Human Practices

Brainstorming the Big Picture of CerveX Project

Figure 1. Verrel, Auzan, Lina, and Belle met with Kak Aul in RSUI to discuss the initial steps in preparing for the iGEM Competition

Description

We approached Kak Aul due to her long standing relationship with iGEM UI, having been part of iGEM UI 2016 and played an advising role in subsequent iGEM UI teams. We discussed the general iGEM competition itself, CerveX, how to gather sponsors and funds within UI, and asked for her input in preparation for the iGEM Jamboree.

Contribution

During the meeting, Kak Aul emphasized the importance of choosing the project. Initially, we were inclined to choose a topical formulation for the project, but Kak Aul advised against it because topical medications have the potential to be dangerous to healthy cervical cells around the cancerous cells. In addition, Kak Aul directed us to UI’s alumni network (Iluni UI) and asked external companies for sponsorships. Kak Aul also helped us upload our research to UI’s virology and cancer pathobiology research center (PRVKP UI) and with our visa requirements before departing for Jamboree.

    Adjustment

    Following the interview, we gathered that topical medications would not be suitable for delivering therapy to cervical cancer cells. As a result, more research was needed to ascertain the correct drug delivery system in order to form a more targeted delivery method.

    Next Step

    The Policy and Practices division passed on the aforementioned information to Wet and Dry Labs and information about sponsorships.

    Figure 2. Aldo, Chico, Akbar, Bram, and Lina had first meeting with Kak Faus to design the outline of the Human Practice programs

    Description

    There was a substantial change in the medal criteria, which caused us to rethink our strategy for achieving a medal during the Jamboree. To answer our questions regarding this, we had a meeting with our advisor, Faustina Prima Martha. Faustina has a lot of experience in iGEM, having participated as part of iGEM UI in 2015 in the Human Practices and Modelling division.

    Contribution

    During the meeting, Faustina suggested a number of programmes and activities for the Human Practices Division. In addition, she also suggested a number of programmes that have become a staple in iGEM:

    • Education A new method is needed because the regular presentation method is not as interactive as what is recommended.

    • Street Survey Street surveys should not be limited to asking the public about the topic at hand but should also include a short movie to more readily engage them.

    • Inclusivity This is an area that iGEM UI has not put forth. Inclusivity can include educating people regarding the topic in less developed areas or areas with a low level of trust in science.

    • IHP iscussions and interviews should be done with relevant experts in governance, research, medical sciences, and industries.

    Adjustment

    Following the interview, we learned that there is a need to revise educational methods, for example in creating a new model of delivering a very technical subject to the masses. Because projects on cervical cancer and sex education in Indonesia remain a largely taboo subject, we devised a way to tailor the education to include Muslim women in Indonesia.

    Next Step

    Discussions with the Human Practices division regarding programmes that can be put in place, keeping in mind the budget and resource constraints.

    Figure 3. Aldo, Lina, Auzan, and Ansell had a meeting with Ketjo to discuss progress, challenges, and solutions that could be chosen.

    Description

    We conducted an interview with Kevin Tjoa, iGEM UI 2021 team manager regarding medal criteria, non-biotech sponsors, and team registration.

    Contribution

    In the meeting, we introduced the project to Kevin. He suggested that we not put too much emphasis on collaboration and prioritise strengthening the Human Practices programmes in order to fulfil the criteria required for the bronze, silver, and gold medals. We also received a sample proposal from iGEM 2021 asking us to further enquire with sponsors. Apart from that, he explained how to register and pay for the iGEM competition

      Adjustment

      Because collaboration is no longer a criterion for medals, we will be focusing on IHP and education aspects. We cut back on collaboration and agreed on the specialisations required to get the gold medal.

      Next Step

      We discussed to have a meeting or appointment with dr.Budi.

      Figure 4. Lina met with Kak Firda to discuss the iGEM UI team programs and things that could be improved

      Description

      Firda Izzain Baliyati was the head of iGEM UI 2021’s Human Practices division. We interviewed her on how best to form the IHP team, how to devise IHP programmes strategically and how to receive iGEM grants.

