Living on the edge c u l t r u r a l
s n i p p e t
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e v e r y d a y
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Imagine two hundred million souls, coming from thousands of different tribes, dozens of different religions, connected yet separated by thousands of islands - and you get Indonesia.
The nationâ&#x20AC;&#x2122;s core philosophy, â&#x20AC;&#x153;unity in diversity,â&#x20AC;? has transcended to all parts of Indonesia, collectively forming all kinds of communities in their many efforts to unite despite their differences. If you ask most Indonesians on what what that may be; God, family and food will most likely be their resounding answer.
A resilient nation that has gone through waves of turbulence and hardship, Indonesians live for the present moment, as one never knows what is going to happen in the near future. The presentcentric lifestyle, with little preoccupation of future consequences, forms certain habits, beliefs and values that inspire the creation of this piece. As eloquently put by one of our respondents:
â&#x20AC;&#x153;Why choose to live miserably for the future, when you can maximize the joy you feel today?â&#x20AC;?
A day in the life
A day in the life
Wake up for morning prayer (‘Shubuh’), feeling tired due to the lack of sleep
Wait for the vegetable carts that pass by every morning. She becomes the cart-seller’s regular customer
She cooks instant noodles mixed with corned beef, eggs and a bit of greens for the family
Wakes everyone up for breakfast. Some members who are in a rush only take the fritters (fried bananas, tempeh or tofu). She prefers to wait until brunch, by drinking green tea with lemon to stave off her hunger
Today’s menu is rice and lamb soup,which was cooked using pre-packaged broth cubes she bought from the market to speed up the cooking process
She makes sure to jab herself with insulin before she eats her brunch
Eating vegetable soup (‘Lontong Sayur’) today. On other days, she would eat chicken porridge (‘Bubur Ayam’) depending on what cart passes by
She passes her time by watching TV dramas, playing with her grandchildren, or making arts and crafts before she goes for her afternoon prayer (‘Dhuhr’)
Walk Her Grandchild to School
It takes her 15 minutes to walk her grandchild to school. She buys herself teh botol to quench her thirst along the way
Sweeping and mopping the house counts as exercise. She asks her helper to do the laundry, as her wound might itch because of the dirty water from the tap
Chatting with the Neighbour Nearby
Pick up the Grandchild from School
Meeting the neighbors is always nice, sometimes to gossip whilst snacking on fried peanuts and rice crackers
The little one wants to but some snacks in front of the school. She buys it for them, and takes a little bite for herself
A day in the life
Late Afternoon Meal
Play with her Phone
Before her late afternoon meal, she takes her insulin, and makes sure to stores it properly in the cupboard, so the children won’t play with it
Eats a bowl of chicken noodle soup (‘Mie Ayam’) from a cart that passed by the neighborhood. If she remembers, she’ll do her late afternoon prayer (‘Asr’)
Opens Facebook to see what her family and friends are up to. Otherwise, she’ll hang out at the nearby shops again but this time with her grandchild. This time, she buys herself a bowl of shaved ice (‘Es Doger’) before her sunset prayer (‘Maghrib’)
Everybody comes home for dinner, eating the lamb soup she cooked earlier today. She remembers to eat ‘only one portion’ to keep it healthy
She plays with her grandchild, while catching up with the family on everyone’s day as they watched TV
Sometimes, the family will get together and go to the mosque to do the evening prayer (‘Isha’)
Midnight Bathroom Runs
She feels tired, so she sleep early while the others are still watching TV outside of her room
Suddenly hungry in the middle of the night, she wakes up her husband to ask him to help cook her some instant noodles
Unfortunately, her sleep is disturbed by frequent trips to the bathroom before she can finally rest before sunrise
Food and Drinks
Rich in Flavor
A country rich with spices and aromatics, strong flavours are fundamental to Indonesians palate. No tea is too sweet, no meal is too salty. In the past, the perfect balance of rich flavors was achieved through skilled craftmanship in the kitchen, whereas the modern day flavor-richness are often achieved through the excessive use of artificial additives and sugar.
