong look for sago for food there, install nets, hunt, "said Andreas.
However, not all residents penetrate the forest. The community leader in Kampung Er, Sawa Erma District, Servandus chose to stay. He must accompany the traditional elders in carrying out the rituals of respecting the ancestors.
"The ancestors have a culture in the village. We cannot make the village quiet, ”Servandus said when contacted by Jaring.id via Andreas's cellphone, Saturday, April 11, 2020.
Apart from that, Servandus also did not want just anyone from outside Asmat to enter his village.
"We want to protect the village. The incoming ship could endanger residents, "he said.
Transportation is hampered
In a separate location, Adriana Saroy (34) is no longer free to go back and forth between Wamena - Tiom Regency, Lanny Jaya. Since the main access to Wamena-Tiom was closed by the Lanny Jaya Regional Government on April 1, 2020, the Bank Papua employee had difficulty buying diesel. Even though the fuel is the only power to turn on the generator so that electricity flows.
"Usually every Sunday we buy diesel for operations. It's hard now, ”said Adriana when contacted by Jaring.id, Thursday, April 9, 2020.
Adriana must wear a mask, have hand sanitation, and show her identity card as a bank employee to the joint Indonesian National Army (TNI) and the Police, as well as the Transportation Service every time she crosses the main road. Without it, it would be impossible for him to pass through security guard.
"The guard is quite tight. It also checks people in transportation, "said Adriana.
The researcher of the Pusaka Bentala Rakyat Foundation felt the same way, Rasela Malinda (28). The Merauke-Jakarta flight ticket he purchased on March 26, 2020 was canceled by a travel agent. Because the runway at Mopah Airport, Merauke can only be used to transport logistics and medical equipment.
Doubtful about the travel agent's statement, Rasela still dragged his suitcase towards Mopah Airport. There he only found cleaners and customer service.
"Quiet, no activity. They said there were no flights until March 29, "Rasela told Jaring.id.
Since March 26, the Papua Provincial Government has closed its airports and ports for 14 days. The closure was then extended to 23 April. According to the Deputy Governor of Papua, Klemen Tinal, the closure of air and sea access was taken to prevent the spread of the new corona virus on Earth of Cendrawasih. The main reason is the unpreparedness of their health infrastructure to handle a large number of Covid-19 sufferers.
"Those who are allowed to enter Papua are goods, basic necessities, medical equipment and other necessities carried by cargo planes or cargo ships. For the flow of passengers, it will be closed for the time being, ”Klemen told reporters after inaugurating the Regional Secretary for Papua, Ridwan Rumasukun at the State Building, Tuesday, April 7, 2020.
Lack of health infrastructure
As of Sunday, April 12, 2020, 62 people tested positive for Covid-19 in Papua. Of that number, 2 of them died, while 3 others recovered. Meanwhile in West Papua there were 2 people who were positive and 1 died. The number of Covid-19 sufferers in Papua is somewhat lower than in other regions in Indonesia, but the Papuan regional government is moving faster than other regions in terms of closing access for reasons of the health system.
The community leader in Kampung Er, Rufus Sati can understand the policies decided by the local government. He also did not want the Covid-19 case, which has now entered all provinces in Indonesia, to diminish the life expectancy of Asmat residents.
During the quarantine period, he asked the regional government to reduce the prices of basic necessities which are now choking people. This is because, since President Joko Widodo announced the first Covid-19 patient on March 2, 2020, the prices of food items such as rice, oil, onions and garlic have crept up. Meanwhile, the distribution of necessities to the “thousand planks” area is starting to drag.
"We, as religious leaders, hear the complaints of the residents, this price (basic needs-ed) has made the residents suffer," said Rufus when contacted by Jaring.id, Saturday, April 11, 2020.
In response to this, the Director of the Papua Legal Aid Institute (LBH), Emanuel Gobay, asked the central and regional governments to immediately control the prices of basic necessities amid the pandemic. If not, he is worried that there will be mass starvation in Papua.
"This is the threat of food shortages in Papua," said Emanuel Gobay when contacted by Jaring.id, Friday, April 10, 2020.
The Minister of Home Affairs, Tito Karnavian, through Permendagri Number 20 of 2020 concerning the Acceleration of Handling Coronavirus Disease 2019 in the Regional Government has responded to complaints from the community in the regions. He requested that all regional heads reallocate regional budgets into Covid-19 handling and mitigation posts, including ensuring assistance and basic necessities for the community.
"For example, the procurement of hospitals, treatment beds, medical personnel and other facilities and infrastructure," said Tito Karnavian in a release received by Jaring.id, Wednesday, April 8, 2020.
The former Indonesian Police Chief also asked the regional government to put the budget into four programs, namely the Hope Family (PKH), basic food cards, pre-employment cards and electricity tariff subsidies during April, May and June. In this case, the government has disbursed IDR 110 trillion from the Covid-19 handling budget of IDR 405.1 trillion. Without that, the Minister of Home Affairs is worried that there will be an explosion of social crisis.
"Of course this cannot happen, because it has an impact on a security crisis. There will be security disturbances, ”said Tito.
