Category: Health

Long road to recovery for Indonesia

The days leading up to the Eid al-Adha festival, which this year fell on July 31, were usually the busiest days of the year for Bintang Tani Madani, a cow breeder in Bogor on the outskirts of Jakarta.

The company specializes in breeding sacrificial cows, also known as qurban, for the Muslim festivities, but the Covid-19 pandemic has put a strain on the business. Sales have plunged as consumer purchasing power is severely affected, he says.

The annual feast of sacrifice obliges Muslims with the financial means to buy prime and healthy livestock and to slaughter them in accordance with Islamic protocols. The meat is then distributed to the needy.

“Sales have dropped significantly. Sacrificial cow traders have seen less than 50% of last year’s sales. We also faced competition from seasonal traders who set up temporary shops in city centers, so there was an oversupply, while the demand had weakened,” said Muhammad Arif, a manager at Bintang Tani Madani.

“[Breeders] were expecting to see a rebound in sales during this season since they lost the momentum to generate business during the end of Ramadan festivities when there was little demand for meat because we had large-scale social restrictions at the time.”

The global economic turmoil caused by the pandemic has had a severe impact on Indonesia, with most Indonesians experiencing income losses, the World Bank said in its latest Indonesia Economic Prospects report released on July 16 in Jakarta.

Mobility restrictions imposed to curb the spread of the virus, and caution among consumers worried about their financial prospects, have led to a freeze in tourism and empty shops and restaurants. The country’s economic growth is projected to fall to zero this year, the report said.

By some standards that would not be a bad performance, given that dozens of countries are resigned to a contraction in the gross domestic product (GDP) in 2020.

But Indonesia could easily end up in the red if the government has to reimpose large-scale social restrictions to combat a new wave of Covid-19, cautioned Frederico Gil Sander, lead economist with the World Bank office in Indonesia.

“We think that the economy could contract by two percent in 2020,” Sander said.

Jakarta administration has extended the transitional period of its large-scale social restrictions for another two weeks until August 13,  Governor Anies Baswedan announced on Friday.

The city has seen a surge in new cases, including in at least 90 workplaces which have emerged as new infection clusters as more employees have resumed working in offices despite city regulation that during the transitional period, workplaces have to slash by half their employees’ presence in the office.

“We will impose a progressive fine for businesses and could eventually close the establishment that repeatedly violates the health protocol,” Baswedan said.

To deter people’s unnecessary mobility, the city administration started on Monday to reimpose the odd-even license plate policy as a form of its “emergency brake” to curb the spread of the coronavirus.

Jakarta remains one of the infection hotspots in the country with 22,616 cases as of August 3 and its positive virus test rate is 6.5% of all tests results, well above the World Health Organization (WHO) guidelines which suggest a 5% positive rate as the maximum benchmark for policymakers seeking to resume economic activity.

A key finding the World Bank report suggested that to support a safe reopening of the economy, having a robust health system remains the priority. A safe sustainable reopening requires continued improvements in health system capacity and readiness, including continued expansion of testing and surveillance.

To date, Indonesia has tested 841,027 people in a population of 267 million. According to the WHO in its weekly situation report on Covid-19 in Indonesia, Jakarta is the only province that has achieved the minimum case detection benchmark, or comprehensive surveillance and testing of suspected cases, of 1 per 1,000 population per week.

In any case, the business community appears eager to get on with normal life again, according to a survey conducted by the Jakarta-based pollster Indikator Politik Indonesia and released on July 23.

Despite the escalating number of cases and widespread infections, 65.1% of the 1,176 respondents are not in favor of the government reinstating mobility restrictions, although 84.7% of them remain “very concerned” about the outbreak, the pollsters found.

The respondents included businesspeople from micro-enterprises to big corporations in seven sectors across nine provinces.

