Self-Medication Practices in North Celebes:

Trust, Interaction and Cultural Beliefs

Mentari Charen Melaty Kolondam1, Rosiana Eva Rayanti1, Theresia Pratiwi Elingsetyo Sanubari2
1
Nursing College, Faculty of Medicine and Health Sciences, Satya Wacana Christian University.
2
Nutrition College, Faculty of Medicine and Health Sciences, Satya Wacana Christian University.
Email: Indonesia/ [email protected]; Indonesia/ [email protected].

ABSTRACT
During the globalization era, the popularity of self-medication is promoted by reasonable costs and the authority to
make convenient self-decisions. This practice is popular in Indonesia. However, the practice constantly raises several
risks, such as dependence or drug abuse, failure drug interactions, side effects until death. Minahasa community in
Woloan 1, Tomohon has a strong self-medication practice, called “obat PAR” which means a combination of
dexamethasone, amoxicillin, allopurinol, and a vitamin that has the function to treat gout. Interestingly, obat par still
existed in the community caused by the success of obat par in dealing with gouty arthritis and the spreading of
information. The aim of this study was to explore information accessibility on par treatment in gouty arthritis patients
in Woloan 1, Tomohon. Qualitative ethnographic methods were used to explore phenomena based on the point of
view of the indigenous people. The chosen location is selected because it is still closely related to culture and is
dominated by indigenous Minahasa people. Data collection was done by September 2020 to January 2021 with seven
participants who met the criteria, namely a retired nurse and six community leaders or traditional elders. The results
revealed that the effectiveness of information on obat par was driven by a strong relationship between a traditional
elder and a retired nurse. This retired nurse mixes several drugs and sells them secretly without any information about
what kind of drugs. The spreading of information was carried out through thanksgiving events, various worship
services, baptisms, and family gatherings. The strong relationship between obat par and community made them trust
obat par more than physician prescription drugs. Even the Tomohon people call par as obat dewa (medicine that
comes from God) because it has the power to cure people and has a fast effect.

Keywords: Gout arthritis, Minahasa, PAR Drugs, Self-medication.

INTRODUCTION The continuous practice of eating by the Minahasa

community can interfere with health and cause various
Minahasa community still depends on its culture. diseases. One of them is gout arthritis[3]. Gout arthritis,
They still carry out cultural practices at celebrations which is influenced by genetic factors, is magnified by
such as mapalus (cooperation technique in Minahasa the eating and drinking culture of the Minahasa
culture), thanksgiving, baptism, sidi (confession of faith community. The high purine content in meat and
in Protestant churches), and other celebrations [1]. These vegetables during celebrations can trigger increased
activities provide a tradition of eating and drinking. gout arthritis levels in the blood[4]. Another factor that
Serving food is vital because it strengthens the increases gout arthritis levels even in the first 24 hours
relationship between each family and guests who come. is alcohol which is used as a drinking culture and
The Minahasa community has a tradition always to complements the menu during celebrations[5]. The
provide certain foods, such as pork, chicken, duck meat, condition of joint inflammation and severe pain in
dog meat, and various other types of meat. Green patients with gout arthritis prompts the need for fast and
vegetables such as kale, cassava, long beans, and appropriate treatment[6].
vegetables processed with coconut milk. Not only food
but Minahasa people are also attached to saguer and Based on an interview with one of the Woloan 1
alcoholic beverages (cap tikus), which are considered as village administrators in Tomohon, the local Minahasa
body warmers as a menu complement at every community considered that legal treatment of gout
celebration[2]. arthritis was very slow in reducing pain. Most of the
Minahasa community in Tomohon trusted word-of- related to alternative medicine for gout arthritis just
mouth information and treatment resulted from their focused on the use of traditional plants [12],[13],[14].
