Health workers in Papua ask for security guarantees after KKB attack on Puskesmas - 'Don't let it happen to friends in other districts'

Health workers (nakes) in Gunung Bintang Regency, Papua, ask for assurances from the authorities so that they can carry out their duties safely.

This request came after an attack on a Puskesmas in Kiwirok district by armed groups that resulted in the death of a health worker, the first reported attack on a health facility in Papua.

Health services in the district are said to have resumed operations after being stopped.

The head of the doctor's association in Papua said the armed conflict in the Kiwirok district had hampered various health programs in the region.

Last Monday (20/09), four health workers from the Kiwirok district visited the Komnas HAM office in Jayapura. They recounted their situation and asked Komnas HAM to facilitate a meeting with the Papuan Police Chief, said Frits Ramandei, representative of Komnas HAM in Papua.

Frits said Komnas HAM also facilitated health workers to convey their hopes to the local government of Gunung Bintang District through the head of the Health Service.

"Their hope, the most important thing is how one of their friends who died can be evacuated for the funeral process, while one who has not been found until now, what will happen to them.

"And they're begging that something like this doesn't happen to their friends in the other districts," said Frits.

According to Frits, the health workers are still in such a state of shock that they don't want to speak to reporters, but they are "strong enough".

Nine health workers on duty in the Kiwirok district were evacuated to Jayapura on Friday (17/09), and all of them are said to be under medical and psychological treatment.

TNI officers are still trying to evacuate the body of Sister Gabriella Meilani and find a health worker who is missing.

Meanwhile, medical personnel in 34 districts and 277 villages have reportedly been pulled to the capital of the Bintang Mountains Regency, Oksibil, due to concerns for their safety.

Spokesman for the Governor of Papua, Rifai Darus, said that currently health services in the district capital have resumed running, but have not been maximized. Meanwhile, in the Kiwirok district, it has not yet started.

Previously, the Indonesian Doctors Association in the Papua region informed that all health services in the Kiwirok, Oksibil, and Bintang Mountains areas were suspended while waiting for security guarantees from the government for the health workers on duty.

Rifai told BBC News Indonesia that Papua Governor Lukas Enembe was working on it.

"The Governor of Papua will communicate and coordinate with the leadership of the TNI and the Kapolda in order to prepare for the security and comfort measures that will be carried out. There will be a meeting on Wednesday tomorrow," he said by telephone.

Health program hampered

The attack on the Puskesmas in the Kiwirok district last Monday (13/09) hampered the ongoing health programs in the area, said the Head of IDI for the Papua region, dr. Ronald Aronggear.

Among the health programs are efforts to reduce maternal and child mortality and cataract removal.

"I must emphasize again, apart from other problems, they have a program that must be enjoyed by people in the mountains, who must receive the same services as those obtained elsewhere," said dr. Ronald in a virtual press conference, Friday (17/09).

According to dr. Ronald, the incident in Kiwirok received a response from health workers in other remote areas.

Many of them are still working, said dr. Ronald, but asked not to let something like that happen at the Kiwirok Health Center.

"Many of them are friends from outside Papua, they left their families to serve the community, so they feel it's good to have a sense of security so that they are protected. That's what they said," said dr. Ronald.

The attack on the Kiwirok Health Center seems to have taken health workers in Papua by surprise. To the knowledge of dr. Ronald, this is the first time that health facilities and health workers have been targeted directly by armed groups.

He recounted that during the riots in Wamena two years ago, there was indeed a doctor who became a victim while on his way to the city. But the attackers didn't know he was a medic.

"I hope this [Kiwirok Health Center] is not a target, we hope this is an 'person' who does something and doesn't know what he's doing. Because I know very well that Papuans shouldn't be able to do that," said dr. Ronald.

Violence continues

The burning of the Puskesmas in the Kiwirok district began with a shootout between the TNI and what the government calls the Armed Criminal Group (KKB).

According to the TNI statement, KKB attacked and set fire to several public facilities, including offices, markets, schools and health centers.

A health worker who survived, Marselinus Ola Atanila (35 years), told the media that KKB broke the glass of the puskesmas, then doused gasoline and set the health center on fire.

The perpetrators then moved to the doctor's barracks where doctors, nurses and orderlies were hiding.

Four health workers tried to save themselves by jumping into a ravine, Ola said, but then several members of the KKB followed them.

