‘We Are Closer To The Dead’: Frontline Workers Who Take Over When Coronavirus Patients Die
VICE followed a hearse driver, undertakers, and healthcare workers in Indonesia for a week to understand the challenges they face.
When 63-year-old Maruf bin Khasan’s health took a turn for the worse after showing symptoms of pneumonia, his son brought him to the emergency room. Khasan had a pre-existing lung condition that worsened his shortness of breath, a common symptom of COVID-19. If left untreated, shortness of breath can lead to hypoxia, or low blood oxygen, and even death if the lungs are too weak to function normally.
Khasan was treated as a suspected coronavirus patient and given oxygen and antibiotics. Still, he showed no signs of improvement. On April 6, he passed away without ever having been tested for COVID-19.
Because he exhibited COVID-19 symptoms, Khasan’s body was buried in accordance with guidelines for handling deceased coronavirus patients. This included wrapping his body in plastic before being laid in a nylon-lined coffin, which was then sealed and wrapped again in plastic.
As is customary with Indonesian burials, Khasan’s family hoped to bathe, wrap, and deliver his body to his final resting place. But the process went by so fast that they never had a chance to officially part with their loved one.
“We couldn’t even say goodbye or pray beside him,” said Satria, Khasan’s 30-year-old son. “We never thought he’d leave us this way.”
Sofyan, a hearse driver with a busy schedule, made his way toward a white Hyundai hearse to gather the bodies of deceased coronavirus patients. His left hand carried a stack of documents, a lunch box, and a bottle of mineral water. Clad in black-orange uniform with N95 mask, yellow boots, medical gloves and hair mask, he looked tired from lack of sleep. It was only 11 in the morning.
“I’m on my way to pick up another body, they’re waiting on me,” Sofyan said from the driver’s seat of a government-owned hearse. “I didn’t have time for lunch, so I’ll have to eat while I drive.”
Sofyan has been driving a hearse for an organisation known as the Black Cross for over 10 years. Since the pandemic began, he and 48 other drivers have been working round the clock.
The Black Cross’ office is a 6 x 7-metre room. In one corner stood boxes of masks and gloves. In another corner was a table stacked with burial documents and a phone that rang constantly throughout the day with requests for body pick-ups.
The Black Cross existed in colonial times as a private organisation, but is now operated by the Indonesian government under City Forest and Park Agency. It provides free mortuary services to the public, picking up anyone from murder and accident victims to unclaimed bodies and people who die of disease. The group bathes, wraps, and delivers bodies to the cemetery.
Since the coronavirus pandemic hit Jakarta in early March, Sofyan has been working long hours at minimum wage. He has been delivering six to eight corpses per day from hospitals to cemeteries, a steep increase compared to his usual workload.
“From the time we get on the road to the time we arrive at the graveyard, working on one body can take up to four hours. With coronavirus victims, we have to act fast to abide by guidelines. My life is on the road now,” Sofyan told VICE.
In a press conference in late March, Jakarta governor Anies Baswedan declared that the government had buried 283 bodies in accordance with guidelines for burying COVID-19 victims from March 6 to 29. On April 5, Jakarta confirmed 1,151 positive cases, with 123 people dead and 64 recovered.
As of April 8, Indonesia has reported 2,738 confirmed cases of COVID-19, with 221 deaths and 204 recoveries. The nation has a death rate of 10.68 percent — currently the highest in Southeast Asia.
The demand for coffins has also increased since the pandemic. Tri Nurcahya, a morgue worker who builds coffins, said he now builds over 30 in a single day. The coffins are made of flimsy wood painted brown, with an orange nylon lining made of the same material used for body bags.
“We have a stock of two dozen coffins in the back. By next week, it will be long gone,” said Nurcahya. “We have already asked the department of forestry for more raw materials.”
On March 28, Baswedan requested the central government to implement a regional quarantine in Jakarta and restrict movement to and from the city. After going back and forth on the issue, the central government finally approved large-scale social restrictions in the capital on April 7.
