WHEN ZERO MEANS TWO

Maybe you noticed that i started counting down from April 4th 2009. When it comes to zero, April 14th 2009, it means two special moments for me. First, there will be zero days left for me to revise my thesis before ‘the judgment day’. Thanks God for this. Alhamdulillah. I always think that this is an everlasting work; i found no way to complete. The more i read the more i was confused. What was I supposed to do?
More than a year ago, i brought an idea about health economy evaluation of workplace cardiovascular screening. It was so much compulsive idea that i had. I had almost no clue about updated cardiovascular disease or about the sophisticated screening tools. I will not say that i know about occupational health and just a bit about health economy evaluation. Oh My! But thanks for mr. Timothy for inventing our beloved www (world wide web). Thanks for Umea Library for generosity so i could access almost unlimited journals throughout the world. I got abundant information but unfortunately my poor brain couldn’t work faster. Anyhow, i can tackle this problem. I am also very grateful to my Professor, Lars Lindholm, for not rushing me to finish it.
Recently, i just realized who the most important person was behind. His name is Abdul Kodir. I knew him from the very beginning of my life. He is my late Father, my beloved one. And today is the day when he passed away two years ago. It was only 2 weeks before i got the announcement of getting scholarship from SI, Swedish Institute. I got it just few days after i whispered to me myself,”I give my dreams up, father”. It seemed that he wanted me to pursue my dreams. I keep moving on till today because i have him in my heart.
Flash back to the last days of him.
He ever told me, “I apologized to my colleagues for smoking and harming their health”.
It was full of sorrows and regrets. I knew how hard he tried to strive and fight against his diseases from this sentence the most. He suffered CVD, Cardiovascular disease, for more than 10 years and gave up for something else, Lung Cancer Stage IV. We knew it just 2 months prior to his death.
One day he told me,”The works were so stressful, and i was isolated in a factory. There was nothing else i can do to cope but smoking”.
Yes, his bad habit of heavy smoking was started after he worked as an auditor. Sometimes he had to travelled for couple of days or weeks to audit let’s say sugar factory. He often brought his works back home and worked overtime. He couldn’t do heavy activity that was why he always skipped weekly sport hour in the office. He became less and less in doing physical activity. And to make it even worse, he liked fatty food the most. Later on, after i knew a bit about disease. I tried to encourage him to do more exercise and reduce his weight. He stopped smoking few years back, finally.
“You must be happy to see me lose my weight,” He said to me within his last two months.
I had nothing to say in return because i knew we counted down the days. Those all were the inspirations behind my work. My real life experience and i don’t want anybody else has the same story as mine. Proudly, i dedicated my thesis for him.
“I fulfilled my responsibility, father.”

Can we plan our love life using Epidemiological Study designs?

I thought about writing this article since last year. It was triggered by our naughty discussion during our Public Health, especially epidemiology, courses. Special thanks to Hii Yien Ling, Malaysian, and Ailiana Santosa for giving me the inspiration. Now, that we are approaching toward the end of our Public Health Program. We get use to epidemiological design and others are so curious with what this matter about.
Discussing about study design is somehow troublesome or complicated for some of us. You will start thinking something that is difficult and so this is the most hindered subject in our daily conversation. Conversely, Love is the most interesting topic. What will happen if we collide these terms all together? Will it make study design as a favored one? Or will that lower our attention towards love? Well, all i can say is that this article is subjected to bridge you to a basic understanding of study designs in epidemiology field for both advance and beginner levels.
To start with, Epidemiologist always divides research in two types: observation and interventions. In the observation we are not suppose to do something actively. All we can do is observation. It is not the case for intervention design. We are hoped to plan a particular ‘intervention’ and then assess the impact and consequences. Let’s make an agreement that the only outcome of this article is a love feeling.
Cross Sectional design
This is the least recommended design but the cheapest choice you could make, i would say. All we have to do is a snapshot. You just make one intensive approach. Any idea comes in your mind may suit this design well. One intimate conversation or even one gaze, but in a very long duration perhaps =)), maybe is enough to make your heart works harder. It beats faster than ever. That’s what our parents’ say love at the first sight. You do nothing. It is a coincidence, unintentionally. For some people it might work pretty well. You may start thinking about her/him. But i will tell you my friends that it has no meaning if we do nothing. I mean some ‘interventions’ should be planned right after or it will just be your memory and part of your past. That’s why cross sectional has the least value in epidemiological setting.
Cohort design
It is a better approach. We keep following a person continuously. We do surveillance. It might be possible in a case that he/she is our friend, colleague. Any type of relationship that makes you possible to see or contact him/her over the time. It takes weeks, months or even years. But keep in mind that secret admirer are not considered. There is no chance to be a stalker. Non-participatory method is excluded. And not to forget that informed consent is a very important thing in research and love. You have a lot of time to nurture your feeling toward him/her. You might not aware because it is something you do routinely. You just simply take it as granted. But a research always has certain period of time so as relationship. By the time she/he goes, it wakes you up suddenly. You might have another chance but mostly it will not come twice. So why not start seeing people surround you. There always be someone who cares about you. And do something!!

