Independen --- The Nabire district of Papua province, Indonesia, with its population of 147,921 people (2018), is currently one of the regions exposed to Covid-19. By August 12, there were 10 new Covid-19 cases in Nabire, the second after Mimika district, which saw 11 new patients.
Papua Covid-19 Task Force on Wednesday (12/8/2020) announced 31 new Coronavirus patients in the province. Cumulatively, the total Covid-19 cases in the region had grown to 3,225.
The breakdown of the origins of the cases are Mimika district (11 cases), Nabire district (10 cases), Lanny Jaya district (4 cases), Biak Numfor district (3 cases), Jayapura district (1 case), Pegunungan Bintang district (1 case), and Merauke district (1 case). Papua Covid-19 Task Force is particularly monitoring the high increase of new cases in Mimika and Nabire.
Nabire is a specific point of concern since the district is the gateway to four other mountain districts. It is situated in the indigenous territory of Mee Pago, along with Intan Jaya, Deiyai, Dogiyai, and Paniai districts.
As a gateway, Nabire is equipped with a harbor and airport connecting it to the capital of Papua province, Jayapura. Those who want to go to Intan Jaya, Deiyai, Dogiyai, and Paniai, must land first at the Nabire harbor or airport, before continuing their travel to the four districts via land or air (small plane) routes.
The so-called defense against Covid-19 for the region crumbled when three patients were tested positive for Covid-19 simultaneously on April 17. To prevent further transmission, the RSUD Nabire state hospital was appointed as the only health facility to treat Covid-19 patients in the area and its surrounding districts.
The local government tried to contain the virus within Nabire by deploying relentless efforts, given the lack of health facilities in the other four districts. Nabire is expected to suppress the rate of viral transmission to not spread further to the four mountain districts.
As one of the advanced prevention efforts, the district heads in the region joined hands in the Mee Pago District Head Association and organized a meeting on April 16 in KM 100 Unipo, Siriwo subdistrict, Nabire. Nabire district head Isaias Douw led the meeting attended by four other district heads, Dogiyai district head Yakobus Dumupa, Deiyai district head Aten Edowai, Intan Jaya district head Meki Nawipa, and Paniai deputy district head Oktovianus Gobai.
One of the agreed points was a Rp1 billion (US$ 68,000) fund and medical equipment from Paniai, Dogiyai, Deiyai, and Intan Jaya for Nabire to tighten its epidemic response and prevention to not spread to other Mee Pago areas.
Currently, funds for the Covid-19 response in Nabire district came from several sources. Among them, as much as Rp33.9 billion came from Nabire regional budget (APBD), which resulted from re-allocation from the respective Nabire Apparatus Organization (OPD). The Papua provincial government has also transferred Rp7 billion, and a further Rp28 billion from the Central Government in Regular Special Allocation Fund (DAK) and Designated DAK that has yet to be disbursed.
Head of the Board of Nabire Revenue Management (BPPKAD) Slamet, SE., MSi. said that the Rp7 billion grant from Papua provincial government have been disbursed via Nabire’s Health Office and RSUD Nabire state hospital.
Limited Fund and PPE
Interviewed in his office, Director of RSUD Nabire state hospital dr. Andreas Pekey, Sp. PD said that with the growing number of Covid-19 cases and the limited fund, there is the possibility of temporarily closing the hospital.
Even though Covid-19 has various symptoms, the one most common is fever accompanied by dry cough and flu, shortness of breath, or diarrhea. Therefore, officers are standing by to check for body temperature. However, even though fever is the most common symptom, it is not always present.
"So, in terms of symptoms, we cannot confirm if a flu patient also has Covid-19. So, to be sure, patients who has the flu, fever, and shortness of breath are being tested. In this case, we carry out the PCR Swab test,” Pekey explained.
Short for Polymerase Chain Reaction, experts and doctors prefer this test to detect the Coronavirus rather than the rapid molecular test. However, the PCR test cost more, which makes it a challenge for RSUD Nabire.
“We have the equipment, but the [reagents] need to be imported from outside Papua via the Health Office,” Pekey continued.
Before June 1, specimens from patients in Nabire who took the swab test had to be sent to Jayapura or the Papua provincial health laboratory (Labkesda). This meant a long waiting time for patients before receiving their results.
However, per June 1, the Nabire government—in this case, the RSUD Nabire, has their own Rapid Molecular Test equipment that can also be used to test for Covid-19 swab samples. Patients can immediately get their results after taking a swab test in Nabire. There is no need to send them to the Research and Development Center of Papua Health Office anymore.
