3rd Edition of ISMKI's Magazine by ISMKI

eMagazine

3rd Edition of ISMKI’s Magazine

Event Tender IMSS 2021: UNRI Story 1 The Latent Threat of Tuberculosis Story 2 A Year of COVID-19 in Indonesia Univ Spotlight Tea Time with UNIPA

Advisor

Fadhil Haﬁdza

Content

Ajib Zaim Alamsyah

Arkan Abdullah Nashiff

Fiona Surya

Farahmiftah Irzal

Elisa Yohana Anjali Wulur

Nuky Yasuar Zamzamy

Made Elian

Design

Ahmad Husein Haekal Alkaff

Dianira Hanum Febia A

www.ismki.org @ismki_indonesia ISMKI

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First, let us give thanks to God because of His blessings, grace, and gifts, we are still allowed to actively contribute with fellow medical students to improve the health of the people, and to publish this episode of our e-Magazine. As we know, the World Health Organization (WHO) has announced the COVID-19 pandemic more than a year ago. Various sectors have been affected by the pandemic, including the health sector. Doctors, nurses, and other health workers go the extra mile during this pandemic, even risking their lives to provide the best health services. The problems of regulation and mechanisms in the health sector are also increasingly complex. As medical students, we must realize that the world needs our real steps. Not only during the pandemic but for the development of the health sector going forward. To become a qualified medical student, WHO has introduced a global strategy of changing the medical education practice for health called the five-star doctor which consists of a care provider, decision-maker, communicator, community leader, and manager. To accomplish all the five competencies, it is not enough to learn only from textbooks and lectures, but also other skills are needed, including soft skills. There are a lot of ways to gain soft skills, one of them is by joining an organization. Indonesian Medical Students Executive Board Association (IMSEBA) is a non-benefit organization that consists of all medical students in Indonesia, who are members of 89 universities. We help to coordinate, consolidate, and advocate for the medical students that are represented by the students' executive board. Besides advocating the government for improving the health system, one of our program's goals is to upgrade self-potential development to make medical students future 5-star doctors. Leadership, communication, entrepreneurship, policy studies, medical education, social, and many skills can be honed through our programmes. To optimize our programmes, we are very open towards collaboration with international organizations (IOs), governmental organizations (GOs), and nongovernmental organizations (NGOs) especially in activities for Indonesian Medical Students. IMSEBA, which will turn 40 years old this year, is the oldest and largest medical student organization in Indonesia. Until this day, IMSEBA has been cooperating with plenty of organizations. Through these collaborations we hope that the quality of the Indonesian Medical Students as future doctors could be upgraded through IMSEBA, in order to pursue the improvement of the health degree of the people in the future and towards the 100th year “Golden Indonesia” in 2045.

Belinda Liliana

Vice President of External Affairs Indonesian Medical Students Executive Board Association 2021/2022

Indonesian Medical Students Executive Board Association

Table of Content 4

2 4

Editorial Page & Greeting

A Year of COVID-19 in Indonesia

IMSS : New Concept, New Thrills

Merchandise Catalogue

Contribution to Nation

Tea Time with UNIPA

The Latent Threat of Tuberculosis

Award

Strip Comic

Crossword

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Table of Contents & Get to Know More #ISMKIBersejawat

Get

to know us:

ISMKI BERSEJAWAT

IMSEBA, or Indonesian Medical Students’ Executive Board Association (abbreviated to ISMKI in Bahasa) is the largest medical student organization in Indonesia and the representation of every indonesian medical student from S abang until Merauke. Currently, there are 89 member institutions joining IMSEBA divided into 4 Regions geographically. IMSEBA was founded in 1969 during the Declaration of Cimacan under the name of Indonesian Medical Student Association (IMKI) with Birran Affandi as the chief administrator. The name IMKI was then ratiﬁed to ISMKI (or IMSEBA) through the ﬁrst ISMKI National Conference known as The Declaration of Hasanuddin. Nowadays, IMSEBA is chaired by Muhamad Arif Djimbula alongside with ISMKIBersejawat Cabinet aiming to actualize development and movement of Indonesian Medical Students on the basis of fellow associates.

ISMKI operates at the national level as well as at the regional level. Both national and regional have various divisions engaged in various sectors. These divisions include Leadership Development; Community Empowerment; Funding and Partnership; Information, Communication, Technology; Medical Education & Profession; Health Policies Studies; Public Relations (only in Region 2 and National); and International Affairs (only on National). In addition, ISMKI has complementary Agencies such as the National Scientiﬁc Analysis and Development Agency (known as BAPINISMKI) and the National Press Agency (known as BPN-I SMKI). Ea ch sector synergizes with the secretary general's vision and is coordinated through the relevant vice president. IMSEBAS’s commitment to its vision is implemented throug h vari ous of its programs. A few to mention are National Student Training on Leadership and Management (known as LKMM Nasional), International Indonesian Medical Olympiad (IMO), Indonesian Medical Student Summit (IMSS), National Coordination Conference (known as Rakornas in Bahasa), National Multi Development Project (NMDP), Training for Trainers (TFT), and Indonesian Medical Student Exchange Program (IMSEP).

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IMSS 2021

Indonesian Medical Student Summit New concept, New Thrills

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What is IMSS?

How will it be done this year?

This year's IMSS is slightly different in terms of concepts and activities because this is the ﬁrst IMSS to be conducted online. The 9th Indonesian Medical Student Summit (IMSS) 2021 is a meeting of all medical faculty institutions in Indonesia in which we discuss the accountability reports of the previous tenure, the grand design of the new tenure, the inauguration of ISMKI and BAPIN, and additional activities held by the host institution.