      Contribution

      We interviewed Firda as far back as June 2022. During the interview, we talked about:

      • Human practices division The policy and practices division does not need a lot of people, with the ideal number being 3-4. Members can come from various backgrounds.

      • IHP IHP needs to conduct interviews or two-way discussions regarding the project as to whether or not the wider public can understand and accept it. The community in question can include children, adults, the elderly, and various tribes and indigenous people of Indonesia.

      • Partnership For partnership, iGEM can collaborate with community elements, such as other iGEM teams in appraising each other’s projects, or bond together in the leadup to iGEM.

      • Education Education means socializing iGEM and its related project. In 2016, iGEM UI helped with educating students in remote areas of Indonesia and created a whole competition to help familiarize high school students in biotechnology. It can be also combined with initiation stories of several iGEM members regarding the iGEM competition, benefits obtained, and how long they know about iGEM. Education can also be done by creating webinars with speakers from industry, government, or experts in synthetic biology.

      • Excellence in another area iGEM can broaden their reach by engaging the arts, for example by creating artsy products such as postcards, paintings, songs, or other fields such as economics by creating a business plan in the biotechnology field.

      • Sponsorship and grant Every year iGEM provided a grant of $2500 for selected iGEM teams to attend the Jamboree. Participating teams must answer a series of questions regarding their project. iGEM UI 2021 put the answers to these questions in their proposal. iGEM grants take many forms, for example providing reagents or winning challenges on Twitter. However, grants should not be used as a source of income but should only be considered as a bonus if your team is lucky.

      Adjustment

      Engagements and programmes need to be tailored to include as many specialisation as possible, in order to maintain effectiveness.

      Next Step

      We created the Human Practices team with team members hailing from many backgrounds so we can cover as broad a subject as possible.

      Figure 5. Ansell, Nadine, Chico, Clara, Syidan, Akbar, Akmal, Bryanna, and Lina had a meeting with Kak Faus and Kak Aul to discuss our progress and problems that we faced. It was our first meeting with Kak Iqbal and Kak Samuel to introduce them about our projects

      Description

      During the research itself, we had a number of difficulties with ethical clearance, time limitations, and lab use. To resolve these issues we held a meeting with our wet lab advisors, namely M. Iqbal Adi Pratama and Samuel Febrian Wijaya.

      Contribution

      In this meeting we talked about a few of the problems that Wet Lab and Dry Lab encountered:

      • Wet Lab Due to time constraints, the viability testing of the engineered Salmonella typhimurium A1-R on the cervical cancer patient's pap smear cells is better canceled and turned into a continuous project that can be continued by the iGEM UI team next year. Since the project involves mutated Salmonella, albeit still being pathogenic bacteria, a risk assessment is needed as an assurance that the requirements and steps taken have ensured its safety. Ethical approval can be sought from the ethics committee of FKUI, but if there are any difficulties, such as long waiting times, they can be addressed by consulting experts at PRVKP regarding biosafety.

      • Dry Lab Because two plasmids are used as p53 sensors to serve as indicators when Salmonella is already inside cancer cells and is ready to release the buforin IIb drug, a selection medium with two antibiotics is required, and the transformation is also performed twice. It is ensured again with PI whether the plasmid will be made as one large plasmid or two smaller plasmids. Also, make sure there is enough time for the lab work and design of the plasmid as soon as possible so that the plasmid is not delayed at customs.

      Adjustment

      The fixed plasmid design will be created soon and will be reconfirmed with other team members whether the plasmid will still be made as one or two.

      Next Step

      The Dry Lab team designs the plasmid to be used and also places an order with the nearest vendor in Singapore. The Wet Lab team replaces the ethical approval submission with consultation from biosafety experts to ensure the safety of the protocol, and testing is restricted to using HeLa cell lines without involving cells from animal or human samples.

      Direct Experiences from The Survivors

      Figure 6. Lina visited Rumah Singgah Kasih Bandung and held a discussion regarding complaints and hope from cancer survivors

      Description

      We aim for the CerveX project to be accepted and recognized by everyone, especially cancer patients. Therefore, we visited the cancer patient community in Bandung, specifically the Rumah Singgah Kasih located at Jl. Sukabungah No.5, Bandung. We conducted interviews with several cancer patients and asked them about their views on our cancer drug research.