“About 53.3% of the respondents prefer the government to prioritize handling the economic sector over the health sector, while 89.4% agreed with the government’s initiative to introduce adaptation to new habits,” Indikator executive director Burhanuddin Muhtadi said at a briefing.

The government has announced a fiscal package amounting to 4.3% of GDP in response to the crisis, which includes funds to improve the preparedness of the health sector and a substantial increase in social assistance.

Without a significant expansion of social assistance, according to the World Bank report, roughly 5.5 million Indonesians could fall into poverty because of the economic halt triggered by the pandemic. The stimulus package could go a long way to mitigate the impact of the pandemic on poverty if fully disbursed and well-targeted, it said.

“It is essential that the package be effectively implemented to have the fullest impact on the people and the economy,” said Satu Kahkonen, the World Bank country director for Indonesia and Timor-Leste.

The story has been updated from its original version in Bangkok Post

Tech-savvy Indonesians go off-grid to help remote villages fight virus

A group of tech-savvy young locals in Indonesia’s northern North Halmahera regency is spreading awareness about the dangers of COVID-19 in remote corners of the archipelago at a time when bureaucracy has impeded a rapid response to the pandemic.

The Relawan Merah Putih, or Red and White Volunteers, includes a multimedia expert, university students, lecturers, civil servants and a web developer in Tobelo, the main city of North Halmahera in North Maluku province, about 2,500 km from the capital Jakarta.

The city is located on Halmahera island, part of the Maluku Islands, Indonesia’s fabled Spice Islands on the northeastern part of the sprawling archipelago.

Stevie Recaldo Karimang, a 28-year-old freelance photographer and videographer, said that he set up the group after social restrictions introduced to counter the pandemic put him out of business. 

He quickly developed a website on the pandemic and created online flyers and audiovisual materials that he and 31 other volunteers distributed on social media platforms and messaging apps to educate the public about the pandemic soon after the first cases in Indonesia were confirmed in Jakarta in early March.

“We translated the information we took from the national COVID-19 task force into the market language spoken here, which is a mixture of Indonesian and the local dialect, to make it more understandable for the locals,” Karimang said.

The group also used a drone to issue public warnings against mass gatherings.

“The drone helped to remind people not to form a crowd when social restrictions were enforced. We attached a flashlight to the device to catch the crowd’s attention, and we were able to dismiss such gatherings.”

But the volunteers shifted their efforts to rural areas after the first coronavirus case in North Maluku province was confirmed on March 23.

Jubhar Mangimbulude, a microbiology expert at Halmahera University and the group’s adviser, said the team had visited 30 isolated villages out of 196 townships in the regency, which is home to 161 million people.

“We reached one village after hours of driving over rough terrain. We have to use four-wheel-drive vehicles because along the way we may have to cross a river where the bridge is damaged,” he said.

Relawan Merah Putih handed over their assistance to village officials in Duma village of North Maluku regency during a campaign to spread awareness of the Covid-19 pandemic. (Photo: Relawan Merah Putih/Komunitas Manyawa)

Mangimbulude said that many villagers were unaware of the pandemic and only knew from TV that a dangerous virus was spreading quickly and infecting people. He was glad to find that no COVID-19 cases had been detected among the villagers.

But he acknowledged that misinformation was rife and said that he had to debunk myths about “how alcohol could be used to prevent the disease.”

“The villagers heard that the virus can be killed with heat in one’s body, and since drinking alcohol can warm the body, they encouraged their children and elders to drink a local alcoholic beverage made of fermented sugar palm fruit,” Mangimbulude said.

Fellow volunteer Oscar Berthomene, a local civil servant, said that the group was able to move faster than the regency administration whose bureaucracy slowed down the response to the pandemic.

“I have support from my supervisor, and we were able to help their activities with cars to allow them to move around,” he said.

The regency has about 18 percent of the 953 cases in the province, which make up about 1.5 percent of the national total of 62,142 as of Saturday.