The dean of our campus does not allow any activities to be done offline since we are still in the middle of a pandemic. Therefore, we held it online within five days and an additional day for a deeper discussion. By holding it online, there are advantages and disadvantages in terms of implementation. The first advantage is that more delegates participate because registration fees are cheaper and easier to meet (Via teleconference). The mobilization of the committee was also smoother because it did not cost much time and money. The extra time also can be added because it is not bound by the delegation's permission to campus (if it was done offline, it will difficult because the delegates have to ask for additional permits) and accommodation costs. In short, it's more flexible. The challenge itself is communication. Communication is one of the crucial things for the event to be done flawlessly. Apart from that, from a technical point of view, more preparations were done to prevent unexpected incidents. For example, during the D-day, it was constrained by the reduced signal strength at night. We solve this by connecting the network to the wifi backup that we have prepared. Also, we try to keep the delegates' interaction closer since it is done online the delegates cannot meet face to face directly.

Indonesian Medical Students Executive Board Association

What

are the series of IMSS activities this year? This year's IMSS was open with a welcoming party consisting of a greeting from the host, entertainment performances and a virtual campus tour. It was followed by a national meeting to discuss the past tenure accountability reports,the memorandum of association (AD-ART and GBHO) ISMKI and BAPIN, and additional ad-hoc discussions on RECON. On the following day, there was an inauguration of the ISMKI and Bapin new tenure, it was followed by an analysis of the grand design of the new tenure and for the event tenderization upcoming ISMKI. There is also a KPU Session, the election of the new ISMKI-elected secretary-general. This entire series of activities lasted for approximately four days. All the activities were attended by all delegates and the chairmen of BEM except for the KPU Session. KPU Session was only attended by the head of BEM. In return, the delegates could join in the SCO Session, which provided a choice of various organizational ﬁelds (such as Leadership Development or Medical Education and Profession) which they could choose at the beginning of registration. Another additional event is the LO Session which aims to strengthen relations between delegates. In this session, the delegation played games and shared stories. Another event is the selection of nationally outstanding students after passing through the selection of their respective regions.

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On the fifth day, a panel discussion was held and were attended by five speakers. The theme raised in this panel discussion was "Quo Vadis Indonesian Doctors Post the COVID-19 Pandemic, between SKDI, Foreign Doctors and Health Policy". Not only that, but there were also two competitions such as a public poster and scientific video tik tok, which were par ticipated by several representatives of the institutions. The two competitions have the theme "COVID-19 Vaccine Updates". The entire series of events was closed by a farewell party on the last day. The closing ceremony consists of an entertainment video, an announcement of the winner of the contest and the awarding of the awardee.

What

is the theme raised at this year's IMSS?

This year's theme is Tanjak-Songket. Take a New Journey is the Key to Start on New Generation and Keep the Erstwhile. Tanjak is a unique Malay hat worn by men. Songket itself is an exclusive Malay cloth. The meaning of the theme we raise is how a generation can create something new, even better, without leaving the values and rules that have existed from its predecessors. Go forward while maintaining inherited values. For ISMKI, it is expected that the new tenure will be able to adapt the previous system such as the existing guidelines and history into a new system to support the future tenure of the organization. Therefore the future of the organization will be even better.

As the host, Riau has a lot of beauty in its city, could you tell us a little about culture and tourism in Riau? Riau has quite a several tourist destinations scattered in its districts. An example is the Siak Royal Palace, which contains Malay history and heritage. Then in Kampar district, there is a Buddhist temple, namely Muara Takus Temple. For natural tourism, there is a beach called Bono waves. Riau is also famous for Dumai, the largest oil producer in Indonesia. Besides, if you want to see the culture, you can visit the Great Mosque of An-Nur and Taman Putri Kaca Mayang. If in West Sumatra there is Malin Kundang, then in Riau there is Batu Belah Betangkup, which keeps a story about a disobedient child who was cursed to stone and is said to still be crying until now.

What

are the messages and testimonials as the host of IMSS 2021?

Regardless of the concept of an event, ofﬂine or online, the success of the event returns to us to prepare it well. In that way, the aim, values, and feel of the event will be accomplished. The whole concept of activity has its advantages and disadvantages. It all depends on how we react to it. Whatever the result will be, we have to enjoy it. In that way, we will learn and have a more open mind. Chief Executive of the 9th IMSS 2021, Fadly Mulia

Indonesian Medical Students Executive Board Association

Contribution

to Nation

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Crisis Center

&RETINA

It cannot be denied that natural and social disasters in Indonesia often occur. Such things may harm property and even life. Crisis Center (CC) ISMKI is an integrated system that aims to accelerate the collection and distribution of funds towards victims in the disaster area, as well as to help the rehabilitation process after the disaster itself which will be conducted by our volunteer team called RETINA. This team consists of Indonesian medical students who have been trained. Currently, IMSEBA is partnering with the Indonesian Medical Associati on to conduct Emergency Medical Training (EMT) for our volunteer team, which will be conducted up to six times during this period. This kind of training will be continuously conducted as our commitment to improving the quality of our volunteer team, RETINA.

Crisis Center funds can be channelled through BCA: 2950353026 an. Alifa Alya Zalfa Contact Person: Alifa Alya Zalfa National Coordinator of Community Empowerment 081213727377

Indonesian Medical Students Executive Board Association

The Latent Threat of

Tuberculosis in Indonesia

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A Quick Introduction of Tuberculosis Tuberculosis (TBC) is a notorious infectious disease in Indonesia. The culprit is a gramnegative, acid-resistant bacteria, Mycobacterium tuberculosis who attacks the lungs. It can also attack the gastrointestinal system, the skin, the lymphoreticular, the central ner vous system, the skeletal muscle, and the hepatic system. The transmission of the bacteria is through aerosolized droplets of cough, sneeze, and speech.

