The Kongsi Covid: A Cultural and Religious Belief Approaches for Covid-19, Battling Stigma and Strengthening Family Resilience for Villagers in Padang, Indonesia

Abstract

Background: The stigma of Covid-19 is culturally rooted in health beliefs and practices in Padang-Indonesia. The aim of this intervention project is to develop cultural & religious belief approaches for Covid-19 battling stigma and strengthening family resilience for villagers. Intervention: The Kongsi Covid-19 is community-based preparedness and response strategy preventing the transmission of Covid-19. The sub-village RT/RW is subordinate to the village as a cluster that has supervision directed in the community and requires 10–14 volunteers. All activities are monitored, coordinated, and supervised by the village leader, sub-district, community health centers, and city health offices. Results and Impact: Padang had developed 1,252 Kongsi Coovid-19 covering 100% of sub-villages. More than 3000 people with positive confirmed cases with asymptomatic or mild symptoms, doing self-isolation under Kongsi COVID-19 local monitoring. The government of Padang was awarded the Best rating II due to its policy for preparing strategic planning which includes efforts to deal with the COVID-19 pandemic through the innovations of the Kongsi COVID-19. Conclusions: Kongsi Covid-19 strengthens existing partnerships to reach and engage with wider community networks. It has an active role to resolve the health issue of Covid-19 battling stigma and strengthening family resilience for villagers in Padang-Indonesia.

1. Introduction

The Covid-19 pandemic has led to cause large-scale morbidity and mortality globally. During the early Covid-19 pandemic, positive numbers of Covid-19 patients in Padang continued to increase every day [1, 2]. The proportion of positive numbers due to Covid-19 increased from 484 cases on June 15, 2020, to 488 cases on June 16, 2020, and on June 17, 2020, to 492 cases [2]. Thus, the city of Padang was designated as a red zone category prone to the transmission of the Corona Disease Virus (Covid-19). Another problem is that the health protocol and self-isolation protocol, which are government programs to control the increase in Covid-19 cases, have not been socialized properly, and what is worrying is the existence of stigma in society, which hinders the control of Covid-19 [1, 2, 3]. The Covid-19 pandemic has distanced people from the healthcare system due to excessive fear.

The high number of cases in the Padang requires a new strategy and order to increase this achievement in the New Normal era [3]. In New Normal conditions, according to the Ministry of Internal Affairs No. 440-830 of 2020, in the end, society must live side by side with the threat of the coronavirus, as an effort to restore community life activities and administration of government conditions such as before the occurrence of Covid-19, so that people become productive and safe in carrying out their activities [3, 4]. As for the activities in this New Normal era, what needs to be done is to carry out activities based on the principles of Covid-19, namely wearing a mask when leaving the house, washing hands with soap and running water, and keeping distance [5, 6, 7]. The activities of this new order should be community-based. This means that this community-based activity is expected to eliminate the stigma against Covid-19.

Meanwhile, the community is the vanguard that has been forgotten so far; it has more impact and builds social solidarity and mutual cooperation. Community engagement plays a role in maximizing the effectiveness of Covid-19 preparedness and response strategies and preventing transmission at the community level.

The communities, when engaged, are the front line in detecting and managing epidemics. They are the most affected and have the greatest influence in anticipation and preparedness as new diseases emerge or old ones re-emerge [6, 7, 8].

By engaging communities in the preparedness and response to Covid-19, the health sector can avoid the emergence of cases that will worsen the pandemic. It can also give the health sector more time to prepare to respond in realistic, relevant, and appropriate ways to the needs and challenges of every population group. Further, community engagement can serve to address and prevent health and gender inequities during the Covid-19 pandemic.

Therefore, we need a community-engaged communication strategy that focuses on Covid-19 messaging in a cultural context that can be a potential channel for responding to the Covid-19 pandemic. Efforts are being made to involve a culture-based community that is already inherent in the Minangkabau community by modifying it to suit the handling and control of Covid-19 in the community. The focus of activities on Covid-19 at this time can be a positive synergy.

2. Rationale: cultural and religious approaches for Covid-19, battling stigma and strengthening family resilience for villagers

Research in another setting has shown the need to address cultural health beliefs about the locus of control in the design and development of programs. In this sense, the word “community participation” is the key word for increasing access to make it easier to detect cases, the socialization process for each stage of the action, as well as community participation in handling Covid-19.

