Potential Improvement in a Portable Health Clinic for Community Health Service to Control Non-Communicable Diseases in Indonesia

The COVID-19 pandemic has limited routine community health services, including screening for non-communicable diseases (NCDs). An adaptive and innovative digital approach is needed in the health technology ecosystem. A portable health clinic (PHC) is a community-based mobile health service equipped with telemonitoring and teleconsultation using portable medical devices and an Android application. The aim of this study was to assess the challenges and potential improvement in PHC implementation in Indonesia. This study was conducted in February-April 2021 in three primary health centers, Mlati II in Sleman District, Samigaluh II in Kulon Progo, and Kalikotes in Klaten. In-depth interviews were conducted with 11 health workers and community health workers. At the baseline, 268 patients were examined, and 214 patients were successfully followed-up until the third month. A proportion of 32% of the patients required teleconsultations based on automatic triage. Implementation challenges included technical constraints such as complexity of applications;unstable networks;and non-technical constraints, such as the effectivity of training, the availability of doctors, and the workload at the primary health center. PHCs were perceived as an added value in addition to existing community-based health services. The successful implementation of PHCs should not only be considered with respect to technology but also in terms of human impact, organization, and legality.

Indonesian Anesthesiologists Preparedness for COVID-19 Surge Capacity in the Early Pandemic.

Background: Anesthesiologists play a crucial role in every disaster event, including biological disasters by COVID-19. This medical specialty should be prepared for a surge in patients due to a pandemic. The present study aims to evaluate the preparedness of anesthesiologists in facing the surge in the number of COVID-19 patients at the beginning of the pandemic in Indonesia. Methods: This is a descriptive cross-sectional study using an online survey to Anesthesiologists in Indonesia, with snowballing sampling method. A distribution frequency was used to describe the univariate analysis results of the variables. Pearson correlation was used to test the correlation between perceived resource adequacy/availability and perceived preparedness to face the surge. Results: A total of 141 anesthesiologists participated in our online survey; 47% of responders said they do not have enough staff, while 53% said that their staff did not have sufficient knowledge of handling the critical COVID-19 patients. They also reported limited resources, especially the limited isolation space and N95 masks. The correlation analysis indicated a strong and significant relationship between limited resources and the preparedness of anesthesiologists. Conclusion: At the beginning of the pandemic, Indonesian Anesthesiologists felt that they still had very limited resources, leading to unpreparedness to deal with the surge in the number of COVID-19 patients with critical conditions.

Evaluasi kesiapan rumah sakit menghadapi bencana non-alam: Studi kasus COVID-19 di Rumah Sakit Bethesda Yogyakarta

Pandemi COVID-19 menjadi masalah global sejak kemunculannya di Wuhan Cina pada akhir 2019. Pengalaman di Cina dan di berbagai negara termasuk Indonesia menunjukkan upaya penyiapan fasilitas kesehatan untuk pasien COVID yang melonjak dalam waktu singkat. Tujuan utama penelitian ini adalah mengukur tingkat kesiapan rumah sakit Bethesda Yogyakarta dalam menyiapkan sumber daya untuk mengatasi lonjakan pasien COVID-19. Penelitian ini adalah studi kasus. Populasi penelitian adalah staf dan manajemen rumah sakit yang terlibat dalam penanganan COVID-19. Instrumen penelitian berupa panduan wawancara mendalam daftar pertanyaan wawancara dan form Hospital Safety Index (HSI). Analisis data ditampilkan sesuai dengan konsep surge capacity rumah sakit yaitu meliputi aspek space staff stuff/supplies dan system berdasarkan data penelitian. Indeks keamanan modul 2 sebesar 0.38 dan klasifikasi b. Indeks keamanan modul 3 sebesar 0.70 dan klasifikasi a. Indeks keamanan modul 4 sebesar 0.29 dan klasifikasi c. Status keseluruhan fasilitas kesehatan termasuk klasifikasi B dengan indeks keamanan sebesar 0.46. Faktor-faktor penentu manajemen bencana di rumah sakit Bethesda Yogyakarta berdasarkan aspek space adalah perubahan tata ruang penyiapan dan penggunaan ruang isolasi penyiapan eskalasi ruang dan alur ke ruang isolasi. Faktor-faktor penentu berdasarkan aspek staff adalah kesediaan kriteria dan kompetensi SDM perlindungan terhadap staf skrining dan isolasi bagi staf yang terpapar COVID-19 dan upaya memotivasi staf untuk pelayanan COVID. Faktor-faktor penentu berdasarkan aspek supplies adalah upaya mencukupkan APD yang sesuai standar dan level sinkronisasi kebutuhan dan ketersediaan logistik upaya mencukupkan logistik peran jejaring dalam mencukupi kebutuhan seperti ventilator dan donasi. Faktor-faktor penentu berdasarkan aspek sistem adalah upaya meminimalkan risiko penularan pemisahan area skrining komunikasi eksternal dan internal sistem informasi tren selama pandemi dan inovasi pelayanan sebagai strategi rumah sakit untuk bertahan. Selama status kedaruratan belum dicabut rumah sakit harus terus melakukan langkah-langkah intervensi untuk mengantisipasi lonjakan pasien COVID atau jika ada gelombang kedua pandemi.

The adjustment of neurosurgical procedures during the COVID-19 pandemic: a case study at Dr. Sardjito General Hospital as a part of an academic health system.

OBJECTIVE: The recent COVID-19 outbreak has forced notable adjustments to surgical procedure preparation, including neurosurgical services. However, due to the uniqueness of the recent situation, neurosurgical centers, especially those located in low-resource settings, are facing several challenges such as a lack of coordination, poor equipment, and shortage of medical personnel. Therefore, several guidelines from local authorities and international neurosurgical bodies have been published to help clinicians manage their patients. In addition, the academic health system (AHS), which is an integrated system containing a medical institution, universities, and a teaching hospital, may play some role in the management of patients during COVID-19. The objective of this study was to describe how each hospital in the authors' network adjusted their neurosurgical practice and how the AHS of the Universitas Gadjah Mada (UGM) played its role in the adaptation process during the pandemic. METHODS: The authors gathered both local and national data about the number of COVID-19 infections from the government's database. To assess the contribution of the AHS to the efforts of each hospital to address the pandemic, questionnaires were given to 6 neurosurgeons, 1 resident, and 2 general surgeons about the management of neurosurgical cases during the pandemic in their hospitals. RESULTS: The data illustrate various strategies to manage neurosurgical cases by hospitals within the authors' networks. The hospitals were grouped into three categories based on the transmission risk in each region. Most of these hospitals stated that UGM AHS had a positive impact on the changes in their strategies. In the early phase of the outbreak, some hospitals faced a lack of coordination between hospitals and related stakeholders, inadequate amount of personal protective equipment (PPE), and unclear regulations. As the nation enters a new phase, almost all hospitals had performed routine screening tests, had a sufficient amount of PPE for the medical personnel, and followed both national and international guidelines in caring for their neurosurgical patients. CONCLUSIONS: The management of neurosurgical procedures during the outbreak has been a challenging task and a role of the AHS in improving patient care has been experienced by most hospitals in the authors' network. In the future, the authors expect to develop a better collaboration for the next possible pandemic.