Pathogenesis

The main symptom of TBC is two weeks or more of coughing up phlegm (mucus). These other symptoms will follow: • Blood in the sputum • Hemoptysis • Dyspnea • Tiredness • Low appetite • Decrease in body weight • Malaise • Random night sweat • More than a month of fever with chills

Tuberculosis arises from primary or postprimar y infection (also known as reactivation tuberculosis). In our ﬁrst exposure to the bacteria, the immune system will recognize the threat. It will tell the macrophages to be in contact with the bacteria. The bacteria will either die or reproduce in the alveoli then spread to other organs. In the lungs, the bacteria will form a small nest-like structure. If the infection spreads to the lymph nodes, it will induce local lymphangitis. Hence, a primar y complex will establish. In reactivation TBC, t h e d o r m a nt b a c t e r i a i n o u r b o d y reactivates and creates an early nest. As our immune system combats this, there will be three kinds of outcomes: resorption (perfect recovery), spread (recovery with deformity), and spread with necrosis. The necrosis will either be active or solidify into tuberculoma. Reactivation of tuberculosis will induce cavity formation. The cavity will make the body susceptible to fungal infection or hemoptysis.

Risk Factors

Complications

Several factors make some people more susceptible to active tuberculosis: • Less than a year infection • Comorbidities such as HIV infection, silicosis, kidney failure, or diabetes • intravenous medication use • Immunosuppressant treatments use • Excessive alcohol consumption • Histor y of gastrectomy, jejunoileal bypass, and transplantation • Smoking habit • Malnutrition

Tuberculosis may induce several conditions: • Bronchiectasis • Empyema • Extrapulmonary tuberculosis - Lymphadenitis - Pleural - Genitourinary - Skeletal - Miliary - Gastrointestinal - Meningitis - Pericardial • Post-tuberculosis obstructive syndrome • Pneumothorax • Hemoptysis

Known Symptoms

Indonesian Medical Students Executive Board Association

Sources of infection Person with pulmonary tuberculosis or cows with M. bovis infection

Primary exposure Inhalation of M. tuberculosisinfected aerosol or ingestion of M. bovis-infected milk and/or other dairy products

No infection Mycobacteria eliminated immediately (innate immunity); IGRA test negative

Primary infection

Local infection cleared Mycobacteria contained or eliminated (acquired immunity); IGRA test positive

Primary tuberculosis Localized in lung, tonsil or intestine (ileum and/or caecum)

Primary tuberculosis complex Ghon focus plus lymphangitis plus regional lymphadenitis (hilar or mesenteric); IGRA test positive

1-5% of cases Local spread to surrounding tissues and adjacent organs

90-95% of cases Containment (acquired immunity)

Extra-pulmonary tuberculosis Tuberculosis of meninges, brain, bones, mucles, liver, spleen, adrenals, lymph nodes, urological tract, reproductive tract, skin and other organs (Biopsies, fne needle aspirates, CSF, urine, pleural ﬂuid are usually GeneXpert and culture positive for Mtb)

Localized progressive primary tuberculosis Pulmonary tuberculosis: pneumonia, consolidation, small cavities and effusion Intestinal tuberculosis: ileal and caecal ulcers, granulomatous inﬂammation (Sputum and tissue biopsies are usually GeneXpert and culture positive for Mtb)

Reactivation Risk factors such as HIV, immunosuppression, smoking, malnutrition, diabetes and stress

Latent TB infection Mycobacteria contained within granulomas (no clinical disease): IGRA test positive

Secondary tuberculosis

Secondary infection (re-infection) Inhalation of M. tuberculosis-infected aerosol or ingestion of M. bovis-infected milk and/or other dairy products

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1-5% of cases Haematogenous and lymphatic spread with widespread dissemination

Reactivation Risk factors such as HIV, immunosuppression, smoking, malnutrition, diabetes and stress

History of Tuberculosis in Indonesia and The Current Situation

Indonesia holds third place for countries with the most tuberculosis cases. People often think that tuberculosis is endemic to Indonesia. One of the reliefs of the Borobudur temple contains the earliest record of tuberculosis in Indonesia. Despite that, tuberculosis control intervention has just started since orde lama with the establishment of lung disease eradication agency, Lembaga Pemberantasan Penyakit Paru-Paru (LP4). Between 1969--1973, the government health department initiated preventive measures against tuberculosis such as BCG immunization under the Directorate General of Contagious Disease Eradication and Control or Pemberantasan dan Pengendalian Penyakit Menular (P4M). As a contagious disease, tuberculosis has been one of the issues targeted in the national medium-term development (Rencana Pembangunan Jangka Menengah (RPJM)) between 2015--2019.

In 2006, the government carried out a drug resistance survey alongside the national tuberculosis drug resistance control. The discovery of multidrug-resistant tuberculosis raised the urgency to intensify the program. When the ﬁrst case of COVID-19 popped up in early 2020, the health service suffered heavily. The medical facility was too overwhelmed to tackle diseases besides COVID-19 effectively, such as tuberculosis. One of the consequences is slight neglect in monitoring patients' drug consumption. As a result, the number of drug resistance cases increases. Indeed, COVID-19 and tuberculosis share some similarities as they both target the respiratory system and show similar symptoms. However, they differ a lot in terms of etiology, diagnosis, and treatment. As most people lack understanding of both diseases, education becomes urgent to suppress the number of cases.

