The Barriers of Self-care among Street Children in Banda Aceh

Lisa Fitriani

, Asniar

and Endang Mutiawati Rahayuningsih

Master Program of Nursing Science, Faculty of Nursing, Syiah Kuala University, Banda Aceh, 23111, Indonesia

Faculty of Medicine, Syiah Kuala University, Banda Aceh, 23111, Indonesia

Keywords: Barriers of Self-care, Street Children, Banda Aceh.

Abstract: Self-care is a basic human regulatory function which is essential to be performed by any individuals to

sustain their lives, health, development, and well-being. As well as other individuals, the street children

perform self-care for the same purpose. However, little was known about how they perform it, particularly

the barriers which they might find to meet their self-care needs. This study was aimed to explore the barrier

of self-care among street children living in Banda Aceh city. This descriptive phenomenological study

involved eight street children of a punk community living in Banda Aceh. Data collected in this study was

analyzed using Collaizi’s method. Two themes emerged as the results of the study: 1) negative perceptions

of self, environment and society; and 2) paid health services and self-care facilities. These findings are

expected to serve as the evidences for the stakeholders to develop a supporting program which facilitates the

fulfillment of street children’s self-care needs, instead of merely focusing on the enforcement of public

regulation or sharia law in Banda Aceh.

1 INTRODUCTION

The large number of the world’s street children

population, which reached 150 million, caused by

many factors such as violence; drug and alcohol

abuse; the death of parents; family conflict; war;

natural disaster; and socio-economic issues. Those

conditions implied many of poor children being

forced to earn living by themselves for living on the

street; scavenging; begging; peddling food in the

slums area; sleeping and living on the street; and

sheltering under bridges, gutters, or at the train

station.

Many of them faced problems such illness, died

in the pavement, victimized by drug crime, involved

in fighting or conflicting among groups, and even

suffered from other diseases. Risks of violence and

exploitation are also high in this group of population

(UNESCO, 2011).

Various researches outline the description of the

problem experienced by street children. One of those

study in India illustrates that majority of the street

children (64%) live in slum area and do forced labor

in polluted environment with long duration and

minimum wages. One-seventh of them (13%) only

having meal once a day, they also experienced

physical and verbal exploitation (69%), and physical

abuses (74%). The uses of psychoactive substances

were also found, such marijuana (35%), inhalation

(35%), pharmacy opioids (18%), sedatives and

heroin (18%) and injections (12,6%) (Khatun &

Jamil, 2013; Srivastava & Sharef, 2016;

Bhattacharjee & Kumar, 2016). Meanwhile in

Africa, the identified cases of street children were

suicide, unprotected sexual intercourse, sexual

exploitation, drugs abuses and physical violence

(Hills et. al, 2016).

In Indonesia, the population of street children

rises significantly. The Ministry of social affairs

(2017) mentioned that there are about 4,1 million of

street children in Indonesia that spread in several

provinces in Indonesia. The biggest population is in

Jakarta with the total population is 7.600 children

then followed by West Java 5.200 population

(Ministry of Social Affairs, 2017).

The increasing numbers of street children create

various cases impacted to physical, social and

psychological violence, economic exploitation,

sexual harassment, trafficking, accident threat and

diseases (Ministry of Social Affairs, 2016).

Although these street children and punk

community issues have been existed for long time,

but still very few studies conducted related to the

problem particularly in Aceh Province. There are

Fitriani, L., Asniar, . and Mutiawati, E.

The Barriers of Self-care among Street Children In Banda Aceh.

DOI: 10.5220/0008394700002442

In Proceedings of the Aceh International Nursing Conference (AINC 2018), pages 75-80

ISBN: 978-989-758-413-8

some studies that have been conducted in this

community, including the community development

and point of view of Banda Aceh citizen (Syam &

Hasan, 2013), studies encompassed sexual

harassment, social issues, political views, genre

music of punk community as well as life values of

punk community (Hasnadi, 2012; Sugiati, 2014).