Compressed rice cake Oil Bay leaves Beef Chayotte Snake beans Beans Coconut milk Palm sugar Salt Shallot Garlic Red cayenne Dried shrimps Galangal Rice crackers
‘Lontong Sayur’ An Indonesian dish made of compressed rice cakes in the form of a cylinder wrapped inside a banana leaf, paired with thick peanut sauce and curry. It serves as the base for this savory morning favorite; a coconut-milk curry made with young papaya, soy-braised tofu and hard-boiled eggs with fried shalllots on top.
Nasi Padang Steamed rice served with a variety of choices of pre-cooked dished originating from Minang Kabau, Sumatra. An array of meat, fish, vegetables, and spicy chilli (‘sambal’) is eaten with plain white rice. A powerful mix of spices and flavors.
White race Shallot Garlic Chili Lemongrass lime leaves Turmeric Salt Chicken Lime water Conconut milk Oil Corriander Candenut Ginger Galangal Egg Tomato Black pepper Beef Citric Acid Immature cassave leaves Sugar Bay leaf
Jajanan Pasar Indonesia’s traditional bite-sized snacks or dessert food made from a variety of ingredients in various forms. Some are steamed, fried or baked.
Glutinous rice Salt Coconut milk Pandan leaves Lemon Grass Chicken Shallot Garlic
Shallot Garlic Banana leves Palm sugar Grated coconut
A delicious dish consisting of crushed fried chicken that is served with ‘sambal bajak,’ a chilli relish made using shrimp paste, shallots, and palm sugar.
Flour Baking powder Black pepper Red Chili Shallot Tomato Sugar
How to drink Indonesian style
Teh Botol A popular iconic Indonesian drink produced by the company Sosro and is sold worldwide. Teh Botol literally means ‘bottled tea’ in Indonesian. It is a sweetened jasmine tea and it is usually served cold. Their tagline is “Whatever you eat, you drink Teh Botol Sosro.”
Soda Gembira NUTRITIONAL FACT Serving
Serving size/bottle 2 Total Energy
‘Soda gembira,’ which translates to ‘happy soda,’ is perhaps one of the oldest mocktails known to Indonesia. This simple drink is made with only three ingredients: soda water, sweet condensed milk, and coco pandan syrup, a crowd favorite that is loved by children and adults from all ages.
Calories 70kkal Calories from fat
Total Carbohydrate 17 g Sugar 16 g Natrium/ Sodium 25 mg
How to make 1. Prepare serving glasses 2. pour condensed sweetened milk (1-2 tablespoon) 3. Then add the coco pandan syrup 4. Add jelly or other topping 5. Give the soda bottle with the prepared glass 6. The user can pour the soda to the glass 7. and stir it themselves until evenly mixed 8. Happy soda is ready!
NUTRITIONAL FACT Serving size 1 gelas (37g) Per porsi Energi 502 kj / 120 kkal Lemak
Karbohidrat 21g Serat 2g Gula 19g Sodium 30mg Kalium
Ingredients • • • • •
Fanta, Sprites or soda water (original) (330) Sweetened Condensed milk Ice cubes Coco Pandan Syrup Gelatin jelly , or extra topping
The key lies in portion control
Indonesians live to eat, not eat to live. People stop eating when theyâ&#x20AC;&#x2122;re full, not when itâ&#x20AC;&#x2122;s enough. Oftentimes, people achieve this by maximizing the portion of affordable ingredients such as rice. With the mindset that is based on portions, people perceive that eating healthy is about eating less, not necessarily changing the foods they eat.
It is tradition to have many options In a Padang restaurant, the waiter will bring you a selection of what could be dozens of dishes, stacked into the centre of your table, where you can choose to eat whatever dish you want. You only pay for what you eat.
In a ‘Warung Tegal’ or ‘Warteg’ is a shop that specifically sells all-time Javanese favourites, made up of a wide array of pre-cooked dishes that are arranged in a glass-windowed cupboard. They are well known for selling modestly-priced meals, popular among the working class.
“I used to eat until I feel full, like 1 plate. I could reduce to about 1/3 of my portion. I couldn’t reduce half of my portion immediately, if I didthen where will I get my energy?” -Dorna Simanjuntak*
Eating is a social activity
One would rarely find a one-person dinner, as eating is such a communal experience in Indonesia. Food are often served in the center of the table and is to be eaten together. It is considered impolite to refuse any kind of food that is offered by others.
