Exclusive, Piprim Basarah Yanuarso Affirms Children's Right To Health Is More Important Than The Right To Get Education

Various problems still surround Indonesian children. This should be a concern for all in order to save our children. According to Dr. Piprim Basarah Yanuarso, Sp.A(K) General Chair of the Indonesian Pediatrician Association (IDAI) cases of infant and child deaths still occur in Indonesia. In addition, the problem of education during the COVID-19 pandemic is also a problem in itself. Many parties are still confused between prioritizing children's health factors or education in this case face-to-face learning (PTM).

The recent increase in COVID-19 cases in Jakarta has made various parties call for the 100 percent PTM implemented by the DKI Jakarta government to be reviewed. IDAI was among those who voiced the need for an evaluation when the number of COVID-19 cases increased, especially recently the Omicron variant continues to grow.

Dr. Piprim Basarah Yanuarso, Sp.A(K) emphasized that the health factor must be prioritized over education. "We have to look at various aspects, from a health perspective, a child's right to health should be prioritized over his or her right to education. When we prioritize education over health, our children end up contracting COVID-19. If this is the case, children will not receive education, nor will their health be because their children are sick," he said.

When the pandemic escalates, Pipirm continued, what needs to be prioritized is breaking the chain of pandemics. After the pandemic has slowed and the situation is under control, only PTM can be reopened or there is a regulation on what percentage of the number of students are allowed to take part in PTM and what percentage is PJJ (distance learning) online.

Another problem faced by Indonesian children is stunting or poor nutrition so that growth becomes stunted. Regarding stunting, said Piprim, the prevention is relatively easy, by providing animal protein nutrition. "So actually, to prevent children from stunting, it's easy to get enough animal protein intake. Children can be given eggs, fish, and other animal protein such as poultry, etc. Beef may be expensive," he told Iqbal Irsyad, Edy Suherli, Savic Rabos, and Rifai who met him at the IDAI Office, Salemba, Central Jakarta recently. Here is the full interview excerpt.

In your opinion, what are the crucial problems faced by Indonesian children today?

In Indonesia, the infant and under-five mortality rate is still high. If we look at the regions, many cases who were referred to the hospital within seven hours had died. Or they come in very heavy conditions. This means that in the upstream part of the primary service, we must be able to do a lot. So how about networking there, health workers recognize the emergency. Don't procrastinate, it's already critical to be referred. Online applications such as telemedicine and convenience can be developed to make it easier to refer patients to higher health facilities. This in turn can reduce infant and child mortality rates.

During the COVID-19 pandemic, how long have you seen the fate of Indonesian children, how long have they been confined to their homes?

We recognize learning-lost when children study at home. It is undeniable that children will get a lot of positive things when they do direct school learning. At school, he met his friends and his teacher. But we have been doing distance learning for two years. We have to look at it from various aspects, from a health perspective, a child's right to health should be prioritized over his or her right to an education. When we prioritize education over health, in the end, he contracted COVID-19. If it's like this, education can't be obtained, health is also not because the child is sick. When we talk about the pandemic problem, the efforts we need to do are to break the chain of this pandemic so that the child can then go back to school as usual.

So actually IDAI's appeals such as not to use 100 percent PTM under certain conditions are our joint efforts so that this pandemic is quickly over and in turn, the children can go back to school as usual. So in the end, it's just that we prioritize or have a different point of view.

The case of COVID-19 in Jakarta has increased again recently, how do you observe?

Yes, as of today (January 27) the positivity rate has reached 12 percent (Jakarta). Pediatricians in Jakarta are already ongoing to collect data, there have been many reports of pediatric patients being treated and the test results being positive for COVID-19. This is something that we must take seriously, in the midst of soaring cases of COVID-19 and also the omicron variant. When PTM was still at 100 percent, actually this was something that was counter-productive to protect children. IDAI and other professional organizations have issued recommendations for the government to review 100 percent of PTM when COVID-19 cases increase and the Omicron variant continues to grow. Hopefully, this can be heard by the relevant ministries and we will soon have a meeting with the Ministry of Health to discuss the evaluation of PTM schools that have been carried out so far.

Regarding the omicron variant, the government said the symptoms were not as severe as the delta variant, but the spread was much faster, how is that exactly?

Yes, it is true that many reports of symptoms of people or children who are not exposed to the Omicron virus are mild in the form of coughs and flu, there is a small number who have severe symptoms in the form of MISC (Multisystem Inflammatory Syndrome in Children) and long COVID. However, the potential for spreading is incredibly fast, it can massively spread everywhere. If so many people are affected, what was previously a small percentage becomes a lot too. For us, doctors must be more vigilant in responding to this variant of Omicron. Protection must be prioritized to be extra careful in dealing with this situation.