This story was first published in Arab News

Indonesia battles dengue outbreak as COVID-19 persists

Indonesia is battling a second deadly disease, dengue fever, which continues to infect its population way past the average peak recorded earlier this year, after efforts to prevent the outbreak were sidelined by anti-COVID-19 restrictions.

According to the Health Ministry, as of Monday there were 68,000 dengue cases across the nation, resulting in 446 deaths.

Deserted tourism hotspots, such as Lombok in West Nusa Tenggara and Buleleng, Denpasar, and Badung in Bali are among the regions recording the most significant number of dengue infections.

COVID-19 cases were also on the rise in Bali, which had 1,080 cases as of Monday.  

“Many hotels that are left empty may have become breeding grounds for mosquito populations,” Siti Nadia Tarmizi, the Health Ministry’s director for vector-borne and zoonotic diseases, said.

“They have always been in check with regular mosquito larvae controlling measures but, with workers off duty, the efforts have been largely unchecked.” 

She said that while Bali had always recorded a significant number of dengue cases, they had never been as high as this year.

“We encourage operators of hotels and places of worship to also conduct larvae busting efforts in addition to disinfecting their premises ahead of the reopening of tourism areas.”

In previous years, dengue fever season would have peaked by March or April. But  this year the country is seeing a prolonged period of infections, with many cases still being recorded in June.

“Normally we would find less than 10 cases by June but, this year, we still find 100 to 500 cases every day so far, although the number of cases and fatalities year-on-year are not as high as June 2019, which recorded 105,000 cases and 727 deaths,” Tarmizi added.

Dengue fever first hit Indonesia in 1968, and the fatality rate had reached almost 50 percent. However, health authorities managed to control the outbreak and reduced the fatality rate to less than one percent over the years.

A spike in the dengue outbreak occurred in 2015, with authorities pulling out all the stops to prevent a recurrence.

But they are also likely to be dealing with double infection cases as the dengue outbreak is occurring in provinces that are most infected by coronavirus such as West Java, Jakarta, East Java, and South Sulawesi, Dr. Tarmizi said.

A chart from the Health Ministry has marked the whole of Java — Indonesia’s most populated island where 141 million of the country’s 270 million people live — in red, indicating that infections are high in the area.

The provinces located in Java, including the capital, Jakarta, West Java, and East Java are also the worst-hit by COVID-19.

Indonesia reported 954 new COVID-19 cases and 35 deaths on Monday, increasing the national total to 46,845, and the fatalities to 2,500, while Jakarta’s cases reached 10,098.

“While dengue can infect people of all ages, we have seen a trend of teenagers who are already in a critical phase being admitted (to hospitals),” Dr. Mulya Rahma Karyanti, a pediatrician, said during an online press conference on Monday.

The Indonesian Pediatric Society (IDAI) chairman, Aman Pulungan, has said that dengue fever is among a list of health problems that many Indonesian minors suffer from, making them among the most vulnerable to be infected by coronavirus.

Living with the dead: Indonesia’s Torajans downsize burials amid pandemic

She had been dead for two years and was ready to be buried. After restrictions to curb the spread of the coronavirus disease (COVID-19) were imposed in March, however, villagers in the La’bo village of the North Toraja regency in Sulawesi Island had no choice but to suspend the ceremony at the last minute.

On Saturday, they were finally able to hold a proper burial for the deceased village elder in a toned-down version of the elaborate, centuries-old ceremony known as Rambu Solo. The ceremony is central to the lives of the Toraja ethnic group, who are predominantly Christian but hold some animistic belief.

The Torajas inhabit two administrative areas — the North Toraja and Tana Toraja regencies — in the South Sulawesi province.

For Torajans, the deceased are not dead yet; they are seen, rather, as sick. Family members still talk to them, bringing food and drinks and keeping essential items nearby. The mummified corpse remains unburied in the family’s tongkonan, or a Toraja traditional house, while years of preparations for the burial ceremony is underway. It is a large family affair which would last for up to a week in pre-COVID-19 times, involving the entire village and requires the sacrifice of dozens of buffaloes.