Ola said he was hiding among tree roots, but KKB found three of his comrades. At that time, Ola admitted that she witnessed her colleague being stripped naked and tortured by KKB.

As a result of the torture, a nun, Gabriella Melani, died.

The West Papua National Liberation Army of the Free Papua Organization (TPNPB-OPM) has claimed responsibility for this attack in statements to several media. However, the spokesman for TPNB-OPM, Sebby Sambom, has not yet responded to a request for confirmation from the BBC.

However, he was quoted by several media as saying that a doctor at the Kiwirok Health Center first took out a gun and fired. The claim was denied by one of the surviving doctors.

The attacks on the Puskesmas and public facilities in the Kiwirok district are part of the ongoing violence between the TNI and KKB since the killing of a Trans Papua project worker in Nduga in 2018.

Previously, there were attacks that killed civilians including a priest and two teachers.

Komnas HAM representative for Papua, Frits Ramandei, emphasized that this conflict could not be resolved with a violent approach.

Komnas HAM, Frits said, encouraged President Joko Widodo to form a team that reports directly to the president and work secretly to develop humanitarian dialogue with community groups in Papua with different views.

What is meant by humanitarian dialogue, according to Frits, means "there is equality between the team formed by the President and them for dialogue in the context of being citizens, even though there are parties who are ideologically different."

"The welfare approach is important, very important. But the humanitarian dialogue approach, by listening to the voices of those who are guerrillas in the forest is also much more important," he said.

The reproduction number of Covid in Indonesia is below one, is the pandemic really under control and when can we take off our masks?

The Indonesian government said the Covid-19 pandemic situation was under control, judging from the effective reproduction rate (R-rate or Rt) for the first time during the pandemic, which was below one, which was 0.98.

However, epidemiologists disagree with this because the R-rate is a number to show the speed of transmission, not a measure of whether or not the Covid outbreak is under control.

The decrease in Rt, according to him, also does not necessarily become one of the factors to make easing that can make the public gather.

There are several conditions to declare the pandemic under control, ranging from vaccination rates, reproduction rates, surveillance, to the implementation of strict health protocols.

After being hit by the harsh Delta variant last July to August, the government now says the pandemic situation, especially Java and Bali, has been under control.

Currently, there are no areas in Java and Bali that are in PPKM level 4.

Even for the first time during the pandemic, the R-rate is below one, which is 0.98 - citing the estimation results of the University of Indonesia Faculty of Public Health team - said Coordinating Minister for Maritime Affairs and Investment (Menko Marves) Luhut Binsar Pandjaitan.

The government is also conducting trials of opening shopping centers for children under the age of 12, opening cinemas with a maximum capacity of 50% and others in areas where the status of Community Activity Restrictions (PPKM) is level 2 and 3.

An example is the easing in Semarang City which fell from level 4 to 2 in September.

The status of PPKM level 2 in Semarang City, Central Java brings fresh air to the community and tourism actors.

Head of the Culture and Tourism Office of Semarang City, Indriyasari said, tourist and entertainment places in his area have been reopened with certain restrictions.

The restrictions include operating hours, the maximum number of visitors is 50% and showing evidence that they have been vaccinated through the Peduli Protect application.

"Our strategy is to increase public trust, show the perception of the city of Semarang that is safe, comfortable, the Covid cases also continue to decline so they can breathe easy and allow people to come with strict health protocols," said Indriyasari to Margi Ernawati who reporting for BBC News Indonesia in Semarang, Central Java, Tuesday (21/09).

One of the changes was felt by Hanna Ristanti, the owner of a cafe in the Tembalang area.

"In the past, we only served take away, now we can eat on the spot even if it's only until 21.00 AM, of course paying attention to health protocols," said Hanna, her nickname.

Although there has been slack, Hanna said his efforts have not been encouraging.

"Turnover has not increased, I hope that the government will care more about business actors, don't make complicated rules so that the economy will recover soon," Hanna continued.

In contrast, the swimming coach, Siti Nurhayati, directly benefited from the slack in public facilities in Semarang.

"Now, in a day, you can train for four hours, so your income also increases. In the past, you only trained one hour per day," said Siti.

The answer is no, says epidemiologist from the University of Indonesia, Tri Yunis Miko.