For children who have been scheduled to be vaccinated immediately. For children who haven't been vaccinated, how can they be placed in a safe environment and don't go to crowds just yet. Like the mall or other places.

This vaccine has been proven for hundreds of years to prevent dangerous diseases such as COVID-19. No less important is the routine vaccination of diphtheria, measles, and other vaccines.

At present how much the findings of omicron for children?

Of course, we are still collecting data. The problem is that children with coughs and colds are swapped positive, but continuing whole genome sequencing is not a priority. At present, it is only in severe cases that whole-genome sequencing continues. So to conclude on the omicron variant or not is a bit difficult, because we have only just reached the stage of knowing, oh okay this is positive for COVID-19. However, if the symptoms are mild, do not proceed to further investigation. So the data needs to be collected more thoroughly.

The problem of stunting has also become an important issue lately, the Central BKKBN has made this issue a priority, what do you think about this issue?

Stunting is a problem of short stature caused by chronic malnutrition. First is the issue of education, education from parents that the main root of children being stunted because, in their blood, the levels of essential amino acids are very low. In fact, this essential amino acid is a signal in the protein complex that is a growth signal, so that children become tall and grow. These essential amino acids are from animal protein. So actually to prevent children from being stunted is easy, they need to consume enough animal protein. Children can be given eggs, fish, and other animal protein; poultry, etc. Beef may be expensive.

Apart from post-birth, before birth when the mother is pregnant, what are these stunting prevention efforts like?

When a daughter is stunted, then she gets married and during pregnancy is malnourished, the growth of the fetus is stunted. In this condition, stunting has occurred since in the womb. When the child is born, it will be susceptible to stunting. Therefore, it is very important to prepare young women so that their nutrition is fulfilled. Education like this is important to do, how to eat healthy food. Today we are bombarded by junk food that is high in calories and poor in nutrients. What needs to be reproduced is animal protein, healthy fats, vegetables. So pregnant women must pay close attention to nutritional intake so that stunting does not occur during pregnancy.

After birth what needs to be considered?

For fetuses with stunted growth, growth can still be pursued and pursued in the first 1,000 days. Mothers who are breastfeeding must also ensure that their nutritional intake is good so that they can provide quality breast milk. For MP (complementary food) ASI also needs to be considered. Many of us have double or triple carbohydrates. Rice porridge topped with pumpkin, potatoes, or bananas. It's all carbohydrates. The problem of stunting must be the attention of all parties.

IDAI itself has a program to tackle stunting?

Yes, we have a program to help prevent stunting. We support our government's efforts through the BKKBN, the Ministry of Health, and other relevant agencies to reduce stunting rates.

Apart from that, what else can be done to make children grow up healthy?

In addition to nutritional factors, stimulation factors are also important. Children need to be given educational games. In the concept of child growth and development, there are honing, loving, and nurturing. Children are provided with basic needs with him being given good nutrition who is given complete immunizations and given food. Then compassion is an emotional need. Don't forget to say hello to the kids. Newborns are born when spoken to or at will respond. Her mother came with a smile that was different from her mother who came without an expression. Then after being given good emotional care, the above is also stimulated.

This is Piprim Basarah Yanuarso's motivation to give up the Obesity Predicate

Everyone has momentum towards change. Dr. Piprim Basarah Yanuarso, Sp.A(K) was actually challenged when one of his daughters-in-law asked a striking question about obesity. "Do you really want to be a quintal human?" he imitated the simple but piercing question. Since then he was determined to get out of the predicate obesity.

To maintain overall health both physically and mentally, Piprim has five guidelines. “First, keep stress from appearing. Because I am a Muslim, what I do is keep my heart so that I remember Allah a lot. People who are close to their creator are usually at peace. If there is a problem he confides with the Creator. That's the most appropriate vent so that heavy burdens become lighter," he said.

The second, he continued, sleep must be enough. “Nowadays, many people often stay up late, watch until midnight and wake up late. It is an unhealthy lifestyle. Because sleep is a process of resetting all of our body systems to return to zero again,” said Piprim, who was assigned to the Indonesian medical team three times during the earthquake in Iran (2003), the China Secuan earthquake (2009), and the Haiti earthquake (2010).

