Bogor volunteers bury those who died at home, as COVID-19 stretches Indonesia's healthcare system
BOGOR, Indonesia: The sun was blazing hot when four volunteers from the local COVID-19 task force, draped in full personal protective gear, descended on a densely populated neighbourhood in Bogor, one of Jakarta’s satellite cities.
Soaking in sweat with their goggles and face shields fogging, they trod along a dusty alleyway filled with tightly packed houses as curious onlookers observed their every step.
Just before the alleyway split into a T-junction, a crowd of around two dozen people had gathered outside a small, neon blue home. No one dared to step inside for the lady of the house, 47-year-old Rita Nurbaeti, had died hours before, following a week of battling COVID-19.
Not even her husband and their three children – who all tested negative for the coronavirus – were brave enough to be with her. She was still in her night gown as she breathed her last.
“We tried to take her to the hospital because she was hyperventilating but all the hospital beds were full,” Mr Mujiburrahman Rizal told CNA of his late wife. “We took care of her the best we could. We gave her medications from the hospital as well as some herbal medicines. But God had other plans for her.”
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Indonesia has seen a surge in COVID-19 cases, mostly due to the spread of the more transmissible Delta variant. This month alone, more than a million people have tested positive for the coronavirus. Experts have warned that there could be many times more cases which had gone undetected.
The rapid rise of cases has overwhelmed the nation’s healthcare system, leaving many patients, even those with severe symptoms, unable to receive proper care in the hospitals. In the last 30 days, at least 28,000 COVID-19 related deaths had been recorded, some of whom died while isolating at home.
Before the pandemic, it was up to the family and the local community to make their own funeral arrangements for the dead.
According to Islam, observed by about 90 per cent of Indonesians, the funeral preparations involve washing and wrapping of the dead with white cloth and performing prayers for the deceased, before the bodies are laid in their final resting place.
At the beginning of the pandemic, health workers and paramedics assisted in the burial preparations of those believed to have died of COVID-19. However, with many of these health workers too preoccupied in treating the growing number of COVID-19 patients, the responsibility to care for the dead, at least in Bogor, now falls into the hands of a group of volunteers.
When Indonesia began imposing the Emergency Community Restrictions for Java and Bali in early July, senior Bogor officials set up a task force to look into the issues and challenges where they would most likely need extra help. These included the problem of providing the necessary care for COVID-19 patients who died while isolating at home.
"The government decided that they need people to remove bodies of those who died while in self isolation," said Mr Rino Indira Gusniawan, the director of a local water distribution company who was tasked with assembling a team of volunteers for the job.
“There are people who are so afraid of COVID-19 bodies, they don't want to touch the bodies at all. Then there are those who are completely negligent and take COVID-19 lightly. These are the two issues that we are trying to address,” he told CNA.
Mr Gusniawan quickly got to work to recruit volunteers from various organisations and groups operating in the city. Before long, the Bogor City Deceased Evacuation and Mitigation Team was formed.
It was barely 10am on Friday (Jul 23) and Mdm Nurbaeti was already the third COVID-19 patient in Bogor to die on that day while isolating at home. She was the 95th death handled by the team since it was set up.
“On average, we can handle around five bodies in a day. There are even days when we have to handle nine to 11 bodies in a day,” senior volunteer Wahyu Trisnajaya told CNA.
“We work 24 hours a day. A call can come at 3am in the morning. We are dealing with an infected body. There is a chance that the dead might infect other people, so we have to move quickly.”
And there is no sign that things are getting better. The number of daily infections across Indonesia currently average between 28,000 and 45,000, while the number of deaths continue to climb and break the previous record five times over the last seven days.
On Tuesday, the national death toll surpassed 2,000 for the first time since the pandemic began, with 30 deaths in Bogor, a record for the city.
Bogor City Health Agency said 21 of them died in hospitals across the city and nine while self-isolating at home.
The nature of the work and the conditions they have to put up with can be overwhelming for the Bogor City Deceased Evacuation and Mitigation Team, which is the only such volunteer group in Bogor. The volunteers do not get paid for their work.
“I haven’t gone home since Jul 4. We are so busy I barely sleep for more than two hours,” Mr Trisnajaya said at the volunteer group’s makeshift headquarters, a small function hall in the city centre.
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Although the team managed to recruit 56 volunteers, only around 30 are active. “The rest have other things to do and can only help in their spare time,” said the 55-year-old retiree.
Of the 30, only 18 volunteers are directly involved in handling the bodies. The other 12 are in charge of taking calls from those in need of their help, doing administrative work or providing logistical support.
“There are not that many people who are willing to do this. Not many are willing to go near a dead COVID-19 patient,” said Mr Trisnajaya.
Of the total, eight are female. The lack of female team members presents its own challenges.
According to Islamic practice, only next of kin and persons of the same gender as the deceased are allowed to assist in the burial rites. This means the female volunteers in the group have to make themselves available round the clock, in case the deceased is a female.
“I stay at the headquarters because you never know when our help is needed,” said volunteer Nur Hasanah, 37.