TCM can check for Covid-19 using a particular unit or cartridge. Because initially, the TCM equipment is used to test for tuberculosis. But with an additional cartridge, TCM can also check for Covid-19. However, it is not easy to bring in health equipment such as the cartridge and others to Nabire due to provincial lockdown.
“Not only Covid-19 equipment but almost all service equipment was on hold because of the lockdown. Therefore, we must find other ways to makes sure such medical equipment arrives in Nabire,” Pekey added.
There is also limited PPE (personal protective equipment) supply for medical workers to protect themselves when examining patients. Whether or not the patient has already been exposed to the Coronavirus. If a patient has an ODP (a person under surveillance) status, the medical workers around the patient must wear PPE. ODP are those who have a fever, flu but without shortness of breath or inflammation.
“When treating ODP, before we conduct a further examination, we have to wear masks. Because we still do not know for sure whether the patient has Covid-19 or not. Therefore, it is best to protect ourselves before treating a patient,” Pekey continued.
However, RSUD Nabire is facing some challenges. One of them is the lack of medical facilities and PPE for their medical workers.
“If, for example, the Government wants and earnestly makes certain how many are PDP [patients under surveillance], ODP, and others, then all the people with symptoms or illness should be tested for Covid-19. But the problem is how much funding is available?” asked Pekey.
With the limited availability of health equipment and the growing number of patients, eventually, the RSUD Nabire state hospital must implement a cost-saving policy for PPE use and the Covid-19 test. Both are reserved for patients who are most likely to have contracted the illness. Not everyone with fever, flu, and others are being tested for Covid-19. This is because the district fund has almost run out. They must save money, especially with the limited PPE available for medical workers and the skyrocketing price in Nabire, where one complete PPE set can be sold for Rp1 million.
“For example, if five people are wearing PPE at the same time. Doctor, nurse, cleaning service, those who enter the isolation room must wear it. Meanwhile, the price for a set is about a million. That will be five million a day. Multiply it by how long we must treat a patient. Can the regional government pay it all?” asked Pekey again.
RSUD Nabire has received a Rp5 billion fund allocation from Papua Provincial Government for the Covid-19 response. This came from the Rp7 billion that it also shares with Nabire Health Office.
"The five billion funds was used for rehabilitation and modification of some [hospital] rooms to isolation rooms, PPE purchase, [PCR test] cartridge, drug deliveries from Jayapura to Nabire," Pekey explained on Wednesday (12/08).
This was also confirmed by the spokesperson for the Nabire government Yeremias Degei. Degei said that the fund has been disbursed for Covid-19 response, such as isolation rooms, ventilator, PCR test kit, and other necessary diagnostic equipment.
Degei also said that Covid-19 is a global pandemic, and everyone is vulnerable to being exposed to the virus.
“So, there is not a single disease in this world that is racist. There are statements and information from ‘intellectuals’ and the public, even from servants of God, who said that Covid-19 only attacked newcomers [non-Papuans]. That is not true. The proof is here, two patients are indigenous Papuans,” said Degei in his office on Tuesday (21/07/2020).
In Timika and Jayapura, Covid-19 patients have reached more than 300 people. From that number, 200 cases were indigenous Papuans. So, Degei asked for the people to not undermine Covid-19. Especially the Mee people and other tribes in Nabire, who usually wait until their condition worsens before going to the hospital. Degei also warned against mild Covid-19 symptoms that may look like a regular cold, cough, fever, and shortness of breath that the people usually consider trivial.
“If one person has it, they will go and meet with more than 10 people. Today they meet with this group tomorrow with another group. In the meantime, OTG [asymptomatic people] is spreading the virus to many people. And this is extremely dangerous,” Degei explained.
RSUD Nabire director Andreas Pekey also worried about health facilities in the four districts within the Mee Pago indigenous territory.
The Intan Jaya district currently has six Puskesmas: 1) Agisiga Puskesmas in Agisiga subdistrict, 2) Bilogani Puskesmas in Sugapa district, 3) Danggatadi Puskesmas in Biandoga subdistrict, 4) Hitadipa Puskesmas in Hitadipa subdistrict, 5) Pogapa Puskesmas in Homeyo subdistrict, and 6) the Wandae Puskesmas in the capital of Intan Jaya, Sugapa in Wandai subdistrict.
Its only hospital, built by the Intan Jaya government in Wapoga village, lies in a wrecked condition following a local insurgence in the previous regional election. To date, it was still not operational as many of the hospital equipment was damaged.