For mortuary workers like Sofyan, the government decree does not change anything. Even though he operates according to strict guidelines and has access to personal protective equipment (PPE), there is still a looming fear of infection, he told VICE.
“At a time when people should be practicing social distancing, we are closer to the dead than to the living,” Sofyan said. “It’s still a risk.”
Government statistics place the number of burials in Jakarta in March at 4,400, a 40 percent increase from the previous month. This raised suspicions that the COVID-19 death rate might be higher than what the government is reporting.
Jakarta, with a total population of more than 10 million, has become the epicenter with the highest positive cases across the country. In early April, the Health Agency conducted rapid tests for 20,532 people in the capital. As many as 428 people were found to be positive. However, experts and scientists doubted the effectiveness, saying that rapid tests are not accurate and the government has yet to impose stricter policy to limit the mobility of its residents.
Indonesian government has been slammed for underestimating the pandemic. In February the government planned to disburse Rp72 billion for social media influencers to promote its tourism, saying that Indonesia is coronavirus-free. The plan was abandoned following public outcry.
Not until March 2 that President Joko Widodo in a speech confirmed the first two of positive cases. The government was deemed too slow in mitigating the pandemic.
The Health Ministry designated two hospitals — RSPI Sulianti Saroso and Gatot Subroto — as national hospitals to treat Covid-19 patients in Jakarta. But both hospitals were soon overwhelmed. The ministry then appointed six more hospitals plus one emergency hospital at Wisma Atlet, Kemayoran that could accommodate more than 4,000 patients. Still, the hospitals do not have enough beds and medical workers, not to mention that most experienced shortage in personal protective gears.
At RSPI Sulianti Saroso, all rooms — including ER — have been converted into isolation rooms. The hospital has 150 beds inside 60 isolation rooms. All rooms are full. So much so that the hospital began to prioritize those with symptoms in worse conditions.
“Sometimes we have to refuse to admit patients,” says Derpina Sinaga, a nurse at RSPI Sulianti Saroso. “We always have a long queue in a day, so we need to prioritize.”
Derpina is a seasoned nurse. She dreamt of becoming a police officer, but her height did not meet the requirements. Desperate, her parents urged Derpina to enroll in a nurse academy. It was a decision that she would never regret.
She began her career as a nurse in 2007 after graduating from Cikini Nurse Academy, Jakarta. When the Middle East Respiratory Syndrome-Coronavirus (Mers-Cov) outbreak ravaged the Middle East, Europe, and parts of Asia in 2012, Derpina was one of the health workers on the front line.
Between 2014–2015, RSPI recorded 17 patients suspected with Mers-Cov due to their travel history in the Middle East. The Indonesian government at that time was on high alert and preparing the worst case scenario as millions of people were going on pilgrimage and Hajj in every single year. However, the government recorded zero cases of Mers-Cov.
“But now it’s a totally different situation,” said Derpina, who is originally from Pematangsiantar, North Sumatra. “We don’t know what we are dealing with right now. When will this be over?”
She said that 21 additional health workers from other regions have been transferred to RSPI to help fight the Covid-19. But still, she was mentally and physically overwhelmed.
“I am always scared that I bring the virus home,” said Derpina, who has a son at elementary school. “But I don’t want that fear to back me down. As long as I follow the procedure.”
But her biggest fear is being stigmatized. During the pandemic, reports said some medical workers across Indonesia have been evicted from their apartments by their landlords. “I haven’t socialized with my neighbors since the pandemic,” she told me.
The Jakarta administration, fearing that such stigma could hamper the effort in eradicating the virus, has provided accommodation for health workers, from April 1 to May 31. But Derpina turned down the free accomodation, saying she couldn’t live far from her son.
“I still have the responsibility of a mother,” Derpina told me. “When I am on a graveyard shift, I usually prepare everything for my son. I also help him do his homework and all those online courses.”