trials more than medical treatment of gout arthritis. However, there has been no research on access to
Treatment information circulating from local information on self-medication, such as PAR medicine
community talks was widespread and was more in the Tomohon City community. Access in the Great
effective than legal treatment. The power of receiving Indonesian Dictionary (KBBI) means entrance. Access
information by word-of-mouth dramatically impacts the to information in this research was aimed at accessing or
determination of a person's decisions, including receiving information about PAR medicine in people
treatment preference[7]. Cultural and social factors that with gout arthritis. Access information must be explored
occur contribute to a person's decisions and behavior because it could continue PAR treatment. Furthermore,
(Kotler & Armstrong, 2009 in (Joesyiana, 2018)). The the research objective was to explore access to
culture of receiving treatment information affects information related to PAR treatment in patients with
people's attitudes and behavior in choosing alternative gout arthritis in Tomohon City. The information
medicine[8]. obtained was expected to be initial information
regarding the spread of PAR treatment to inform the
Based on an interview with one of the Woloan 1
origin of PAR treatment and the parties involved in
sub-district administrators in Tomohon, the treatment
disseminating PAR treatment information. Therefore, it
preference that the local community believed was
was widely spread and trusted by the surrounding
effective in dealing with gout arthritis was self-
community.
medication with PAR medicine. PAR medicine was a
local term that meant a pair, package, combination, or
mixture of several medicines that reduced swelling, METHOD
pain, and gout arthritis levels. This medicine consisted
The research method used was qualitative because
of Phenylbutazone and Dexamethasone or Prednisone.
the researcher explored access to PAR treatment
The content in PAR medicine was classified as complex
information by using open-ended questions without
medicine that was not traded freely by the government
fixing certain question boundaries. Additionally, this
and required a doctor's prescription[9]. Rules regarding
research used an ethnographic approach during the data
the indirect use of PAR medicine in Government
collection process. Iskandar (2008) says the
Regulation No. 50 of 2009 concerning Pharmaceutical
ethnographic approach aims to understand by exploring
Work and Regulation of Ministry of Health No. 919 of
or investigating phenomena that occur and then describe
1993 concerning Criteria for Medicine Allowed to be
from the point of view of the natives. The ethnographic
Delivered were written for prohibiting the sale of
approach that had been used helped researchers to
medicine that were classified as complex medicine
comprehensively understand and explore phenomena
without a doctor's prescription.
related to access to information on PAR treatment for
Based on the phenomenon found from the results of indigenous Minahasa people with gout arthritis.
interviews with several traditional elders of Woloan 1 in
The research location was in Woloan 1 Village,
Tomohon, people with gout arthritis chose PAR
Tomohon City, from September 2020 to January 2021.
medicine because the medicine’s effect was very fast in
Tomohon City was an area that is recorded as having
overcoming disease complaints, namely about five
many gout arthritis sufferers with a prevalence of 27.3%
minutes to one day. The community considered PAR
(172 sufferers out of 630 people)[16]. The number of
medicine to be effective in overcoming pain and
patients with gout arthritis in Tomohon City encouraged
reducing swelling. However, like other self-medication,
researchers to prefer it as the research location on this
PAR medicine could pose a dangerous risk to the
joint disease. In addition, Tomohon Regency is one of
consumer's body[10]. Long-term use of the medicine
the areas targeted by research institutions. Hence,
could attack the patient’s kidneys and stomach. The side
researchers understood the issues circulating there,
effect was that the patient could die due to organ
especially those related to gout arthritis and people's
damage. However, there were still Minahasa people in
behaviors. Woloan 1 was one of the villages in
Tomohon who took PAR medicine without a doctor's
Tomohon City and became the research location due to
prescription.
the many local people who lived there. The researchers
A journal on treating degenerative diseases such as were also part of the local community, namely the
gout arthritis in Tomohon City has been previously that Minahasa people involved in various cultural practices.