The Dogiyai district has 15 Puskesmas and one state hospital, the RSUD Pratama Dogiyai. However, the hospital has minimal facilities and rarely open. In the Deiyai district, a hospital is operational but has no specialist and only two to three General Practitioners standing by. The Paniai district fared better for having a state hospital in Category C, which means it is equipped with several specialists.
The minimum service offered by the health facilities in the four districts has made residents opt to go directly to RSUD Nabire hospital whenever they are in severe or critical condition. Especially in the times of the Covid-19 pandemic. Of course, this requires a high cost for residents.
“So, we are ready to respond to Covid-19, but please remember that there is only one hospital in Nabire. In contrast to other districts in the Papua dan West Papua provinces. Timika has three hospitals. Even Merauke, there are three hospitals. Jayapura has more than seven. There are three in Biak. There are three in Sorong, and some places have more,” said Pekey.
Almost all districts have more than two hospitals, but Nabire—the entryway to four other districts in the Mee Pago region, only has one RSUD.
Pekey continued that RSUD Nabire also treats patients from other regions, including Wasior district, Kaimana district, and Serui district. Based on its current database, to date, RSUD Nabire is treating patients from 11 districts. If the number of Covid-19 patients increases in those districts, there is the possibility that they will be referred to the RSUD Nabire.
“We have to anticipate [patients coming] from Deiyai, Dogiyai, Intan Jaya. Nabire has tools, officers, and isolation rooms ready. The problem is, if the case continues to grow, then RSUD Nabire might have to close its doors. Moreover, currently, there are already 25 Covid-19 cases. Seven patients are still in isolation rooms, and the rest have recovered,” Pekey continued.
Reflecting on other regions, Pekey added, especially in Jayapura, that has around seven hospitals with almost full capacity after several of their medical officers were infected with Covid-19, RSUD Nabire need to anticipate a similar thing from happening by limiting its service hours.
According to Pekey, who is also the Chairperson of the Indonesian Hospital Association (PERSI) for the Mee Pago regions, Nabire needs three to four more hospitals. Dogiyai needs to start operating by bringing in specialists, as well as Deiyai and Intan Jaya.
Meanwhile, according to Nabire government spokesperson Yeremias Degei, the district administration has carried out rapid tests on 4,000 people—those in direct contact with ODP and PDP. As well as others who might be exposed, such as bank employees and public transport drivers.
“They are parties at risk because their job requires them to interact with a lot of people. These are the steps that have been taken by the Nabire local government,” Degei explained.
Closure of Access, Students Sent to Jayapura
In the fifth meeting of Mee Pago district heads on Thursday (16/07/2020), they discuss and deliberate—in particular, the various efforts to curb Covid-19 within Nabire and prevent it from spreading to other regions. Steps to be taken, among others: First, closing all airports and seaports for the next two weeks. Second, the Nabire administration will facilitate the students—freshmen and seniors, to leave for college in Jayapura.
“The Laa Pago area has been breached, [the disease] has entered several districts. If Covid-19 reached the Mee Pago area [Dogiyai, Deiyai, Intan Jaya, Paniai], it could be dangerous. That is why the policy that the district heads had come up with, be it closing access to land, air, and sea routes, is a policy to protect the public,” said Degei.
However, the said policy led to dissatisfaction in the students. Those from Mee Pago who were about to continue their studies held a protest on Tuesday (21/07/2020) in front of the Nabire district head’s office. They demanded the local government to provide transportation to continue their studies in their chosen universities.
According to Degei, the protesting parties demanded access to the need for specific individuals and groups. Meanwhile, those who are responsible are the district heads.
“So, those who protest a lot against the government are not thinking about the safety of a bigger community group of Mee Pago in Intan Jaya, Paniai, Deiyai, and Dogiyai,” he explained.
Additionally, the students also demanded the Nabire local government provide them with a ship, considering there is no certainty on flight schedules. While the registration period for several universities in Jayapura and outside Papua has entered the final period. This can severely affect the continuation of their studies.
“We demanded, new students who are going to [study] in Jayapura, that this week new students are prioritized then seniors on the week after,” said Hubertus Dogomo, one of the protesters on July 21.
The demands of students in Nabire to leave for Jayapura was because that the Cenderawasih University (Uncen) and other private universities in Jayapura has no distance or online learning program. So that students in Nabire who are studying in Uncen must return to Jayapura.
Previously on March 18, the Uncen rectorate had suspended lectures to prevent Covid-19 transmission following a circular from the Ministry of Education and Culture.