      Contribution

      During our visit to the Rumah Singgah Kasih, we inquired about the cancer treatments they were undergoing. During the interviews, we encountered differences between theory and practice. As far as we know, cancer treatments such as surgery, chemotherapy, and radiotherapy are typically chosen based on the location, type, and stage of cancer. However, the cancer patients shared that they received all types of therapy, including surgery, chemotherapy, and radiotherapy. Even after surgery, they still needed regular consultations and annual check-ups to prevent cancer cell regrowth or the spread of cancer cells to other organs. They also informed us that unhealthy lifestyles, such as frequent consumption of instant foods and lack of physical activity, were contributing factors to the development of cancer. They advised us, as the younger generation, to reduce our intake of instant foods and recommended cooking our own meals to ensure cleanliness and avoid MSG content. They emphasized the importance of consuming plenty of vegetables and fruits. Furthermore, they stressed that some types of cancer still lacked a cure, which is why the research we are conducting could encourage other researchers in Indonesia or interested students to collaborate in the search for and development of cancer treatments.

        Adjustment

        By listening to the stories of cancer patients due to the effects they experience after treatment, it enhances our enthusiasm as part of the younger generation to conduct research related to cancer treatment. Additionally, we are also aware of the importance of maintaining our health and lifestyle to avoid cancer.

        Next Step

        Our spirits have been revived, and we continue to pursue the CerveX project despite facing numerous challenges in terms of finances, transportation, and human resources.

        Reaching Out to the Frontliner

        Figure 7. Lina and Aldo had opportunity to interview with Kak Ami who is a nurse

        Description

        Ns. Ami is a nurse at the PMI Hospital in Bogor, West Java. She has been dedicated to PMI Hospital for 22 years and has a lot of experience in caring for cancer patients. We had the opportunity to interview her about her experience in caring for cancer patients and palliative therapy.

        Contribution

        From Ns Ami's experience, she shared that discipline is required in cancer treatment. Without discipline, it can lead to an advancement in the patient's stage. On average, cancer patients undergoing treatment at Bu Ami's hospital are detected at stage IIB, sometimes with multiple-organ involvement. Patients undergoing treatment should be in a fit condition, for example, not experiencing nausea and vomiting, and with normal electrolyte and hemoglobin levels in the body. In addition, cancer patients also receive supportive palliative care such as medication and psychological support. Many cancer patients are in denial about their fate and experience depression, so support from their family and environment is needed. Treatment for advanced-stage cancer patients or those with a low chance of recovery can only alleviate symptoms. Bu Ami is very pleased and hopes that in the future, more researchers will develop cancer drugs that are not like chemotherapy, which can harm healthy cells and target only cancer cells.

          Adjustment

          Many healthcare practitioners support research aimed at developing cancer drugs. Cancer patients not only need therapy in the form of treatment but also psychological therapy that can help them cope, forget, and accept their condition.

          Next Step

          The Human Practices Division is attempting to create an approach in the form of games that will be played together with cancer patients and record input from the cancer patients.

          Understanding Healthcare in Indonesia

          Figure 8. Lina took part in the Health Innovation Day event

          Description

          The Health Innovation Day held at the Ministry of Health of the Republic of Indonesia on May 30, 2023, is an incubation program by the Ministry of Health aimed at realizing digital innovation in healthcare and biotechnology. This event is open to the public and was attended by many individuals from the government, health technology enthusiasts, and Owen Jenkins, the British ambassador. During the event, dr. Dante emphasized several points regarding the importance of digital transformation in the healthcare field and the healthcare criteria needed by the Indonesian community.

          Contribution

          dr. Dante Saksono's speech influenced the final form of the CerveX project, which initially was a topical medication but later changed into an IVA administered into the body through injection. However, the limited number of doctors in Indonesia, remote and hard-to-reach areas, and the lack of awareness among Indonesian people about health products have led the iGEM UI team to believe that the choice of the final product in the form of IVA is still considered less suitable. He also said that it was a good starting point for students to take part in health-based projects, research, or events.