focused on increasing public understanding about the They had much understanding about the local
use of certain plants[11]. Furthermore, another researches
community’s behavior and environmental conditions importance of an event. The variety of food served
there. was dominated by types of meat such as pork, beef,
dog, snake, bat, and chicken dishes. From this
Data collection techniques consisted of open-ended
variety, several types were only considered normal
interviews, observation, and documentation. Interviews
on the dining table by the Minahasa community,
were conducted with seven participants who met the
such as dog meat, snakes, and bats. Meanwhile, the
research inclusion criteria. The participant’s
drinks provided in various events were liquor,
characteristics were divided into several categories with
known as saguer and cap tikus alcohol. The tradition
their respective codes, namely a traditional elder who
of eating and drinking has survived to this day. It
was the head of one of the large family pillars (P.A 1);
also appeared in the Woloan 1 village, which is
village administrators (P.B 1 and P.B 2); village
expressed as follows:
administrators as well as consumers of PAR medicine
(P.B 3); a traditional elder who was one of the majority “rupa laengkali dang ibadah baptisan ato sidi to
religious leaders there and a consumer of PAR medicine rupa pesta kaweng, pangucapan sama deng apa jo
(P.B 4); a traditional elder who retired from the village kwa tu sagala makanan to... sagala rupa babi, sapi,
administration, who was also the first to use and rw to blum le tu sayor-sayor kong minuman paket
introduce PAR medicine there (P.B 5); Lastly, medicine doh dapa tako” (Participan 1, Januari 2021).
dealers who incorporated PAR medicine (P.E 1). “Sometimes when doing ‘baptism or sidi’ (Christian
faith readiness), a wedding party, or thanksgiving, we
The data collected from the participants were then could find many kinds of foods. All kinds of pork, beef,
tested in a data triangulation process and involved three dogs, vegetables, and liquor could be found there. Those
additional participants. The participants' characteristics were scary”.
included PAR medicine consumers in Woloan 1 with The eating tradition of the Minahasa community
precarious jobs (P.C 1); consumers of PAR medicine did not only appear when there was an event, but it
outside Woloan 1 who lived in the same area as those has become a habit. Their access to food supported
who combined PAR medicine (P.D 1); lastly, the this habit. Forests and gardens, which were
participants who worked as health workers at the considered as sources of food supply, provided
community health center in Woloan 1 of Tomohon (P.F various types of vegetables, such as spinach, pangi,
1). The participants were told about the occurrence of kale, and other types of vegetables that were ready to
gout starting from triggers and their feelings when be processed. Not only vegetables, but various types
relapse to the treatment of gout, including PAR of animals such as porks, dogs, rats, snakes, bats,
medicine based on each participant’s perspective. and various other animals were also provided to be
Obstacles were experienced during the research, namely hunted and made into processed food ingredients.
the secret sale of PAR medicine. It made participants Obtaining food from nature was not the only thing
hesitant to tell the process of distributing PAR medicine. that made it easier for people to access various food.
The relationship built with the participants made the Nowadays, people become more accessible by the
participants trust the research process and the occurrence of various markets, both traditional and
confidentiality of their identity in the research. The supermarkets that provide a variety of vegetables
stages of research analysis started from preparing and and meat to be cooked directly.
selecting the data collected from participants, compiling
a clear picture of the overall data based on the verbatim In addition, the Minahasa community was attached
results, then analyzing in more detail by coding the data to the tradition of drinking liquor. Like food, support
or processing it into specific categories until a theme of from the local environment made people easier to
the results emerged. access various types of liquor. People took
advantage of sugar palm plants known as seho trees
RESULT AND DISCCUSSION into a liquor called saguer and cap tikus alcohol.