Among the studies, health care issue for punk

community and street children is the subject that

missing especially the barriers they might face to

fulfill their self-care needs. Therefore, this study was

conducted to explore the obstacle faced by punk

community in meeting their self-care needs.

2 METHODS

This research is qualitative research using

descriptive phenomenological design to investigate

extensively, critical, and systematic phenomenon.

The selection of design aims to explore the depth

and complexity of the punk community in Banda

Aceh regarding self-care.

The data collection used in depth-interview

method started from December 2017 to March 2018.

The researcher has been conducted in-depth-

interview to all participants in this study through

face to face interview. The additional instrument

applied in this study namely audio tape recorder,

demographic data form, interview guidelines as well

as field note to write the moment, body language

and nonverbal gesture occur during the data

collection.

This research has been passed the test of practice

by Faculty of Nursing’s Ethical Review Board of

Syiah Kuala University with (No.

320/MKEP/UN11.1.19/KM/2017. After that, the

researcher obtained permission from National Unity

and Politics Agency of Banda Aceh to be passed to

social office of Banda Aceh.

Before collecting the data, the researcher has

been clarified about the study to all participants in

order to get their informed consent. The explanation

covers the participant’s right to participate or ignore

their self without any consequences, contribution of

the participants expected in this study; data

confidential, data collection method, data collection

tools, and participant’s right to determine the

information given to be shared with other researcher

or parties. Participants who agreed to get involved in

this study give their consent by signing the approval

sheet. Before conducting in-depth-interview, the

main researcher built rapport with the participants

while they were doing their daily activity.

3 FINDINGS

3.1 Setting

Banda Aceh is the capital city of Aceh province

which is a center of government as well as focal

point of economics, politics, socials and culture of

Aceh. Banda Aceh was known historically as the

oldest Islamic city in Southeast Asia. This city used

to be as capital city of sultanate Aceh Darussalam,

one out of the five biggest Islamic sultanates in the

world. The city conserved historical heritage sites

form various period, ranging from the sultanate, the

colonial period, joined in a frame of unitary of

Republic Indonesia period, during the conflict time

to reconciliation phase after Tsunami. The historical

heritage sites are Baiturrahman Great Mosque,

Ghairah Park compound, Aceh Historical Museum,

Aceh Tsunami Museum, Mausoleum of Sultan

Iskandar Muda and another historical relic sites in

various spot of the oldest Islamic city in South-east

Asia (Government of Aceh, 2010).

Post Tsunami in early 2005 is a time when other

cultures entered and developed in Banda Aceh. One

of those is Punk community, as told by one of

participants. There are some Acehnese teenagers

who joined in this community and they choose

Taman Sari Park as they center point to meet and

gather. Early 2014, this community moved to

Museum Tsunami and then until 2018 they used a

small highway in traditional market as their center

point. In the area, it looks different and striking

compared to surrounding environment. Almost

every inch of the pathway full of the graffiti and

doodle shown punk’s identity about rebellion.

The government of Banda Aceh considers the

punk community as persons of social welfare

problem who must be organized in order to

implement the Qanun number 11 about social well-

being. The authority of Banda Aceh, in collaboration

with stakeholders, such as social workers, polices,

and wilayatul hisbah (sharia police), arrange routine

patrols and controls towards punk community and

other groups which considered to contribute to social

problems.

Based on District Office of Social Affairs (2017),

the regulations have been implemented since 2010 to

2017 in some focal points of development. At least

29 street children from punk community were in the

sweeping and they finally returned home to their

parents. However, even when the regulations are

enforced, this punk community keeps gathering and

doing their activities in the streets without staying

overnight on it. This community has been renting a

AINC 2018 - Aceh International Nursing Conference

house close to the traditional market. The

participants used this way to prevent the sweeping

from the officers. This house occupied by the punk

children who has no family to stay with, while for

gathering spot they are still using the small alley

near the traditional market.

