Medan, Indonesia – On the night after Eid al-Adha, the Muslim holiday on July 20, Hambal M Zain started to have a fever. The 61-year-old coffee shop owner who lives in Banda Aceh, northwest of Aceh, didn’t think much about it. After the fever subsided, Zane went back to work as usual.

However, about a week later, he suddenly had a fever and Zane had a splitting headache.

“I told him we must go directly to the hospital,” his wife Azlinda told Al Jazeera. “But he didn’t want to. He was too scared of what would happen when he got there. I couldn’t sleep at all that night because I was so worried.”

Two days later, Azlinda still had a fever and forced her husband to undergo a COVID-19 test and the result was positive. When they arrived at the Zainoel Abidin Regional General Hospital, his blood oxygen saturation had dropped to 85%.

Fortunately, Zain’s saturation rose rapidly after receiving oxygen in the hospital, and he was discharged that night, and was instructed to isolate and continue to use oxygen at home. It was in the hospital that Azlinda and Zain met Dr. Ferry Dwi Kurniawan, the head of the Aceh branch of the Indonesian Respiratory Society (PDPI), and he introduced them to a new program he created that allows COVID-19 positive patients to obtain I am in quarantine at home to consult a doctor via WhatsApp.

After the Eid al-Fitr holiday, the coffee shop owner Hambal M Zain had a fever.He is now in quarantine at home due to COVID-19 and is in regular contact with the doctor via WhatsApp [Courtesy of Hambal M Zain]

“The number of cases we have seen in Indonesia is just the tip of the iceberg, and the data we have is not in line with reality,” Dr. Cunhawan told Al Jazeera and explained why he established the organization.

According to official data from the Ministry of Health, Indonesia has reported more than 107,000 COVID-19 deaths and 3.6 million cases since the pandemic began. In Aceh, there have been more than 25,000 cases and more than 1,000 deaths.

“Most of the patients who come to the hospital have already developed respiratory failure,” Dr. Cunhawan said. “Usually it’s the 10th or 11th day [of their symptoms] When we saw them. They don’t want to go to the hospital because they are scared, so they wait as much as possible. However, the complications of COVID-19 may appear suddenly and cause sudden death, especially if the patient has been waiting for treatment for too long and there are potential problems such as heart problems or comorbidities. “

According to LaporCOVID-19, a civil society organization that monitors coronavirus data in Indonesia, as of August 3, since June, at least 2,970 people have died in isolation or outside the hospital. Due to limited data and under-reporting in many provinces, the actual figure is considered much higher.

“This phenomenon appears to be caused by the collapse of health facilities, which makes it difficult for COVID-19 patients to obtain appropriate medical services. The organization stated in a press release on July 3 that poor risk communication exacerbated the situation. This has caused some people to avoid going to the hospital.

WhatsApp was planned to be launched on July 26 and involved 12 doctors from Aceh Province, which has a population of more than 5 million and is located on the top of the island of Sumatra in western Indonesia. The doctors are all pulmonologists, they are volunteers, and they agree to provide consulting services outside of normal work.

“Our hospital has limited beds, so we are grateful for patients who can be isolated at home,” said Dr. Cunhawan. “We also thank the doctors who wish to provide free advice. They are very enthusiastic about the launch of this service. We also hope that its scope will be expanded so that general practitioners can also join the program, not just pulmonologists. We also hope Include staff from local health clinics in the program so that people can continue to contact us and let us support them through this matter.”

Dr. Kurniawan advises 15 to 20 patients through the WhatsApp service every day, and said that he handles all types of issues, from which drugs or supplements patients need to take to more practical issues, including the length of time they should be isolated. Patients also Other questions will be asked, such as whether they need to repeat the COVID-19 test and when or whether they should be vaccinated.

“Proactive” response

In view of the limited needs and resources, the doctor’s consultation hours are limited to 8:30 am to 4 pm from Monday to Friday to reduce the risk of burnout. However, in reality, Dr. Kunyawan said, many people provide advice outside of these hours.

More than 100,000 people in Indonesia have died of COVID-19.Doctors hope that closer monitoring of people who are isolated at home can reduce the risk of severe deterioration of the patient’s condition [File: Chaideer Mahyuddin/AFP]

According to documentary filmmaker Nasier Husen in the city of Lhokseumawe on the east coast of Aceh, the WhatsApp advisory service is particularly important in the province because many people who self-isolate or suspect that they may be infected with the coronavirus often try to hide it because of fear of stigma and concerns. Misunderstandings of health risks.

“If people hear that someone has or suffers from COVID-19, they usually overreact immediately and think it means they will also be infected automatically. They think the effect will be huge,” he told Al Jazeera. “One of my neighbors died of suspected COVID-19, and the community immediately panicked. Many people will not go anywhere near his home or near his family, even if there is a health agreement.”

Husen added that when someone died in Aceh, it is customary for communities to gather for public prayers. Aceh is the only province in Indonesia that implements Sharia law. However, if someone suspects or confirms that they have died of the coronavirus, people usually choose not to participate in prayer meetings, even if they have adapted to the pandemic.

Hu Sen said that because of the stigma surrounding the virus, social pressure usually means that people are more willing to simply isolate without telling anyone. “It’s still a very hidden thing. People feel uncomfortable and don’t want other people to feel uncomfortable,” he said.

For Azlinda, who tested positive for the coronavirus a few days later, the WhatsApp service was like a lifeline.

Azlinda found that Dr. Kurniawan’s chat group was reassuring because she and her husband were isolated from COVID-19 at home [Courtesy of Hambal M Zain]

The 53-year-old housewife contacted Dr. Kurniawan first thing in the morning when she sent him a photo of her husband’s oximeter, which measured his saturation and wrote down the couple’s progress Overall update of the situation.

She sends another update at lunch time. If she is late or forgets to contact Dr. Kurniawan, he will often contact her in the late afternoon to ensure that everything goes well with Azlinda and Zain.

“I have told all my friends [about the WhatsApp service]If you are sick and need to be isolated, you will be taken care of,” Azlinda said. “Now we know that Dr. Cunhawan cares about us very much, so we feel more comfortable at home and the isolation here is more peaceful. I have told my friends that they don’t need to be afraid anymore. “

Although the plan is still in the experimental stage in Aceh, Dr. Kunyawan said it may be difficult to implement in other parts of Indonesia where the pandemic is more severe.

“Jakarta and Java more generally are in a state of complete chaos, especially because the Delta variant is terrible for everyone. So far, the plan has been positively welcomed, but because doctors in hard-hit areas such as Java have already It’s exhausted, so launching can be tricky.”

Dr. Kurniawan said that the increasing number of cases in Java has also inspired him to start this service, and he hopes that this approach will slow down the epidemic in other regions such as Sumatra.

He said: “So far, the doctors in Indonesia who treat the coronavirus have been hospital-based, but at least we are working hard to contact them through this service.”

“We are concerned about the surge in the number of cases and decided that we cannot wait. We must take action and raise awareness.

“If we do nothing, the pandemic will never end. This virus will continue to mutate, so we need to actively respond.”

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