“We condensed the ceremony to only two days. We also conducted the burial in compliance with health protocols by providing a hand washing station at the entrance. All mourners who came in had to wear face masks,” Yohannes Limbong, a family representative said.

The family was supposed to hold the ceremony on March 25, but it was suspended after the regency administration issued a stay-at-home order on March 23, advising citizens to hold off on any events involving large gatherings of people such as the Rambu Solo.

A relative mourns on the deceased’s coffin. (Photo: Lisa Saba Palloan)

As of Saturday, the regency has not reported any COVID-19 deaths, but there were four confirmed cases, all of whom were travelers from virus-infected areas, including the provincial capital, Makassar, about 317 kilometers away. 

The province has had 3,635 confirmed cases so far or about 8 percent of the 45,029 national caseloads. North Toraja, which has a population of 230,000, has lifted some restrictions in recent weeks after the region was considered an area where the risk of infections is low, allowing for religious events. Participants are nevertheless required to observe health protocols.

“There were less than 100 mourners who attended the ceremony. Normally, it would be double that amount or more,” Lisa Saba Palloan, a local tourist guide, said.

Romba Marannu Sombolinggi, chairwoman of the Indigenous Peoples Alliance of the Archipelago Toraya chapter, said that families who conducted the burials recently had to compromise between the obligation to perform a respectable send-off and compliance with social restrictions.

“A complete ceremony could take at least five days,” she said.

“But we are obeying government regulations. There are some disappointments, but we understand the situation. We do not want people to be infected because we insist on having the long ceremony.”

A few people had died who were under treatment but who had tested negative for COVID-19. They had to be buried in accordance with health protocols as soon as possible, which meant that the surviving family members could not keep the deceased embalmed in their houses as they would traditionally do.

“The families still performed the most essential rituals, including sacrificing at least a pig or a buffalo before the burial,” Sombolinggi said.

Sombolinggi said that buffaloes are sacrificed to mark the symbolic passage to death since they would serve as the deceased’s “carriage” in the afterlife.

“It is very much about the family’s dignity. They would otherwise experience social repercussions if they were not able to hold a presentable burial,” she added.

Read the full story in Arab News

Mahfud MD slammed for comparing coronavirus to wives

Indonesia’s coordinating minister for political, legal and security affairs, Mohammad Mahfud MD, has been criticized sharply for comparing the novel coronavirus to a wife in an attempt to allay public concerns about easing COVID-19 restrictions. 

The Indonesian government is preparing to lift partial lockdowns in parts of the country in early June and adopt what it calls ‘the new normal’. 

“Are we going to be holed up forever? We can adjust to the situation while still paying attention to our health,” Mahfud said in a video posted on YouTube on Wednesday. 

“The other day I got a meme from my colleague Luhut Pandjaitan that says: Corona is like your wife. Initially you tried to control it, then you realize that you can’t. Then you learn to live with it,” he said in English. 

Pandjaitan is the coordinating minister for maritime affairs and investment.  

The off-the-cuff remarks drew ire from women’s rights groups and other Indonesians online.

“Not only does the statement reflect the incompetence of the government in tackling the COVID-19 pandemic, it also demonstrates the sexist and misogynistic attitudes of public officials,” Women’s Solidarity Society said in a statement.  

“Jokes that objectify women will only normalize the culture of violence against women,” it said.

Indonesians on social media joined the chorus of criticism. 

“A man who marries a woman with the intention to control her is horrifying. Comparing a woman to a virus is an insult to the dignity of women,” a Twitter user named Deslina wrote. 

Some Indonesians have expressed concerns about the plan to reopen the economy at a time when the curve appears to have not flattened. 

The government is deploying 340,000 security personnel in four provinces – Jakarta, West Java, West Sumatra and Gorontalo – to enforce “the new normal,” Armed Forces chief Air Marshal Hadi Tjahjanto. 