As long as we are gathered together A feature of rice and an assortment of dishes, including fried chicken, fried salted fish, fried tempeh, fried tofu, and fried vegetable fritters, served on top of a banana leaf spread. This is a welcome meal from the Sundanese culture.
Snacking doesn’t count
Indonesians love to snack, and snack-sellers can be found in every corner of the street. Snacking gives people an excuse to socialize, and it serves as a necessary filler between the “larger” meals they’ll have throughout the day. People eat when they’re hungry, but resort to snacks when they want to have some “taste” in their mouth.
Snacks comes to you Fritters or ‘Gorengan’ People love their high-calorie classic fried snacks made of various ingredients coated with flour batter. Normally, it covers tofu, tempeh, bananas, or springrolls. It comes in sweet and savory varieties to eat on its own, or as side dishes.It can be found anywhere, from street carts to hawkers.
Tapioca Dough or ‘Cilok’ An Indonesian snack made with a blend of all-purpose flour and tapioca flour, ground toasted dried shrimp, thinly sliced scallions, grated garlic, and seasoned with salt, sugar, and ground white pepper.
Shaved Ice or ‘Es Doger’ Meatball Soup or ‘Bakso’ The Indonesian meatball, or a meat paste called beef ‘surimi’. The word ‘bakso’ may also refer to a single meatball or a complete dish of meatball soup.
An Indonesian coconut milk-based shaved ice beverage pinkish in color that is often served as a dessert, served with red tapioca pearls (‘pacar cina merah delima’), avocados, fermented cassava (‘tapai’), black glutinous rice (‘ketan hitam’), jackfruit, diced bread and all topped off with condensed milk.
Snacking like Pak Tegar*
Snacking like Bu Yulita*
Tegar* has had diabetes for up to 5 years. When we went to his home to conduct the interview, his wife served us sugar-covered donuts, instant powder-mix drinks, and instant noodles, commonly eaten by the family in their day-to-day.
Yulita* is a housewife and has had diabetes for up to 4 years. She admits that it is difficult to control her cravings, and often asks for her husband to go and buy her all kinds of food that she might be craving at any given time.
Instant powder-mix drinks, popularized by ‘Jas Jus’ An instant powder-mix drinks that comes in a variety of flavors, such as orange, lemon, melon, strawberry, guava, and grape, sold in sachets in most little shops on the side of the road (‘warung’).
Chocolate-Avocado Smoothie A blend of avocado, chocolate syrup, condensed milk, and a bit of simple sugar syrup as well.
Sugar-covered donuts A popular snack among the low-SES, which can be found sold in carts by the roadside.
Instant noodles, popularized by ‘Indomie’ Indonesians categorize instant noodles as snacks, not full meals. It is also a favorite snack food for any SES.
Spudnuts or ‘Donat Kentang’ This picture was taken by Yulita’s* husband. “She’s finished it all, I didn’t get to have any myself. And it was still not enough,” her husband said.
Popular among low-SES. Can be sold in warung, or street
Advertisements create reality Advertising is still, and has always been, a credible source of information for many Indonesians. Through consistent messaging, information presented at face-value is immediately taken as fact, and a basis for many lifestyle decisions. With lax advertising regulations and a knack for creativity, advertisers often emphasize the “healthy” properties of unhealthy products, which the masses tend to easily fall for.
Mizone An isotonik drink branded composed of rich vitamins and electronics, light fruity flavor and a refreshing taste. Mizone positions itself as an “everyday restoration drink”, replenishing youths, making them feel like they can take on the rest of their day.
Nestle’s Bear Brand Milk It is canned sterilized milk, which a lot of people perceive as an all-rounding recovery drink, as it’s milk content is advertised as nutrient-rich, and is able to alleviate many ailments. Frisian Flag’s Sweet Condensed Milk
Okky Jelly Drink
Condensed milk is cow’s milk with 60% of its water removed, often found with sugar added. A lot of Indonesians believe that if it was mixed with water, that it would be equal to “real” milk.
A jelly drink which positions itself as a combination of a drink and snack, advertised as “drink that keeps your hunger at bay.”