Intervention design
The key hints of this design are intervention and randomization. We do randomization, somehow. We never choose someone to love purposively. We can’t decide that i just want a man/girl in this particular age, race, or exactly him/her. Of course you decide whom to love but that’s after you develop the feeling inside. It can end up with a totally different person. Maybe someone you saw and chatted in the train, your friends, colleague, whatever. But the most important thing is do something. This is a higher level compare with cohort study. Once you do something you will see the outcome difference compare with observation designs. It doesn’t really matter for how long or how many times you do it. Sometimes one romantic dinner or a poetic love letter or even an intimate conversation will be enough.
It might be costly but this is a good approach. Maybe you don’t have enough money or time. So what about to try ‘hit and run’ intervention? It simply means you do intervention for one time only. But make sure you do it with your best effort. I will only recommend you to do this if you have good excuse. Let’s say you have to study abroad or have to move because of your work. But you have the feeling already and you just simply want to let her/him knows the truth. So why not give it a try? He or she might have the same as you. Even if not, it’s nothing to lose.
So which type of ‘study design’ do you prefer? Will this satisfy your thirsty of love in your life? You are the one who should make the decision. And i hope you will have more positive point of view related with study design and your love life. Lastly, keep fighting with our thesis!!

APAKAH MUSIKMU?

Semalam, 8 Maret 2009, aku mendengarkan radio Swaragama. Beda waktu enam jam dengan Indonesia, membuatku leluasa mendengarkan musik dini hari. Jenis musik yang diputar waktu ini adalah favoritku. Ringan, enak didengar dan mengalun. Djnya seru pula seperti kuis tebak kata. Sang DJ menyebutkan 8 kata dengan awalan S dengan cepat, ”sinten sumerep sate sapi saged singsot suwe sanget”. Aku pernah dengar banyolan ini tapi tetap saja lucu sewaktu mendengarnya.
Sebuah lagu mengingatku akan masa beberapa tahun yang silam. Dinyanyikan ulang oleh Tohpati feat Shakila.


LUKISAN PAGI
Bulan terangi malam
Diam s'ribu bahasa
Menanti sepercik harapan
Dalam khayalan
Fajar yang berkilau
Datang membuka hari
SinarMu memberi harapan yang bersahaja

Lihatlah warna pada cahaya
Menjadi lukisan pagi
Bukalah renda agar cahaya
Sinari damainya arti kehidupan

SinarMu memberi harapan yang bersahaja

Dengarlah suara dari sanubari
Menuntun arah yang pasti
Sejauh batas pandangan mata
Sedalam hati mencari kedamaian