They have been tasked with ensuring the public observe health guidelines prescribed by the government, including wearing masks and respecting social distancing. 

The number of confirmed COVID-19 cases in Indonesia rose to 23,851 on Wednesday, an increase of 686 from the previous day. 

An additional 55 deaths brought the number of fatalities to 1,473.

Indonesia urges pregnancy postponement amid fears of COVID-19 baby boom

Indonesia’s family planning agency on Thursday urged couples to delay pregnancies after estimates showed that 10 percent of reproductive couples in the fourth most-populous country had abandoned contraception as a result of restrictions during the coronavirus pandemic.

The lack of access to contraceptives could result in 420,000 unplanned pregnancies, sparking fears of a COVID-19 baby boom, said Hasto Wardoyo, the head of the National Population and Family Planning Agency (BKKBN).

“With an additional 420,000 births next year, population growth in Indonesia could surge dramatically,” he said. “If you plan to get pregnant, now is not the right time.”

The government estimates that about 15 percent of 3 million couples who stopped using contraception between March and April could end up pregnant, Hasto said, adding that 95 percent of contraceptive users in Indonesia are women.

Hasto said people had been reluctant to visit health clinics because of fears they would contract COVID-19, while many health workers have suspended their practices to avoid contact with other people.

Government health workers assisted by military personnel are going door-to-door to provide contraceptives and other family planning services, along with personal protective equipment (PPE) for medical personnel in the field of reproductive health, he said.

Health officials in Tasikmalaya, a regency in West Java province, reported earlier this month that the pregnancy rate doubled to more than 3,200 in the January-to-March period compared to last year.

“The April-to-May period may see another rise,” said Uus Supangat, chief of the Tasikmalaya health office, according to Kumparan.com online news portal.

Nearly 5 million babies are born every year in Indonesia and about 28 million couples were using contraception last year, according to government data.

COVID-19 cases

Indonesia recorded 973 COVID-19 cases on Thursday, the largest single-day rise so far, taking the total to 20,162. East Java province saw the highest daily increase on Thursday, 502, COVID-19 task force spokesman Achmad Yurianto said.

Globally, more than 5 million people have been infected by COVID-19 and nearly 330,000 have died as of Thursday, according to data compiled by disease experts at U.S.-based Johns Hopkins University.

Meanwhile, the Indonesian Obstetrics and Gynecology Association (POGI) has urged couples planning pregnancy to postpone visits to clinics until the pandemic is under control as health workers are focusing their attention on providing services to expectant women to prevent COVID-19-related complications.

“Even though there’s no evidence yet that the fetus can be infected by COVID-19, we still have to take precautions,” said Budi Wiweko, POGI’s deputy secretary general.

“We have to avoid caesarian delivery as much as possible,” he said.

Angga Sisca Rahadian, a researcher with the Population Research Center at the Indonesian Institute of Sciences, said the predicted 420,000 additional births in 2021 would make it harder for Indonesia to achieve its total fertility rate target of 2.1. The rate refers to the average number of children a woman would have if she survives all reproductive years.

Indonesia’s total fertility rate is 2.4, according to a 2017 demographic and health survey.

“With the increase in pregnancy rates during the pandemic, it will certainly affect the growth rate,” Angga said, referring to population growth.

Angga said the government must ensure that women who are pregnant during the pandemic are given maternity care.

“These are unplanned pregnancies and the government has to find ways to keep pregnant women well-nourished to prevent complications,” she said.

Infant mortality rate in Indonesia is 24 per 1,000 live births, while under-5 mortality rate is 32 per 1,000 live births, far beyond the Sustainable Development Goals (SDGs) target of 70 per 100,000 live births, according to the 2017 demographic survey.

Travel concerns

Task force spokesman Yurianto attributed the jump in single-day COVID-19 cases in Indonesia to increased testing and the failure to observe social distancing measures.