To control of the social welfare problems, the

district office of social affairs conducts regular

patrols every month on 2018. The officer

confiscated their belongings and accessories like

outfit, jacket, boots, guitar, and their saving money.

In reconciliation phase, this group obtained

knowledge and education about religious thing,

briefing and instruction for not return to the street’s

life and to adjust the appearance in order to meet the

expectation of shariah Islam determination. They

were suggested to wear long sleeve shirt and long

pants to cover the tattoo in their body. In addition to

that, the hairstyle is also change significantly from

what they used to be as a punk identity with their

accessories like earrings and metal necklace which

seized by the officer. The last step to return the punk

children into their own family, unfortunately some

of them were arrested due to drugs abuses.

3.2 Participants

This study involves eight children from punk’s

community who are spending their life in above

setting area. All the participants in this study are

male, Muslim, whose age are scaled from 26 up to

30 years old. One of eight participants are married

and having two kids under five years of age, while

the rest are still single. Most participants are

Acehnese, one person is Acehnese-Javanese and the

other one is Javanese - Bataknese. Most of them are

graduated of Senior High School. Six out of eight

children are categorized into “on the street children”

which means the street children who earn on the

street but return home at night. The rest are labelled

as “off street children” who are spending all activity

on the street. The characteristic of the subject in this

research is presented in table 1.

Generally, the participants are not wearing any

of punk’s accessories, but their former piercings are

still visible clearly especially in the ears with the

width of the hole piercings about one centimeter.

During process of the research, the participants were

wearing long sleeves shirt to cover their tattoo in the

wrist. Some of them were also had it in their neck.

The color of the shirt mainly black with the doodles

and scratches typically punk children used.

Moreover, their jeans are deliberately torn knee or

wear short pants as well as putting on shoes. All of

them are smoking in both public area and the place

they gather. To transport from one place to another

spot they more often on foot or utilize unpaid public

transportation. They stick on their idealism to have

simple life, independently without taking and

receiving any property from their parents as a

guideline for anti-established life.

Table 1: Participants' characteristic.

Characteristics

Number of

participants

Sex

Male

Female

Age

19-25

25-30

Religion

Islam

Educational

Junior high school

Senior high school

University

Marital status

Married

Single

Ethnic

Acehnese

Acehnese- Javanese

Javanese- Bataknese

Type of street children

On the street children

Off the street children

Participants are often seen together as a group.

One brings the guitar and others having the

percussion instrument made of the used good that

have been modified. They usually busk together

around the coffee shop, food court and traditional

market. After finishing the activity, they took a rest

in an alley behind unoccupied shop while smoking

one cigarette for all members. They often buy meals

and eat by hand together and referred it as Sunnah of

the prophet. In the morning until afternoon they just

have a rest at their meeting point and creating the

bracelet made from thread. While waiting for others

friend to gather, sometimes they play guitar and

compose the song. Among them, there is a

participant who runs a cloth printing business, while

the rest mostly just earn money from busking.

In the afternoon the participants are ready for

busking together in coffee shops or cafes at

traditional market or culinary spots. The busking

activities will be stopped for a while before the

evening prayer to honor those who pray. Later, the

The Barriers of Self-care among Street Children In Banda Aceh

participants return to the market hall and smoke

cigarettes together.

In the evening, participants will do same

activities as they did in the afternoon until around

23.30 PM. Finished busking, they regrouped in the

alley and calculated the money they earned. For

them, the money they collected is enough to buy

food and cigarette. If there are some money

remained, they will be saved as collective saving.

The saving then stored to use for anytime

needed, like to pay the treatment of sick punk

community member or as a business capital in the

future. After that, the members will have coffee

together in the nearest coffee shop from their

gathering point and last return home.

3.3 Themes

Two themes emerged as the results of the study: 1)

negative perceptions of self, environment and

society; and 2) paid health services and self-care

facilities.