Derpina works eight hours within a shift at the ER. During her round, Derpina could treat six to nine patients. But she feels that her job is not just checking the vitals and temperature or administering medicines. During this hard time, where all patients are isolated, things can be mentally stressful. So Derpina sees herself as a counsellor, where she dedicated a few minutes of her round to talk to each patient to support them. Sometimes she asked them to pray together with her.
“I realized it’s stressful to be in this situation,” Derpina told me. “Not a single family member could see them. So I spent at least five minutes talking to them, I told them they could carry on.”
Inside the hospital is a matter of life and death. As of March 24, six medical workers at RSPI died due to Covid-19. There is a possibility that most medical workers are at risk during improper decontamination.
Derpina realized she could be contracted with the disease at any time. She refused to undergo a test, saying that it makes her paranoid. “I’m just trying to stay fit by not watching TV during this pandemic, because it stresses me out. When you are stressed, you are more vulnerable.”
During her 13-year career, she has never seen more deaths than during this pandemic. “Those who died are no longer carried to the morgue. Instead, they are being carried straight to the cemetery,” she told me. “Their bodies are wrapped in plastics, still in their last hospital clothing.”
As per the Covid-19 protocols. The bodies should be buried within four hours. The bodies of Covid-19 patients are laid to rest in two cemeteries: TPU Tegal Alur in Kalideres, West Jakarta and TPU Pondok Ranggon, East Jakarta.
At the Tegal Alur cemetery, hearses come and go throughout the day. Asep, a gravedigger, is constantly on standby to receive new arrivals. A one-hectare (10,000 square metres) plot of land designated for deceased coronavirus patients is blocked off from the main cemetery. Nearby residents made complaints that the cemetery was accommodating COVID-19 patients, but the cemetery had complied with WHO guidelines when designating the plot at least 500 metres from any residential areas.
The blue excavator smashed into the earth, digging ten graves by midday. Asep and his team bury up to a dozen bodies a day. So far, 56 graves have been excavated exclusively for deceased coronavirus patients. Most of them do not have headstones or identifiers. Only the cemetery staff have records of who is buried, and where.
When another hearse pulled into the cemetery, the gravediggers approached the vehicle in full PPE. When masks, suits, and gloves are in short supply, they use plastic raincoats instead.
“We use bleach or carbolic acid as a disinfectant,” said Asep. “We went through the supply from the health department fast.”
The team then hauled a plastic-wrapped coffin out of the hearse and spent the next hour securing it in the ground. “It was a quiet burial,” Asep noted.
Shortly thereafter, Asep’s phone rang. “Not today, we’re fully booked. You know how it is. Maybe tonight,” he told the voice at the other end of the line.
Roughly 40 gravediggers work on the 50-hectare plot of land that makes up Tegal Alur cemetery. Since March 20, when Indonesia saw a sharp increase in coronavirus-related deaths, they have been digging graves day and night. Grave plots designated for those who have died of COVID-19 are running out, forcing Asep and his team to search for more land.
Satria arrived at the cemetery on a motorbike in search of his father late that afternoon. Asep redirected him to a grave without a headstone, which had been sprayed with disinfectant. He too, was disinfected. Satria pulled out his phone, snapped a photo, and closed his eyes in prayer.
Large gatherings, including those at places of worship, have been restricted since the pandemic. Because of this policy, families like Khasan’s were made to stay home while their loved ones were being laid to rest, forcing them to forgo the usual burial ceremony and seven-day rituals that typically follow Islamic funerals.
“Maybe when the pandemic is over, we’ll do the rituals at home,” said Satria. “In the meantime, all we can do is pray.”
*This article was published on VICE Asia on April 9, 2020. Translation by Jade Poa and Adi Renaldi. https://www.vice.com/en_asia/article/7kz33g/frontline-workers-coronavirus-patients-die-gravediggers-healthcare.
This is the original version.