However, this policy was rejected by students Cenderawasih University students and other state and private universities in Jayapura. Yulianus Boma, studying at Uncen, said, “We firmly declare that we reject online lectures. Because most of the Uncen students are not familiar with Online science and technology, and there are a lot of students who do not know at all. “
Therefore, when the odd semester period begins in August, Cenderawasih University and other private universities in Jayapura will re-impose face-to-face learning.
As a response, Nabire district head Isaias Douw said that his office is trying to obtain an aircraft and a ship to Jayapura for the students.
“The local governments of the districts in indigenous Mee Pago area agree to fund the transportation for students who recently graduated from High School/Vocational school and its equivalent who want to continue their studies in Jayapura. Not only for freshmen but also for seniors finishing their dissertation, they will be flown along with the freshmen to Jayapura. For other students, the regional government will provide a ship,” said Douw.
The departing students will have to fulfill several requirements, one of which was to take a rapid test in Nabire. For those who want to continue their travel outside Jayapura or Papua will have to personally bear the cost of the trip.
The local government recorded more than 1,000 students and freshmen who are planning to leave for Jayapura. Their departure was carried out in stages. On August 12, the last of the third batch—116 students had set off. Previously, Nabire district head Isaias Douw S. Sos. M.AP., who also chaired the Mee Pago District Head Association, had sent away 300 students in five different flights and more than 600 students aboard two passenger ships to Jayapura. Thus, in total, there are more than 1,000 students were deployed from Nabire to the Papua provincial capital, Jayapura.
The entire transportation cost was covered by the Mee Pago District Head Association, since the all the students and freshmen came from the Mee Pago indigenous area, Papua: Nabire, Dogiyai, Deiyai, Paniai, and Intan Jaya districts.
Student Funds
During this pandemic, the Nabire government has also disbursed direct cash assistance (BLT) to students and the communities of Nabire.
“Regarding social aid, the Nabire district has disbursed funds to students. Each student receives Rp1 million. Other districts in Mee Pago are also doing the same,” said Nabire government spokesperson Degei.
On student funds, Degei continued, the government quota was reserved for only approximately 300 students. So, it was limited. Meanwhile, the government recorded that there are about 800 students in the area.
Apart from distributing the BLT, Nabire regional government also conducted several activities. Among them are Covid-19 public campaigns by utilizing various media such as 15 banners in 15 locations in Nabire city, giving out announcements using the command cars, mass media, and Nabire state-radio (RRI) broadcasts. The government also carried out direct communication and approaches to communities such as the Enaimo Community.
“For the application of health protocols, campaigns were carried out in traditional markets even though it was largely ignored by the traders. Especially Mama-mama [female] merchants,” regret Degei.
No Information Disclosure
Information disclosure, as regulated in Law No. 14 of 2008, was never optimally implemented by the Nabire local government. This was also apparent in the confusing allocation of Covid-19 response funds and the lack of transparent reporting to the public.
The BLT—a sum of Rp600,000 that each family was promised to receive, was cut to half in several villages. Based on Kabar Mapegaa’s monitoring, families such as in the Uwapa subdistrict received only Rp300,000.
Alfredus Pekei, a resident of Nabire, said that he only received Rp250,000 for his BLT. He had heard complaints from other villagers where each family only received Rp150,000.
Meanwhile, the Association of Native Papuan Traders (APAP)’s spokesperson Mikael Kudiai said that his organization did not look into detail into Nabire’s regional government. However, he understood that the Covid-19 response and protocol fund from the Health Ministry was substantial.
“Nabire in particular, received funds from the Ministry, in addition to the [fund from] Mee Pago District Head Association, in which each district head donated Rp 1 billion for Nabire. Unfortunately, as far as I am concerned, the Covid-19 Task Force was not optimal in preventing [the disease]. There have been two new cases this week,” Kudiai explained at the APAP secretariat in Jalan Yapis, Nabire, Papua, (24/07/2020).
Looking at the Covid-19 development, he continued, the latest tally from Papua Health Office on the number of people exposed to the virus, some recovered, and some are still undergoing treatment. There are also those with ODP and PDP status. Which means that Covid-19 is still around, not yet over.
“So, we have to see Nabire as a whole. Currently, it is still on alert, but what the Task Force is doing is not optimal. A large fund has been disbursed, but [new] cases still emerge,” Kudiai continued.
He took Italy, China, and Cuba as examples of countries carrying out mass testing for Coronavirus.