People in West Sumatera are mostly of the Minang tribe and have culturally rooted health beliefs and practices. This activity is based on the sub-village. Every time someone dies in the sub-village, it will be held together in mutual cooperation by the local sub-village residents. It is such as a community bereavement service which is initiated by community in favor to support the loosing family by the neighbourhood where they lived. The community is homogenous and solid. It is called Kongsi Kematian.

Leveraging existing networks and community forums in sub-village. We have modified a strategic approach for addressing the preparedness and response strategies and preventing the transmission of Covid-19 in the community. We modified a community engagement that has been rooted in Minang Kabau devise such as Kongsi Kematian.

It is hoped that this concept can be applied in the preparedness and response strategies and preventing transmission of Covid-19 at the community level, which is called the “Kongsi Covid”.

We also had already identified and reviewed Kongsi Covid as the terms of reference for previously established partnerships that could be of value in reaching and engaging solid communities.

Strong existing networks in Padang have established a platform to facilitate discussions among the community about how they can support one another and come up with their own solutions that would be beneficial in Covid-19 promotion and prevention. Kongsi Covid, with the principle of mutual cooperation, removes stigma, increases family resilience, and raises awareness and mental health of the community.

The assignments of the Kongsi Covid are to keep negative cluster areas negative; to monitor clusters, if there are positive people, to become negative; to remove stigma; to raise public awareness; and to work on mental health. The community empowered by the principle of working together means that the concern of promoting and preventing behaviors becomes and is controlled by society itself.

3. The intervention and implementation of the Kongsi Covid

The ‘Kongsi Covid-19’ concept is a micro lockdown unit in a sub-village, called RT/RW, where the RT/RW sub-villager community serves as a sharing center for food, medicine, and information. Its establishment requires 10–14 volunteers.

Therefore, the RT/RW sub-village is a Covid-19 Consortium Cluster. The clusters as a micro lockdown unit are smaller and more numerous, in fact, minimizing the risk of transmission and making it easier to monitor and evaluate the handling of Covid-19. The role of the sub-village RT/RW in the Kongsi Covid-19 is that of supervision at the community level, no longer at the family nor at the regional government level.

For this reason, for the success of the Kongsi Covid-19, we cannot rely on the role of the health sector alone, but cross-sectoral roles, such as RT/RW, youth organizations, NGOs, the head of village, the head of district, and the presence of academics also play a decisive role. One of the real supports from academics in the success of this partnership is through community empowerment, together with students and lecturers, to improve the management of Covid-19.

We selected Mata Air Village, Padang Selatan District, as the pilot project of the implementation of Kongsi Covid-19. Mata Air has the highest cases among the sub-districts in Padang Selatan District and tends to increase the cases of Covid-19. It has 20 positive cases, 9 people recovered, and 2 people died. The challenge of Mata Air Village is the area that has a dense population, making it easier for Covid-19 transmission to occur [9].

The activity model that will be carried out is as follows: socialization regarding health protocols during the Covid pandemic and the self-isolation protocol. Collaborating with cross-sectoral partners such as villages, Youth Organizations, NGOs, Head villages, Head sub-district, and Health Offices.

The activity model that will be carried out is as follows: 1. Socialization regarding Health Protocols during the Covid Pandemic and the Self-Isolation Protocol; 2. Collaborating with cross-sectoral partners such as villages, Youth Organizations, NGOs, Head villages, Head sub-district, and Health Offices; 3. Preparing the Establishment of the Kongsi Covid-19 at the sub-village level, and its organizational structure and duties and responsibilities; 4. Make periodic reports that describe conditions in each RT/RW sub-village using the Google form or application; 5. Form socialization by using print media and online media; 6. Create an RT/RW WhatsApp (WA) group for monitoring; 7. Monitoring and evaluating the implementation of the RT/RW Kongsi COVID-19 activities through regular virtual meetings; 8. Creating a Covid Positive community monitoring system; 9. Create a monitoring and reporting system through an application that contains: case identification, reporting of suspected Covid-19, recording of suspected Covid-19, and monitoring of independent isolation that occurs in each sub-village [10, 11].

4. Flow and stages of the implementation of Kongsi Covid-19 activities

The activity indicators are the formation of the RT/RW Kongsi Covid-19; activities of the Covid-19 partnership, discovery of new cases of Covid-19, and self-isolation patients are well monitored (Figure 1).

Figure 1.

The flow of Kongsi Covid-19 concept and platform [10, 11].

If there are people with symptoms of COVID-19:

1. People contact the call center at 112 or 081112112112.

2. The Department of Health, through surveillance officers, will trace people with close contacts (cases within 2 days; before the case develops symptoms; until 14 days after the case develops symptoms).

