Infectious Disease Reports 2020; volume 12(s1):8763

Transformation of infectious during the stages of national struggle and diseases and the Indonesian development. The typical field hospital in Correspondence: Soroy Lardo, Kramat Jaya was initiated by a health platoon Baru Street F1/280 Central Jakarta 10560, national military health forged by migration of guerrilla warfare, Indonesia. research collaboration in sup- which constantly kept moving from one E-mail: [email protected] porting national health security place to another. Geographical and epidemi- ological differences of diseases in migration Key words: Infectious diseases, battle trans- formation, integration and networking. area had become an essential lesson in the Soroy Lardo development of organization structure and Conflicts of interest: The author declares no Division of Infectious Diseases and human resources including TNI soldiers potential conflict interest. Tropical Medicine, Department of that subsequently proceeded to a health bat- 3 Internal Medicine, Indonesia Army talion along with a field hospital. Funding: None. Central Hospital Gatot Soebroto, The establishment of strong TNI health Indonesia organization with missions on health care Acknowledgements: This article is part of services, heath care support and research in contribution in acitivity of infectious diseases health development indicates the impor- research in TNI (The Armed Forces). tance of management of resources and terri- torial power. Territorial empowerment with Conference presentation: Part of this article Abstract was presented in International Conference functionalization of territorial non-commis- Transformation of infectious diseases is Military Medicine 2016 in Bali. sioned officers becomes a main benchmark a dynamic movement of the spread of dis- of synergy of TNI health in the community.4 ease that is largerly determined by the abil- Received for publication: 17 February 2020. ity to understand geomedical maps, disease Accepted for publication: 1 July 2020. transmission and impacts on national secu- This work is licensed under a Creative rity. Disease transformation is an order of Materials and Methods Commons Attribution-NonCommercial 4.0 infection that can be life threatening in a onlyInternational License (CC BY-NC 4.0). clinical perspective an outbreak at the com- The method developed in this paper is munity level. The involvement of the the study of infectious disease transforma- ©Copyright: the Author(s), 2020 Indonesian National Military (Tentara tion strategies to support health security Licensee PAGEPress, Italy Nasional Indonesia, TNI) in the transforma- policies through continuous collaboration,use Infectious Disease Reports 2020; 12(s1):8763 tion of infected diseases is a network that integration and networking (Figure 1). doi:10.4081/idr.2020.8763 needs to be strengthened, considering that its role is very important to maintain health Transformation of Infectious packing; (4) Social behavioral changes, use security as a gate for national security. Diseases and Zero-War (Nir-Yudha) of narcotics and travelling behavior; (5) Strength in dealing with the extraordinary Policy Environmental changes such as deforesta- event of infection requires on going collab- The context of infectious diseases tion, ecosystem changes, flood and drought; oration, competence, networking and inte- nowadays is associated with various system (6) Infrastructural problems on community gration. interactions, which are internal and external health, which are surveillance and limited systems. The internal system is body system infection control; (7) Microbial changes.5 with a capacity of cell degeneration that has The abovementioned condition bridges Introduction impacts on changes and structures of immu- infectious diseases in association to the The Indonesian National Military nity system when dealing with a microor- impact of global warming (GW) over a (Tentara Nasional Indonesia, TNI) Health ganism intervention. Degenerative diseases national problem that needs special atten- Research is an organization to reinforce that become comorbidities now such as dia- tion.6 Flood, forest fire and drought increase health security. Due to the historical process betes, hypertension and geriatric conditions respiratory disorders as well as early death since independence war, the roleNon-commercial and func- have brought a new power for infectious due to respiratory and cardiovascular dis- tion of TNI is different from that of similar diseases to set in a condition of aggravated ease. Their indirect impacts are changes in institutions in other countries. The history infectious cases in a community; while the the bionomics of the mosquito vector as of Indonesian independence with its guerril- external system is an environmental or even with increasing temperature and certain la warfare has provided specified concepts, global condition that affect the behavior of humidity, there will be mosquitoes with idea, strategies and managerial values along infectious diseases to have an asymmetric more active mating and with shorter life with TNI health contribution through the relation with its generated reality. One of cycle, which will cause increased mosquito role of field health services to enhance mil- those that has been published is a new strain 1 density; therefore, it may have impacts on itary battle operation. of influenza virus that may have a potency greater level of infection in the community.6 Dealing with the changing battle pattern of outbreak similar to the H7N9.5 from conventional to modern, infectious Some factors that affect the develop- disease associated with battle transforma- ment of infectious diseases are: (1) Social tion has a role in biological and chemical events, which are associated with lack of wars. However, our understanding about economy, interpopulation conflict and Results and Discussion infectious disease is not detached from explosive migration; (2) Health problems, Policy on military battle transformation interaction process between body system particularly the extensive use of antibiotics is one of technology-based modern systems and military battle environment.2 without considering rationales and side that must be continuously developed. The Unlike developed countries, the concept effects; (3) Food production, which is asso- no war or zero-war policy (Nir Yudha), of field hospitals has precisely expanded ciated with preparation, processing and according to Moeldoko,7 is an effort and it