“I snack on Okky Jellys when I’m hungry... Yes, they are good for stave off hunger. It’s not bad because you can feel full after consuming three cups of it...” -Yulita Septianti*
Reliance on word-of-mouth Indonesia makes up one of the largest social media user bases in the world. With the proliferation of social media, it has made information much more accessible, regardless of its validity. As most Indonesians have multiple social groups they interact with, information can come from all sorts of channels, and the filter is often based on trust and the member of the group’s credibility.
Herbal medicine on e-commerce website
“This app informs us about the different symptoms of diabetes, and I like reading information from it. This gives us information about herbal treatment, right? One time, it showed me an article about how drinking this certain drink is good for you...” -Ferita Asih,* on using her UCME App
Alternative Medicine With a present-centric mindset, offers with the promise of quick fixes often resonates with many Indonesian people.
Blood Cupping or ‘Bekam’ Is a treatment method that removes static (thick) blood which is believed to contain toxins from the human body. It can be quite controversial for diabetic patients, as diabetic wounds is known to take a long time to heal.
Healing Service or ‘Ruqiyah’ ‘Ruqiyah’ is a healing medical service delivered through prayers, which are excerpts taken from the Qur’an and al-Hadits, which are religious text of Islam. It is believed that it can improve health, and bring about healing. It is often conducted as an exorcism ritual, fighting against black magic, spirit possessions (‘jinn’) and evil eye.
Yakon, or Insulin Plant
Accupressure Massages These type of massages is an ancient form of massage that is one of the treatment methods used in traditional Chinese medicine. The goal is to encourage the movement of life’s energy (or ‘qi’), but is quite controversial as it may lead to nerve damage.
The consumption of insulin leaves is believed to lower one’s blood glucose levels. To consume it, the leaves are boiled and is brought to room temperature. It is recommended that it be taken daily, though the dosage remains unclear.
• • •
• Gum problem (red, wounded) • Muscle aches
Medical explanation: Certain conditions may lead to impaired blood circulation, making the wound significantly more difficult to heal. The area lacks of oxygen and nutrients, until it slowly becomes necrotic. Poor blood circulation in the legs can disrupt the body’s immune system to fight these infections. High sugar levels makes it easier for germs to breed, further supporting the spread of infections throughout the body. This may make patients prone to infections in the mouth, cervix or foot.
• • • • •
Dry Diabetes • Tingling sensation (due to neuropathy) • Feelings of itchiness • Bad breath • Swollen leg/foot
Wounds will be difficult to heal, taking a long time to form scabs and may end up festering; cuts growing bigger and gets worse May or may not be characterized by weight loss Perceived as still curable, as long as the necrotic tissue is treated/removes (surgically removed, for example). When the necrosis spreads, it usually leads to abrasive measures such as amputations Tend to have high blood glucose level
When wounded, the wound will heal quickly and dry as normal Characterized by blackened or dry skin without injury Usually characterized by extreme weight loss Perceived as incurable, and it usually leads to amputation, usually because the blackened and dry tissue is actually necrotic May not necessarily be a characteristic of those with high blood glucose levels
Medical explanation: Injuries may occur due to damaged blood vessels resulting from prolonged hyperglycemia, where constricted blood vessels restrict blood flow from reaching parts of the body. Impaired blood circulation inhibits oxygen and nutrients to be spread around the body, which may lead to necrosis of certain body parts. People with ‘dry diabetes’ tend to lose a tremendous amount of weight, as the body uses fats or lipids in substitute of energy conversion. High insulin levels also boost pigmentmentation, which causes what may look like black spots covering parts of their skin.
Many communal activities The collectivist nature of Indonesian societal groups call for numerous festivities happening all year long. From religious ceremonies, cultural rituals, to back-to-back wedding parties, these celebrations shape social activities within their groups. These include saving up their money to host celebrations at their homes, a month-long intermittent fasting season, and endless meals shared with others are examples of common “lifestyle shifts” that most people do to fulfill their communal duties.
Indonesian Weddings Known to be an open invitation to family, friends, and family of friends, the Reception dinners come in a form of an all-youcan-eat buffet.
Visiting friends or family to reconnect kinship. In Indonesia, if you are offered something (food, snacks, or drinks) by the host. it would be deemed impolite if one to refuse the offer.
Eid al-Adha or Eid al-Qurban The “Festival of the Sacrifice” is the second largest Islamic holiday celebrated worldwide annually. People will gather to mosques usually in the masses, to spectate the slaughter of lamb, sheep, carabao or cows and share its meat to those people in need, which are then made into “blessed” dishes.