Papua Is Not Ready to Face Corona
The head of the Asmat Health Service, Richard Ruben Mirino, is worried about the health facilities in his area. He said Asmat would not be ready if he had to deal with the spread of the new corona virus in large numbers. Still sticking in his memory how unprepared Asmat handled malnutrition and measles a few years ago.
Ministry of Health data shows that the 2018 Public Health Development Index (IPKM) for Papua and West Papua are not moving from the most distended position. Papua only has an IPKM of 0.4888, while West Papua is slightly higher at 0.5491. This condition did not move from the previous five years.
Of the 7 sub-indices used to calculate IPKM, the value of health services is the lowest. From a scale of 1, the score for Papua is only 0.3166 and West Papua is 0.3724. Two of the five factors contributed to the low number of doctors per district and the minimum number of people who had access to health care insurance.
According to Richard, the health facilities in Asmat are only one hospital building, one polyclinic, two pharmacies, 17 puskesmas and 62 auxiliary puskesmas. Apart from 180 units of rapid test kits, until now there has been no assistance provided by the government.
The closest covid-19 referral health facility from Asmat Regency is the Merauke Regional General Hospital (RSUD), which is two days away when using the Pelni Ship. Meanwhile, traveling by plane via Ewer or Kasuari Airport to Mopah Airport in Merauke takes at least two hours.
"Access from the village to the hospital is very far," said Richard when contacted by Jaring.id, Friday, April 10, 2020.
Richard said that his party had prepared several scenarios for handling Covid-19 in Asmat. One of them is to prepare the Puskesmas as the front line to anticipate the spread of Covid-19 cases.
If the situation worsens, according to him, the first level health facility officer will take the patient to the Agats Regional General Hospital (RSUD) which can be reached by fast boat or long boat for two hours down the river.
"Arriving at the port, we picked up by ambulance," he said.
He hopes that assistance in the form of personal protective equipment (PPE), medicine, disinfectants and an ambulance can be sent by the central government. Five days ago, Richard admitted that he had sent a letter to the Ministry of Home Affairs to immediately send the needs for handling Covid-19 to Asmat.
Meanwhile, the chairman of the Indonesian National Nurses Association (PPNI) for Papua and West Papua, Isak Junus Hans Tukayo, stated that the easternmost region of Indonesia does not have adequate facilities and health workers. Papua has only one special hospital and 42 general hospitals, while West Papua only has 18 general hospitals. Meanwhile, the number of nurses in the two provinces is 7,000-8,000 people. About 5,000 of them work in the Papua region. In contrast to DKI Jakarta, which has 33,484 nurses.
That is because, said Isak, Papua and West Papua will not be able to accept the spike in covid-19 patients like other areas in Java.
"If the existing developments are not booming, then we can. However, otherwise it cannot be handled, ”said Isak when contacted by Jaring.id, Thursday, April 9, 2020.
The same thing was admitted by a pulmonary specialist who served at the Jayapura Regional General Hospital (RSUD), RS. Bhayangkara and RS. Dian Parahita, Victor Manuhutu. The doctor, who was widely discussed on social media for wearing refillable gallons as a substitute for face shields, admitted that the health system in Papua is not ideal, but the hospital is still in control of the situation.
"Currently, there is no need to ask (for help) from the central government. Currently it is still enough, "said Doctor Victor.
Doctor Victor explained that the three covid-19 referral hospitals in Jayapura Regency include the Hospital. Jayapura, RS. Dian Harapan and RS. Bhayangkara already has a number of facilities to treat patients who are positive for Covid-19. RS. Jayapura has 10 isolation rooms, while three isolation rooms are located in the hospital. Dian Harapan.
Meanwhile, RS. Bhayangkara does not have a ventilator even though it is equipped with an isolation room. As for the number of pulmonary specialists, said Doctor Victor, only three, including himself. Therefore, handling covid-19 in Papua will involve a specialist in internal medicine.
The minimal number of specialist doctors in Papua conveyed by doctor Victor Manuhutu has reached the table of the Papua Province Regional Leadership Communication Forum (Forkopimda) which took place on Thursday, April 8, 2020. From the document on the results of a joint agreement on prevention, control and overcoming of the 2019 coronavirus disease (covid-19) ) received by Jaring.id, regional leaders highlighted the limitations of health support tools, such as ventilator, exhauster and hepa filter in Papua hospital.
Therefore, regional leaders in Papua have prepared a number of anticipatory steps, including preparing medical personnel, paramedics and volunteers at covid-19 referral hospitals, as well as special incentives for medical workers. In addition, they also plan to set up a referral infection hospital, a disaster emergency response system, and fulfill the need for personal protective equipment (PPE), both for medical personnel and the community.
However, until this manuscript was published, Jaring.id could not get more detailed information. Spokesperson for the Papua Covid-19 Task Force, doctor Silwanus Sumule, when confirmed, stated that his party was still conducting a study.
"I am still in a meeting again," said Doctor Silwanus, Thursday, April 8, 2020.Abdus Somad)