Author: Christopher Raymond
Raymond, Christopher, 2022 Coronavirus contingencies: An ethnographic case study of local knowledge and community responses to COVID-19 in Kupang Kota and Kupang Regency, East Nusa Tenggara, Indonesia , Flinders University, College of Medicine and Public Health
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BACKGROUND & RESEARCH PROBLEM
The COVID-19 pandemic has triggered unprecedented social, economic, and political disruptions in Indonesia. Nusa Tenggara Timur (NTT), among the poorest provinces in East Indonesia, has been drastically affected by COVID-19. Weak leadership, unprepared health systems, misinformation, stigma, and pervasive uncertainty accompanied the virus as it swept through NTT. A systematic review of the qualitative literature was initially conducted, focusing on community-based research into COVID-19 experiences, perceptions, and responses in low- and middle-income countries (LMICs). Gaps in the literature underscored the need for in-depth social ethnographic research to contextualise lived experience, challenges, and perceptions towards improving public health approaches.
METHODOLOGY AND ANALYSIS
An ethnographic case study was conducted in NTT in early 2020 during an acute phase of the pandemic in Indonesia. Observations of daily community and social life, stakeholder interviews, and focus group discussions were undertaken. A critical ethnography of health lens was used, which considered the distribution of power, (de)legitimation and use of various pandemic knowledges, and the intertwining of religious and empirical biomedical epistemologies in pandemic practices. Data from field notes, interviews, and focus group discussions were subjected to qualitative thematic analysis.
RESULTS
Nine themes clustered around three domains (systemic, sociocultural, individual), identifying deficient leadership, power asymmetries, and ill-prepared health systems as exacerbating the negative consequences of the pandemic, with religious institutions and traditional adat culture playing a crucial role. Misinformation, rumours and hoaxes, social restrictions, surveillance, and sanctions affected community responses. A range of narratives revealed the complex nature of how power, politics, religion, and knowledge systems circulated among the villages and influenced behaviour, driving transmission, and exerting significant social pressure amid uncertainty, fear, stigma, and a little hope.
DISCUSSION
The discussion is focussed one two key themes to come from the systematic review, namely reactions and adaptations. Reactions were responses to the exogenous perturbations of the onset of the pandemic; adaptations were examples of resilience, cohesion, and trust-building as the community and health system struggled to establish resilience. Most respondents focused on the disruptive nature of what was occurring in which blame, uncertainty, insecurity, and frustration prevailed. Adaptive responses consisted predominantly of the stabilising structure of religion, both materially and spiritually.
CONCLUSION
Research into the COVID-19 phenomenon in a remote, east Indonesian context demonstrated that the sociocultural rupture of the pandemic revealed more about community structure and vulnerabilities, and less about the biology of a virus and the illness it caused. This crisis was one of temporality, space, and the construction of new cultural forms to address a dramatic disruption and shift in social norms and stability.
KEY CONTRIBUTIONS TO KNOWLEDGE
This research contributes new knowledge into how resource-constrained communities in LMICs face the challenge of this global crisis, adding to our understanding of how these disruptive unique events are confronted by religion, technology, history, and social structure. This research also contributes to the development of qualitative methodology by demonstrating real-world implementation of field data collection at the height of the global pandemic. The results demonstrated that local context embedded in tradition, religion, political economics, and intersubjective experience is vital to consider when designing and implementing public health interventions in constrained locales in LMICs such as Indonesia.
Keywords: public health, Indonesia, Nusa Tenggara Timur, COVID-19, ethnography, medical anthropology, LMIC, community health, health equity, qualitative research, pandemics
Subject: Public Health thesis
Thesis type: Professional Doctorate
Completed: 2022
School: College of Medicine and Public Health
Supervisor: Courtney Ryder