            Adjustment

            Many healthcare practitioners support research aimed at developing cancer drugs. Cancer patients not only need therapy in the form of treatment but also psychological therapy that can help them cope, forget, and accept their condition.

            Next Step

            Further discussions will be conducted, and the advantages and disadvantages of the final product of the CerveX project will be in the form of IVA or an orally consumed drug.

            Consulting with the Experts

            Figure 9. Nadine had an opportunity to have a talk with dr. Fitri

            Description

            Dr. dr. Fitriyadi Kusuma is a consultant obstetrician-gynecologist oncologist. We had the opportunity to interview him about the potential of targeted immunotherapy drugs for cervical cancer and also the shortcomings of existing cancer treatments.

            Contribution

            During the consultation, it was mentioned that non-causative (non-treating the cause) cervical cancer drugs are becoming more effective with fewer side effects. According to them, radiation therapy is considered less effective, and some chemotherapy drugs, such as trastuzumab, have shown virus modifications in ovarian cancer. Chemotherapy drugs can lead to various side effects, such as nausea, vomiting, hair loss (alopecia), decreased appetite (anorexia), kidney damage, neutropenia (very low neutrophil count in the blood), and anemia (low red blood cell count). Both chemotherapy and radiation therapy can also lead to infertility, prompting the search for alternative, albeit more expensive, conservative treatment methods. They also expressed concern about the shift where previously most cervical cancer patients were aged 50 and above, but now many young people are being diagnosed with cancer caused by lifestyle factors like unprotected sex.

              Adjustment

              Because the current cancer treatments are still not very effective at killing cancer cells and often cause many side effects, there is a need for cancer drugs that have minimal or no side effects.

              Next Step

              It will be discussed between the Dry Lab Division and Wet Lab Division regarding the appropriate, selective therapy methods for targeting cancer cells, without causing many side effects.

              Figure 10. Nadine and Lina had a meeting with Prof Ocvi and Kak Shabrina to discuss cervical cancer cases in Indonesia and its preventions.

              Description

              Prof. Dr. Dwiana Ocviyanti is a specialist doctor and a specialist obstetrics and gynecology lecturer at the Faculty of Medicine, University of Indonesia (FKUI). We had the opportunity to interview her regarding cervical cancer cases in Indonesia and also methods for preventing cervical cancer.

              Contribution

              Indonesia does not yet have an integrated platform for providing the number of cancer patients in various regions of the country. Data on the number of cancer cases and deaths in Indonesia can be found in Globocan and WHO for the year 2020. The 'One Health' approach, which combines human, animal, and environmental aspects and involves multiple sectors to integrate standardized data, has been introduced within the G20, aiming to reduce the risk and anticipate potential outbreaks in the future. A significant portion of the Indonesian population does not seek immediate medical attention and tends to ignore symptoms such as vaginal discharge and difficulty urinating, resulting in many cervical cancer cases in Indonesia being detected at an advanced stage. Furthermore, cervical cancer screening coverage in Indonesia is still below 10%, primarily due to reluctance among the population to undergo screening. However, the government has made efforts to reduce the number of cases and deaths from cervical cancer through mandatory HPV vaccination. The government provides free HPV vaccines to children in elementary school under 13 years of age, with a requirement of 2 doses. With this vaccination program, the prevalence of cervical cancer incidence can be reduced by up to 70%.

                Adjustment

                The high number of cervical cancer cases and deaths in Indonesia is due to the reluctance of the Indonesian population to undergo screenings that can detect the presence of cervical cancer at an early stage. Therefore, there is a need for awareness campaigns that can encourage Indonesian society to regularly undergo cervical cancer screenings and receive HPV vaccines.

                Next Step

                The Human Practices Division will discuss socialization targeting the PKK (Family Welfare Empowerment) mothers and remote areas with the aim of raising awareness among the local community to undergo screening and receive the HPV vaccine.

