In fact, aside from being a social problem that is causing anxiety and depression, stigmas are making efforts difficult to break the chain of transmission.
By
AHMAD ARIF/ DEONISIA ARLINTA
·6 minutes read
Kompas/AGUS SUSANTO
A woman underwent a test with the polymerase chain reaction (PCR) method or a swab test in the operation of the Mobile Laboratory Biosafety Level (Lab BSL-2) at the courtyard of Moh Ridwan Meuraksa Hospital. East Jakarta, on Tuesday (16/6/2020).
JAKARTA, KOMPAS – Stigmas against Covid-19, which has spread across Indonesia since the first cases were detected in early March 2020, have been growing as a result of the absence of reliable communication and weak health education for the public. In fact, aside from being a social problem that is causing anxiety and depression, stigmas are making efforts difficult to break the chain of transmission.
The social stigmas that people who have or have had the disease are experiencing vary from prejudice to being shunned by neighbors, to being evicted from their homes. Albert Ade, a Covid-19 survivor, said that when he tested positive for Covid-19, a number of his neighbors grew worried that they might be infected and stayed away from him.
So far, the victims of social stigmas against Covid-19 have included suspect cases of the disease, confirmed cases, and health workers, as well as their families.
"Many people refuse to be tested and do not want to be open [about their condition] for fear of being stigmatized. Covid-19 is considered shameful,” professor Akmal Taher of the University of Indonesia (UI) medical school said in Jakarta on Sunday (11/10/2020).
The emergence of stigmas against Covid-19 indicated poor health literacy, which has existed for a long time.
"Social stigmas against HIV/AIDS, leprosy and other infectious diseases are an old problem in Indonesia," said Akmal. Other countries like Thailand had taken serious measures to address the issue of social stigmas against disease before the pandemic even emerged.
Executive chairman Daeng M. Faqih of the Indonesian Medical Association (IDI) said that social stigmas had more to do with concern and fear of people with disease. "It should have been prevented if the early efforts at mitigation were optimal," he said.
Social stigmas against HIV/AIDS, leprosy and other infectious diseases are an old problem in Indonesia
Kompas/Wawan H Prabowo
A medical officer prepares a polymerase chain reaction or PCR test kit to detect Covid-19 at Pondok Indah Hospital (RSPI) Bintaro, South Tangerang, Banten, on Saturday (19/9/2020).
Some people are afraid to reveal their positive Covid-19 diagnosis because they do not want to be shunned by their neighbors. This hinders the testing, tracing and treatment of patients. The situation could even become more dangerous if people with comorbidities live in the same household with people who have contracted Covid-19.
Irma Hidayana, a public health researcher and a founder of Laporcovid19.org, said that the stigmatization of Covid-19 was exacerbated by unclear patient management, including delays in testing and in the responses of local health services. Her team had received many complaints. One of these came from a tenant of a rental room in Depok, West Java, who was evicted because he had tested positive for Covid-19, while the local puskesmas (community health center) did not help him locate a self-isolation and treatment facility.
Range of stigmas
The results of a survey Laporcovid19.org conducted with the UI psychology faculty’s Social Intervention Specialty Group show that stigmatization targeted those who had recovered or currently had Covid-19.
The stigmas they experienced included being the subject of rumors/gossip (55.25 percent), being shunned (33.15 percent), being blamed for spreading the virus (24.86 percent), and cyberbullying (9.39 percent).
Moreover, some had been prohibited from using public facilities (4.42 percent), denied assistance/services (4.42 percent), evicted from their placed of residence (3.31 percent), or dismissed from their workplace (0.5 percent).
UI psychology lecturer Dicky Pelupessy, who was on the research team, said that up to 181 respondents took part in the online survey, which was conducted in August 2020. The respondents included health workers, who comprised 56.35 percent of all respondents, as well as teachers, daily wage workers, employees, students, and members of the Indonesian Military (TNI) or National Police (Polri).
A man receives a vaccine injection during a simulated trial of giving the Covid 19 vaccine at the Tanah Sareal Community Health Center, Bogor City, West Java, Sunday (4/10/2020). The simulation was carried out for the readiness of the Tanah Sareal Health Center in Bogor City, which is one of the two health centers in Indonesia designated for the implementation of the Covid 19 vaccine trial.
The majority of those who experienced stigmatization were people who had tested positive for Covid-19 (39.78 percent), people who had been declared suspect cases (26.52 percent), people who had sought testing at health facilities (12.71 percent), people who had recovered from the disease (12.71 percent), and people who were hospitalized (8.9 percent).
Dicky said that stigmatization had serious implications for the mental health of respondents. The majority experienced low-level depression (66.3 percent), while 33.7 percent experienced severe depression. As a result, 78.4 percent had suffered mild anxiety disorders while 21.5 percent suffered severe anxiety.
Those who suffered severe depression presented nine out of 12 symptoms. These symptoms included difficulty concentrating, difficulty sleeping, difficulty making decisions, excessive worrying, loss of self-esteem, and feeling unhappy.
Meanwhile, those with mild depression experienced four to eight symptoms.
"It has a long-term effect on the victims and disrupts productivity. Moreover, many continue to experience stigmatization even after they had received a clean bill of health,” he said.
Health workers
The stigmas they have experienced is extremely burdensome amid their increasing pressures at work
Among health workers, stigmatization is a very serious problem. Herni Susanti, a lecturer of mental health nursing at the UI nursing faculty, said that the stigmatization of nurses and their families had caused anxiety and depression. Some even thought about ending their lives.
A survey involving 1,172 nurses showed that all respondents had experienced stigmatization, of whom 26 percent said they had experienced severe stigmatization and 74 percent mild stigmatization.
"The stigmas they have experienced is extremely burdensome amid their increasing pressures at work," Herni said.
Kompas/AGUS SUSANTO
A man undergoes a polymerase chain reaction (PCR) or swab test at Moh Ridwan Meuraksa Hospital, East Jakarta, Tuesday (16/6/2020). The mobile testing will serve people who have registered through the Covid-19 monitoring app and the results will be sent to their respective mobile phones.
The stigmatization they experienced took a variety of forms, including local residents avoiding seeing nurses, being evicted from their homes, being prohibited from taking public transportation, their families being ostracized, being prohibited from marriage, and threats of divorce from their spouses.
Herni explained that a follow-up study using a qualitative approach found a shift in the form of stigmatization against nurses.
"Evictions decreased, perhaps because nurses limited their interactions in their environment. However, stigmas are widespread in society because the number of cases is increasing,” she said.
Child and family psychologist Mira Amir said that the social stigmas were a result of the limited information the public was receiving. This was exacerbated by the information distortion on social media. "The sharing of unacceptable information could be a cause," she said.
Chairman Ede Surya Darmawan of the Indonesian Public Health Experts Association (IAKMI) said that misunderstandings about illness and health among the public needed attention. Health must be maintained while illnesses must be treated immediately, not avoided.
Patients were experiencing greater stigmatization because the health system was not yet optimal.
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