Lendo (2014) also revealed that the Minahasa
1. Gout Arthritis in Woloan 1, Tomohon community used the sugar palm plant as the liquor
ready to be sold. In addition to using plants, the
People in Woloan 1 of Tomohon, North Sulawesi people could easily access the cap tikus liquor on
Province, were still attached to eating and drinking small stalls and the roadside. It was also reported in
culture. The tradition of eating and drinking in the Lungan’s research (2017) that the sale of cap tikus
Minahasa community had strong socio-cultural liquor is currently mushrooming and can be easily
meanings and values. The Minahasa community obtained in small stalls by the Minahasa community.
interpreted food and drink as a sign of the
 The tradition of eating and drinking in the control or control on an individual's behavior also
Minahasa community, which was maintained and happened to the Minahasa community in Woloan 1,
made into a daily menu habit, had a negative effect Tomohon. The tradition of serving various food and
on health. The tradition of eating and drinking that drinks influenced people to maintain that behavior.
provides a variety of food and liquor above had
The eating and drinking behavior of the Minahasa
turned out to be a risk factor for various degenerative
community had a significant effect on the incidence
diseases, such as hypertension, cholesterol, coronary
of gout arthritis, especially in Woloan 1 of
heart disease, stroke, diabetes mellitus, obesity, and
Tomohon. The tradition of providing various types
gout arthritis[19],[20],[21]. It also happened in the Woloan
of high-purine foods and alcoholic beverages at
1 village of Tomohon and caused the incidence of
various events continued to be carried out and has
joint disease there to be included in the category of
even become a habit of the community. In addition,
the top ten most common diseases, which are
the ease of access provided by the environment
described as follows:
seemed to support the community to maintain their
“jadi torang kwa ada kriteria-kriteria dang 10 behavior in consuming these foods and beverages.
penyakit terbanyak nah kalo yang peradangan ini Even though they were aware of this, the local
yang arthritis dia pernah maso dia 10 besar” community still consumed various types of foods
(Participan 10, Januari 2021). and drinks that triggered gout.
“We have criteria for the top ten most common diseases.
Then, inflammation, especially arthritis has ever been in 2. PAR Drugs as a ‘obat dewa’ Gout Artrhitis
the top ten”.
The Minahasa community often referred to gout
arthritis as foot pain because the signs and symptoms
were pain in the joints, especially the joints of the
feet. After several years of suffering from gout,
many sufferers would have lumps in the joints as a
complication. This condition was known as Gout
Arthritis. The process of gout arthritis often occurred
The number of people with gout that attacked the in the joints in the toes, knees, heels, wrists, fingers,
joints was also expressed by the sixth participant as and elbows[23],[24]. Gout disease that caused lumps
follows: with pain in the patient's legs was treated with the
“sini asam urat sampe pa apa so sampe so samua
consumption of PAR medicine or what used to be
sto so ja kena asam urat” (Participan 6, September known as 'foot pain medicine.'
2020). Currently, local people call 'pain medication' with
“Everyone in this place seems has been affected by gout PAR medicine (obat PAR), which means a pair,
arthritis”.
package, combination, or mixture in the Manado
People were aware that many gout diseases were language. PAR medicine combined several types of
caused by their eating and drinking behavior. complex medicine believed to overcome
However, the local community still maintained inflammation and pain due to increased gout arthritis
various consuming types of high-purine foods and in the body. Even this medicine was often referred to
liquor. It was also expressed by one of the traditional as a God's medicine because it could directly cure
elders who was a participant in both studies, as gout attacks. When there was inflammation and pain
follows: in the joints, many sufferers could only lie down.
However, after taking PAR medicine, the pain
“Tomohon le kwa yah kurang ja so nda talalu ee apa
immediately disappeared, and they could return to
tu kontrol makang karna makanan pemicu (penyakit
activities. The expression of a health worker as the
asam urat) itu mudah didapat di Tomohon”
(Participan 2, September 2020).
tenth participant is as follows:
“People in Tomohon do not have much control over “obat dewa dorang ja bilang dari kan pas pe minum
their foods because triggering foods (gout arthritis langsung bae. tu obat kwa capat skali biasa kalo
triggerings) were easy to get in Tomohon”. torang minum nda lama langsung bae. kalo obat
The eating and drinking behavior of the Tomohon dokter kwa lama” (Participan 10, Januari 2021).