3. Contact data include complete personal data, contact category, and date of contact/exposure to the duration of contact.

4. The Department of Health, through surveillance officers/Primary Health Care (PHC), will contact close high-risk contacts and convey:

   1. Risk communication against close contact.

   2. No need to be hospitalized.

   3. Mandatory self-isolation at home for 14 days.

5. Covid-19 specimens will be collected.

6. Periodic monitoring will be done by the health center to evaluate the presence of symptoms for the next 14 days.

7. Primary Health Care (PHC) can provide a certificate in monitoring if necessary.

8. If Covid-19 is not confirmed, then it is considered not a Covid-19 case. Continue to prevent transmission of Covid-19.

9. If Covid-19 is confirmed, continue self-isolation and periodic monitoring by the Primary Health Care (PHC) for up to 14 days.

10. If after 14 days, you are healthy/have no symptoms and the test results after 14 days are negative for Covid-19, you will be declared cured.

11. If within 14 days, the person has symptoms (fever (≥38°C)/cough/flu/sore throat/shortness of breath or acute respiratory infection (ARI)).

12. Immediately contact the nearest Primary Health Care (PHC).

5. Result

The Kongsi COVID-19 has been developed after all set in Mato Aia Village as a pilot project model. There are 1.252 Kongsi Covid-19 in other sub-villages in Padang. It covers 100% of sub-villages which has an incident of Covid-19. It spreads in all eleven districts in Padang city.

There are more than 3000 people with positive confirmed cases, but with asymptomatic or mild symptoms, doing self-isolation under Kongsi Covid-19 local monitoring. Several of Kongsi Covid-19 societies have quarantine houses that can be used by the local citizen for self-isolation. This Kongsi Covid-19 has collaborated with the health care workers from the health center in managing and reporting the suspected cases and facilitated doing contact tracing to persons who have had contact with the confirmed cases.

We advocate the stakeholder—the mayor of Padang city—to make a local regulation concerning guidelines for the implementation of Kongsi COVID-19 in Padang city and a guideline book with ISBN.

The innovation of the Kongsi Covid-19 has been rewarded by the national government for the success in preparing quality planning in order to achieve better regional development. The award from the Ministry of National Development Planning-Bappenas was handed over virtually at the National Development Conference, which was opened directly by the President of the Republic of Indonesia Joko Widodo, in Jakarta, Tuesday (4/5/2021).

The city of Padang was awarded the Best rating II in the city category, because from a planning perspective, it has a policy for preparing strategic planning, which includes efforts to deal with the Covid-19 pandemic through the innovations of the Kongsi Covid-19.

The villagers in Padang City developed deep relationships within the community and organizations to work together to address Covid-19 issues. It promotes and prevents behaviors to decrease morbidity and mortality due to Covid-19. The principle of mutual cooperation removes the stigma and raises awareness, strengthening the family resilience and mental health of the community. It has established a platform to facilitate discussions among the community about how they can support one another and come up with their own solutions that would benefit in healthcare and treatment.

6. Conclusion

A community-engaged communication strategy that focuses on Covid-19 messaging in a cultural context, which is called Kongsi Covid-19, can be a potential channel for responding to the Covid-19 pandemic. Efforts are being made to involve a culture-based community that is already inherent in the Minangkabau community by modifying it to suit the handling and control of Covid-19 in the community. It is a modified activity that has existed for a long time in the city of Padang, where this activity is based at the sub-village level.

Kongsi Covid-19 is a local community-based social restriction that is more sustainable or supportive because it requires constant vigilance. This intervention in the community made the front line in preventing Covid-19.

Kongsi Covid in the Mato Air Village, Padang Selatan District, became a pilot model, which was followed massively in other villages in the city of Padang. It has been held jointly in cooperation with local sub-village residents to help eliminate stigma in society and raise awareness and community mental health and family resilience.

Acknowledgments

Thank you to our Dean Faculty of Medicine Andalas University give us full support on Kongsi Covid project. And especially to our collages Irvan Medison MD, Dr. Emilzon Taslim, MD have a huge contribution to the implementation.

Conflict of interest

The authors declare no conflict of interest.

Notes/thanks/other declarations

Thank you to our Major of Padang City Mahyeldi Ansharullaah, District Health Office of Padang Feri Mulyani Hamid, MD, M.Biomed, head sub-district of Padang Selatan, and head of sub-villages, head of Primary Health Cares in Padang and community where Kongsi Covid implemented, with all collaboration that made Kongsi Covid had a national level reward.