He warned that the country could see an increase in infections because of higher mobility during the holy month of Ramadan culminating in the Eid al-Fitr festival, which falls on Sunday.

Traffic in the greater Jakarta region has been busier in recent days ahead of Eid al-Fitr, while airports, sea ports and markets have also started to reopen.

The head of the COVID-19 task force’s team of experts, Wiku Adisasmito, said public perception that travel restrictions had been relaxed could also be a factor.

“It could be due to increased testing, or due to the lack of discipline in observing health protocols,” he said.

President Joko “Jokowi” Widodo on Monday said the government would not ease restrictions amid criticism that the government is silently relaxing measures to curb the spread the virus to keep the economy running.

Speculation that the government is taking steps toward reopening the economy emerged last week after Wiku said residents 45 and younger could be allowed to return to work.

He said West Java has been a bright spot in the fight against COVID-19 for its success in flattening the curve.

“Hopefully other provinces can catch up,” he said.

East Java Deputy Gov. Emil Dardak told local television that the provincial government had tested not only people who showed symptoms of COVID-19, but those who were at risk, resulting in the high number of daily cases.

The story was first published on BenarNews.org

Indonesia extends partial lockdown in second-largest city

Indonesia extended the partial lockdown of its second-largest city Surabaya and the two neighbouring administrative regencies of Sidoarjo and Gresik, in East Java province, as new infections and deaths spiked at the weekend.

East Java Governor Khofifah Indar Parawansa said on Sunday that the decision was taken following a review of the Covid-19 growth rate and consultations with epidemiologists.

“After evaluation on the first phase of enforcing the large-scale social restriction, we agreed to extend the restrictions in Surabaya, Gresik and Sidoarjo,” Parawansa said in a statement.

The first phase of partial lockdown in the three regions had been set to end on May 11. It is now due to expire on May 25.

The governor said authorities would more strictly enforce the anti-virus restrictions – including stringent social distancing measures and bans on events and other social gatherings – in place during this second phase.

IMG-20200507-WA0070

Achmad Yurianto, the spokesman for the national Covid-19 task force, said on Sunday that the national caseload in Indonesia rose to 14,032 with 387 new confirmed infections.

Out of the total national tally, 1,502 are in East Java where the death toll rose to 143 and 83 new cases were recorded, surpassing West Java as the second-most infected province after Jakarta, where more than 5,000 infections were found.

East Java found new clusters of Covid-19 cases in the past two weeks, including in a Surabaya plant owned by Indonesia’s largest tobacco company, HM Sampoerna, where two workers died of infection and dozens of others tested positive.

Parawansa also said the provincial administration is seeking approval from the Health Ministry to impose the large-scale social restrictions in the greater Malang area, which consists of Malang and Batu municipalities and Malang regency, after assessment from epidemiologists at Airlangga University showed new infection cases have spiked in the area.

Dr. Corona chairs campaign to contain coronavirus chaos

It seems he was born and named for the job. Emergency medicine expert Dr. Corona Rintawan is heading a task force set up by Indonesia’s second-largest Muslim organization, Muhammadiyah, to contain the spread of coronavirus.

“The Muhammadiyah COVID-19 Command Center (MCCC) is set up to consolidate all Muhammadiyah assets in an integrated effort to mitigate the spread of the coronavirus,” Rintawan said.

Rintawan was appointed to lead the MCCC, an interdisciplinary task force with 13 experts educating the public on how to stop the spread of the virus.

His emergency experience includes being in medical teams responding to Typhoon Haiyan in the Philippines in 2013 and the 2015 Nepal earthquake. He also took part in a humanitarian mission for the Rohingya in Myanmar in 2017.

“We are taking a proactive approach to assist the government in early diagnoses or early treatment for patients that show initial symptoms of infection,” Rintawan said.