“We only announced the alert status, keep wearing masks, and others, given the minimal medical facilities. So, vigilance is essential,” Kudiai added.
Halfhearted Covid-19 Response
Adam Dimi, one of the members of the indigenous community in Nabire who was affected by the disease, also expressed his disappointment towards the government and the Covid-19 Task Force.
“The access, funds that were given were great. But the government protocols were never communicated to the people. There is no handwashing facilities or hand sanitizers in public areas,” said Dimi.
According to him, because of his status, his rapid test was covered by the government. “With the substantial fund, [the government] should not wait for [people] to get symptoms before testing. Do not wait for the people to come to the hospital before testing them, even charging them [for the tests]. This is not following the mandate,” Dimi said.
When Covid-19 hits Nabire, many volunteers and community initiate awareness campaigns and distributing masks and basic needs for the underprivileged. APAP was one of them.
“We have helped registered Mama Pasar [market women]. We distributed face masks [for them],” explained APAP Secretary Pekei.
He said that after the new normal was declared and transportation access was re-opened, his organization will organize another similar charitable activity.
“Basic needs are important, but local government urged the kiosks to close. While access for basic supply needs was also closed. So APAP did fundraising for basic needs to be distributed to Mama Pasar,” Pekei continued, adding that the organization also campaigned about the dangers of Covid-19 to the community.
“APAP’s activity was a grassroots movement, where people help people. There was no intervention from Nabire local government, in this case, the Covid-19 Task Force,” said Pekei.
Pekei hoped that the Task Force could go hand in hand with existing communities so that they can work together in preventing Covid-19 transmission.
On the other hand, the world standard for Covid-19 testing that was approved by the WHO was the swab test due to its high accuracy. WHO did not recommend a rapid test because it was less accurate. WHO also recommends the test rate to be at least one per 1,000 population to get a better picture of the breadth of the viral transmission.
Furthermore, the number of Covid-19 cases in Indonesia per August 22 (including its 34 provinces and 485 districts) was 151,498 people, of which 105,198 people have recovered, and 6,594 people had died.
Per August 14, there were 65 confirmed Covid-19 cases in the Nabire district. From this number, 29 had recovered and sent home, while 36 were still undergoing treatment. So far, there had been zero death reported.
In a statement released by the Nabire district’s government website humas.nabirekab.go.id, Nabire Covid-19 Task Force spokesperson dr. Frans Sayori said, “Those who are being treated are each 31 at the Education and Training Center, 5 in isolation rooms of the RSUD. Those treated at the Education and Training Center were with mild and even almost no symptoms,” said dr. Sayori.
The 36 patients who were still being treated came from Paniai (22 patients), Deiyai (12), and Nabire (3).
Covid-19 Response Budget Allocation for Nabire District
|
NO. |
AMOUNT OF FUND |
ORIGIN OF FUND |
ALLOCATION |
|
1. |
7 Billion |
Papua Provincial Government |
Aid fund from the Papua Provincial government of Rp7 billion had been disbursed through the Nabire Health Office and RSUD Nabire state hospital
|
|
2. |
More than 33 billion |
Deducted from all Nabire Apparatus Organization (OPD).
|
According to a May 2020 report: · Total health care fund Rp16,482,366,989.54. Broken down into: · Unexpected expenses (DID/Regional Incentive Fund) Rp4,448,913,000 Total expenses Rp4,400,000,000 (98.9%), · Unexpected expenses (DAU/General Allocation Fund) Rp500,000,000 Total expenses Rp500,000,000 (100%), · Unexpected expenses (DBH/Profit-Sharing Fund) Rp8,836,778,139 Total expenses Rp7,670,000,000 (86.80%), · Total expenses (SILPA OTSUS/Special Autonomy Budget Surplus) Rp2,696,675,850.54 Total expenses Rp2,446,600,000 (90.73%). From the total budget of Rp16,482,366,989.54 the total expenditure was Rp15,016,600,000 (91.11%). · Meanwhile, to respond to economic impact, the allocated budget was Rp5,100,000,000. |
|
3. |
4 Billion |
Funds from four districts (Intan Jaya, Paniai, Dogiyai, Deiyai) |
Each of the four districts contributed Rp1 billion. This was discussed during a meeting in April at KM 100 Unipo, Siriwo subdistrict, Nabire district. |
|
4. |
More than Rp50 billion. |
Special autonomy fund for Nabire local government |
Deducted for PON (National Sports Week) |
*This article was published in Bahasa at kabarmapegaa.com in August 2020
Author: Manfred Kudiai / D02
