Authors: Florencia Yuniferti Sare & Elisabeth Schröder-Butterfill
Indonesia has so far seen approximately 12,000 confirmed COVID-19 cases and more than 400 deaths. The epicentre of the Indonesian pandemic is Jakarta, home to nearly 10 million people. Many of these maintain close ties to their communities of origin spread across the archipelago. Here we report on the situation in a densely populated, relatively impoverished urban neighbourhood (kampung) of Jakarta. Nearly 30,000 people live in an area of less than 0.3 square km, with dwellings, small shops, home industries and garment factories crammed close together.
Since early April, a poster published by the Jakarta government has been widely distributed. It highlights the special dangers of COVID-19 for older people and provides guidance for keeping older people safe. This poster has caused confusion among local health volunteers (kader): How can 1-metre distance (let alone 2, as advised in the UK!) be maintained when interacting with elderly people? How can good ventilation and sunlight be ensured? On average, dwellings are just 30 square meters in size, often shared by 8 or more people. The alleyways are so narrow that hardly any sunlight penetrates. Many of the houses are dark, narrow, and stuffy, and the recent floods in Jakarta mean that if it rains, water still seeps through floors and into the alleys. Given the degree of crowding, residents are long used to treating the alleyways and passages as natural extensions to their homes. Much of daily life happens here: washing clothes, cooking food, selling vegetables, catching sunrays and chatting. “We have to be clever here”, says one health volunteer. “It’s impossible to keep a distance according to the government’s instructions. So, we have to find other ways to avoid infection.” The instruction to ‘stay at home’ has been reinterpreted to mean ‘stay in the immediate neighbourhood’! Entrance points to the kampung, such as a bridge over a river forming a natural boundary, have been sealed off.
Photo credit: Haryo, BBC News Indonesia, 28.04.2020
A key local response has been the purchase of water pumps and handwashing facilities throughout the neighbourhood. A resident, recently qualified as a doctor, provides training on correct handwashing to health volunteers, who in turn pass on this knowledge to others. Elderly people are also instructed in this way. Besides, great efforts are made to keep the environment clean, for example by spraying houses and alleyways with disinfectant every few days. The area is home to several garment factories which produce textiles, especially for export to Africa. As export has been temporarily suspended, many of the factories have closed. However, some have been repurposed to make protective gear. Thanks to the generosity of these factories, thousands of re-usable masks have been distributed among residents. It is hoped that this measure will help to prevent the spread of the disease.
So far there have been two confirmed COVID-19 casualties in the neighbourhood, and several people have tested positive. Their identity is being protected, but this causes concern to the village officials who feel they need to know which areas to isolate in order to keep others safe. Thus far any identification of cases has been as a result of people approaching the health centre or hospital, not thanks to any symptom tracking or testing in the community. For this, there aren’t the testing resources, nor the protective equipment to undertake such work safely.
Photo credit: Neneng, RW09.
The collective response to help mitigate the effects of the lockdown have been tremendous. Every day a changing team of volunteers prepares parcels of cooked food for approximately 100 households in the kampung. The primary targets for the food distribution are elderly people, to reduce the burden on their families, many of whom have experienced job losses in recent weeks. Intergenerational co-residence is the norm in this crowded location, and most elderly people depend on their children and grandchildren for their daily needs. Relatively few older people still work. In addition to the cooked food, there are handouts comprising rice, oil and other essentials from the President and the Governor of Jakarta. This targets more than 3,000 households in the kampung. As there is considerable overlap in the recipients of presidential and gubernatorial largesse, there have been understandable grumbles from residents who have not received any support. A local leader thus exhorts those who have benefited to remember their neighbours and “share the fortune, especially in these difficult times”.
Since the end of March, all regular health programmes conducted by local health volunteers (kader) have been stopped. This includes drop-in health services for elderly people and home visits by health volunteers. News that one volunteer in a different part of Jakarta died of coronavirus following a home visit on a dengue fever prevention programme has acted as a strong disincentive. However, health monitoring efforts continue, albeit in a different mode. Kader women have organised themselves into WhatsApp groups to report on local circumstances in real-time. Health volunteers keep tabs on elderly people who are unwell or have not been seen for a while. Visits still happen, but any enquiry is done from the threshold of the house and while wearing gloves and a mask. What causes the most concern is that all routine health checks and hospital visits have been put on hold. Elderly people with diagnoses of cancer, high blood pressure, cholesterol, stroke or heart disease are no longer being sent to the hospital for check-ups, as the primary health centres who make referrals consider this too dangerous. One woman explained that she phones the doctor when her mother needs a repeat prescription. But without her mother being properly examined, how can she be sure the medication and dose are still correct? Of course, some elderly people have never seen a doctor when ill, they merely drink jamu (herbal remedy). For them, the lockdown has not affected their healthcare.
Ramadhan this year is a quiet affair, with all communal prayer abolished and visits home by migrant labourers forbidden. The fast is still broken at sunset in the alleyways in front of people’s houses but in small groups of families who live close together. Yet for many elderly people in the neighbourhood, the lockdown seems to bring unexpected rewards. As one resident put it: “I see my parents laughing more, joking, looking happy because we are all together. Maybe it’s different in other families. But the impression I get is that elderly people are happier because now many people are engaging them in a chat. Now everyone has time for elderly people.”