                Figure 11. Nadine, Lina, Akbar, and Syidan were discussing the right medium to culture cervical cells from human samples

                Description

                Prof. Iko is a lecturer at FKUI (Faculty of Medicine, University of Indonesia) and a specialist obstetrician and gynecologist at Pondok Indah Hospital. We consulted with Prof. Iko because he has extensive research experience related to cancer cells. We inquired about the medium and discussed ethical approvals at FKUI.

                Contribution

                At the beginning of the consultation, we introduced the CerveX project to Prof. Iko. Before answering our questions, Prof. Iko informed us that he did not have prior experience in cervical cancer research, and most of his research was related to colorectal cancer (CRC). Therefore, our questions would be answered in a general context of cancer. He told us that there are many mediums that can be used to culture cancer cells, such as HPLM (Human Plasma-Like Medium), MEM (Minimal Essential Medium), IMDM (Iscove’s Modified Dulbecco’s Medium), DMEM (Dulbecco’s Modified Eagle’s Medium), and others. Each medium has different nutrient components, and these varying nutrient compositions can affect the metabolism of cultured cells. The most commonly used medium for growing CRC is DMEM, while for cervical cancer cells, we could refer to the literature or ask dr. Norma. If samples are to be taken from humans, specifically cervical cells from a pap smear, ethical approval is required. For ethical approval submission, it is better to do so one month before sample collection, as the queue for ethical approval submissions is usually long, and the fastest approval can take up to one month to be granted.

                  Adjustment

                  In the selection of the growth medium, it is necessary to conduct a literature study or consult experts who often conduct research on cervical cancer. Prof. Iko suggested to us to conduct an interview with Dr. Norma and also urged us to apply for ethical approval from the Ethics Committee of FKUI (Faculty of Medicine, University of Indonesia).

                  Next Step

                  A literature review will be conducted by the Dry Lab and Wet Lab teams regarding possible side effects and identifying product limitations.

                  Figure 13. Verrell and Lina had a consultation with dr. Puspita regarding mutations in cancer cells

                  Description

                  Dr. Puspita Katili is a lecturer in the Biomedical Engineering program at the Faculty of Engineering, University of Indonesia. Dr. Puspita teaches the Medical Therapy Technology course for cancer cases. We introduced our project and the design strategy of our plasmid, which utilizes the p53 sensor, to her. She also provided some input regarding our project, specifically regarding the use of Salmonella in drug delivery systems.

                  Contribution

                  In the initial session of the interview, Dr. Puspita first explained about cancer and the challenges of cancer treatment. According to her, the reason why tumors can be cured while cancer is difficult lies in the characteristics of cancer cells themselves. Tumor cells are well-contained, whereas cancer cells are not, which leads to the persistence of cancer cells during removal (through surgery) or destruction (through radiotherapy). Cancer cells exhibit a mimicking behavior resembling healthy cells, making them difficult to target with drugs. Cancer is caused by DNA damage at checkpoints in the cell cycle. Cells cannot trigger cell apoptosis and stop cell proliferation due to this damage. One of the damages occurs in the p53 protein, which regulates apoptosis to eliminate damaged cells. Cancer cells often experience damage to p53 and are thus referred to as tumor suppressor genes. Although cancer may appear the same in one type macroscopically, genotypically, it differs between individuals. Therefore, personalized medicine has emerged, where drugs are designed according to the patient's genotype.

                    Adjustment

                    Dr. Puspita provided input that mutations in the p53 gene are often found in cancer cells, so designing a plasmid by inserting a p53 sensor to detect alterations in that gene is a good idea and should be reinforced by reviewing previous studies that have used this strategy. Additionally, Dr. Puspita also advised caution regarding human errors, especially in manual steps. Ensure the success of the Salmonella engineering and also identify potential side effects that may arise and determine the exact target consumers of the product, whether it is for stable cancer patients or can be consumed by individuals with compromised immune systems.

                    Next Step

                    A literature review will be conducted by the Dry Lab and Wet Lab teams regarding possible side effects and identifying product limitations.

                    Recognizing the Bacteria's Nature

                    Figure 14. Aldo's Discussion with Mrs. Fitria Ningsih

                    Description

                    Mrs. Fitria Ningsih is an instructor in the Department of Biology at the Faculty of Mathematics and Natural Sciences, University of Indonesia. Mrs. Fitri has a strong interest in and research related to culture collections. We had the opportunity to discuss with her about the purchase of culture collections at UICC (University of Indonesia Culture Collection) and beyond the scope of UI (University of Indonesia).