3.3.1 Negative Perceptions of Self,

Environment and Society

The theme of “negative perceptions of self,

environment and society” describes about how

participants consider their self-suspected by the

society and environment will behave negative like

stealing and disturbing the community. Due to those

negative stigmas, the punk community feel

frightened utilize self-care facility to fulfill their

personal hygiene needs which is available and free

in the mosque. Below is their expression about it.

There are many obstacles we face, especially in

the mosque. They suspect us stealing or destroy

the facility or make a noise. At the end they will

chase us away. Because the mosque is a clean

and holy place, so we cannot enter it with our

dirty outfit. We decide to find gas station or

coffee shop and house of resident. (Participant 3)

Other participants also express the same thinking

with participants 3. It is inappropriate to enter the

mosque and using self-care facility if they are

wearing the punk outfit which is contrast with

religion value. Below is the expression from one

of participants.

I never even thinking to enter the mosque for any

basic needs due to my appearance (Participant 5)

3.3.2 Paid Health Services and Self-care

Facilities

This theme elaborates on how the participants

recently used their own money and their collective

saving for receiving health services when they faced

any health problem. At the same time each of them

also spends two thousand rupiah to use personal

hygiene or self-care facility both for bathing and

other needs elimination. Below is the expression on

how they spend money to have medicine or

treatment regarding any health issues.

When we got sick, we spend our collective

saving to buy the medicine. We cannot just let

our friend being sick without any treatment.

Sometimes for fever case, we buy bodrex or

paracetamol and take it then getting better next

day. If any of us get accident, we will bring them

to the hospital. (Participant 3)

Another participant also told that they used the

community saving to buy the drug that commercially

available in the stall or generic drug in the drug store

as expressed by the participant here:

We take the drug that we buy in drug store or

hospital. If we need to get hospitalized, we spend

money from our collective saving, some we used

to buy medicine the rest to visit our sick friend in

the hospital. (Participant 6)

Paying for self-care facility is also become a

barrier for the participants in fulfill their self-care

needs. They will be able to have only by paying

it. The conditions as shared by some participants:

To use the public toilet, sometimes we must pay.

(Participant 4)

We used public toilet, but we must pay for it. As

Padangnese said, indak ado hepeng indak ado

means you have nothing if you have no money

((laughing)) there are a lot of public toilet and we

spend two thousand for enjoying the facility.

(Participant 6)

4 DISCUSSION

Syam and Hasan (2013) conducted the research

concerning about the development of punk

community in Banda Aceh. This study found that the

existence of punk community in Banda Aceh has

been disturbing the resident at the same time it also

desecrates the image of Banda Aceh as Islamic city.

AINC 2018 - Aceh International Nursing Conference

The data shown that 68 residents of Banda Aceh

(77.28%) viewed that the government of the city

failed in handling and eradicating the growing of

punk community in Banda Aceh. Furthermore, the

citizen of Banda Aceh also rejected the development

and existence of the punk community in the city of

Banda Aceh, because the existence of the

community was contrary to religious values, as well

as the customs and culture of Banda Aceh. In

addition, the punk child community also considered

to bring the negative effects for families and young

generation in Banda Aceh.

The same view as above also found in other

research. In Ilhami’s (2018) study of women’s punk

existence in Surabaya found that the punk

community was labelled as having behavior

appearance counter to culture within the society.

In a society that still honored the Eastern culture,

which is full of manners, punk life style is still

consider as Western culture oriented that respects

freedom of speech, action, deed and behavior.

Public views related to punk community were

also found in a research conducted by Helmy (2012).

Helmi described negative perceptions of the

Bakonang community in Surakarta which against

punk children. The community views teenagers who

are punk children who have adopted a lifestyle that

is not in accordance with the surrounding

environment, as the freedom adopted by punk

children has been misunderstood through the

behavior of punk children such as hanging out while

drinking, making noise, behaving indifferently to the

surrounding environment by ignoring the prevailing

norms and influencing other teenagers to become

punk.