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Status Quo

Tuberculosis in Pandemic According to data from the Indonesian tuberculosis information system, Sistem Informasi Tuberculosis (SITB) (16/07/2020), there were 31.216 TBC cases in January 2020 and 11.839 in July. While the number of TBC cases dropped, the number of drug resistance cases increased. Between the ﬁrst and the second quarter of 2020, there are 5.398 cases of children and adult drug resistance. Globally, according to WHO, 1.400.000 people died of tuberculosis in 2019.

Tuberculosis Management and Planning during Pandemic Following a circular letter (no. HK 01.02/III/9753/2020), the Ministry of Health released a protocol for treating tuberculosis a s a c o m p r e h e n s i v e r e f e r e n c e fo r tuberculosis governance in health service facilities. It talks about management and planning, caution against laborator y services, and an additional attachment of personal protective equipment. The letter stated that the health workers from nearby health facilities would handle the drug consumption monitoring mechanism for patients suffering from drug-resistant tuberculosis. T h e g ov e r n m e nt a l s o d i d a n o n l i n e evaluation of the implementation of tuberculosis treatment policy during the p a n d em i c . T h e r e w e r e p r o b l em s i n tuberculosis treatment, both drug-sensitive and drug-resistant, either in the red zone or not. Although community cadres held online tuberculosis screening and socialization, many people are unfamiliar with online mechanisms, hindering the process.

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Delayed Immunizations The number of immunizations for toddlers decreased by 35% as 85% of health facilities reported that they had some trouble in carrying out the program. It signiﬁes that immunizing toddlers to deal with tuberculosis has become a challenge in the pandemic. We can prevent tuberculosis by giving BCG vaccine once to babies under three months old. If we did not vaccinate the babies in those three months, the babies would miss the best chance to gain antibodies against tuberculosis because the effectiveness of the BCG vaccine would drop afterward. Therefore, we should pay attention to this matter to decrease the number of tuberculosis cases.

Contrasting Tuberculosis and COVID-19

The Ministry of Health estimated that the number of tuberculosis cases in Indonesia reached 845.000 and has conﬁrmed 69% (~540.000) of the number. The mortality rate of tuberculosis is considered high. Every hour, thirteen people die of tuberculosis. Undetected cases also have as high contagion potential as COVID-19 as tuberculosis spreads through droplets and attacks the respiratory tract. However, tuberculosis and COVID-19 are inherently different diseases. The table below describes several differences between the two. TBC

COVID-19

The pathogen is a bacteria, mycobacterium tuberculosis, discovered by Robert Koch on March 24, 1882.

The pathogen is a new type of coronavirus found in 2019. Also known as the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

It attacks the respiratory tract and can spread to other systems (bones, glands, etc.)

It only attacks the respiratory tract

It is contagious

It spreads through the inhalation of aerosol droplets from cough, sneeze, and speech.

It spreads through the inhalation of aerosol droplets from cough, sneeze, and speech or when our eyes, nose, or mouth are in contact with a surface contaminated with nasal droplets from an infected person.

Giving anti-tuberculosis drugs within six months is effective for TBC.

There is no effective treatment yet.

Indonesian Medical Students Executive Board Association

Symptoms

Covid-19

TBC

Fever

Often reported < 38°C

Often reported >38°C

Headache

None

Sometimes reported

Tiredness

Often reported

Cough

Chronic cough for > 2 weeks

Sudden dry cough, would be with phlegm in a more severe case

Sore throat

None

Has been reported

Body weight loss

Often reported

None

Night sweating

Often reported

None

Low appetite

Often reported

Unknown

Dyspnea

Constant

Gets worse in a few days

Diagnosis

Polymerase Chain Reaction Polymerase Chain Reaction (PCR) with phlegm as the sample (PCR) with nasal swab as the sample

Vaccine

BCG

Sinovac,Oxford-AstraZeneca, Sinopharm, Moderna, PﬁzerBioNTech, Novavax, and BioFarma inc. vaccines

People who suffer from HIV infection or diabetes have a higher risk of catching tuberculosis. Smoking habits and the age factor (toddler or elder) can also make the risk of tuberculosis more signiﬁcant. Someone who has the risk factors with active tuberculosis is more likely to end up with severe tuberculosis. On the other hand, people from every age range can get infected with COVID-19, especially smokers and immunocompromised people. Someone who already suffers from a disease will have a higher risk of catching a more severe COVID-19.

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When a Tuberculosis Survivor Catches COVID-19

Scientists are still developing a treatment for COVID-19. Instead, the treatment given is to relieve the symptoms. Meanwhile, there is no evidence that anti-tuberculosis drugs can increase the risk of COVID-19. However, if a tuberculosis survivor catches a COVID-19, the prognosis will worsen. It gets worse if it interrupts the tuberculosis treatment. Thus it is necessary to ensure that there is no interaction between tuberculosis drug and COVID-19 medication.

What a Tuberculosis Survivor Should Do in a Pandemic

The patients who are still in treatment must maintain their immune systems. If the patients do not comply with the drugs given, drug-resistant tuberculosis (MDR-TB) will arise. Unfortunately, disobedience of the patients in taking the medication remains an obstacle. As a high dropout rate will result in a massive number of resistance cases, drug-resistant tuberculosis becomes a growing threat to global public health even before the pandemic. The estimation of new drug-resistant tuberculosis cases worldwide was 3.7%, whereas the number of tuberculosis cases with treatment history was 20%.