“They usually called PAR medicine as a God’s
people in Woloan 1 was also influenced by the
medicine. Because after drinking it, they recovered
cultural values that characterized the Minahasa tribe. immediately. The medicine was famous for its swift
Keesing (2014) reveals the existence of cultural healing. If we drank it, not long after that, we would
 immediately recover. In contrast, drinking doctor's namely two large and two small with different
medicine took a long time”. colors. The method of using the medicine also
Foot pain medicine, which was later called God’s appeared in an interview involving one of the
medicine, was used by most sufferers of 'foot pain' in traditional elders and the first participant of the
Woloan 1 of Tomohon. The medicine consisted of research, ”ini dua kali ampa macam” (Participan 1,
four different medicine, namely Dexamethasone, September 2020). (These were two times four kinds).
Allopurinol, Ampicillin/Amoxicillin (Antibiotics), The instant way of consuming medicine, the cheap
and Vitamins (Participants 1 and 2, September selling price of medicine, and the speed of the
2021). Participants received information on the type healing effects of medicine made PAR drug (obat
of medicine because they had collaborated with this PAR) called by the public God’s medicine at this
medication with prescription medication and asked time. The story of changing medicine nicknames was
the doctor about this type of medicine. Participants developed by local people based on their judgment.
expressed the following: The community initially called this medicine foot
“itu obat PAR itu to, ini semacam amoxicillin pain medicine because it handled complaints of
mungkin am e ampicillin itu ato apa ee antibiotik itu recurrence of gout that attacked the patient’s feet.
dan juga obat panas dan itu dexa deng vitamin. ini 4 Furthermore, the community named it PAR
ini” (Participan 6, Desember 2020). medicine because it combined several drugs. Then,
“It was a PAR medicine. It was a kind of amoxicillin. people gave the nickname ‘God’s medicine’ because
Perhaps it was ampicillin or an antibiotic and also a it was considered fast in overcoming complaints at a
fever medicine. Meanwhile, these were dexa and low price and instant way of use.
vitamins. Here were these four”.
3. The Recurrence of Gout Arthritis is the
The four types of medicine were made into one Reason for the Dependence on PAR Drugs
‘PAR’ or one pair or package of medicine packaged
in small transparent plastics to be sold without using Patients with gout arthritis felt unable to withstand
a doctor's prescription. One package consisted of two severe pain when gout recurred, especially in a short
medicine packages. One package consisted of four time. Feelings of severe pain interfered with daily
different medicines. The medicine mixture in one activities so that it encouraged sufferers to choose
package was different in color from the other the treatment that was considered fast and
packaging. Although there were color differences, appropriate to overcome their complaints. It also
the function of the medicine remained the same, happened to the sufferers in Woloan 1, Tomohon,
namely to treat gout arthritis. One pack of medicine which the sixth participant revealed, as follows:
was sold for IDR 10,000. This expression also
“dari mo pi kantor so nimbole no bayangkan kalu
appeared in interviews with PAR medicine dia datang saki skali helehkan mo badiri susah.. mo
consumers who were the seventh participant in this tahang so saki skali mo pi kobong nda bisa heleh ta
research, ”cuman di ee plastik kecil cuma spuluh ribu sontong di apa jo mo jatung, no saki skali”
satu” (Participan 7, September 2020). (It was packed (Participan 6, Desember 2020).
only in a small plastic bag. The price was ten thousand for “I could not even go to the office. Just imagine, if I had
each pack). a relapse, it was hard for me to stand up. I could not
stand the pain when I wanted to go to the garden, even if
I only touched anything. I felt that I would fall. It hurt
terribly”.