Lagu ini tidak ada kaitannya dengan ‘cinta’ dan segala macam penghambaan cinta manusiawi lainnya. Sebait lirik sederhana sebagai ungkapan syukur akan hadirnya hari ini. Bahwa matahari akan tetap bersinar serumit dan sesedih apapun nestapa mendera.
Rumahku selalu ramai dengan musik. Berbagai jenis musik kecuali Rock dan musik-musik metal. Jangan berharap mendapat ruang untuk memutar lagu keras di rumahku. Sekitar sepuluh tahun yang lalu setidaknya ada empat jenis musik untuk tiga generasi mengalun di rumah.
Aku mendapat kesempatan pertama karena aku masih sekolah. Nasyid, lagu-lagu rohani. Ada waktu dimana aku sangat fanatik dan ekstrem dalam selera musik. Bahwa musik hanya boleh dalam rangka penghambaan kepada Sang Khalik. Setelah aku berangkat sekolah, kakak sulungku memutar lagu-lagu instrumental atau popnya. Mulai dari Kenny G, Kitaro, Richard Marx, Phill Collin, Katon, KLA Project dll. Kakekku mendapatkan kesempatan ketiga setelah kedua cucunya pergi. Tembang-tembang Jowo dari radionya mulai diperdengarkan. Lalu ketika tiga musik itu menghilang, giliran alm. ayah dan ibuku yang mendengarkan tembang kenangan. Lagu-lagu Titik Sandora, Titik Puspa, Dewi Yull, Rafika Duri mengalun ringan.
Aku ingat ada satu pengamen favorit kami. Ia selalu menyanyikan lagu “setangkai anggrek bulan” tapi dengan nada yang...awhhh sulit dikatakan. Jauh berbeda dari aslinya.
Sering aku bertanya,”Mana pengamen setangkai anggrek bulan, Yah?”.
Rasanya nyaman mendengarkan dia menyanyi sambil menikmati semilir angin di serambi rumah. Oya, sambil minum dawet ayu yang lewat. Whuaaa...lewat dehh segala kerumitan masalah.
Majalah the economist membahas tentang music di Bulan Desem 2008. Kalau remaja Amerika sono mendengarkan lagu selama satu setengah sampai dua setengah jam sehari, maka aku bisa jauh melampaui itu. Music selalu diidentikkan dengan cinta. Kenyataannya memang 40%nya bertemakan cinta. Shakespearean theory mengatakan,” Music is at least one of the foods of love”.
Akhirnya, kalimat Dr Pinker yang akan menutup tulisan ini,”Like real cheesecake, music sates an appetite that nature cannot”.
Pertanyaanku hari ini,”apakah musikmu?”

Kutemukanmu hari ini

Hadirmu telah lama kurindu
Kurasa aku memerlukanmu
Tahu?
Kukira kau belum ada yang punya
Tak terdengar desah
Darimu atau tetangga
Saat kita bersama
Hingga begitu saja kau menjauh
Apa salahku?
Tapi hari ini
Tak terperi rasa hati
Saat menemukanmu lagi
Kumohon tetaplah di sini
Saringan teh

