Letter from Indonesia: Older Adults in Yogyakarta Coping With The Changes Since 2nd March
By Hezti Insriani, Ciptaningrat Larastiti, Dyah Rahayuningtyas, Nathan Porath
On the 2nd of March Indonesia announced its first two cases of COVID-19 patients. Until this date, Indonesian nationals could look out in wonder from their vast nation-state across the seas at neighbouring countries fighting to contain the virus. Could and would this disease reach the shores of any of Indonesia’s 11,000 inhabited islands? The thought that it possibly had already done so undetected must have crossed many people’s minds. From this date, however, Indonesian complacency was dislodged and normal life destined to change.
Initially, the cases appeared confined to Jakarta and a few major cities. With the gradual increase of people in the provinces testing positive during March, government authorities and health personnel became concerned that the disease could spread like a forest fire through village communities and areas with poorer health services, making it difficult if not impossible to trace and manage. In Yogyakarta (on Java) the first reports of coronavirus infections surfaced during the third week of March. As of 13th May, there have been over 180 reported cases in Yogyakarta. Of these, at least 33 people are over 59 years and at least four have died.
Since then the Indonesian government has taken measures to reduce people’s risk of contracting the virus. Health media have been instructing people to use and safely discard masks, promoting handwashing and social distancing and persuading people to stay home and avoid large gatherings. The health authorities have also taken to checking people’s temperatures and sanitising public spaces. Directives for some of these measures are presented in unthreatening and easy to follow animated films on television and the internet. Indonesian officials have also expressed their concern with the heightened vulnerability of older people, recognising that special measures should be taken to protect them.
One major worry in stemming the virus has been the potential for its spread through mass inter-regional mobility. With rapidly diminishing economic possibilities in larger cities and the homeschooling policy, there was concern that many people would want to return to their natal village, thereby putting elders at risk. Some returnees were unwilling to self-isolate upon arrival. This caused antagonism towards those who flaunted quarantine procedures. In Yogyakarta, there have been reports of unpleasant situations between villagers and returnees. People were asked to self-quarantine, and basic food items have been organised for those infected with the virus. Some sub-districts in Yogyakarta have turned to more extreme measures. In response to the influx of returnees, residents have independently placed their residential area under lock-down. They have set up barriers in roads leading to their hamlets and placed guards to bar people from entry without permission. Most of the signs on these barriers warn people not to underestimate the severity of COVID-19’s threat to people’s lives.
Closure of the main road to a subdistrict in Yogyakarta. The banner reads, ‘Emergency Response Centre, main gate for exiting and entering the village’ (Photo by Rahayuningtyas).
Although village lockdown has not been encouraged by the central government, provincial governments have been allowed to make their own decisions as to what strategies they want to take. Posters with the image of an elderly person requesting younger relatives not to visit them this year have been appearing on street corners.
A further worry was how to manage the movement of people during the days leading up to Ramadan. Normally, prior to the start of the fasting month, many people return to their natal villages for annual visits. Congregational prayers are carried out in mosques and prayer houses, and people break the fast together in larger gatherings. This year has seen encouragement for people to stay put, pray from home and avoid making social visits. For those who cling to the conviction that communal prayer in the mosque is more powerful, sterilising units have been placed at the entrance and the floor is marked to encourage social distancing. With the mosques much quieter this year, the ‘takjil’ food traditionally prepared for worshippers who break the fast together is being distributed among local families experiencing economic hardship.
A sterilising unit in a mosque as one strategy to prevent the spread of the virus by those attending congregational prayers. The sign reads ‘(It is) required to enter the unit before entering mosque’ (Photo by Rahayuningtyas)
Many of the measures to reduce the virus risk to older people may not be feasible for them to follow. Whereas some older adults enjoy a pension, others continue working in their rice fields or work as market or street vendors. For these older people practising social distancing and keeping hands constantly clean in public places can be very difficult. Whereas many Indonesians wear masks in public, not everybody is able to purchase one. Concerned NGOs have been seeking donors to get masks to the older population.
Practising social distancing while praying in a mosque in Yogyakarta (Photo obtained by Rahayuningtyas)
A member of Indonesia Ramah Lansia (IRL)/Indonesian Elderly Friendly Organisation hands over a donation of masks to a hamlet head. The label on the box reads ‘donation of non-medical masks for the elderly people’s school’ (Photo courtesy IRL).
In Yogyakarta, there is still relatively easy access to medicine and medical facilities. Hospitals and primary healthcare services remain open although older adults are advised to avoid them. Older Indonesians must be initially shocked to see health personnel dressed in PPE. One older adult returning from a hospital visit in Yogyakarta confided to his daughter that he had “a sense of loneliness and fear, the medics and doctors were dressed like astronauts!” He was not the only person to react with anxiety on seeing the new medical dress. The way medicine is represented can influence a patient’s decision whether they want to access it. With constant warnings to keep safe from the virus and the sight of hospital personnel attired in a way usually seen only in sci-fi movies, many older adults might feel more than a little anxious to visit hospitals for their monthly check-up or other health needs.
A member of IRL teaching older adults how to wear masks (Photo courtesy IRL)
Visiting older adults by formal and volunteer carers from primary health care services have been stopped due to the pandemic. Some local volunteers are older adults themselves. Social programmes and activities organised by concerned local NGOs for the social well-being of the older population have also been temporarily put on hold, as have religious institutions offering face-to-face social services for older people.
Javanese poster on Yogyakarta street corner: ‘Son and daughter, if you miss me, just make a phone call. It’s the corona season. Don’t return (home). Your return will endanger your mother and father’ (Photo by Larastiti).
During the pandemic there still is family to socialise with. Older adults in Yogyakarta usually live with other family members or have family members living close-by. The younger relatives can purchase medicine and food. Whether this is a safe solution depends on the younger people’s own measures to protect themselves in public. For poorer older adults living in small overcrowded houses, it would be difficult if not impossible to keep a distance from an infected family member. We can also surmise that it is most difficult for elderly people to keep a distance from their children and particularly grandchildren who are not living with them. For many older adults who are not technologically literate or lack the appropriate technology, using social media for virtual visits might not be an option. Thus, family members living locally may still try to sneak in a visit. After all, it must be very difficult for a grandparent to reject a visit from an angelically exuberant grandchild!