Healthcare Worker Challenges
Yohana's story (January 2021)
Local staff at a private clinic in Sumba, Indonesia
During this pandemic, everyone is required to wear a mask, wash their hands, and to keep their distance. This is something new for the people here [in Sumba]. They have never worn masks and don't wash their hands properly, even though the government handwashing campaign has focused on the villages for a few years. The villagers often have activities together such as traditional death ceremonies, joint planting and harvesting of the crops, and so on. So they feel awkward when they are required to keep a distance from each other.
Another challenge related to wearing masks is that people often chew a betel nut. It has become a daily community habit that happens everywhere, even when they are waiting at the clinic It becomes uncomfortable to wear masks when you are chewing a betel nut because sometimes you need to spit. So they prefer to take off their masks
At first, it was difficult to ask them to comply with this protocol. We found many people who came to the clinic without masks. Nowadays, they are following the protocol, especially after we announced the clinic will not treat any patient who doesn't wear a mask. Even though sometimes, when they get outside, they immediately take it off, or even lend it to someone else so that person can access services at the clinic. This is still a clinical challenge
Healthcare Worker Challenges
Ani's story (January 2021)
Midwife in Sumba, Indonesia
My name is Ani and I am a midwife. In 2017, after graduating from Ken Dedes Health Polytechnic in Malang, East Java, and joining the Midwives Independent Practice program in the same city, I decided to return to Sumba. After almost a year of looking for a job, and applying at various existing health facilities, I was finally offered work at the puskesmas [health centre] in Bondo Kodi, Southwest Sumba, in 2018.
At this puskesmas I am responsible for providing maternal and child health services, including antenatal care, intranatal care, postnatal care, neonatal care as well as contraceptives In addition, I am also in charge of providing health assistance in two villages. This includes providing maternal and child health counselling, producing 'communication, information, and education' media, carrying out posyandu [integrated child healthcare] activities every month, as well as home visits for pregnant women.
Unfortunately, when the pandemic occurred, we were forced to cancel posyandu activities, and any counselling activities in the villages as well. I can still do the home visits, but not as often as before the pandemic.
Healthcare Worker Challenges
Ani's story (January 2021) Midwife in Sumba, Indonesia
In the puskesmas [health centre], we work on a shift basis. One day, I was on the night shift. Usually, during the handover from the afternoon staff to the night staff, we check the availability of PPE, but for some reason, I forgot to check it that night. I must have been thinking that it is usually available and complete, so it is okay not to check. At around 1am a patient came in to the centre. I was sleepy and in hurry to assist the patient, so I didn’t wear my mask.
As a routine protocol, I checked the patient for signs of labour, then filled out an administrative form asking for her identification details (name, address and the number of children). I then examined the patient. I totally forgot about the mask until one of the junior midwives came and told me that there was a recent COVID-19 positive case in the patient's village. I was shocked and panicked, then realised that I wasn't wearing a mask. I went to the equipment station and looked for PPE, but couldn’t find any. I tried to call my colleagues from other puskesmas, but because it was dawn only a few of them responded to my call [and] replied that they also had limited PPE
At that time, I continued to help the patient, wearing used handscoon [medical gloves] But there was no other option, and this mother must be helped immediately [to give birth] Realising that we didn't have proper PPE, my junior midwife refused to help because she was afraid. I continued the delivery process with my junior midwife watching from afar and only coming near if I asked her to help. I tried to reassure her that these are the risks of our job. She was reluctant, but then willing to help. After the birth went smoothly, we both sat up and breathed a sigh of relief. At that time I told my junior widwife that if the mother was confirmed COVID-19 positive then I might also be positive. I said that because I was well aware of my health situation. But thank God, the mother was confirmed negative.
Healthcare Worker Challenges
"Educate My Family"
Jovhiend Boli's story (February 2021)
Nurse in Sumba, Indonesia
I am working as a nurse in one of the non-government clinics in Bulir, Southwest Sumba It operates a full day from Monday to Friday, a half-day on Saturday, and a day off on Sunday Every weekend, I travel to Lamboya, West Sumba to visit my parents. When COVID-19 first occurred in Indonesia in March 2020, my family asked about this virus whenever I returned to West Sumba. They thought I might know more because I am a nurse. From the casual chatting with my family, I decided to educate the community in my home village. I shared the information about the symptoms, how dangerous it is, and how to prevent it. Most of them were surprised to hear how easily someone can transmit it by not following the health protocols.
My family saw on TV that many people died because of COVID-19. However, they have a belief related to our faith that people die when it's time to die. So no matter whether you have COVID-19 or not, you'll die one day. But, I told them, it's correct that one day we will die, but our faith also believes that God gave us the ability to think and make efforts. So we shouldn't blind ourselves with our faith. God reminds us in many ways: one of them is through the government and the experts, including the healthcare workers like me. In the end, they were willing to accept and understand the dangers. Until now, families at home still adhere to the health protocols. In front of the house, there is a handwashing spot, and any visitors who come must wash their hands first.
Healthcare Worker Challenges
Jovhiend Mano's story (February 2021)
Nurse in Sumba, Indonesia
Before the pandemic, I usually only washed my hands at the clinic before and after doing medical procedures. But now I have to wash my hands before and after doing any activity. It's quite a hassle, but I feel more hygienic and safer than before.