Mdm Hasanah is a mother of three and a seasoned rescue worker. Having volunteered in countless disaster areas before, being around dead bodies is nothing new to her.
But dealing with a pandemic like COVID-19 is a totally different experience.
“In the beginning I was fearful. This is different. This is COVID-19. I am not dealing with an ordinary body. They had virus in them,” the housewife said.
“I do feel a bit anxious. I worry that I might get infected. I have a family waiting for me at home. But as long as we take all the necessary precautions and protect ourselves we should be fine. And thankfully, so far, none of us had ever got infected.”
DIFFICULT SITUATIONS ABOUND
All members of the team are trained to perform burial rites in different religions. It can be as straightforward as dressing the deceased in their best clothes for Christians or non-Muslims, to something that requires specific procedures such as those prescribed in the Islamic practice.
Whatever the case maybe, the volunteers involved understand that their responsibility requires a certain degree of people skills such as in negotiation and persuasion especially with family members, relatives or neighbours.
Mdm Hasanah recalled a time when she had to get involved in a long argument with family members, who insisted that the deceased must be buried at the family’s private cemetery instead of a burial ground dedicated for COVID-19 patients.
The team must also delicately handle those who wish to help with the burial ceremony but insist on not wearing the personal protective gear.
“This is the reason why I stay at the headquarters. Most of the female volunteers are college students. They know how to perform the burial rites but they lack the experience to handle these types of situations,” she said.
Senior volunteer Mr Trisnajaya said the team had encountered every imaginable situation.
“We had to deal with all sorts of people. There are those who are so paranoid they wouldn’t help carry the coffin even though they have been wrapped and sterilised,” he recalled.
There are also COVID-19 deniers who refused to believe that their neighbours or loved ones had died of the virus. They would not let the deceased be buried using the COVID-19 protocol and insisted that they should be left alone to arrange the funeral themselves.
“We have to know when to be firm and when to step back. The last thing we want is to get into a heated argument which could lead to physical violence,” Mr Trisnajaya said.
The team had encountered such incidents twice so far.
“We got the family to sign a written statement explaining that we had tried to do our job but the family refused. We then notified the authorities what had happened. Thankfully, they didn't turn into COVID-19 clusters,” he said.
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For volunteer Aan Andriyani, she sometimes feels angry at the complacent attitude displayed by some people towards COVID-19.
“It makes you feel unappreciated. We work long hours in protective gear, risking our health and yet some people don’t believe in COVID-19, some don’t think it is that dangerous and ignore health protocols,” the 44-year-old housewife told CNA.
“All I can do is focus on my job. It is a moral and religious duty to perform burial rites for the dead. Not many people are willing to do this to a COVID-19 patient. Not many people know how to do it safely. This is a calling for me.”
GOVERNMENT PROMISES MORE HOSPITAL BEDS
By the time the body of Mdm Nurbaeti was ready to be laid to rest, 90 minutes had passed since the team first arrived in the neighbourhood.
After the ritual bathing of the body and the water used safely disposed of, her body was then wrapped in the white burial shroud before it was again wrapped in a clear plastic sheet.
As required by the COVID-19 health protocol, all dead patients must be placed in orange body bags before their coffins are closed and sealed.
The ambulance that carried Mdm Nurbaeti's coffin then carefully navigated its way down the tight alleyway, ready to bring it to the cemetery.
At least a dozen plots of grave had been freshly dug by an excavator by the time the ambulance arrived at the Kayumanis Public Cemetery, some 15 minutes away from Mdm Nurbaeti’s house. Cries from grieving family members and relatives accompanied the solemn occasion as her body was gently lowered into the grave.
Just as Mdm Nurbaeti’s funeral was about to be over, an ambulance arrived, bringing yet another body of COVID-19 patient.
“This whole section of the cemetery was opened early this month. This section is specifically for COVID-19 patients,” one of the cemetery’s gravediggers, Mr Ahmad Ridwan, told CNA.
In a matter of weeks, at least 100 bodies had been buried at the cemetery and there was only room left for dozens more, he added.
Since Indonesia imposed the emergency community restrictions on Jul 3, the city of Bogor reported deaths of more than 400 COVID-19 patients, one-fourth of them while isolating at home.
Bogor mayor Bima Arya told reporters on Monday that he expected the daily death toll to decrease in the coming days, particularly after new hospital beds were added and more people were vaccinated.
“Eighty-five per cent of those who died while in self isolation had not been vaccinated. Most are over 50 years old and generally had underlying medical conditions,” said the mayor.
Mr Arya said several facilities in the city have been converted into COVID-19 isolation centres where patients can be treated as they wait for hospital beds to become available.
Mr Gusniawan, the volunteer coordinator, said he looks forward to a time when teams like his are no longer needed.
“Hopefully in one or two months, we will see cases declining and things returning to the way they were ... when we have zero patients (dying at home) in Bogor,” he said.
“But as long as we are still needed, we’ll be here.”
Read this story in Bahasa Indonesia here.