Medan, Indonesia – It was the evening after the Muslim holiday of Eid al-Adha on July 20 when Hambal M Zain began to run a fever. The 61-year-old coffee shop owner, who lives in the city of Banda Aceh in the northwestern Aceh Province, thought little of it at the time and in the days that followed the fever subsided and Zain went back to work as usual.
About a week later however, the fever suddenly returned and Zain developed a crushing headache.
“I told him we had to go straight to the hospital,” his wife Azlinda told Al Jazeera. “But he didn’t want to. He was too scared of what would happen when he got there. I couldn’t sleep at all that night because I was so worried.”
Two days later, with his fever still spiking, Azlinda forced her husband to take a COVID-19 test which came back positive. By the time they got to Dr Zainoel Abidin Regional General Hospital, his oxygen saturation levels had dropped to 85 percent.
Fortunately, Zain’s saturation levels rose quickly after he received oxygen at the hospital and he was discharged that evening with instructions to isolate and continue to use oxygen at home. It was at the hospital that Azlinda and Zain met Dr Ferry Dwi Kurniawan, the head of the Aceh branch of the Indonesian Society of Respirology (PDPI), who told them about a new programme that he had created allowing COVID-19 positive patients who are isolating at home to consult with a doctor over WhatsApp.
Coffee shop owner Hambal M Zain had a fever following the Eid al-Adha holidays. He is now in home isolation with COVID-19 and in regular touch with his doctor over WhatsApp [Courtesy of Hambal M Zain]“The numbers of cases that we are seeing in Indonesia are just the tip of the iceberg and the data we have doesn’t match reality,” Dr Kurniawan told Al Jazeera, explaining why he set up the group.
According to official data from the Ministry of Health, Indonesia has reported more than 107,000 COVID-19 deaths and 3.6 million cases since the start of the pandemic. In Aceh, there have been more than 25,000 cases and more than 1,000 deaths.
“The majority of patients who come to the hospital are already experiencing respiratory failure,” Dr Kurniawan said. “It is often already day 10 or 11 [of their symptoms] by the time we see them. They don’t want to go to hospital because they are scared, so they wait as long as they can. But COVID-19 complications can come on suddenly and result in sudden death, particularly if the patient has waited too long to seek treatment and has an underlying issue like a heart problem or comorbidity.”
As of August 3, at least 2,970 people have died in isolation or outside a hospital since June, according to civil society group LaporCOVID-19, which monitors coronavirus data across Indonesia. The actual figure is thought to be much higher due to limited data and under-reporting in many provinces.
“This phenomenon has been caused by the collapse of health facilities which has made it difficult for COVID-19 patients to get proper medical services. This situation has been exacerbated by poor risk communication, which has caused some people to avoid going to hospital,” the group said in a press release on July 3.
The WhatsApp programme, which launched on July 26, involves 12 doctors from across Aceh Province, which is home to more than five million people and located at the top of Indonesia’s western island of Sumatra. The doctors, who are all pulmonologists, are volunteers who have agreed to run the consultation service in addition to their regular workload.
“Our hospital beds are limited, so we appreciate patients who can isolate at home,” Dr Kurniawan said. “We also appreciate the doctors who want to give free advice, and they have been so enthusiastic about the launch of the service. We also hope that it will grow in scope so that general practitioners can also join the scheme and not just pulmonologists. We hope to add staff from local health clinics to the programme too so that people can continue to contact us and let us support them through this.”
Dr Kurniawan advises between 15 and 20 patients per day through the WhatsApp service, and says that he deals with all types of issues from what kind of medications or supplements patients need to take to more practical questions including the amount of time they should spend in isolation. Patients also ask about other issues such as whether they need repeat COVID-19 tests and when, or if, they should get vaccinated.
‘Active’ response
Given the demand and the limited resources, the doctors’ consulting hours are limited to Monday to Friday between 8:30am and 4pm to reduce the risk of burnout. In reality, however, Dr Kurniawan says that many give advice outside of these hours.
More than 100,000 people have died from COVID-19 in Indonesia. Doctors hope closer monitoring of those isolating at home can reduce the risks of serious deterioration in the patients’ condition [File: Chaideer Mahyuddin/AFP]According to Nasier Husen, a documentary filmmaker based in the city of Lhokseumawe on the east coast of Aceh, the WhatsApp consultation service is particularly important in the province, because many people who self-isolate or suspect they may have coronavirus often try to hide it for fear of stigma and a misunderstanding of the health risks involved.
“If people hear that someone has or had COVID-19, they often immediately overreact and think that it means that they will also automatically become infected. They think that the effect will be enormous,” he told Al Jazeera. “One of my neighbours died of suspected COVID-19 and the community immediately panicked and many people wouldn’t go near his house or anywhere near his family, even with health protocols in place.”
Husen added that it is customary for communities to congregate for communal prayers when someone has died in Aceh, which is the only province in Indonesia to practice Sharia law. If someone is suspected or confirmed of having died of coronavirus however, people will often choose not to attend the prayer sessions, even though these have been adapted to the pandemic.
Husen says that as a result of the stigma that surrounds the virus, social pressures often mean that people prefer simply to isolate without telling anyone. “It is still something that is very hidden. People feel uncomfortable and don’t want to make others feel uncomfortable as well,” he said.
For Azlinda, who tested positive for coronavirus several days after her husband, the WhatsApp service has been like a lifeline.
Azlinda has found Dr Kurniawan’s chat group reassuring as she and her husband isolate at home with COVID-19 [Courtesy of Hambal M Zain]The 53-year-old housewife contacts Dr Kurniawan first thing in the morning when she sends him a picture of her husband’s oximeter that measures his saturation levels and writes a general update of how the couple is progressing.
She sends another update around lunchtime. If she is late or forgets to contact Dr Kurniawan, he will often check in with her in the late afternoon to make sure that Azlinda and Zain are doing well.
“I’ve told all my friends [about the WhatsApp service]. If you get sick and need to isolate, you will be taken care of,” Azlinda said. “We are so much more comfortable at home and feel much calmer isolating here now that we know Dr Kurniawan cares so much. I have told my friends that they don’t need to be scared any more.”
While the programme is still in the trial phase in Aceh, Dr Kurniawan says that it may be difficult to implement in other parts of Indonesia where the pandemic is even worse.
“Jakarta and wider Java are in complete chaos, especially because of the Delta variant which is scary for everyone. The programme has received a positive reception so far, but it may be tricky to roll out as doctors in hard-hit areas like Java are absolutely exhausted.”
Dr Kurniawan says that it was rising cases across Java that also inspired him to start the service, and that he hopes that this approach will slow the pandemic in other areas like Sumatra.
“Until now, doctors treating coronavirus in Indonesia have been hospital-based but through this service at least we are trying to reach out,” he said.
“We were worried by the spiking case numbers and decided that we couldn’t wait and that we had to get moving and raise awareness.
“If we do nothing, the pandemic will never end. This virus will keep mutating so we need to be active in our response.”