If a pandemic is controlled or not, he said, it can be seen from the daily curve of Covid-19 cases, the positivity rate, which has decreased steadily in one incubation period of the virus.

It is not seen from the R-rate which is the number of people infected by one case during its infectious period. That is, if the Rt is one, then one person can transmit the corona virus to another person.

"Rt less than one means there is a slowdown in transmission, I agree. But that doesn't mean the outbreak is under control," Yunis said.

Similarly, an epidemiologist from Airlangga University, Windhu Purnomo, said that the decline in Rt did not necessarily bring the pandemic situation under control.

"For example, many countries, Singapore in the north, Australia in the south. They managed to lower Rt, but suddenly it rose again, right," he said.

Windhu added, if the R-rate is below one for a consistent period of 28 days in a row, then the new positive cases can be called "relatively under control".

"At the beginning of the pandemic, our Rt was three, now it's one, it's getting better. But that Rt goes up and down."

"It is influenced by three factors, namely the characteristics of the virus, such as Delta, then the longer the infectious period, the greater the transmission, and the strict implementation of the prokes," he said.

Spokesperson for the Covid-19 vaccination of the Ministry of Health, Siti Nadia Tarmizi also said that although the Rt was below one, the pandemic was not under control.

"Currently, the transmission rate is decreasing, but the threat of an increase in cases and a third wave is still there. Because vaccination has not reached all targets. The reproduction rate is a measure for controlled conditions but this must be seen in a certain period of time," said Nadia.

Nadia also explained that Rt is not used as a factor in making policies, but for final evaluation.

Previously, the Coordinating Minister for Maritime Affairs and Investment (Menko Marves) Luhut Binsar Pandjaitan said the pandemic situation in Indonesia was under control.

The indicator is to look at the effective reproduction rate (Rt) which for the first time was below one, which was 0.98 - citing the estimation results from the Faculty of Public Health, University of Indonesia team.

In addition, Luhut added, daily cases also show an improving trend - national confirmed cases are below 2,000 and active cases are less than 60,000.

"For Java and Bali, daily cases fell by 98 percent from their peak on July 15. With these improvements, I can say that there are no more regencies and cities that are at level 4 in Java and Bali," he said.

The government, said Luhut, will also make easing, among others, testing the opening of shopping centers for children under the age of 12, opening cinemas with a maximum capacity of 50% at level 2 and 3 areas, and others.

Based on the development of the Covid 19 situation until yesterday, Tuesday (21/09), there were more than 3,200 cases added in one day. This number is much smaller than the previous few months which reached up to tens of thousands of people.

Siti, a resident of Semarang, expressed one question that became the anxiety of some people,

"When can we take off our masks when we gather in public spaces, without any distance restrictions, we can live as usual as before?" asked Siti.

Related to that, epidemiologist Tri Yunis predicts, maybe in the next few years, after going through the pandemic, elimination, and eradication phases.

"Maybe two to three more years. Right now we are still plagued, not yet in elimination," he said.

Meanwhile, an epidemiologist from Airlangga University, Windhu Purnomo, said there are several conditions so that we can take off our masks and live side by side with Covid-19.

The first stage is the R-rate is close to zero for a long time, at least 28 consecutive days without ever touching the number one.

But can't take off the mask just yet. After that, there is the next stage, which is that we all have to be protected with 100% vaccination - which is meant if the infection is not chronic.

"Next, is strengthening supervision by testing and tracing. So if there are positive ones, they can be immediately found, isolated, and those outside are healthy."

"If it can be done, I think we might be able to remove masks like in other countries. Now? We can't," he said.

However, according to Windhu, that hope will be difficult to realize.

In the midst of the decline in Rt and positive cases, the government has instead issued an easing policy that has the potential to increase the number of cases again.

"Today, mobility is the same as the base line last March, it's dangerous. The relaxation causes mobility to increase, followed by non-compliance with procedures, crowds appear, and cases increase," he said.

"So don't be too los dol (without obstacles) even though there are easing, so it's like conditions without a pandemic," he said.

Regarding when to return to normal, the spokesman for the Covid-19 Handling Task Force, Wiku Adisasmito, said that everyone, even experts, did not know for sure.

"For this reason, the best effort being made at this time is to suppress the transmission rate properly as a new form of habit that cannot be separated, considering that we will live side by side with Covid-19 in an undetermined time," he said.