With healthcare workers in the country suffering a staggering death toll from Covid-19, dentists in Indonesia have been feeling the strain.
By Farida Indriastuti
October 14, 2021
Among Asian countries, Indonesia has suffered one of the highest mortality rates for healthcare workers during the Covid-19 pandemic. As of August 2021, at least 1200 medical professionals, including dozens of dentists, have died from Covid-19 in the country. Over the past 18 months, overworked healthcare workers have been forced to treat patients without adequate personal protective equipment, leaving them at high risk of getting infected by coronavirus. Coupled with pervasive skepticism among the public about the effectiveness of vaccines, Indonesian medical professionals are weathering a perfect storm of challenges as they try to care for patients.
To learn about the devastating toll Covid-19 has taken on Indonesian healthcare workers, Covid Update reached out to dentists in the country to hear about their experiences during the pandemic.
Drg. Elizabeth Juliana Widyaningrum, Sp.KG, is an endodontist and founder of Klinik DW-8 in South Jakarta. Widyaningrum explained how during the initial outbreak of coronavirus in 2020, she experienced constant anxiety.
“I was scared of watching [the news], especially knowing how prone dentists are to the risk of coronavirus infection,” she recounted. Over time, she began to hear about dentists being infected and dying from Covid-19: “It was devastating to lose so many colleagues.”
As the pandemic dragged on, Widyaningrum began feeling mentally drained. Eventually she became physically ill with a purulent inflammation, which was treated with a minor surgery. During her recovery, which took almost four months, she had no choice but to stop seeing her patients. Further, during the lockdown protocol from March to June 2020, she had to shutter Klinik DW-8 entirely.
As the pandemic raged, Drg. Indranurani, Sp.Ort, began having problems with her respiratory system that eventually triggered her asthma. “I stayed at home all the time, afraid to go out,” she said. Indranurani didn’t work for 10 weeks and was constantly worried. Ultimately, however, she decided to face her fears: she went back to work at Klinik DW-8 and helped emergency patients as often as she could bear. “If dentists are scared [of Covid], patients will be scared too,” Indranurani said.
In March 2020, the Indonesian Dental Association issued official guidelines for dentists to follow when treating patients during the pandemic. These included regulations that require dentists to screen all patients and refer suspected Covid cases to hospitals. It was also recommended that treatments for asymptomatic patients, including elective procedures, aesthetic dental treatments, and treatments that require the use of drill, scaler or suction be deferred to a later date.
Today, coronavirus infection prevention protocols remain strict: patients are required to rinse their mouths with 0.5% to 1% hydrogen peroxide for 60 seconds, or 1% povidone-iodine for 15 to 60 seconds, before an examination. Dentists must wear disposable protective equipment during appointments and follow dental equipment disinfection procedures. They must ensure all working spaces, including treatment rooms and waiting rooms, door handles, tables, and chairs, are disinfected regularly. Routine disinfection must be performed to dental units and floors must be cleaned using 2% benzalkonium chloride. As the final protocol, dentists must change into clean clothes before going home.
As a director of Klinik DW-8, Widyaningrum had to be thoughtful regarding her employees and patients’ safety. She asked her patients to provide negative antigen tests and vaccine certificates, to use hand sanitizer and to monitor their body temperatures. Widyaningrum also suggested her staff members take antigen tests and self-isolate if they ever felt unwell.
Klinik DW-8 experienced significant financial losses during lockdown and struggled to pay the salary of its 70 employees. Only once lockdown ended were patients able to come back to the clinic. Klinik DW-8 has now applied a new protocol of providing more preventative treatments, along with digitizing patient records for easy sharing. Widyaningrum has established a partnership with Halodoc, a telemedicine app, and has employed teledentistry to consult with patients living far away.
“I had patients that called for sessions from London, England,” Widyaningrum said. She told me it is her top priority to keep the principles of justice, veracity, and beneficence at the core of her practice during these difficult times, and to stay committed to the code of professional conduct. “In this pandemic, dentists must be wise. All dentists need to follow the government health protocol for the safety of all,” she said.
One particular challenge in Indonesia is vaccine storage. All vaccines must be kept at varying ranges of cool temperatures; for that reason, cold chain procedures become essential to ensure proper storage and distribution of vaccines. As an archipelago country of 17,505 islands, keeping vaccines at the right temperature during distribution can be difficult, to say the least.
There’s also some mistrust among the population toward the companies manufacturing vaccines. Some manufacturers, including Pfizer and Astra Zeneca, have been granted a legal indemnity to protect them from liability claims. Worries about potential side effects, coupled with the prevalence of misinformation on social media, has fed public distrust of vaccines.
According to data from the Indonesian Ministry of Health released in July 2021, nearly 33% of Indonesians rejected the vaccine because they were apprehensive about it. In September 2021, it was reported a health worker suffered contusions and bruises after being attacked by an anti-vaccine mob. It was also reported that the infuriated mob demolished a vaccine center, damaging vaccines and medical supplies including packages of masks, hand sanitizer, blood pressure monitors, and syringes.
Although the Indonesian Health and National Food and Drug Association (BPOM) has issued an emergency use authorization (EUA) for Sinovac, Astra Zeneca, Pfizer, Moderna, Janssen, Novavac, Sinopharm, Sputnik, Covidecia, Cansino, and Zifivax, some people remain unconvinced.
“The government has attempted to obtain the vaccine, but people [don’t trust] it,” Drg. Indranurani said.