May 11, 2020
By May Rahmadi
Dawn had not yet broken in Cileungsi, Bogor, when 31-year-old Widya Astuti, 36, was already on her way to work at the Sulianti Saroso Hospital for Infectious Diseases in the Sunter area of North Jakarta. Astuti, is a nurse.
“I wake up at three thirty. I then hold my prayer and then prepare breakfast at home. After morning prayer’s time, around five or five thirty, I leave, board a public transport, If it happens that my husband also has to leave at the same time, then I will go with him,” Astuti told Ekuatorial on Wednesday (1/4).
She spends half her day for work, a fourth for her family and another fourth to rest. At home Astuti still has to care for her children who are still in primary school.
“I get home around six or seven in the evening. Once I got home, again I put order into the house such as washing the dishes, or helping my children do what they have to do, or other things, I would sleep early because I usually am already tired by then,” she said.
At the Sulianti Saroso hospital, Astuti works at the isolation room with 28 other nurses, The Covid-19 pandemic is making her busy with the intense monitoring and caring of patients. She also has to continuously record her patients’ vitals such as blood pressure, heartbeats, and body temperature.
Astuti also must make sure that the needs of the patients are also met. She sometimes has to spoon fed patients or help them get to the bathroom. “One nurse takes care of two patients,” she said.
The isolation rooms where she works are only three by four square meter. One patient gets one room that is equipped with a bed, a television set, and an en-suite.
Between isolation rooms, there is an intermediary room known as an anteroom, where nurses can change into protective gear.
The isolation rooms differ from the normal hospital rooms. Due to the highly infectious nature of the patients’ disease, nurses must wear complete protective gear that has to be changed every time the nurse leaves an isolation room.
Astuti spends about two to three hours in isolation rooms in a day to care for the patients. Following her visits to isolation rooms, she heads to the nurse’s room to study medical records of the patients.
She said that the handling of Covid-19 patients is similar to the handling of patients of other infectious diseases, such as bird flu or MERS. But the difference being that with Covid-19 patients, their psychological conditions need special attention.
“Under the isolation condition, the patient sometimes cries, or are scared, because their family cannot visit, they can only see them through a video call or hear them on the telephone. Sick people that cannot be visited by their family face a different psychological problem.” Astuti said.
What she usually does is chat with the patient, sometimes also sing to keep them entertained.
“We once treated a foreigner and she was an elderly and alone in Indonesia. We invited her sing to with us,” Astuti said.”Every time we enter her room, she would cry but after that, she would say ‘I am glad that you can come here. I am not alone.’”
It is moments like these that made her forget her exhaustion. Astuti feels useful because she could make her patient comfortable.
As a nurse, however, Astuti does not get mental health therapy or services.
“Sometimes, we have our Whatsapp group, where we can mutually boost our moral. Maybe because this hospital is a reference hospital, we are used to dealing with HIV patients or sufferers of tuberculosis that is resistant to drugs, as they too are isolated. We are used to cases of infections so I think my friends here are psychologically already used to this,” Astuti said.
On medical workers’ mental conditions, the Journal of American Medical Association conducted a survey on the mental health of medical personnel who cared for Covid-19 patients and it showed that around half of the 1,257 medical personnel in 34 hospitals in China who were surveyed, reported some symptoms of depressions, 45 percent suffered from anxiety, 34 percent from insomnia and 71.5 percent felt being under psychological pressures.
The study that was released on March 23, 2020 showed that female nurses suffered from serious mental health problems. They have to hide their feelings because they have to care for their Covid-19 patients who continue to arrive at the hospital.
Female nurses have the long-term potentials of suffering from stress. The survey concluded that the protection of medical personnel including mental health protection, is an important element in the handling of the Covide-19 pandemic.
Astuti added that she was not at all worried that she might get infected by her patients. Astuti said the procedures to be followed at the hospital are already complex and safe enough.
One of them is that one must immediately shower following visits to isolation room.
“Every time we go into a patient’s room, we have to shower. If the patient suddenly calls us again, we have to put on the protective gear again, and when we leave we have to shower again. That is how it is. Every time we leave an isolation room we have to shower. Before we go home, we have to shower and change into cloths to go home. Therefore, God’s Willing, we can safely return home because the procedure is quite complex, having to shower several times. When I reach home, I would shower again, because I had to go through the trip home,” she said.
The National Commission Against Violence on Women, includes nurses into the category of women that are vulnerable to Covid-19 infection. Commissioner Mariana Amiruddin in a press statement, said that the increasing in the number of Covid-19 patients was not commensurate with the number of nurses. While protective gear were also very limited in number.
“They have to work hard in excess of normal working hours, amid the limited social security and even facing the possibility that whey would have difficulties finding a place to stay because of the stigma in their environment,” Amiruddin said.
A 2017 data from the National Association of Nurses of Indonesia (PPNI) showed there are 359,339 nurses. Around 71 percent of that or more than 250,000, are women.
The commission also pointed out that other women who are vulnerable to Covid-19 include those working in services directly in contact with people such as cashiers, receptionists, customer service, marketing or even sellers at the market. Not all of them can maintain a safe distancing with clients or buyers.