Fasting of Ramadan During the entire month of Ramadan, Muslims are obligated to fast from dawn ‘til sunset. Fasting requires the abstinence from food and drinks which might significantly affect diabetics in particular.
“No, I still want to try (continue fasting).” - Sunarto,* 15 minutes before his condition drops due to the absence of food
‘Takjil’ A sweet snack or dessert that is eaten upon breaking the fast during the fasting month. It is believed that it is “better to break the fast with something sweet.”
Eid al-Fitr “Festival of Breaking the Fast” is the biggest Muslim holiday in Indonesia that is celebrated worldwide, marking the end of Ramadan season. People normally will go back to their hometown for ‘silaturahmi’ with their extended families. A lot of special, traditional dishes and snacks will be provided during these visits.
‘Mudik’ or Homecoming Migrant workers return to their hometown or village during or before the major holidays, especially for Eid al-Fitr. Traffic is rampant during the exodus, leaving many restless in their strenous journey home, which may cause the body’s condition to drop due to a lack of rest or food.
‘Aurat’ & Modest fashion Exposing certain parts of the body in front of anyone outside of their immediate family is deemed unlawful in Islam, and is regarded as a sin. These bady parts that are presumed to be intimate are called ‘Aurat’ happen to be the some spots for insulin injection such as in thigh, buttocks, stomach or upper arms.
Facilities: Hospital These are the many situations and conditions found at the hospitals, known to the diabetic respondents living in the Greater Jakarta Area.
Injection dummy for demonstrations
Confusing signage at the hospital, or lack thereof
A morbid poster showing all the complications that may arise with diabetes, next to an outdated doctor’s schedule
B-Class hospitals are separated into multiple buildings with no connecting indoor passage ways
The small consultation room, where several patients may sit lined up by the door, and whose turn it is would only be separated by a curtain
An empty hallway, a rare sight. It is a quiet Friday afternoon as many have left for their Friday prayers (‘Jum’ah’)
Educational posters decorating the hallway near the stairs, not in the waiting area where people sit and wait for hours
Basic medical information covering the walls
A range of educational tools behind a glass-door cabinet for class sessions
The storage cabinet where they keep the Sahabat Diabetes starter kits
Every 5-7 patients are called into the consultation rooms as they wait their turn, separated only by a curtain. Every patient can hear everything that goes on during anyone’s consultation.
“Every time we’re sitting here (behind the curtains), we can hear every single thing the doctor tells the patient, including the scoldings.” - Tubor*
Consultation and diagnosis rooms
A larger waiting area out front
A waiting area in the same consultation room
The road to obtain insulin
05.00 Wake up to line up at a nearby primary healthcare unit Everyone wakes up early and walks over to a nearby healthcare unit (or ‘puskesmas’), before it opens. Obtain a waiting number from the security guard. Different units have different waiting policies.
Day 1: Primary healthcare center
7.00-8.00 Wait to see GP
8.00 GP consultation
Wait for their number to be called, so that they can register their details.
The clinic is already flooded by patients and their families who accompany them. It is always better to arrive earlier so one can get a seat.
Upon meeting the GP, one obtains the prescription for blood work at the laboratory.
Registration allocation to a general practitioner (GP) standing by at the puskesmas.
9.00-13.00 Wait for lab results
13.00 Obtain the lab results
13.00-14.00 Bring lab results to GP
14.00 Re-consult to the GP
The wait can last up to 3 hours; there’s also a lunch break at noon.
Obtain the blood work results, and bring it back to see their GP.
Wait in line again for a chance to see the GP that day.
If further action is required, a referral letter to institutions that are more equipped to handle them will be given.
8.15 Bring the prescription for blood work to the lab Waiting for their blood work. Some tests requires patients to fast beforehand. In those cases, and if the patient did not fast, they must return and restart the process the next day.