Resistance to Anti-Tuberculosis Drugs

In general, resistance to anti-tuberculosis drugs has three categories: 1. Primary resistance (if the patient has never previously received TB treatment) 2. Secondary resistance (if the patient has a record of medication) 3. Initial resistance (if the history is unknown)

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Based on the results of the drug sensitivity test, there are five types of drug-resistant tuberculosis: 1. Monoresistant (MR TB): resistant to one of the first-line anti-tuberculosis drugs only. 2. Polyresistant (TB PR): resistant to more than one type of the first-line anti-tuberculosis drugs apart from Isoniazid (H) and Rifampin (R) simultaneously. 3. M u l t i - d r u g - r e s i s t a nt ( M D R T B ) : resistant to Isoniazid (H) and Rifampin (R) simultaneously. 4. Extensive drug-resistant (XDR TB): resistant to Isoniazid (H), Rifampin (R), one of the fluoroquinolone drugs, and at least one of the injectable types of drugs (Kanamycin, Capreomycin, and Amikacin). 5. Rifampin-resistant (TB RR): Rifampin resistance with or without resistance to other drugs.

Drug-resistant tuberculosis patients rely on second-line or backup drugs. However, these second-line drugs are not as effective as the ﬁrst-line and cause more side effects. The treatment strategy should adhere to susceptibility test data and the frequency of drug use in the country. Here are some MDR-TB treatment strategies: • Standard treatment: drug resistance survey data from a representative patient population becomes the basis of treatment regimens because of the unavailability of individual susceptibility test results. All patients will receive the same treatment regimen. Patients suspected of having MDR-TB should take a sensitivity test for conﬁrmation. • Empirical treatment: the previous tuberculosis treatment history and data of representative population sensitivity test results become the basis of constructing each regimen. Typically, the empiric treatment regimen will once adjust to an individual susceptibility test result. • Individual treatment: the previous tuberculosis treatment history and sensitivity test results become the basis of treatment regimens.

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Preventing Tuberculosis BCG Vaccine

Administration of the BCG vaccine can reduce the risk of tuberculosis by up to 50%. Some studies even state that the BCG vaccine can prevent worse complications with 70--80 % effectiveness. The vaccine known as BCG (Bacille Calmette-Guérin) contains a weak form of bacteria (germs) that causes tuberculosis. Because these are attenuated bacteria, they do not cause tuberculosis in healthy people. On the contrary, they serve to establish protection (immunity) against tuberculosis. BCG vaccination is recommended for newborns up to two months of age because this age group is the most effective for receiving the BCG vaccine. Adults are also allowed to receive the BCG vaccine if they do not receive it as a child. However, the effectiveness of this vaccine in adults will be lower, so it is unfavorable except for those at high risks, such as medical personnel who treat tuberculosis patients

Maintaining Our Immune System Indeed, apart from BCG vaccination, the essential thing in preventing tuberculosis is to maintain the body's immunity. If people have a secure immune system, they are less likely to contract the disease. Conversely, people with weak immune systems will be more susceptible to infection. Moreover, it can increase the risk of reactivation of bacteria that are already dormant. Maintaining body immunity can be done by adopting a healthy lifestyle such as below: • Maintain a regular diet of nutritious food • Perform moderate exercises that stimulate various parameters related to cellular immunity to reduce the risk of infection • Do not smoke • Wear a mask properly when going out to reduce the risk of being exposed to bacteria or other viruses from other people. • Cover the mouth when coughing or sneezing under the proper etiquette • Do not spit phlegm carelessly • Wash your hands regularly with soap and water or use 70% alcohol for at least 20 seconds with six steps

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Reference

1. Asry A. 2014. Jurnal UIN Syarif Hidayatullah. “Masalah Tuberkulosis Resisten Obat”. 2. Ayu I. 2020. Jurnal Kedokteran Unram. “Respon Imun Olahraga”. 3. Indonesian BCG vaccination fact sheet • https://sehatnegeriku.kemkes.go.id/baca/umum/20200324/0633499/pasien-tbcharus-lebih-waspadai-corona/ • https://yki4tbc.org/ • https://www.who.int/teams/global-tuberculosis-programme/covid-19 • https://tbindonesia.or.id/pustaka-tbc/dashboard-tb/ 4. Harrison https://tbindonesia.or.id/informasi/tentang-tbc/sejarah-tbc-di-indonesia/ accessed on 13.08 WITA 07-03-2021 5. https://kebijakankesehatanindonesia.net/25-berita/berita/3587-indonesia-bebas-tbmampukah-kita accessed on 13.39 WITA 07-03-2021 6. Pusat Data dan Informasi Kementerian Kesehatan RI Tahun 2018 7. Buletin Eliminasi Tuberkulosis Volume 1 2020 8. Colditz GA, Brewer TF, Berkey CS, Wilson ME, Burdick E, Fineberg HV, Mosteller F. Efﬁcacy of BCG vaccine in the prevention of tuberculosis. Meta-analysis of the published literature. JAMA.1994 Mar 2;271(9):698-702. PMID: 8309034. https://www.nhs.uk/conditions/vaccinations/bcg-tuberculosis-tb-vaccine/ 9. Yue Z, Qing Y, Jingwei C, Bingzi D, Wenshan L, Liyan S, Yangang W. Comorbidities and the risk of severe or fatal outcomes associated with coronavirus disease 2019: A systematic review and meta-analysis, International Journal of Infectious Diseases, Volume 99, 2020, Pages 47-56, ISSN 1201-9712, https://doi.org/10.1016/j.ijid.2020.07.029. 10.https://covid19.go.id/peta-sebaran-covid19 11. https://www.who.int/docs/default-source/hq-tuberculosis/covid-19-tb-clinical 12.management-info-note-dec-update-2020.pdf?sfvrsn=554b68a7_0 13.Mousquer GT, Peres A, Fiegenbaum M. Pathology of TB/COVID-19 Co-Infection: The phantom menace. Tuberculosis (Edinb). 2021;126:102020. doi:10.1016/j.tube.2020.102020

