The story from the igd doctor, the front line of handling covid

Experts say handling the COVID-19 pandemic in Indonesia must be done from all sectors. Of course, with medical personnel who are at the forefront of tackling this pandemic.

Currently, 29 days have passed since Indonesia first confirmed its first positive case of COVID-19 in Indonesia. The wave of the COVID-19 pandemic in Indonesia continues to increase. Medical personnel are overwhelmed, while energy must be pumped in such a way.

"We are like we are at war but we don't have complete weapons, we don't have supplies of weapons," said Doctor Tri Maharani on Friday (27/1). He is a specialist emergency who currently works as the head of the Emergency Room department at the Daha Husada General Hospital, Kediri.

The specialist doctor's story emergency in handling COVID-19 in Indonesia

Doctor Tri Maharani talked about how he handled COVID-19. How the hospital where he worked was flooded with People Under Monitoring (ODP) and Patients Under Supervision (PDP).

ODP is a person who has a history of traveling to a place infected with COVID-19 or having had contact with a positive patient, but has not shown any symptoms of illness.

Meanwhile, PDP is a person who has shown symptoms of COVID-19 such as runny nose, cough, shortness of breath, sore throat; have ever traveled to a place infected with COVID-19; or have interacted with positive patients.

He had to find a referral hospital for these patients for further treatment and it was not an easy matter. All referral hospitals in Kediri are full even though the patient must immediately get treatment in the ICU.

The flow of ODP and PDP patients in Indonesia continues to increase, not to mention the handling of other patients besides COVID-19.

COVID-19 Outbreak updates Country: IndonesiaData

1,024,298

Confirmed

831,330

Recovered

28,855

DeathDistribution Map

The increase is up to 200 percent from normal days, but the labor force does not increase. Each shift has only three nurses, one doctor on duty, and doctor Maha as the head.

Even today, dr. Maha, Maharani's nickname, even had to work three shifts to take care of the COVID-19 case in his hospital.

"If I don't have a problem for up to three shifts, the nurse and doctor on duty have to be guarded by their energy and mind so that they can take care of the patient optimally," said dr. Maha.

Keep medical personnel at the forefront of handling COVID-19

If handling COVID-19 in Indonesia is likened to war, then medical personnel are the main force at the forefront. Their position is very vulnerable. Therefore, they must be equipped with complete weapons and means of defense.

Reporting from the Executive Board of the Indonesian Doctors Association (PB IDI), until Monday (6/4) at least 24 doctors died from COVID-19. They consist of 18 doctors and 6 dentists.

According to dr. Maha, completeness of personal protective equipment (PPE) is one of the most important things that must be given to health workers.

Doctor Maha who also works as advisor The World Health Organization (WHO) for snake bite cases said that medical workers in Indonesia must be given security in handling COVID-19 cases.

The hospital where he works is a COVID-19 pre-referral hospital, where they accept patients who are not known whether positive for COVID-19 or not. In principle, the treatment of all patients was considered positive, namely by using complete PPE, maintaining distance, and minimizing contact.

But the application in the field did not go well.

"Currently PPE, masks, and alcohol, all are lacking. If the condition is like this, how can we focus on treating the patient? " said dr. Maha.

Moreover, after the patient was transferred to the referral hospital, the medical staff at the pre-referral hospital did not receive information on whether the patient was positive or negative. This worries medical workers who have been in contact before.

Medical staff must focus on handling patients even though they have to spend extra energy and remain professional amid the lack of adequate protective facilities.

"My principle is to make them think only of the patient at work, pay attention to all patient complaints, without worrying about the completeness of PPE, without thinking about what to eat, and other things," said dr. Maha.

These needs are also so that health workers avoid fatigue, lack of vitamins, and anxiety. Three things that are very important in maintaining focus in carrying out tasks.

Evaluation note: one month of handling the COVID-19 pandemic in Indonesia

Major disasters in Indonesia are not new, from natural disasters to non-natural disasters caused by disease outbreaks.

"But disaster in fact caused by the virus is not able to make us learn about mitigation and prehospital which is good, "said dr. Maha, who for more than 20 years of his career has been dedicated to medical management in disaster areas.

Doctor Maha gave notes on the handling and intervention of COVID-19 that had been carried out in Indonesia so far.

“Indonesia is arguably the last country affected by COVID-19, apart from China, there are South Korea, Singapore, Vietnam who were first affected. Why don't we all learn from the start and take steps? ” said dr. Most sorry.