He added: “We will ensure that such patients will receive treatment in accordance with the health protocol that the government has issued for the outbreak before we refer them to government hospitals should they need further treatment.”

The 45-year-old doctor, who is based at a Muhammadiyah-run hospital in Lamongan, East Java, said: “The public has to be well-informed that they could carry the risk of spreading the virus. We want to encourage the people to take the initiative to prevent it, by washing their hands often, getting themselves diagnosed should they feel they have symptoms, knowing when they have to wear face masks, donating masks to those who need them and eventually to self-isolate when necessary.

“It is about self-containment by one person who is aware of the situation and knows what to do to take care of oneself in the face of virus threats. It could create a positive domino effect in terms of reducing the potential to contract others with the virus.”

According to Rintawan, Muhammadiyah has designated 20 out of its 171 hospitals across the country to serve as referral facilities for persons suspected of having contracted the virus.

Asked about his name, the doctor said his parents would name their children in alphabetical order. Being the third, his name had to start with “c.”

“There was no such thing as baby name books at that time, so they decided to take my name from the Toyota Corona car, which was a popular model back in the 1970s, and as they also found that it means a crown, which symbolizes something good,” he said.

Government spokesperson for the outbreak Achmad Yurianto said Indonesia reports 17 new Covid-19 positive cases as per Monday, of which 14 are in Jakarta, raising the total confirmed cases to 134 including the first Indonesian senior official contracted by the virus, transport minister Budi Karya Sumadi.

Jakarta Governo Anies Baswedan on Monday urged city residents to exercise social distancing and companies to send staff to work from home, as government officials sent signals that hospitals are overburdened in treating coronavirus patients, with Yurianto saying that not all positive cases should be in hospital isolation and those with asymptomatic cases can self-isolate at home.

“The risk in this city is high. We have to be disciplined in exercising social distance,” Baswedan said.

The story has been updated from its original version in Arab News

Indonesia’s HIV medication muddle

HIV patients in Indonesia have been forced to adjust their daily medication routine because of problems with the government’s medication procurement program.

They are now taking single-dose medication twice a day for their antiretroviral (ARV) therapy regime, as the country is facing a scarcity of the fixed-dose combination medication in one tablet that only needs to be taken once a day.

The ordeal began when a tender from the health ministry to procure the drugs in 2018 failed twice because of agreements over pricing issue, according to Indonesia AIDS Coalition (IAC), a non governmental organization.

The limited tender process, which only involved two state-owned pharmaceutical companies, became deadlocked, and as a result the available supplies in inventory ran out last year.

Selvin Pancarina, a HIV/AIDS activist based in Surabaya, East Java, said she had to switch to the single-dose medication two months ago after using the fixed-dose combination ARV medication that contains tenofovir, lamivudine and efavirenz (FDC TLE) since 2012.

Even though supplies of the single dose drugs remain steady and she continues the medication, she admitted that it has not been easy to switch her routine after six years taking medication just once a day before she goes to bed.

“I have to be more disciplined with the new regime, by taking them in the afternoons and the evenings,” she said. “Sometimes I forget to take the afternoon medication, not to mention that each drug is said to have side effects if taken separately and there are contradictions to certain foods, so we have to be stricter in our diet and really pay attention to what we eat before we take the drugs.”

“One of the drugs we take separately is said to cause a side effect on the kidneys if we don’t take it with a lot of water. So, we keep wondering if the water we are drinking with the drugs is ever enough,” she added.

Selvin said members of her organization, Ikatan Perempuan Positif Indonesia (IPPI) or Association of Positive Women Indonesia had also experienced discomfort and irregularities in their daily routines after switching from fixed-dose to single-dose medications.  “The effect of single-dose medication is different in every patient. Some really have a hard time adjusting, some even experience hallucination or insomnia. They can’t sleep well at night and it causes them to feel dizzy and exhausted the next day,” she said.