[Infectious Disease Reports 2020; 12(s1):8763] [page 125] Article becomes the most essential learning source research.1,4 The developed scope includes process of thought and scientific-based about meaningless role of any form of research in military technology and disci- management of military resources; there- armed violence. War may provide a piece plines that support the objectives of the fore, it can create futuristic mission on of confiscated land, an imperial structure Indonesian National Military (TNI) devel- enhancing TNI ability as the users of power that on top of that may develop into a civi- opment including military medicine. The and the guardians of national defense.4 lization. However, a civilization established ongoing research nowadays through the TNI territorial development during the using armed violence will soon be gone, TNI internal research and development era through the principle of Unity leaving war debris and wreckage. Only institution has resulted national and interna- in the Military Armed Forces of Indonesia innovative creation of human thought and tional publications. However, the institution (ABRI Manunggal) has set an important mind, which is developed in a free and joy- should be developed further as an instru- notification for research development in the ful manner, can be a long-lasting legacy of ment for integrated networking with field. Territorial social service activities, civilization. War, or military attack to be research collaboration. Collaboration and which were initiated as a breakthrough pro- exact, is an acceptable sacrifice of resources integration would become inevitability if gram, have raised isolated regions to be as it can be repaid by confiscated resources the Indonesian National Military yearns for connected with social and economic that may provide better advantages or even further advance in research. 4 changes in the community. The concept glory. However, it obviously wastes TNI research is a process of research in becomes an essential reference that TNI has resources and it is a potential resource of a general, which finds new innovation of mil- established axiological science based on 7 problem. Dealing with the era of battle itary system and doctrine that becomes field application. Their involvement in transformation nowadays, it is necessary to basic reference of activities as civil ser- world peace through the Contingent create a new climate of consideration, vants. The concept of innovation is a is an embodiment of development and orga- which denies war by transmitting an under- standing of human basic equality with vari- ous differences that are obvious on the sur- face.7 Utilization of regional district encour- ages creation of self-consciousness that can only be placed side by side with each national identity. One of the main roles is the role of TNI health in Military Operation of War (MOW, Operasi Militer Perang, OMP) and use Military Operation Other Than War (MOOTW, Operasi Militer Selain Perang, OMSP).2,4 The role of Indonesia is to be the front- line pioneer in establishing confirmed peace of a dynamic geopolitical region. The ongo- ing war may be unavoidable, but the upcoming war can be prevented indeed. On the last calculation, the zero-war (nir- yudha) policy is a military translation of civil policy to enhance welfare and to wipe out poverty (zero poverty). Military or Armed Forces have the duty to maintain democratic growth and freedom against various parties that endanger democratic climate. Guarding peace and basic human rights of a nation so that a region canNon-commercial grow with full dignity is the scope of work of mil- itary folk that is extremely worth to be fight for with all one’s might.7

Discussion TNI Collaboration Research and Health Security One thing that has been slightly forgot- ten nowadays is the importance of research collaboration to support Health Security. Research should be established not only based on the norm and power of scientific evidences, but also should reach the per- spective of national defense. Developing Figure 1. Model for management of infectious disease and bioterrorism in battle trans- Indonesian National Military research is a formation. form of TNI’s concern on education and