"If only since December, Indonesia had already had mitigation measures. Starting from controlling the selling price of masks and PPE, to training medical personnel, "he continued.

In one month, the guidebook and instructions issued by the Ministry of Health for handling COVID-19 in Indonesia have changed four times. This is according to dr. This is one small piece of evidence that Indonesia is stuttering in facing COVID-19.

Advice and predictions for the COVID-19 pandemic in Indonesia

Several researchers made models to find out when the peak time for the spread of COVID-19 in Indonesia.

One of them is a study conducted by ITB researcher Donny Martini. He made a model using two parameters: distribution rate and population size.

The study predicts that the peak spread of the coronavirus pandemic will occur in the middle of Ramadan, between April and May.

However, this prediction could be faster and more precise or much longer, depending on the interventions carried out by all sectors.

Such predictions must be followed by appropriate and integrated countermeasures. According to dr. Maha, the COVID-19 pandemic in Indonesia could end quickly if there were ties in the handling intervention that made all sectors work together well.

Regarding health management interventions, the following is a suggestion from dr. Maha.

Handling COVID-19 in Indonesia starts with empowering health centers

In order to avoid accumulation of ODP and PDP patients, study patients (screening) starting from a level one health facility.

Doctor Maha recommended that puskesmas officers be trained for simple laboratory physical examinations. Provide puskesmas with easy access to supporting examination tools such as x-rays or direct distribution rapid test which the government has bought.

"Indeed rapid test the result is 30% accuracy, but it's okay. It can be used for screening, screening the term, "said dr. Maha. " Screening starting at the bottom, at the grass roots. So good at mitigation."

Patients with negative results from screening still under surveillance for a few days, while patients with positive results are admitted to type D and type C hospitals.

From there, the patient will carry out a second test. If the second test is positive, it will go up for the test Polymerase Chain Reaction (PCR) in type B and type A hospitals.

The most important thing is to create a strong network to connect communication between puskesmas, type D, type C, type B, and type A hospitals.

"Don't give it all to Eijkman or Litbangkes. They won't be able to. Indonesia has many clinical pathologists. If you can't, do it online training even two to three times, "said dr. Maha.

The Eijkman Institute and the Health Research and Development Agency (Litbangkes) are two institutions dedicated to the process by the government screening COVID-19.

According to dr. Maha, it is common for long distance consultations to seniors and experts in the medical world.

Compliance with drugs and tools to treat life-threatening symptoms

COVID-19 is a new virus that scientists still don't fully recognize. There is no drug that can really treat SARS-CoV-2 virus infection.

According to dr. Maha, Indonesia should not depend on research conducted by other countries, especially on medicine. This is because its application to COVID-19 patients in Indonesia could be different. The differences can be due to comorbidities, the immune system, or other conditions.

So far, the key to the safety and recovery of COVID-19 patients is rapid handling of symptoms that arise not specific to the use of certain drugs.

"So that means, buy or provide drugs and tools for handling that nature life threatening (life threatening). In this coronavirus problem, the most common causes of death are pneumonia and respiratory failure. That means Indonesia has to buy a lot of ventilators, "said dr. Maha.

The most important thing, according to him, is to save the patient's life. Doctor Maha took the example of Singapore, which until now the death rate from COVID-19 is very low.

"I use a ventilator because the biggest death was caused by respiratory failure. That was what was handled first, saving lives, "said dr. Maha.

Leave the patient handling to the experts, the government makes a system and policy

After providing the drugs and tools needed for treatment life threatening , the next thing to do is hand over the handling of COVID-19 patients to a team of doctors.

"Let the doctors do the work with." art and knowledge (art and knowledge). They do this together with collegials and medical associations, ”said dr. Maha.

The specialist doctors discuss with their respective organizational bodies to discuss the most appropriate treatment for their patients.

"Doctors will understand what effect COVID-19 has on these patients, what must be done, and which experts should consult. The doctor won't inconsequential give drugs, so let them determine. There is no need to buy drugs that other countries say are effective, "explained dr. Maha.

Medicines and tools for the management of life-threatening symptoms, screening starting from grassroots and an uncomplicated referral path, meeting the needs of medical personnel, and submitting patient care to the medical team are four aspects that dr. Maha.

These aspects must be tied to regulations, and it is the government's job to make these regulations.