THE BUSINESS OF BUSINESS IS BUSINESS

Kalimat ini sangat sexy di mataku, somehow. Aku menemukannya dari sebuah panduan mengenai CSR. Corporate Social Responsibility (CSR) menjadi istilah favoritku hari ini. Terima kasih untuk Mbak Ririn atau Patricia Rinwigati (Uppsala) atas kuliah yang sangat menarik hari ini.
I’ll tell you that you inspired me a lot today.
Lalu apa kaitannya dengan dengan Kesehatan Masyarakat? Kaitannya sangat erat apalagi dihubungkan dengan tesisku. Autumn 2008 yang lalu aku sama sekali tidak ada dasar pengetahuan tentang kesehatan kerja (occupational health). Intuisiku mendahului logikaku. Proposal mengenai evaluasi ekonomi pencegahan penyakit jantung dan pembuluh darah (CVD_Cardiovascular Diseases) di tempat kerja kubuat. Akhir-akhir ini aku baru sadar bahwa topik ini sangat seksi dan strategis. Aku yakin cukup efektif jika orang-orang public health berfokus pada setting ini ketika merumuskan intervensi untuk meningkatkan kesehatan masyarakat umum.
Mbak Ririn memberi contoh begitu mudahnya pelaku bisnis itu berkelit dari tanggung jawab pada kasus Lumpur Sidoarjo. Bencana itu kuidentikkan dengan meningkatnya kasus CVD di masa mendatang akibat ‘kerja’. Jalur stres adalah jalur termudah untuk melacak hubungan kerja dengan penyakit ini. Job Strain Model (Karasek 1979) menjelaskan bahwa ini akibat beban kerja yang berlebih dan rendahnya kebebasan keputusan kerja (misal deadline ketat di luar kontrol kita). Sistem hormonal terkait dengan stres teraktifasi dan berakibat pada kondisi fisik kita.
Tingkat stres kerja yang tinggi ditambah dengan beberapa faktor lain bisa menjadi bom waktu bagi total beban penyakit kronis, dalam hal ini di Indonesia. Pekerjaan menguras perhatian kita sehingga sebagian dari kita lebih memilih makanan fast food, tidak ada waktu untuk olah raga dan mungkin ditambah merokok. Hal detil sederhana di atas akan berbuah kesuksesan menuai penyakit kronis bahkan di usia muda. Proses yang terselubung, tanpa kita sadari.
Hal ini diperparah dengan tidak adanya fasilitas atau bahkan waktu untuk karyawan membuat pilihan yang sehat. Tapi maukah perusahaan melakukan itu? Maukah perusahaan menyediakan makanan yang sehat dan fasilitas olah raga? Itu yang saya tidak yakin juga. Dan saya kehabisan ide bagaimana membuat tesis saya terlihat meyakinkan bahwa perusahaan sebaiknya memperhatikan hal ini. Mereka ada untuk menghasilkan keuntungan. Memperhatikan masalah tanggung jawab sosial, termasuk kesehatan, hanya akan menambah biaya saja. Selain itu, penyakit ini biasa menyerang di usia tua. Benarkah argumen seperti itu?
Cost externalities, suatu istilah ekonomi yang merujuk pada biaya tambahan atau tidak langsung. Penjelasannya sederhana saja. Mari kita samakan persepsi mengenai cost/ biaya. Para ekonom merujuk istilah biaya bukan hanya dalam artian uang tapi juga waktu dan konsekuensi lain. Dalam hal ini penyakit menjadi salah satu komponen biaya.
Kita bekerja anggap kita bekerja selama 35 tahun (mulai umur 25 sampai 60 tahun). Delapan jam perhari lima hari kerja, jika tanpa lembur. Perhitungannya adalah 8x5x52x35= 72800 jam waktu kita tersita di tempat kerja. Jumlah yang tidak bisa kita sepelekan apalagi itu sekitar sepertiga dari total hidup kita. Selama itu pula kita menabung untuk berkembangnya penyakit ini dalam tubuh kita. Bukan hal umum lagi bahwa kasus darah tinggi/ hipertensi lebih banyak ditemukan ketika kita bekerja.
Mengabaikan kesehatan kerja terutama aspek promosi kesehatan sama saja memberi beban tambahan pada masyarakat. Perusahaan boleh berkelit bahwa kasus darah tinggi, penyakit jantung, kanker dan penyakit lainnya jarang terjadi di perusahaannya. Menolak rekomendasi untuk lebih memperhatikan kesehatan kerja menjadi mudah. Tapi masihkah Anda berpikiran serupa setelah membaca uraian saya diatas? Jika masih maka saya harus membuat sekuel kedua dari artikel ini.
Perusahaan yang jelas ada organisasinya lebih mudah dijerat. Tapi saya ingin membuat Anda berpikir bagaimana dengan para TKW, supir-supir bus atau rekan-rekan wartawan kita. Mereka yang secara independen mempekerjakan diri mereka sendiri. Berat hati saya katakan pada teman-teman wartawan dan para supir bahwa Anda termasuk beresiko tinggi untuk menderita penyakit ini dengan penjelasan yang sudah disebut di atas.
The business of business is business menjadi tidak relevan. Tidak satupun dari kita bukan bagian dari masyarakat. Etiskah para pelaku bisnis menolak melakukan tanggung jawab sosial ketika mereka juga bagian dari masyarakat itu sendiri. Anda adalah bos bagi diri Anda sendiri. Mari kita buat keputusan yang sehat untuk masa tua kita.
Referensi
Amnesty Business Group. Guidelines for corporations’ work on human rights. 2007
SIDA. Guideline’s for Sida’s support to Corporate social Responsibility. 2005 available from http://www.sida.se/?d=118&a=3494 accessed on February 25th 2009.
Schnall PL, Belkic K, Landbergis P, Baker D [editor]. Occupational Medicine: The workplace and cardiovascular disease. Philadelphia, 2000
Tuchsen F, Hanerz H, Roepstorff C, Krause N. Stroke among male professional drivers in Denmark 1994-2003. Occup Environ Med 2006;63;456-460 [abstract]