[page 126] [Infectious Disease Reports 2020; 12(s1):8763] Article nizational tasks with multidisciplinary sci- TNI Research Innovation and Its formance.4 Military research investigator entific structures of the TNI. The success Prospect previously was a complementary profes- that has been achieved indicates that the Innovative research is a main key of sion; however, global development has TNI has a system and structured method for TNI research. The empowered scope is demanded a reorientation of policy as good 4,8 work target that has become its goals. bridging military socio economy process as a promising alternative carrier and has a Through the three above mentioned activ- (epidemiology) of tight domestic and for- similar prospect with the main military ities, it has been demonstrated that the research eign assignment with the utilized military work scope; nevertheless, a hard work and instrument in TNI is very extensive, from the technology and the most updated validation. strenuous effort are necessary to achieve it.4 upstream to the downstream level. Research of Innovative research, in consistent with its the upstream level includes policy concept of function, has developed a new level of TNI activities as an update on the development research, which is guided by results and Conclusions of military technology as an innovation of aims of study to support TNI duties and improving functional ability on defense force. basic functions.4 The TNI health research is a main gate The downstream research includes empower- Currently, innovative research in TNI to open the role and function of empower- ment of TNI resources and their supporters to has been growing rapidly. The level of ing the transformation of infectious disease, optimize the function of military operations of research development includes material and which is a threat to health security. war (MOW) duties and the military operation non-material aspects. On material aspects, Institutional power will support an integra- other than war (MOOTW) such as disaster which are associated with primary weapon tion and networking with various domestic management. It is expected that the axiology and defense system or the alutsista (alat and foreign research networking that of TNI research can be developed based on utama dan sistem persenjataan), the enhance the spirit and technology innova- epistemological approach as the basic princi- research and engineering has been very 4,8 tion based on health security principles. ples of further TNI activities. advanced. Non-material research is associ- ated with the empowerment of various sup- Integration and Networking portive scientific disciplinaries, which has Integration and networking of TNI important contribution in applying the main Referencesonly research rest on three aspects. The first duties of TNI such as some applied activi- 1. Lardo S. Indonesia’s Defense Health aspect is developing or completing infra- ties of soldier assignment at the borders. In Perspective. Jurnal Pertahanan structures of research institution of the military medical sector, currently the ongo- 2019;5:46-60 Armed Force of TNI, which currently is a ing research involves a study onuse malaria 2. Lardo S. Bioterorisme Mikrobial dan strong institution. The Research Institution herbal drug as a prophylaxis for soldiers Penyakit Infeksi dalam Transformasi of the TNI, in fact, is easier to combine con- who are on duty at the border of malaria Pertempuran. Jurnal Yudhagama sidering that the institutional infrastructure endemic region. The study is collaboration 2014;34:62-72. of each military force has performed between the Institute of Tropical Disease, 3. Lardo S. Manajemen Kejadian Luar research activities. The second aspect is Airlangga University and Kimia Farma Biasa (outbreak) infeksi Perspekif opening networking with military research Corp. Results of the preliminary study have Epidemiologi – Klinis. Jakarta: PT institution of various countries based on demonstrated the efficacy and safety of the Adfale Prima Cipta; 2018. principles of openness and transferring sci- first study, which was then continued to the ence based on principles of universal scien- second study to evaluate the efficacy, which 4. Lardo S, Budiman W. Kesehatan tific collaboration. Through the gate of is followed using a cohort method.9 Pertahanan dalam Integrasi Sistem research collaboration, it will connect diver- The principle of innovative research in Ketahanan Nasional 2019. Jakarta: PT sity and peculiarity of each country to fill TNI is to empower the ongoing institutional Adfale Prima Cipta; 2019. the gap of basic military research to support component by optimizing facilities in TNI 5. Katz R, Sorrell EM, Kornblet SA, the arrangement and execution of military institution into a harmonic work system of Fischer JE. Global Health Security and non-military operational activities. The research and development system among Agenda and the International Health third aspect is empowerment of TNI human the military forces. The policy that has been Regulations: Moving Forward. resources that had been preparedNon-commercial early so introduced is the spirit and breakthrough of Biosecur Bioterror 2014;12:231-8. that it can cope with the interconnection of TNI research through several steps, which 6. Hadisaputro S. Global Warming and global collaboration in military research. are: (1) Drafting the framework of institu- Incidence of Tropical Infectious The fundamental base that has been devel- tion for TNI research as well as its future Diseases. Kongres Nasional Petri XV. oped is the fighting character of TNI human role as national research networking; (2) 2009;30-40. resources on the early moment of duty in TNI research institution has one command 7. Moeldoko. Kebijakan Nir Yudha. different field scopes (axiology) as well as chain with each research institution for ;2014. having a perspective of the process of every military force; (3) Developing an 8. Babinsa Ujung Tombak Teritorial TNI action without denying the epistemological integrated network system for research AD. Dinas Penerangan Angkatan Darat; values of research. For example, an assign- institution of military force, particularly in 2017. ment during disaster is a huge integration of optimizing the collaboration of both domes- organization and multidisciplinary human tic and foreign military research; (4) 9. Lardo S, Waruyanti W, Tantular I, Hafid resource, which so far has structured stan- Empowerment of human resource for mili- AF. Pre Eliminary Study of Safety and dard operating procedure (SOP), both in tary research through a breakthrough of car- Toxicity of Cempedak Capsules planning and execution. Benchmarking of rier path, work stratification, certification Alternative Complementary Drug for effective utilization of human resources for research investigators and academic Malaria Prophylaxis at Nanga Badau during disaster should be supported by competency as military research investiga- Kalimantan. International Review of research.4 tor that allowing them to have an apprecia- the Armed Force Medical Services. tion of promotion based on their work per- 2016;89

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