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You Do What You See

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The end Indonesian Medical Students Executive Board Association

A Year of Covid-19 in Indonesia:

How Do We Cope? 26

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Preface

On 2 March 2021, Indonesia entered the anniversary of its ﬁrst case of coronavirus disease (COVID-19). Here is how Indonesian policy has developed over the year in response to the COVID-19 pandemic. 02/03/ 2020

11/03/ 2020

17/03/ 2020

31/03/ 2020

02/04/ 2020

13/04/ 2020

20/05/ 2020

11/07/ 2020

21/07/ 2020

07/10/ 2020

06/01/ 2021

09/02/ 2020

Kasus pertama terdeteksi di Depok

WHO menyatak an COVID19 sebagai pandemi

Indonesia menyatak an COVID19 sebagai bencana nasional

PP Nomor 21 Tahun 2020 tentang Pembatasan Sosial Berskala Besar dalam Rangka Percepatan Penanganan Corona Virus Disease 2019 (COVID19) terbit

Indonesia menghentikan kunjungan dan transit WNA

Indonesia menetapkan Gugus Tugas Percepatan Penanganan COVID-19 melalui Keppres Nomor 12 Tahun 2020 sebagai pelaksana penanggulangan COVID-19

Pemerintah menerbitkan istilah new normal dalam rangka mengurangi pembatasan dan memulihkan ekonomi melalui Keputusan Menteri Kesehatan Nomor HK.01.07/ MENKES/ 328/2020

Pemerintah mengklariﬁkasi istilah new normal dengan mengganti nya menjadi adaptasi kebiasaan baru

Gugus Tugas dibubarkan dan fungsinya digantikan oleh KPCPEN (Komite Penanganan COVID-19 dan Pemulihan Ekonomi Nasional) yang dipimpin oleh Menko Perekonomian, Airlangga Hartarto

Pemerintah mengeluarkan Perpres Nomor 99 Tahun 2020 untuk mengatur program vaksinasi

Pemerintah mengeluarkan istilah baru lagi, yakni Pemberlakuan Pembatasan Kegiatan Masyarakat (PPKM) yang diatur pada Inmendagri Nomor 1 Tahun 2021

Pemerintah mengeluarkan Perpres Nomor 14 Tahun 2021 yang mewajibkan masyarakat yang sudah terdata oleh Kemenkes untuk divaksinasi dengan pengecualian tertentu

During the ﬁrst year of the pandemic, the government has tried its best to contain the increasing number of patients. Although they are currently succeeding, we shall not forget some mistakes that set us back. If we take a few steps back to early exposure of COVID-19, we will realize that Indonesia's attitude towards the virus was far from appropriate.

First Reaction of The Government Firstly, we will be focusing on the initial reaction of our government to coronavirus news. It is no secret that the comments from some of our government ofﬁcials, ranging from the Minister of Transportation to the Minister of Health himself, reﬂected that we were not ready to prevent the outbreak.

"Get Harvard here. I have been candid about everything. There is nothing to hide," said the Minister of Health, Terawan Agus Putranto (11/2/2020). He challenged Har vard University to prove their research that stipulates that the coronavirus should have entered Indonesia at that time.

"We just joked around with the President. Well, in sha Allah, COVID-19 would not stand a chance in Indonesia because we eat cat rice every day so much that we become immune," said the Minister of Transportation, Budi Karya (17/2/2020). He was giving a speech in commemoration of Engineering Education Day in Gadjah Mada University, Yogyakarta.

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"Corona? Corona entering Batam? Huh? You mean the car, Corona. Shouldn't it get ex p o r t e d fr o m I n d o n e s i a a l r e a d y ? " snapped the Coordinating Minister of Marine and Investation, Luhut Binsar Panjaitan (10/2/2020). He commented about the issue of six people suspected of getting infected by COVID-19 entering Batam.

Let alone initiating some mitigation. Instead of preventing the pandemic, the government ofﬁcials chose to treat the potential pandemic as a joke. It is as if they waited for COVID-19 to infect an entire population before they decided to do something. The government should have been wary of any potential danger due to infection even when it is yet to exist and act preventively in a rapid manner. That way, we could have saved many lives. The aftermath of the COVID-19 pandemic would have been less disastrous.

Large-scale Social Restriction

Alas, the pandemic happened. The number of positive cases spiked. Moving on from taking the issue with a grain of salt, the government activated its combat mode and published plenty of health policies. According to the constitution, titled UU No. 6 2018 (also known as UU Kekarantinaan Kesehatan), there are four measures we should take to ﬁght a pandemic. 1. Quarantine, isolation, vaccination/prevent, referral, disinfection, decontamination of people as indicated; 2. Large-Scale Social Restrictions (PSBB); 3. Disinfection, decontamination, disinfection, derivatization of Transport Equipment and Goods; 4. Health, safety, and control of environmental media.

Based on this constitution, the government released a new law, titled PP No. 21 2020, to specifically fight the COVID-19 pandemic. However, the law does not fully adhere to the constitution. Therefore, it has a few drawbacks that limit the country's success in fighting the virus. Out of every measure mentioned in the constitution, the said law currently only relies on largescale social restrictions. It means that the government ignored the other three actions needed to tackle the spread of COVID-19. Also, as the new law only talks about PSBB, it seems that the fulfillment of every citizen's rights in a public health emergency was not much of a concern. Another aspect that differs the law from the constitution is the application of regional quarantine. The central government now takes over the local government in fulfilling the basic needs of the resident and the livestock in a quarantine zone.