The ARV medication is fully subsidized by the government and available to HIV patients at 895 distribution points such as hospitals and healthcare centers in all 34 provinces. In 2017, the government allocated about 800 billion rupiah for the medication.

Aditya Wardhana, the IAC executive director, said that changing medication to single doses poses risks that some of the drugs may not be available at the same time for every patient. As well, there are some patients that can only take two drugs instead of all three, resulting in sub-optimal treatment.

He added that although the fixed-dose combination drugs are still available, they are now in very limited supply, which constitutes an “emergency”.

“The safe benchmark to ensure drugs availability is for there tobe enough supply for at least six months at the national and regional levels. Now, it’s only available for less than one month at the national level and three months at the regional level,” he said.

Even though a tender for drug procurement is being processed, it will be a while before the drugs are available again.

“If the process goes well and no glitches in the process, we can have the stock back to normal by June,” he said.

The health ministry has reassured patients that the ARV medication supplies will be in adequate quantities for the rest of the year.

“The procurement tender for next year’s supply of fixed-dose combination is being processed,” ministry spokeswoman Widyawati said.

The ministry’s pharmaceutical and medical devices director general, Engko Sosialine Magdalene, said the availability of ARV supply has taken into account the average growth in the number of patients by about 1-3% per month.

She also said the ministry had taken steps to ensure the drugs are available by receiving a grant to import 222,000 bottles of fixed-dose ARV medication in December last year from the Global Fund, a financing group that fights AIDS, tuberculosis and malaria. Each bottle contains 30 tablets.

”These 222,000 bottles are enough to meet patients’ needs for the next five to six months,” she said, adding that the ministry has also prepared 564,000 bottles of ARV medication by the end of 2019 and that the government continues to provide and allocate spending to procure ARV medication.

HIV/AIDS case in Indonesia was first found in Bali in 1987. According to health ministry data, the number of HIV patients in the country as of October 2018 was 305,000, and 107,000 of them were on medication.

According to UNAIDS, the key populations in Indonesia that are most affected by HIV are sex workers, with a HIV prevalence of 5.3%, gay men and other men who have sex with men, with an HIV prevalence of 25.8%, people who inject drugs (28.76%), transgender people (24.8%), and prisoners (2.6%). New HIV infections have decreased by 22% and AIDS-related deaths have increased by 68% since 2010.

Wardhana of IAC said without the ARV medication, it would be hard for HIV patients to maintain their stamina at the same level as the non-HIV people.

“Their health condition can deteriorate. About 95% of people with HIV/AIDS died because they failed to take the medication,” he said.

“By taking the medication regularly, HIV patients can live normally and have the same life expectancy as the non-HIV people.”

This story was first published on Bangkok Post

No signs of life as search goes on week after Indonesia mine collapse

Rescue workers have detected no signs of life as the search continued for dozens of people still buried after last week’s collapse of an unlicensed gold mine in Indonesia’s North Sulawesi province, an official said Tuesday.  

Scores of miners were buried after a wooden platform they were using at the mine in Bolaang Mongondow district collapsed on February 26 due to unstable soil, officials said.

Searchers found four more bodies and body parts on Monday, bringing the confirmed death toll to at least 13, said Ferry Arianto, spokesman for the provincial search and rescue agency.

Twenty miners were rescued, but two of them died later, he said. It was not clear how many were still buried, with estimates ranging from 30 to 70. 

“We used a life sensor but there were no signs that any victims were still alive,” he said.  

“Only 20 families have so far come forward, because the workers came from outside the area and they didn’t know each other,”      

Deadly accidents in artisanal gold mines are not uncommon in Indonesia.  

There are at least 1,000 such mines across the archipelago, according the Indonesian People’s Mining Association.  

The United Nations Environmental Programme says artisanal and small-scale miners make up 90 per cent of the global gold mine workforce of about 15 million people.

Artisanal miners often work under dangerous conditions, with exposure to mercury used to extract gold from ore among the hazards, the UN said.