Rural Health Response and Community Preparedness for the Covid-19 Pandemic

Covid-19 is a highly contagious disease and has infected more than seven million people worldwide. Deaths due to this disease have reached 418,000 deaths in June 2020.1 Based on data from the Indonesian Covid-19 Task Force, there were 172,053 cumulative cases with a death rate of 4.3% in Indonesia up to August 30, 2020.Indonesia is an archipelago country which has different geographical characteristics. Currently, access to basic healthcare and quality of basic health services has not reached all regions, especially those in underdeveloped, remote and archipelago areas. Health problems in rural areas become a concern for Indonesian government. This is because around 43% of people live in rural areas or around 116 million people. Government should pay attention to rural health problems as well as urban health. Likewise, during the Covid-19 pandemic rural area will face same problems to Covid-19.

Scientific Prediction of the Covid-19 Pandemic and What Should Society Do?

What is the scientific prediction for the Covid-19 pandemic? Currently, as of April 8, the world’s confirmed cases have over 1.2 million, the death of more than 72 thousand. For Indonesia, today 2,738 confirmed cases, 221 deaths, and those who recovered 204.1-3. The update on April 8 today, WHO itself estimates that the Covid-19 Contagion Rate is 1.4 to 2.5. This will form the basis of predictive modeling. Several studies conducted show that currently the basic reproduction number or R0 of Covid-19 is higher than SARS. Initially in the range of 2-3 or an average of 2.5, currently R0 is 1.4 - 6.9. This is what will form the basis of modeling. R0 or the basic reproduction number shows how many people a person can become infected with. If the R0 is more than 1, we are in an epidemic status as it is today, R0 = 1 endemic, and our R0 is less than 1 we have eradicated. R0 itself consists of three components, namely p: transmission, c: number of contact, and D which is the duration of the infection itself. These calculations are the main points in modeling.

Starting Online Services at University Clinics at the Beginning of the Covid-19 Pandemic

The UI Makara Satellite Clinic (KSUI) is a university clinic that serves UI residents and the public as well as a vehicle for education and health research in primary services. It has been a BPJS Outpatient Service Clinic (KPRJ) since October 2018. It is called a Satellite Clinic because it is planned to become a satellite for university hospitals in the academic health system at the University of Indonesia. Currently, KSUI is located on the Depok campus and the Salemba campus. In its daily services at the Depok campus, KSUI provides services for doctors, dentists, nursing, pharmacy, laboratories, action rooms, and psychological counseling.KSUI’s mission is not the same as an ordinary outpatient clinic, but because KSUI is a health service facilitated by the university, KSUI has a mission to maintain the health of the academic community, and not only treat them when they fall ill. Therefore, in addition to services that respond to patients coming to the clinic, KSUI also organizes periodic health check services, facilitates Posbindu activities in the faculties and office buildings on campus, and participates in medical care at any gathering or sports activities provided on campus.With the Covid-19 case being found in Indonesia, KSUI decided to change its service method as quickly and as firmly as possible from face-to-face services to online services, following the Chancellor’s Decree to close the campus from face-to-face learning and other student activities. With the return of the UI dormitory students and the implementation of work from home (WFH) for lecturers and education staff, KSUI must provide safe services during a pandemic and can be accessed by service users without having to come to campus. Therefore, this article is a brief piece of information that has been done by KSUI when it decided that services should be carried out online. It is not easy for the officer, because it has never been done, and it is not easy for the patient.

New Civilization in the Post-Covid-19 Health World & Lesson Learned from the Netherlands

New Civilizations in the Post-Covid-19 World Health There are several possibilities that will happen after the Covid-19 outbreak ends. This is the other side of the Covid-19 pandemic. There is a term called see the un- seen, or seeing something before it happens. An illustrative example is that everyone sees the apple falling down, but only one person sees why or what causes the apple to fall down. This is Isaac Newton. Based on this phenomenon, the formula for the gravitational force or the gravitational force of the earth is triggered. This paper focuses on what might happen in the future.Indeed, the earth repairs itself in its own way, and that is for the benefit of mankind. The Covid-19 outbreak that is currently happening is a very positive thing for human life. Under the earth there are shifts in the earth’s plates which cause tectonic earthquakes. What is the goal? The aim is to stabilize the earth so that an asteroid collision does not occur. There is a plague on earth, what does it mean? Its meaning is to improve human life. So, let’s interpret the current outbreak as something positive. Previously in Europe, there were millions of deaths due to PES disease. At that time, most farmers died, so the land owners were short of labor. What is the meaning? First, farmers have a high bargaining position. Second, after the plague occurred, then there was the collapse of feudalism. In the past, peasants worked in a kind of forced labor. Then the modern economic system was born. It was started at that time when farmers were paid in cash which had never happened before. This was the beginning of the growth of the modern economic system2.

Preface

The Roles of Primary Care Services in the Midst of Covid-19 PandemicsIt is generally understood that the majority of health problems could be solved in primary care settings. Pandemics due to Covid-19 brings about more complexities in primary care services. Health care workers should protect themselves by minimizing physical contacts with patients and coworkers. A frequent option now is teleconsultation or remote consultation, typically using internet. Teleconsultation is asynchronous or synchronous consultation using information and communication technology, mainly for diagnostic and therapeutic purposes.

Concept of Primary Care Clinic Facilities and Management in the New Era of Covid-19

This is a concept paper of how a primary clinic should be managed in the new normal era, facing the pandemic of Covid-19, but also the possible pandemic in the future. We proposed how to manage the clinic based on several findings regarding epidemiology, virus transmission, and many other best practices to reduce contact but maintaining the service through an online connection. We also highlighted the recommended use for indoor air quality management, which is the use of a HEPA filter. Other devices may be used but in special precaution.