For patients who visit the clinic where I work, we also provide a place to wash their hands. Unfortunately, not all patients wash their hands once they arrive at the clinic, so we have to remind them repeatedly. What happens most often is that when my fellow nurses and I want to take a patient's blood, and we find that their hands are still dirty, we have to ask them to go outside, wash their hands, and then come back inside
Washing hands with soap is the best thing for patients because, in addition to most patients spending time in the garden which requires their hands to be cleaned only with alcohol or hand sanitiser, patients are also not familiar with using hand sanitisers. Posters on how to wash hands correctly have also been posted near the hand washing stations, to make it easier for the public to read them.
However, I believe that direct counselling with the villagers about handwashing should still be done, especially in the Sumba language It is more useful considering that many people cannot read and speak Bahasa Indonesia.
Healthcare Worker Challenges
"Contact Tracing"
Karola's story (January 2021)
Health Promotion Staff at PHC* in Sumba, Indonesia
Beginning in March 2020, people outside Sumba started to return. They are students who are on vacation, workers who have been laid off, or people whose companies are temporarily closed. Their return makes us worried that they might carry the COVID-19 virus from outside Sumba.
At that time, we did not have complete PPE, but we still had to collect their identity data as a preventive measure. During the data collection process, we recorded their identification details, their previous place of origin, date of arrival, and reason for returning. We also checked their body temperature and gave them vitamins. We sprayed disinfectant around the homes of the newly arrived people, as well as in public locations such as churches and schools
In addition, we left information posters on COVID-19 in people's homes so that they could remember to comply with the health protocols of washing hands, maintaining a safe distance, and staying away from crowds.
*PHC is primary health care also known as 'puskesmas' in Indonesia
Healthcare Worker Challenges
"Patients in My Clinic"
Dr. Vian's story (January 2021)
Doctor in Sumba, Indonesia
The emergence of COVID-19 in Sumba a few months ago was enough to make us realise that Sumba had already started the fight against COVID-19. The cases have been increasing in every district in Sumba. Many health workers have also been infected with COVID-19.
So at the clinic we must be more strict with the rules we make: "Patients who come to the clinic must wear a mask, if there is no mask, they must go and get a mask from home." This is a clinical rule that we must enforce. But it is noted, if there is an emergency patient, we will serve that patient. If the patient doesn't have a mask at all, or the mask is outdated, we will provide a new mask by providing a note in the medical record that we have provided mask assistance. This is enough to make the patient aware that wearing a mask is important. This rule was finally accepted by many patients.
One day, two patients ('Woman A' and 'Woman B') sat side by side in the waiting room, waiting for their names to be called to the examination room. Woman A came not wearing a mask, and Woman B came wearing a mask. When Woman A entered the examination room, she borrowed a mask from Woman B. I warned Woman A not to borrow someone else's mask, but she just smiled without wanting to return the mask. When she went back to the waiting room after her appointment she returned the borrowed mask to Woman B.
Then Woman B entered the examination room using the same mask. She brought with her a plastic bag containing medicine. Woman B told me that she had had a cough for a long time. When I opened the plastic bag containing the medicine, I was shocked and just shook my head. I was surprised to see that Woman B had been taking TB medicine for 3 months. I thought: Woman A who did not know anything about Woman B and had behaved carelessly by using another person's mask, is now at risk of being infected with TB.
I wanted to be firm with them but understood there were other behaviors that also needed to be addressed. It's a challenge to explain that wearing masks, washing hands, and keeping a distance is, at this time, necessary and is everyone's personal responsibility.
Healthcare Worker Challenges
Being a health worker in a place with less access to information does affect how people think about me and other health workers
With minimal information, people see us as the cause of 'the virus' [COVID-19] being brought to the area When I came home from the puskesmas [primary health center], people often shouted “corona corona” at me. This shows that people still do not understand COVID-19.
Not only that, but I often get questions such as: "Aren't you afraid of getting covid?". In response to that I explained that, as health workers, we have no other choice. That it is our responsibility. If everyone is afraid, who will work? Furthermore, we live in an area with poor internet signals and electricity.
Over time, and as the public becomes more educated [about COVID-19], our activities are better understood by the community. They are more obedient to health protocols and also want to support us. Some have been seen wearing masks when leaving the house and handwashing areas have been provided in front of their houses
Every time I come home from the puskesmas, I always take a clean shower before entering the house and doing activities with my family. *PHC is primary health care also known as 'puskesmas' in Indonesia
Karola's story (January 2021) Health Promotion Staff at PHC* in Sumba, Indonesia "Stigma"
Healthcare Worker Challenges
Solichatun's story (October 2020)
Community Cadre in Jakarta, Indonesia
As community cadres, we have to keep reminding the residents in our areas to always obey the health protocols, for the benefit of both ourselves and for others We must follow the 'mask wearing movement' launched by the government during this pandemic period We often have to encourage ourselves so that our children can remember to keep wearing their masks This is important because I can see they take their masks off if they are not reminded There are still many people out there who do not keep their distance and get together in a crowd.
Sometimes I am sad to see this. There are still many of them who do not follow the health protocols. For this reason, we must care about those around us and not hesitate to admonish and remind them to always follow the health protocols. Sometimes, there are also those who make fun of us when we ask them to comply with health protocols. My friend and I always take part in this movement with the village officials. We go around our neighborhood and tell all residents in our area to always comply with the health protocols.
We are not only encouraging people to follow the health protocols, but we are also distributing the masks to those who don't wear them. I feel we should not see this pandemic as an excuse not to contribute any good or do something useful for others. In fact, there are many things we can do, even if it might be a simple, ordinary gesture.
