Community preparedness and response in Indonesia - Eka Wulan Cahyasari, Indonesian Red Cross

“Preparedness is always better than response.”

Indonesia is currently suffering another wave of COVID-19, in addition to 10 other major infectious diseases. In this episode we talk with Eka Wulan Cahyasari from the Indonesian Red Cross Society about how, with the support of the Centre, they are drawing upon existing pandemic preparedness tools and influential community volunteer networks to support surveillance, vaccine hesitancy programs and community resilience in the face of challenging times in Indonesia.

Links for further reading

https://www.ifrc.org/en/what-we-do/where-we-work/asia-pacific/indonesian-red-cross-society

https://indopacifichealthsecurity.dfat.gov.au/strengthening-front-line-health-secure-communities

Tags: #CommunityPreparedness #COVID-19 #Indonesia

Transcript

Eka

Many hospitals have very critical oxygen supplies. And most of them are overwhelmed with the number of sick persons because of COVID. But we have to dealing with other diseases during the pandemic situation so it will be challenging for us, for everybody I think. But specifically in Indonesia.

Robin

Hello, I'm Robin Davies from the Indo-Pacific Centre for Health Security. And I'm joined by Dr. Stephanie Williams, Australia's Ambassador for Regional Health Security. Today, we're talking with Eka Wulan Cahyasari from Red Cross Indonesia, about how they're supporting the response to the current COVID emergency, drawing on a strong foundation of community networks and preparedness.

Stephanie

What are some of the activities the Indonesian Red Cross is currently undertaking in response to the latest surge in cases? And can you give us a sense of the general mood of the population where you are, at least at the moment?

Eka 

Yeah, thank you, doctor. Yeah well, actually as you monitor from the media, the huge number of the cases are also increase in Indonesia. Many hospitals have very critical with oxygen supplies. And most of them are also overwhelmed with the number of sick persons because of COVID. But we have to deal also with other diseases during the pandemic situation so it will be challenging for us, for everybody, I think. But for specifically in Indonesia. Because numbers of the population in terms of the diversity of the geographical area, access to health facilities and everything. So that's, another challenge that we have to deal with also.

Stephanie  

Can you tell us a bit more about the specific activities of the Red Cross at the moment in Indonesia in the COVID surge?

Eka  

It's already started before the pandemic itself, it's coming from coming last beginning of last year in Indonesia. Up to now, we still working and running some activities for health promotion. All our volunteers do that, even though even also our volunteers at the community level. And we do some health services, not only in the health facilities that we have in the hospital and also in the clinics, but also yes, some health post or health centre in the bordering area or something. We also teach the community, we strengthen our community response for COVID. So we give them some training or life skills to support themselves within the community. So actually, the structure already exists. We call it Gugus Tugas for COVID. So it's like the technical working group at the community level. It means that for the whole country, of course, maybe in some places, there is some weakness or some strength. So we are playing this role to the fill in the gap to ensure that these existing structures exist at the community.

Robin  

Every country is seeing some level of vaccine hesitancy in the population, in some countries that is reducing, because people are particularly concerned about the Delta virus. What level of hesitancy are you seeing in Indonesia? And what sort of work is the Red Cross doing to counter that?

Eka  

For vaccine hesitancy, it's actually not only happen for COVID vaccine. It's already happened before for any type of vaccine or vaccine preventable diseases. So we actually working with a Risk Communication and Community Engagement Technical Working Group. So we manage these kind of issues or hoax or any types of vaccine hesitancy. So we try to address the groups. We use the local capacity from the religious leaders or the figures that have very good influence for other communities.

Robin 

So we're more than a year into this pandemic, but your work on pandemic preparedness and response started much, much earlier than that. Could you tell us a bit about the project that you've been working on; why it was established and what sort of outcomes you've been able to achieve so far?

Eka   

Community Pandemic Preparedness Program - actually it's not this the first time that we are running pandemic preparedness. It already started since 1990. But many types of community-based programs including the pandemic preparedness. So, with this project, with the programs and projects, we have increasing our capacity in terms of the organisational preparedness. So it means that this community, or pandemic preparedness is not only belongs to the health person, but also it's everybody’s business for the natural disaster, everybody knows already knows what, what they have to do. With the support by the Australian Government on also the Australian Red Cross, we strengthen our we extend our community preparedness in more villages, and more populations. For example, we now have a guidelines for the epidemic control for volunteers, we also do strengthening the community based surveillance systems because our government already has an existing surveillance for public health centre or animal health centre and also the wildlife. So, community will have more capacity to really detect unusual event, whatever the case in the field. And they do many exercise before the pandemic happens. 

Robin 

I was just going to ask which parts of Indonesia are you mainly working? And is there a particular focus on the risk of avian influenza? Or is it broader than that?

Eka  

Actually in Indonesia, we have more than ten types of diseases, potentially causing outbreaks. So it's not only talking about of pandemic influenza, but also almost all of them they have pandemic influenza as a priority disease, but also have to deal with like dengue, leptospirosis, anthrax, malaria, and measles. So they already have an exercise dealing with this type of disease before COVID-19. I mean, before the real pandemic happened.

Stephanie 

You've given such great examples of some of the many benefits of the Red Cross's long standing involvement with communities in pandemic preparedness. And so, I was wondering if you could expand a bit on when COVID hit last year and even up to today, were there specific benefits you saw in some of those communities where you had been working for such a long time? Were they more confident in responding to public health messages today? Are they more receptive to vaccination campaigns? 