                    Contribution

                    Bu Fitri informed us that the University of Indonesia Culture Collection (UICC) possesses a collection of filamentous and non-filamentous fungi, yeast, and bacteria. The bacterial cultures available at UICC are non-pathogenic in nature, while the pathogenic ones are available at the Microbiology department of FKUI (Faculty of Medicine, University of Indonesia). To determine the availability of isolates, they can be checked through the catalog. For species identification, UICC utilizes 16S rRNA for bacteria. Bu Fitri also mentioned that bacteria with innate hazards, such as Salmonella, require different handling procedures. The purchase of pathogenic isolates requires a Material Transfer Agreement (MTA) to ensure that the buyer possesses the knowledge and skills to maintain and cultivate them. For industries with their own collections registered as intellectual property, it is mandatory to include the isolate code and place of purchase. Culture collections usually provide information on the common medium used for post-purchase care. Before making a purchase, the culture collection typically asks for the purpose of the isolate and requires the signature of a supervisor if it involves handling by a student. Bu Fitri stated that genetic engineering of organisms is an unavoidable process. After engineering, the organism's code will change, but the initial source of the organism must be noted.

                      Adjustment

                      Bu Fitri agrees with our plan to use local cultures first before purchasing from abroad. She will also provide a letter of recommendation to the microbiology department at FKUI if needed.

                      Next Step

                      Inquire about the availability of the culture collection at INACC in Cibinong. If it is not available at INACC, we will proceed with the purchase of the culture collection from abroad.

                      Recognizing Good and Acceptable Medical Products for Everyone

                      Figure 16. Lina's Discussion with KH. Syamsul Ma'arif

                      Description

                      The Eid al-Fitr moment is related to Halal bi Halal event. Our members have the opportunity to build relationships with KH. Syamsul Ma’arif. He is chairman of the Special Capital Region of Jakarta PWNU (Nahdlatul Ulama Regional Management) for the 2021-2026 period. We asked about the religious perspective regarding disease and treatment in Islam.

                      Contribution

                      KH. Syamsul Ma'arif said that all humans in the world will return to their Rab, nothing is eternal. All people and living creatures in the world will experience death, but in various ways. One of the causes of human death is illness. We as humans, who have been entrusted with body and soul by God, should look after and care for ourselves as best as possible. If your body feels sick, you can try to seek treatment and pray for healing. In fact, in a hadith, namely HR Muslim, that 'every disease has a cure, if the right medicine is found for a disease, the disease will be cured with Allah's permission.' However, until now there is no known cure for some diseases, for example cancer. We as Muslims should try to find a cure and support these efforts. However, not all medicines can be consumed immediately by Muslims. It is necessary to check the composition of the medicine first before consuming it, whether the medicine is halal or haram (contains things that are forbidden in the Al-Quran and the Prophet's hadith).

                        Adjustment

                        The majority of Indonesia's population is Muslim. As a target consumer for CerveX products, it is necessary to pay attention to the halal and haram aspects of a drug. To be more trusted by Muslims, a medicine or food and beverage product in Indonesia must obtain a Halal label issued by the MUI (Indonesian Ulema Council).

                        Next Step

                        CerveX is designed to provide a prototype and test the safety and success of new drugs reaching the in vitro stage (testing indirectly on living creatures, for example through cells). If the product is successful and reaches the clinical trial stage, a drug is required to undergo halal certification before being distributed on the market.

                        Healthcare Regulations in Indonesia

                        Figure 18. Aldo, Lina, Verrel, Nadine, and Bram Interview with dr. Nancy and Mrs. Nani

                        Description

                        We had the opportunity to conduct an interview with dr. Nancy who is the Head of the Surveillance Sub-Directorate of the Coordinating Ministry for Human Development and Culture (Kemenko PMK) and Mrs. Nani Rogani who is the Head of the Basic Services and Referral Division of the Coordinating Ministry for PMK. The interview we conducted was to ask questions about the government's response and regulations to prevent the high number of cervical cancer cases in Indonesia.