Knowledge, Attitude, and Practice of Malaria Community Worker towards Prevention and Control of Malaria in Kokap, Kulon Progo: A Pilot Study

Background: Malaria Community Worker (CMW) has a crucial role in malaria prevention and control in the community. However, a number of studies showed that there is a lack of competence from MCW in carrying out its duties. Knowledge, attitudes and practice (KAP) can represent the behavior about health services. Objective: This study aimed to assess the knowledge, attitudes and practice of the Malaria Community Worker towards prevention and control of malaria in Kokap, Kulon Progo. Methods: KAP survey with cross-sectional design was conducted in this study. CMW from Puskesmas Kokap I (n = 8) was asked to fill out a KAP questionnaire. Descriptive statistics and inferential tests were used to analyze the data. Data were analyzed by IBM SPSS Statistics Version 25. Results: The study found that 100% of respondents (n = 8) obtained high knowledge scores with the highest aspect on understanding about malaria and the lowest on diagnosis. The attitude score showed a moderate attitude for 100% of respondents (n = 8) with the highest aspect was fogging for malaria prevention and the lowest was the attitude that malaria is a serious disease. Meanwhile, the score of practice described good practice in 100% of respondents (n = 8) with the lowest part was compiling daily/weekly reports to the malaria program coordinator of Primary Health Care. From the observations, there was no significant correlation (p> 0.05) between demographic characteristics and between knowledge, attitudes and practice. Conclusion: The CMWs had a high knowledge score, moderate attitude, and good practice towards malaria prevention and control. Further studies with a larger sample are recommended for future study. CMW training is also recommended to improve the KAP of CMW.

The Need of Trusted Primary Care: Lesson Learnt from The COVID 19 Outbreak in Indonesia

Indonesia declared COVID 19 as an outbreak since March 2020, where the President of Indonesia announced the fist two cases who were cured already. Since then a lot of publication, as well as information, spread out through social media. The hoax buster of the government had already put 134 hoaxes in the website only in one month 1. Thus, one can imagine how difficult for Indonesian people to understand the situation of the outbreak and to properly respond to it. Cases increased exponentially and it was estimated that Indonesia would reach 20,000 cases at the end of March 2020 2. The fact is up till the 6th of April 2020, Indonesia reported 2,491 cases 3.What happens to the estimation? Was it wrong or a lot of underreported cases occur in the community? Is it because of the intervention that the government launched effectively?

Adaptation of Home Falls and Accidents Screening Tool (HOME FAST) as a Fall Risk Screening Tool for the Elderly in First Level Health Facilities at Purworejo Regency

Background: The Home Falls and Accidents Screening Tool (HOME FAST) is used for early detection of unsafe environmental conditions at home and risk factors for falls in the elderly. However, in Indonesia there are no data on the adaptation of this instrument. Objective: To determine if the HOME FAST adaptation can be used as a screening tool for the risk of falling in the elderly in the First Level Health Facilities/Fasilitas Kesehatan Tingkat Pertama (FKTP) of Purworejo Regency. Methods: This research was a quantitative study with a cross-sectional design. Subjects were elderly with age over 65 years in the Puskesmas Loano working area that met the inclusion and exclusion criteria. Results: After the adaptation of the HOME FAST instrument was completed, a validity test was performed and a r table result of 0.361 was obtained, indicating all questions were valid. Reliability testing using the Cronbach Alpha formula obtained 0.8461. Subjects were 300 respondents with a distribution of 135 men (45%) and 165 women (55%). The results of the bivariate analysis found three factors that were statistically significantly related, namely gender, age, and the total score of the HOME FAST adaptation instrument. Gender was statistically significantly correlated with a history of falls p = 0.045 (95% CI 2.14-2.56) with RP 1.57 while age was significant with p = 0.046 with (95% CI: 2.85-3.46), and the risk of unsafe total HOME FAST scoring with p = 0.024. From the 2x2 table calculations, the sensitivity of the HOME FAST adaptation scoring method was low with 46% and the specificity of 67%. Conclusion: The adaptation of HOME FAST has a sensitivity of 46% and a specificity of 67%. The prevalence of adaptation results from HOME FAST risk of falling was 36.66%, with the number of safe houses were 190 housing units and 110 unsafe houses.

Prediabetes Screening with American Diabetes Association (ADA) Scoring in the Primary Health Care Yogyakarta (Development And Validation Of Scoring Systems)

Background: Numerous studies have shown the increasing of prediabetes incidence from the time being. Some of the prediabetes screening methods that can be performed at primary health care were American Diabetes Association (ADA) scoring for prediabetes. However, there was no data that describes the validity and applicability of the ADA scoring on prediabetes patients in Indonesia. Objective: To discribe prediabetes screening and to find out the applicability of the ADA scoring method in Yogyakarta primary health care. Method: The diagnostic test by scoring system of the ADA questionnaire was compared with OGTT (oral glucose tolerance test) as the gold standard. The subjects were patients of primary health care in Yogyakarta who fulfill the inclusion and exclusion criteria. Result: The subjects were 279 respondents with 227 female (81.4%) and 52 male patients (18.6%). The mean age of the study subjects was 50.4 years (SD 12.81). The sensitivity and specificity of the scoring method of ADA was 61% and 71%. This could be influenced by the difference in BMI standard as one of the scoring items. Conclusion: Prediabetes prevalence was 11.1% in the study population. The sensitivity and specificity of the scoring method of ADA is 61% and 71%. The scoring method of ADA could not be used in primary health care.