Eka  

There is so many benefits that I can share also to you, because they have better understanding, how is the flow for the case management and more responsive in terms of prevention, they can get how to do the early detection for this COVID-19 because they already have had exercises for other diseases. And they come through our COVID alert when COVID-19 first happened in the villages and get in touch with the public health centre to ensure the community gets better feedback from the public health centre, even though they also bridging this communication, they know what to do, for example, we have three or six key points to prevent COVID-19 but they already exercise that before like hand washing or social distancing or something that using masks when you are facing or have to close working closely with like the sick person and everything. So they are more familiar with how to isolate a sick person and how to taking care taking care of their family member for example if there is any symptoms. They are really working closely with community case definitions. So even though they cannot diagnose but they can facilitate this into the health facilities just to ensure this is false or true alert so they can get the feedback from the closest public health centre.

Stephanie  

Yes, it's an important point about those pre-existing relationships from a community to the health sector and just knowing who to talk to and when and the practice that comes from preparedness.

Eka 

Actually the community volunteers that join in the project are also now joined in the community technical working group for COVID. So actually, it's easier for us because in the headquarter levels, we are working in the risk communications and community engagement technical working groups, so we can get the firsthand key messages from the government. Because this group not only consists of the government but also many international and national NGOs working on that. So we will share or disseminate the key messages. 

Stephanie 

It strikes me that, in a way Indonesia was better set up for the community engagement in the COVID pandemic if I could contrast to some of the lessons Australia has learnt along the way about communication with a range of communities both in Melbourne and Sydney in particular over lockdowns and recent surges in cases, it took us a bit of time to treat this pandemic first with a people focus rather than a pathogen focus. There's lots we could learn from the region. But Robin, you've got the next question. 

Robin  

Some of our listeners will be particularly interested in what Australian support for the project has achieved. The project was started with funding from the United States Agency for International Development, it was part of a pilot in several countries, including Indonesia. And when Australia's Health Security Initiative was launched, we selected your project for additional Australian funding. Could you just say something about how that funding has been used to expand the scope of the project?

Eka  

So actually, it's really support us in terms of the preparedness, because for the previous one we are working in preparing the modalities, the guidelines, but not so much working at the many populations or our communities. So with this additional support we are adding more villages, and we are really strengthening their capacities in terms of understanding of health literacy. I think the key point is the capture phase, because it's important things that we have to do from the beginning. But since the guideline is not finished yet, but with Australian support, we can finish this because we get more technical assistance on that. And the community-based surveillance, it's something that’s good also because the we are in the process of developing this community-based surveillance. So with support from the Australian Government, and also the Australian Red Cross we strengthen our capacity on the community-based surveillance itself.

Robin

And can I ask whether the Pandemic Preparedness Project has been modified in some ways, as part of Indonesia's COVID response, for example, is it now incorporating health promotion messages about vaccination, or monitoring for COVID symptoms?

Eka 

We adjust all this COVID-19 response into the epidemic control for volunteers tool kits. We do adjustment into the community case definitions in community key messages/community action, what types of first aid that they can do in the community. We do also, some adjustments in the first aid apps that can used by the community, so many things and many protocols that we really have fast adjusted during the COVID response.

Robin  

And before I pass back to Steph for the final question, I'm curious how the Red Cross works with the Indonesian Government at district level or provincial level the national level, for example on surveillance, is your work integrated with national surveillance systems.

 Eka  

Yes we have several communications with the government at the national level. We have a meeting with the ministry, not only Ministry of Health, but many governments coming also into that meeting and from the university, and we are have the opportunity to present our community-based surveillance systems just to ensure that our systems are really connected with the existing surveillance system run by the governments. So we can play our roles to bridging this community to strengthen the community capacities, and to really strengthen the community awareness, about why they have to also play the roles into the existing surveillance systems.

Stephanie  

This is our last question. So COVID-19 will be with us for a long time and there will be more outbreaks, epidemics and pandemics, thinking about the Community Preparedness and Response Project that you're leading, where would you like to see that in five years? 

Eka   

This experience actually influenced our way of thinking, because preparedness is always better than response. Even though we already exercised many things during the preparedness, it will be very helpful for us during the response, because you already prepared the guidelines, the tools, the flow, how to manage the case, how to solve the problems. So many things that we also already have the modalities like we just made many protocols during this COVID response: for the first aid, for the  ambulance, for the psychosocial support, for the self-isolation, how to assist people to ensure their mental health, not only physically, but also the mental health, and how to do it with social distancing, for example. And something that really important is the community-based surveillance because pandemic is coming from the community and it should be at the community. So community should be in the front line - not only the medical person. The medical person has to be at the end of the fighting. It's better that we put more investment at the community because they know what happens in their environments, in their families. So they can be a first responder before everything has to go to the health facilities. I mean, like, yeah, we have to protect our medical personnel also with the prevention and promoting health behavior.

With this investment of Community Pandemic Preparedness Program and community-based surveillance, we see there is a big demand, not only from the government but also from the community. We have to deal with so many disasters during the pandemic situation, so it's like multi hazard. So, with this preparedness, it already exists in our strategic plan for at least five years. As far as Red Cross is still there, we will still run community preparedness. So I mentioned now we are in 2021. But this community-based programming already started in 1990. So now we are 20 or 30 years later than that. I'm the one who picking up the effort, so I have to bring this with somebody next to me in the future - I don't know who they are, but I will and we will do this for next generations!

Stephanie

Thank you for joining us on Contain This, as we discussed the importance of community preparedness and response with Eka Wulan Cahyasari from the Indonesian Red Cross. Join us next fortnight for the next episode of Contain This, brought to you by the Indonesia-Pacific Center for Health Security.