A sign at the entrance announces it’s a friendly city, and Depok, located directly south of Jakarta in West Java province, is living up to that claim.
A city of commerce and education that delights tourists with its attractive colonial architecture and great food, Depok is making strides towards becoming an Angels Region, and offering its more than two million citizens a safe haven for stroke.
The goal to make Depok a stroke-ready city is shared by the regional health authority and emergency services. Two hospitals – Sentra Medika Cisalak Hospital and RS Hermina Depok – have already reached WSO Angels Award status, while others are still catching up. Four more stroke-ready hospitals are needed for Depok to meet Angels Region criteria; targets must also be met for public awareness education, and the regional emergency medical service, PSC 119 Kota Depok,must qualify for an EMS Angels Award.
At PSC 119 Kota Depok, the leadership wasted no time identifying gaps and drawing up action plans. But however enthusiastic and passionate they were about prehospital stroke care, emergency services head Dr Ika Herayana, MKM realized they would need a more creative solution for the relative scarcity of ambulance resources.
With one office and just three ambulances, there was simply no way they could cover all the districts of Depok, overcome distance, beat traffic, and deliver stroke patients to stroke-ready hospitals within the gold period for treatment. Until they found a solution, their citizens’ brains and lives were at risk.
This was why, on 20 February 2025, a very important meeting took place at the Regional Health Department Office. Present at the event were staff from Depok General Hospital, and the head and ER doctor from every one of the 38 Puskesmas within the Depok city boundaries. In addition to the 85 or so people who attended in person, about another 50 followed the proceedings online.
What is a Puskesmas
Puskesmas is short for Pusat Kesehatan Masyarakat, which means community health center. In the Indonesian healthcare system, Puskesmas are a first-level health facility where citizens go to receive treatment for less serious ailments. Puskesmas also support disease prevention, and carry out initial screenings before patients are referred to more advanced health facilities if their condition requires it.
Under the country’s Universal Health Coverage system, patients are required to attend these first-level facilities before they can be treated at an advanced hospital. Although the rule excludes emergencies, people tend to seek help from these community health services regardless of the urgency of their case. For this reason, raising the level of stroke awareness among the public as well as Puskesmas providers is vital.
Every Puskesmas in Depok has its own ambulance that is typically used to provide emergency transport to a referral center. Each ambulance is staffed with a driver and a nurse. Puskesmas doctors often have to deal with long queues of patients and crowded conditions, and are seldom available to accompany patients in the ambulance.
Before dr. Ika Herayana became head of PSC 119 Depok in 2024, she headed up a Puskesmas for four years. The purpose of the 20 February meeting was to involve Puskesmas in a unique prehospital service network for stroke emergencies, with the PSC 119 Depok head office functioning as call center. If a call came in about a suspected stroke patient that PSC 119 wasn’t able to cover in time, they would redirect the call to the closest Puskesmas ambulance, which would attend the patient and transport them to the nearest registered stroke-ready hospital.
The plan comes together
The PSC 119 Network event was opened by the Chief of Depok Regional Health Department, dr. Mary Liziawati, MKM, a key supporter of the vision of stroke-ready Depok city. This was followed by an insightful presentation about prehospital and hyperacute stroke care by Prof. Dr. dr. Rakhmat Hidayat Sp.N, Subsp. NIIOO(K), MARS. Prof. Hidayat is an experienced neurologist with a subspeciality in neurovascular disease who is also the Director of Medical and Nursing Services in RS Universitas Indonesia, the university hospital in Depok.
Dedicated to saving patients’ lives by building a stroke network within regional Depok, he provides training to hospitals and has established a WhatsApp group so doctors can share and confer about stroke cases. He is also the creator of an app called DESAK, which allows you to pinpoint and notify nearby stroke-ready hospitals. His presentation on this occasion was an eye-opener about the vital role of prehospital care in a stroke emergency.
Next, dr. Fikrotul Ulya, MKM from the Depok Regional Health Department gave a presentation that highlighted the distribution of ambulances and stroke-ready hospitals in Depok, as well as efforts to convert Depok into an Angels Region. An optimized EMS network for stroke could be a deciding factor, dr Ulya explained.
Finally, PSC 119 Depok’s dr. Ika herself took the floor to talk about prehospital stroke checklists, the stroke-ready hospitals list, and the proposed EMS network. In one interesting moment, a Puskesmas head was put on the spot when dr. Ika dialled their emergency referral number to check whether they were ready to pick up the call. As the number rang and rang and no-one answered, it’s safe to assume that several Pukesmas heads in the meeting made a mental note to check if the phone line was covered at their own center.
It was further agreed that the network would commit to quality monitoring, integrating the data collected at each Puskesmas, and uploading it to the international stroke registry, RES-Q. This would allow them to evaluate the service, identify gaps and provide even better care.
Creativity and community
The PSC 119 Network is an outstanding example of the sort of collaborative community-based solutions needed for the Angels Regions strategy to succeed. Better prehospital care is better stroke care and better stroke care means better outcomes for patients.
The next dot that needs to be connected is public awareness about stroke emergency and the hotline number for PSC 119 Depok. Most people still do not know the symptoms of stroke or how important it is to seek help fast. Many also don’t realize that they should dial 119 rather than order an online taxi or borrow the neighbor’s car, which could result in their being taken to a hospital without the capacity for treating acute stroke.
Meanwhile, the PSC 119 Network is experiencing teething problems as a result of overcrowding at Puskesmas. Still more creativity is needed, and dr. Ika is considering opening another PSC 119 office at the Depok General Regional Hospital 55 minutes away to expand coverage in the West Depok area.
The road to Angels Region status may be long, but every step counts because it’s a step closer to the goal of saving lives, and making the friendly city of Depok safe for stroke.