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New Normal

N ev e r t h e l e s s , w i t h t h e n ew l aw , t h e government carried on its ﬁght against COVID-19. During the large-scale social restriction (PSBB), people isolate themselves in their houses to prevent a new cluster of COVID-19 patients. As a result, many activities inevitably freeze. The lives of people, including the government, got disturbed. Everybody wanted to turn back time to when coronavirus didn't exist and live normally. To grant the collective wish, the government declared the state of new normal to convince people that they don't have to worry about COVID-19 as much as before. In two months, the term changes into adaptation to new habits, although it means the same thing.

It was a hasty decision by the government. WHO has speciﬁed six conditions that qualify a country to declare the state of new normal: 1. The daily rate of cases should have declined; 2. The capacity of health service facilities should be adequate; 3. The risk of transmission in a vulnerable environment should be little; 4. Workplaces should be able to carry out preventive measures (3M) 5. The risk of imported cases should be in control; 6. The community should participate.

The state of the new normal is more of an indicator than a measure. It implies that a country has notably succeeded in tackling the pandemic and is by no means a counter to the pandemic itself. Unfortunately, the government did not get the memo and hence understood the other way around. The new normal or the state of adaptation to new habits should have gone alongside a decline in the daily rate of cases or even afterward. Because the government declared the new normal too early, the COVID-19 trend hardly fell off.

Testing, Tracing, and Treatment

One may wonder what else could deter Indonesia's recovery from the COVID-19 pandemic. It turns out that the execution of testing, tracing, and treatment (3T) did not meet the expectation. The main problem with the testing is that not every region is capable of performing the test. The distribution hence became uneven. Besides, the testing often heavily missed the target because they tend to test commuters/travelers rather than COVID-19 suspects.

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"We are indisciplined (in testing). We even got the procedure wrong. Why the hell the number of positive cases rise when we have done so many tests, you might ask? That is because they test people like me (commuters). Every time I want to meet the President, I had to take the test. I mean, I just had a swab test! There can be ﬁve tests in a week because I go back and forth to the presidential palace", uttered the new Minister of Health, Budi Gunadi Sadikin. The minister talked about what went wrong in the 3T execution on a YouTube channel (20/1/2021).

He continued to talk about t r a c i n g . " Tr a c i n g h a s a different yet similar story. It feels like we do not have enough power to meet our tracing target number. We should have been able to track 30 close contacts for the last couple of weeks. Yet Indonesia can only manage to track four close contacts, even though it has been three weeks." (22/1/2021).

Therefore, no wonder that the treatment process has not been advancing. Treatment relies on the succ ess of testing and tracing. Even after testing and tracing, we still need to keep an eye on the patients. Patients who self isolate or who have shown severe symptoms should be in closer watch.

Epilogue In terms of facing a future pandemic-like threat, we have to learn from our mistakes. We recognize that the government has educated the mass well on how to adapt to a pandemic. Despite that, we still struggled to decrease the number of cases. For that reason, we as the people must cooperate with the government to establish effective preventive measures. Our priority in terms of tackling the COVID-19 pandemic consists of three actions: 1. Improving the testing's accuracy; 2. Increasing the tracing's capacity; 3. Enhancing the treatment. Recently, the government has been ruling out vaccination programs. The success of the program depends on the people's trust in science. However, we know that the anti-vax community has spread its wings to monger fear into the laymen. It is therefore crucial for the government to be more aggressive in enlightening the people about vaccines. Effective communication is the key to put people's faith back in science. In the end, we can never eradicate the number of positive cases without the cooperation between the government and the people.

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Reference

1. Government Regulations No. 21. 2020. Pembatasan Sosial Berskala Besar dalam R a n g k a Percepatan Penanganan Coronavirus Disease 2019 (COVID-19) 2. Law No. 6. 2018. Kekarantinaan Kesehatan 3. CNN Indonesia. 2021. Menggugat Strategi 3T Pemerintah Tangani Pandemi C o v i d - 1 9 . [online] Available at: https://www.cnnindonesia.com/nasional/20210202135111-20601346/menggugat-strategi-3t-pemerintah-tangani-pandemi-covid-19 [Accessed on 27 Feb 2021]. 4. CNN Indonesia. 2021. Menkes Akui Salah Sasaran Tes Corona dan Kacau Data K e m e n k e s . [online] Available at: https://www.cnnindonesia.com/nasional/20210123113554-20597473/menkes-akui-salah-sasaran-tes-corona-dan-kacau-data-kemenkes [Accessed on 27 Feb 2021]. 5. CNN Indonesia. 2021. Menkes Tantang Harvard Buktikan Virus Corona di Indonesia. [ o n l i n e ] Available at: https:// www.cnnindonesia.com/nasional/202002111 95637-20473740/menkes-tantang-harvard-buktikan-virus-corona-di-indonesia [Accessed on 27 Feb 2021]. 6. Hikam, H., 2021. Canda Luhut saat Ditanya Corona Masuk Batam: Mobil?. [online] detikﬁnance. Available at: https://ﬁnance.detik.com/ berita-ekonomi-bisnis/ d4893152/canda-luhut-saat-ditanya-corona-masuk-batam-mobil [Accessed on 27 Feb 2021]. 7. Pranita, E., 2021. Menkes Sebut Testing Covid-19 Indonesia Salah, Ini Kata Epidemiolog. [ o n l i n e ] KO M P A S . c o m . Av a i l a b l e a t : h t t p s : / / w w w . k o m p a s . c o m / s a i n s / read/2021/01/22/194157323/menkes-sebut-testing-covid-19-indonesia-salah-ini-kataepidemiolog [Accessed on 27 Feb 2021]. 8. Saubani, A., 2021. Kelakar Menhub: Kita Kebal Corona karena Doyan Nasi Kucing. [ o n l i n e ] Republika Online. Available at: https://republika.co.id/berita/q5ul4k409/kelakar-menhubkita-kebal-corona-karena-doyan-nasi-kucing [Accessed on 27 Feb 2021]. 9. Thomas, V., 2021. Menkes: Kemampuan Contact Tracing Corona Indonesia di Bawah Standar. [online] tirto.id. Available at: https://tirto.id/menkes-kemampuan-contacttracing-corona-indonesia-di-bawah-standar-f89T [Accessed on 27 Feb 2021].