From the perspective of the punk community

itself, Anditya (2016) found that the punk

community did not care and listen to negative words,

nor did they feel the negative label given by the

community to participants. So that participants are

free to do anything regardless of the surrounding

community.

Regarding health-seeking behaviors, several

studies describe the behavior patterns of street

children when experiencing health problems and

need health care. Research conducted by Ali (2005)

in Islamabad, Pakistan, states that self-medication is

preferred by punk children due to several things,

such as medical pluralism, long waiting time,

monetary. These things are obstacles they feel to use

health services.

Furthermore, a survey conducted in Cambodia

shows that street children who experience with

health problems prefer to treat themselves by buying

drugs or taking medication in a house they live in

together. The choice is taken based on the decisions

or costs they have (Rivenbark, 2008). The punk

children of Banda Aceh also experienced the same

thing, where participants chose self-medication

because it was easier and faster by using shared

savings, namely collective money that participants

had collected through the group treasurer.

Although some of the studies above emphasize

that street children prefer to treat themselves and

avoid public health services, Slesnick, et al (2008)

and Calheiros (2014) state that homeless teenagers

can be involved in treatment and respond well to

intervention efforts provided by health workers. This

is supported by Whelan (2010) who conducted a

study involving 150 homeless people in Canada. The

study showed that 86.0% of homeless people who

had health problems chose to use mobile cars to get

basic treatment. This is done by the government to

reach services for high-need populations (Whelan,

2010).

In addition to health services in the form of

mobile cars, an alternative form of other health

services is the medical home care model. Toole et al.

(2016) describes a medical home care model

conducted by the Veterans Health Administration

(VHA) in Pennsylvania to serve homeless patients.

Toole et al also mentioned that there was an increase

in visits and types of primary care services that

homeless patients received with the existence of the

medical home care model (Toole et al, 2016).

Cumber and Gwegweni (2015) also explained

some alternative solutions to protect street children

from neglect, abuse, increase their access to

education, and improve their health status. Some of

the primary interventions that need to be upheld by

policies and laws in all countries in Africa include

such as providing safe housing, proper nutrition,

access to health care, health education, and sexual

reproduction health, protection from all forms of

harassment, violence and substance abuse.

Based on the description above, there are many

solutions that can be done by health care providers

in the community. In addition, policies, local

regulations or laws are needed to eliminate obstacles

faced by street children, especially punk children, in

doing self-care, including obtaining accessible

primary health services. Some alternative solutions

that can be realized include the provision of safe

shelter, proper nutrition, and access to health care as

well as health education. For the context of street

children in Banda Aceh, similar forms of service

may be used as an alternative to the Banda Aceh city

government policy.

The Barriers of Self-care among Street Children In Banda Aceh

The same thing is expected to be realized, in

order to facilitate risk groups such as street children

and punk children to utilize free health care facilities

that are easily accessible to this community. With

this service, the government can also more easily

screen, prevent and control treatment for the spread

of infectious diseases, such as TB, HIV, STDs, as

well as monitoring other deviant behaviors such as

violent behavior and drug abuse in punk

communities

5 CONCLUSIONS

The themes emerged in this study explicated

concerns on self-care which might be considered as

evidence for stakeholders and policy makers to

change the policy towards punk community or other

risk groups. Instead of merely focusing on law

enforcement, the policy should also support the

fulfillment of the groups’ basic need, including their

self-care needs.

ACKNOWLEDGEMENTS

The researchers extended their gratitude to the

Office of Social Affairs in Banda Aceh for providing

access to the data of the social rehabilitation

program which assisted in recruiting participants for

this study. Great appreciation is also addressed to

participants who were willing to actively participate

in this study.

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AINC 2018 - Aceh International Nursing Conference