                        Contribution

                        In an interview, dr. Nancy informed that the main authority for controlling cervical cancer in Indonesia is the Ministry of Health, while the Coordinating Ministry is tasked with coordinating, synchronizing and reviewing policies mandated by law to carry out supervision and control. The only policy related to cervical cancer is in Presidential Instruction 1 of 2017 concerning the Germas (Community Movement). In the SDGs, there is a mandate to reduce the mortality rate by ⅓. The Ministry of Health has implemented many programs in the context of preventing and controlling cervical cancer such as HPV immunization. Coverage of HPV immunization in Jakarta has reached 90%, while cervical cancer detection screening is only 7.4% or 3 million out of 42 million Indonesian women. Early detection will be implemented in all regions of Indonesia in 2025. It is still difficult to reach remote areas so careful preparation of infrastructure and human resources is needed. sufficient. The percentage of cervical cancer screening in Indonesia is still low due to the Indonesian people themselves. Communities around Jabodetabek (Jakarta, Bogor, Depok, Tangerang and Bekasi) are easy to reach and invited by the Ministry of Health in terms of distance. For regional communities, cooperation with various parties such as the Health Service, Child Protection, BKKBN which supports women and families, the Manpower Service, the Education Service, the Religious Service by providing training to the KUA and penghulu, as well as Local Radio which can broadcast government programs to the local community.

                          Adjustment

                          There are still no regulations that specifically deal with cervical cancer and it is still handled centrally by the Ministry of Health. Collaboration with various parties is needed to socialize cervical cancer screening in the regions.

                          Next Step

                          Collaboration with local regional agencies is needed by the Human Practices Division to disseminate cervical cancer screening to the surrounding community.

                          Discussing the History and the Journey from Year to Year of Synbio Id Community

                          Figure 18. Aldo, Lina, Verrel, Nadine, and Bram Interview with dr. Nancy and Mrs. Nani

                          Description

                          We had the opportunity to conduct an interview with dr. Nancy who is the Head of the Surveillance Sub-Directorate of the Coordinating Ministry for Human Development and Culture (Kemenko PMK) and Mrs. Nani Rogani who is the Head of the Basic Services and Referral Division of the Coordinating Ministry for PMK. The interview we conducted was to ask questions about the government's response and regulations to prevent the high number of cervical cancer cases in Indonesia.

                          Contribution

                          In an interview, dr. Nancy informed that the main authority for controlling cervical cancer in Indonesia is the Ministry of Health, while the Coordinating Ministry is tasked with coordinating, synchronizing and reviewing policies mandated by law to carry out supervision and control. The only policy related to cervical cancer is in Presidential Instruction 1 of 2017 concerning the Germas (Community Movement). In the SDGs, there is a mandate to reduce the mortality rate by ⅓. The Ministry of Health has implemented many programs in the context of preventing and controlling cervical cancer such as HPV immunization. Coverage of HPV immunization in Jakarta has reached 90%, while cervical cancer detection screening is only 7.4% or 3 million out of 42 million Indonesian women. Early detection will be implemented in all regions of Indonesia in 2025. It is still difficult to reach remote areas so careful preparation of infrastructure and human resources is needed. sufficient. The percentage of cervical cancer screening in Indonesia is still low due to the Indonesian people themselves. Communities around Jabodetabek (Jakarta, Bogor, Depok, Tangerang and Bekasi) are easy to reach and invited by the Ministry of Health in terms of distance. For regional communities, cooperation with various parties such as the Health Service, Child Protection, BKKBN which supports women and families, the Manpower Service, the Education Service, the Religious Service by providing training to the KUA and penghulu, as well as Local Radio which can broadcast government programs to the local community.

                            Adjustment

                            There are still no regulations that specifically deal with cervical cancer and it is still handled centrally by the Ministry of Health. Collaboration with various parties is needed to socialize cervical cancer screening in the regions.

                            Next Step

                            Collaboration with local regional agencies is needed by the Human Practices Division to disseminate cervical cancer screening to the surrounding community.