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Tea Time with

U N I PA Medical Faculty, University of Papua Sorong, West Papua

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Hello guys! For this edition, we have the opportunity to get to know more about how to study medicine in Papua by talking with the Chairperson and Vice-Chairperson of the Student Executive Board Faculty of Medicine, University of Papua, Mr. Arsen and Mr. Owen.

UNIPA in general? The University of Papua (UNIPA) is a university in Sorong, West Papua. Lecturers who teach from various regions and used to b e t au g h t by l e c t u r e r s f r o m o t h e r universities, for example from the University of Indonesia. The Faculty of Medicine UNIPA has existed since 2014. It is still in its early stages, and several issues must be discussed and established.

Mr. Arsen

Chairperson of BEM FK UNIPA

The characteristics

of UNIPA compared to other universities, especially the medicine faculty characteristics?

There are many cultures in Papua. There are more than 200 ethnic groups, with the highest diversity compared to other par ts of Indonesia. Even though the population of Papua is only around 2 million, it is very diverse and we are all united with the Republic of Indonesia. Besides that, according to the lecturer, we are different from other regions. Faculty of medicine UNIPA students have to go to college and have the responsibility of serving the regions. This is what motivates us.

Mr. Owen

Vice Chairperson of BEM FK UNIPA

Indonesian Medical Students Executive Board Association

How are The

"Organizational Life" at Your Campus? The organization of the faculty of medicine UNIPA itself is almost the same as other medical faculties in Indonesia. The Student Executive Board Faculty of Medicine, University of Papua was founded in 2014, being the highest student organization at the faculty level. I am the 5th head of the SEB. It has divisions of ICT, Student Resource Development, Community Service, Education and Profession, Christian and Islamic Spirituality, Business Funds, Interests, and Talents. Apart from divisions, some units are under the auspices of SEB but have their own unit rules, such as dance, choir, and futsal. The unit will be empowered by SEB when there are events. There are also communities such as the Research Agency Faculty of Medicine UNIPA.

What are

The Superior Work Programmes of The Student Executive Board? From the Community S er vice Division, conducting community service activities in the Wilti village in Sorong Regency, West Papua. This activity is highly supported by the University because it is in line with its motto "Pro Humanitate Scientea", which means science for humanity. In this program, we will provide coaching in the health sector so that the human and community development index c a n i n c r e a s e . T h e S t u d e nt R e s o u r c e Development Division carries out local student management leadership training online as well as organizational regeneration. Meanwhile, the education and profession division prepares delegates for competition because the education process creates superior student character. In the selection of outstanding students, there are many winners. In the nonacademic ﬁeld, the women's basketball competition is the champion in Manokwari Regency. This removes the stigma that medical children not only learn but also develop other skills. Also, 5 people are registered as staff of IMSEBA and BAPIN. I hope that IMSEBA as a forum for medical students can unite universities throughout Indonesia so they can get to know each other

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Does The Geographical Location Far From The Capital Considered as an Obstacle?

• Because our university is already in the city, there is no obstacle to the distribution of medical equipment and learning. Geographically, it is very far from Java, so communication and cooperation are less pronounced because they are far away. The pandemic situation is good for communication, to be able to meet in person at Zoom and get to know each other together. • Concerning the scarcity of health workers in Papua, particularly specialist doctors, until the health office holds an auction. Health workers rarely travel to Papua for geographical reasons, particularly in conflict zones, as well as malnutrition (related to work comfort and safety factors). • For clinical education, there is no teaching hospital in West Papua, several stations have to go to Makassar. The first batch of 2014 is currently on duty as co-assistant and there are still obstacles.

As a Medical Student at UNIPA,

What Are Your Hopes and Dreams for The National Health Situation, Speciﬁcally for Papua?

Mr. Owen: The Papuan son wants to be a leader and also a doctor. Because the majority of doctors in Papua are not indigenous Papuans, it is hoped that many Papuan sons will realize their potential to work as doctors in Papua. That way, there are more medical personnel and can eradicate health problems. Mr. Arsen: Health in West Papua can get better. We are the hope, we want to study seriously and hope that education is equal to other regions. If UNIPA has a problem, we hope that IMSEBA can help. Under the vision of the faculty of medicine UNIPA, it wants to be independent, competitive, able to do community service with herbal plant research. The hope is that Papua will be more advanced with a lot of nature that can be explored.

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Theme: Medical Across 6. Impaired or death of substantia nigra 7. Type III hipersensitivity 9. Neural ascending tracts 11. Rectouterine excavation of women 12. Fracture on convex side, intact on the opposite

Down

1. Etiology of Malaria 2. Hepatic Macrophage 3. Diuretic-causing gynecomastia 4. Increase number of cells in an organ or tissue 5. Reentry loop bundle on WPW syndrome 8. Drug of choice for newborn TB prevention 10. Color receptor is called ... Cell

Previously Across 1. Evaluation 3. Screentime 6. Ofﬂine 7. Rakornas 10. Coordination

Down 2. Twenty 4. Communication 5. Commitment 8. Online 9. Creative

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