Three weeks after the first case of Covid-19 was announced in Indonesia on March 2, the commission stressed the importance of an approach that integrated human rights with special protection for women.
Policies on the handling of Covid -19 that required a physical and social distancing, have specific impacts on women.
Particularly, in relations to the position of women in the family and as a female worker. “The social distancing policy can only increase the multi-layer work load for women, especially as mothers,” Amiruddin said.
The government had previously decided on a policy of physical and social distancing that later led to work from home or the reduction of operational working hours, leaving employers to decide between cutting wage or not paying their employees at all, as company income dwindle.
Chair of the Inter-Factory Workers Federation (FBLP) Jumisih says the policy on social and physical distancing is an additional burden for her as a working woman.
She said that she still had to split her time and energy to be a mother, a labor movement executive and a student. Although she had already split domestic chores with her partner, she still feels overwhelmed.
“I have some difficulties dividing my time, because just as I have to attend my only course, my children must also do their work online. Therefore, could not really concentrate on my course because I also have to help my children do their school tasks. And in my resting time, I still have to build communication with other members of the organization,” Jumisih said.
Despite this, she remained in agreement with the policy of physical and social distancing in a bid to curb the spread of Covid-19. But she deplored that the government appeared to be half-hearted in implementing the policy.
This could be seen from a number of regulations which are not accompanied by wage protection or social security.
“On one hand, it calls for social distancing but there does not appear to be any protection of wage and work continuity, and sustainability so that they can survive during the pandemic) and this is what we actually demand from the government,” Jumisih said.
She expressed hopes that the government seriously think about not only the handling of Covid-19 but also a comprehensive protection for workers. She wanted that the policy on the handling of the pandemic is spread out and could be benefited by all.
“So, the government shouldn’t be half-hearted. If they implement the work from home policy, then do not be discriminative, meaning that only certain people can do it. For the likes of me, who works in the garment industry, this cannot be done,” Jumisih said.
“The government should consider impacts of massive job dismissal. Also, the matter of annual bonus that workers would normally receive, as it is nearing the Eid al Fitr Holiday.”
After the social and physical distancing policy began to come into effect, many workers filed complaints to her organization, Jumisih said. They complained that their companies were dismissing their contract workers.
“So their contracts were not extended by the employers because export is not running well. Last week, there were around 30 of our members who were laid off in North Jakarta,” Jumisih said.
Higher infection risk for women
During the Covid-19 pandemic — in reference to previous epidemics — besides facing problems of work load and welfare, women also face the highest risk of being infected because of their role as care givers or medical personnel. This was expressed by the United Nations Population Fund (UNFPA) on its official website during the Ebola epidemic in West Africa in 2014-2016.
The closing down of schools adds up to the load of caring for home and the family, a responsibility that would normally be handed to the woman in the house. When women are exhausted after caring for their family, household and other activities, their body’s immune usually weakens and as a result, they become increasingly vulnerable to virus infections.
Operational restrictions that affect the service industry and informal workers also have greater impacts on women, who, in numbers, dominate those sectors. In Indonesia, the Central Bureau of Statistics (BPS) noted that 61 percent of the Indonesian workforce are female informal workers. And the sector that absorbs the most female workers, at 53.86 percent, is the creative economy sector.
The National Commission Against Violence on Women has issued a number of recommendations for the government to protect women who are more vulnerable to the impacts of Covid-19, namely the Minister for Women Empowerment and Child Protection and the Acceleration of the Handling of Covid-19 Task Force
The commission calls on the task force to prepare an affirmative approach in the prevention of Covid-19, concerning the vulnerability of women, the development of mental health services, and ensure access to information in relations to the mitigation of Covid-19.
For the Ministry, the commission says that the government needs to make sure the accessibility of quality services, and an inclusive perspective in counseling. The Ministry also needs to work together with the Ministry for Communication and Information to develop and disseminate information that uses a gender equality perspective in pushing for gender equality in the domestic sphere.
Minister for Women Empowerment and Child Protection Bintang Puspayoga said she is aware of women’s vulnerability in the times of Covid-19. In a meeting with the Commission VIII of the House of Representatives on April 10, 2020, Puspayoga mentioned a rise in the risk of Covid-19 infection on women and increasing gender-based violence.
“In this Covid-29 pandemic situation, the risks of gender-based violence is rising, triggered by the stress level resulting from the economic conditions and the double burden. The risk of infection is also high among female workers in the direct service sector, among medical personnel, poor women, the elderly , the disabled and among Indonesian migrant workers,” Puspayoga said.
Puspayoga sayst he would take the issue as a priority and promise to change the focus of activities and relocate budget for communication, information and education activities to protect vulnerable women.
“The refocusing of activities and the reallocation of budget of Rp3.6 billion will be oriented towards the provision of KIE material on the prevention and handling of Covid-19 and how to meet the specific needs for affected women and children. Counseling and special protection for children of Covid-19 victims and the cooperation of the concerned stakeholders in relations to social protection and the economic empowerment of women,” Puspayoga said.
Ekuatorial has tried to contact, by telephone and short text messages, the Deputy for The Protection of Women’s Rights at the KPPPA, Vennetia Ryckerens Danes to learn about the progress in modifying activities and the reallocation of funding, but until this story is published, no response has been received. Ekuatorial.