9.00 Bloodtest at the lab Get their blood drawn and tested.
Referral (Type A)
When the facility/treatment isnâ&#x20AC;&#x2122;t available in type B hospitals the patient will be referred to a superior hospital
Referral (Type B)
Only given when the diagnosed has been enforced. Must bring supporting documents
Type A Hospital
Specialty hospital (cancer, heart, eye, etc)
Primary Healthcare Unit
BPJS is the Indonesian health care insurance program that provides medical coverage for the Indonesian people, so that they may obtain almost all medical care for free. The referral process is crucial to follow, in order for anyone to receive the treatment they need.
The road to obtain insulin
Day 2: Hospital (1/2)
06.00 Go to the hospital with the referral letter
07.00 Register at the Type B hospital
07.20 Take a waiting number to see their Internist
07.20-11.30 Waiting to see their Internist
11.30 Consulting with the Internist
The referral letter obtained from the ‘puskesmas’ is usually valid for 1-3 months. Patients can use that referral letter anytime within that period, but more specialised hospitals may require them to do another online registration first.
If they want to use their BPJS to pay for their medical care, first-time patients will need to register at the BPJS counter and input their personal data, as well as providing all the necessary documentation the hospital may need.
Upon completing their registration process, they must get a waiting number to see their internist or endocrine specialist.
If they are waiting for an internist, they must wait for other patients who may have other internal health problems.
After the long wait, they get a 15-minute quick consultation to discuss lab results and conditions.
They usually must bring a bit of food and drinks themselves, as they may be inaccessible there.
If the lab results fulfill the BPJS requirements, the patient can obtain prescription for insulin.
If the patient needs to see more than one doctor (e.g. cardiologist), then they would need to wait again and repeat the process from zero. Normally, two consults with two doctors is difficult to complete in one day.
To obtain insulin, the BPJS system requires the results of the HbA1c test. If it isn’t included in previous lab work from the ‘puskesmas,’ the patient would need to have their blood work done again.
If the other specialist isn’t available that day, they would need to come back the next day.
This test requires patients to fast beforehand. In those cases, if the patient did not fast, they must return and restart the process the next day.
Arrive to hospital, and obtain waiting number to use their BPJS.
If they can’t provide the necessary documentation, they will be asked to return the next way with those documents.
If the patient have more than one complication, they might be referred to a more superior hospital, or national hospital. In these types of hospitals however, patients would need to complete an online registration process prior to showing up at those hospitals (and this registration process may vary in lengths, between waiting for 3 days to 2 weeks long).
Journey on getting insulin
12.00 Go to pharmacy
12.15 Waiting for drugs
Go back to the registration desk to have their documents and referral letters sorted out. The patient may obtain a control form to bring at their next visit, and get it stamped at each visit.
Depending on the type of prescription, some can be provided straight off the counter, where others might need to be prepared specifically to the type and dosage the doctor ordered, which may take a long time to do depending on how crowded the pharmacy may be at any given day.
As patients wait for their drugs to be ready, they might be in line to see another specialist doctor.
Patient is then given a prescription to be dropped at the pharmacy to have them prepared.
Other times, patients can go out of the hospital to find lunch, or eat the lunch they brought from home.
Day 2: Hospital (2/2)
17.00 Receive their drugs which will last for a month After a month, patients will need to return and repeat the process (depending on the validity of their letters) to obtain more. *Free for BPJS users
If their house is nearby, they can go back home (only if the transportation fee isnâ&#x20AC;&#x2122;t a burden) and return to take the drugs later in the afternoon. Some unique hospitals (such as in RSUD Bekasi) now provides a drug delivery service for the elderly patients, which isnâ&#x20AC;&#x2122;t a standard offering amongst hospitals.
17.00 Drug being delivered to their homes
Implications Cultural contexts that need to be taken into consideration when designing solutions for the majority of Indonesians
Actions are often dictated by their stomach, especially because of the fact that access to unhealthy food is ubiquitous and affordable.
Rampant misunderstanding of what healthy food means persists, which is directed by misleading information proliferated by advertising and word-of-mouth
Indonesians instinctively act on instant feedback and put far greater weight on the present, rather than future consequences. Support and treatment has to be given in a way that can showcase a sense of instancy.
The focus on the present drives their desire to maximize todayâ&#x20AC;&#x2122;s joy, as the fate of their future is perceived to be predetermined by the will of their God.
Family plays a pivotal role in providing support to initiate behavioral change, especially as agents who balance the role between the exertion of control, with the provision of sustained motivation and emotional support.