Furthermore, the third to lead a healthy life it takes exercise. “Many people nowadays are lazy to exercise. I try to exercise regularly, maybe three or four times a week. I also often cycle to the office, I will be picked up by car. The problem is the weather in the afternoon is not good, lazy because there is a lot of dust, "he said. The important thing, he continued, is to take advantage of every moment to move. "When I go to the hospital to visit patients, I go up the stairs," he said, a pediatric specialist who works at the Kramat Jati Vaccination Home Clinic, a Pediatric Cardiologist Consultant at the RSCM, and at the Echo House.

Then the fourth tips to get healthy is fasting. “Fasting is detoxification, so our body's waste during fasting is recycled. Usually, I only have water for breakfast, so my stomach can be empty in about 22 hours. That's good enough to detoxify,” continued Piprim, who tries to keep his fasting routine on Mondays and Thursdays.

And the fifth reduce carbohydrate intake to the maximum. “I used to be obese, I cut down on carbohydrates and replaced them with protein. Fat in the body can be used for energy. This pattern of reducing carbohydrate intake turns out to be beneficial in reducing obesity, diabetes, and hypertension," he said.

If these five things are done well, said the doctor, who is diligent in sharing his activities on social media, it will make the body fitter and it is very good for daily activities.

1 quintal

In the past, Piprim's body weight was almost 1 quintal in 2017. But now it has stabilized in the range of 73 kg to 75 kg. "I started to be intrigued after one of my daughters-in-law said, Abi wants to be a human being 1 quintal, right," he said imitating his son-in-law's words.

"The question is very striking. I thought how can I be skinny? Had thought of liposuction surgery or gastric binding. But how come many reports from my friends that doctors died while having their fat aspirated? Finally, I met a senior psychiatrist, he advised me to reduce carbohydrate intake. What you eat is protein and fat (healthy) only,” said Piprim, who avoids junk food and unhealthy fats in his diet.

In that way, slowly his body weight decreased. This carbohydrate-free diet was able to remove Piprim's obesity status. “Even though I don't eat carbs, I can still eat well and feel full. And there is a bonus, the body becomes slim, he said.

But of course not only that, but he also accompanied the reduction of carbohydrate intake with regular exercise. He even called a personal trainer to supervise his sports activities so that they were directed and maximized their benefits. In addition, he also fasts on Mondays and Thursdays, and gets enough sleep.

For sports, he dismissed the notion that has been held by old people. That they are no longer allowed to exercise with weights, just jogging and walking. "Actually, in sports theory, this is wrong because as we get older there is a loss of muscle mass or sarcopenia," he said.

Because of that, even parents, he said, can still do weight sports. "To prevent that (sarcopenia) we have to do simple weight training such as push-ups, and other muscle exercises that make our muscles build. But it doesn't have to be Ade Ray. The increased muscle mass can reduce sarcopenia and prevent fractures," explained the owner of the Instagram account @dr.piprim.

That is why he is diligent in weight training accompanied by a personal trainer. “What I'm doing now is training with kettlebells. Because in a short time can train strength and cardio. So if we are lazy to run or bike, with a kettlebell with sufficient weight, usually 12 kilos and above is very fast to make the maximum heart rate, "he said.

Communication

Family for Piprim is a place to unwind after struggling with his busy life as a doctor and also the leader of a professional organization (IDAI). "Amid motherhood, family is entertainment, chatting with children, wives, and grandchildren must be done to support activities in the office," he explained.

Parents, said Piprim, must establish intense communication with their children. “Parents must be good friends to chat with their children. If not, he will look for friends to chat with on social media, later he can talk everywhere," said the teaching staff at the Cardiology Division of the Department of Pediatrics, FKUI RSCM, and medical staff at the RSCM Integrated Heart Service.

Problematic children, usually due to lack of attention from the family. "It is very important to pay attention to children. Cases of brawls and drugs usually arise when children don't get proper attention from their parents," he continued.

When a child makes a mistake, his advice cannot be immediately judged. “Make the child a friend. When he makes a mistake, don't be judged right away. Reprimand him like reprimanding an adult," he said.

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One more thing that needs to be straightened out, said Piprim Basarah Yanuarso, is the assumption that a fat child is healthy. "During this pandemic, a lot of children are obese, their weight can increase from 10 kg to 20 kg. When he took part in distance learning, his parents provided snacks in the form of sweet drinks, junk food and as a result, his son was calm, but the impact was that the child became obese. It can become a severe comorbid when COVID-19 strikes," he said, adding that children also need to be directed to exercise.

“Children's right to health must be prioritized over their right to education. When we prioritize education over health, our children end up contracting COVID-19. If it is like this, children will not get an education, nor will health,”