The widely chosen treatment to treat gout was
self-medication using PAR medicine. PAR medicine
was considered capable of curing pain quickly but
was at risk of injuring the stomach and kidneys of
medicine users if consumed continuously. Even the
worst risk of medicine use could lead to death. This
expression also appeared in an interview with one of
Figure: PAR drug’s packaging. (Personal data was the health workers who became the tenth participant,
collected in September 2020 and January 2021). as follows:
The medicine was consumed instantly, which was “depe efek samping itu yang torang temui biasa dia
2x1 days after eating. The medicine consumed in kase luka lambung deng ginjal le jadi biasa ada yang
one drink consisted of four types of medicine,
 datang malah so tatambah-tatambah, lalu te cuma ”memang disini so sempat ada swiping tu ba jual di
hyperuricemia to tau to kelebihan kadar asam urat warong” (Participan 2, September 2020). “Indeed, there
skarang datang yah so deng luka lambung ato nda had been raids in some stalls here”.
ginjal itu. jadi yah biasa orang bilang dia mati karna
Another expression appeared in the results of
gout arthritis mar katu bukang karna itu to, gara-
gara minum tu obat talalu banya sampe depe efek interviews with a consumer of PAR medicine who
katu bahaya sampe depe diagnosa pas meninggal was the eighth participant in this research, as
katu karna tu luka lambung ginjal itu” (Participan follows:
10, Januari 2021). “nda sembarang orang itu ba bli, musti dia kenal tu
“The side effects that we encountered usually injured orang kong dia kase.. nyanda bebas kwa tu obat itu..
stomach and kidneys, so it was common for someone to iyo musti kanal pa dia baru, kalo nyanda kanal yah
come, and there had been additions. Previously, it was biar mo bayar brapa dia nda mo kase dia bilang
only hyperuricemia. You have to know it well, the
nyanda ada dia nentau.. kalo torang kan so baku
excess gout arthritis level now came with stomach
ulcers or the kidneys. So, usually, people say that the
kanal kong ba apa yah dia kase” (Participan 8,
patient passed away due to gout arthritis, but actually, it Januari 2021).
was not because of that. The reason was that the patient “Not anyone could buy the medicine. The people have
took too much medicine until the effect turned out to be known, and they would be given the medicine. It
dangerous. Then, he was diagnosed with gastric ulcers was not free medicine. Yeah, we had to know each other
on the kidneys”. first. If we did not know the people, we would not give
the medicine no matter how much he paid. However, if
The local community has widely known the we already know each other, we could give anything”.
dangerous side effects of PAR medicine. Not a few
When new people wanted to buy medicine, they
sufferers were aware of the risks that arose due to the
would not be given it immediately. Medicine sellers
side effects of using PAR medicine self-medication.
would first pay attention to prospective buyers, ask
However, they still chose to use it because of the
where they live and the people who would use them.
speed of healing of pain and inflammation due to
Although not distributed to just anyone, information
recurrence of gout attacks. In the other side, self-
about PAR medicine had long been known to the
medication behavior had several risks of use[10]. It
public in Woloan 1 of Tomohon. The information
also happened to self-medication with PAR medicine
was first started by a traditional elder, the sixth
used by the Minahasa community in Woloan 1 of
participant. He had gout arthritis and was told to take
Tomohon.
PAR from the medicine seller’s wife, who worked
Even though it had side effects and dangerous there. The statement of the seventh participant
risks of using the medicine, patients with gout still supported it, “pertama da tau tu apa itu dari
preferred PAR medicine with PAR drug over other ‘Participan 6 (P.B 5)’.. kanal kwa tu bapak” (First, we
treatments, including medicine according to doctors' had to know where him (the Participant 6 (P.B 5).. He had
prescriptions. Consumers seemed to depend on this known that man) (Participan 7, 23 September 2020).
divine medicine and ignore the dangerous risks of Another expression appeared in the interview of the
this treatment option. The recurrence of gout that sixth participant who was a traditional elder in
could not be contained encouraged consumers to Woloan 1 of Tomohon, as follows:
look for treatment options that quickly deal with “so lama (konsumsi). diatas 10 tahun. dulu le no pas
their complaints. It was also what made some gout guru kong da sama-sama deng pak…(penjual obat)
sufferers there depend on PAR drug and bore the itu pe bini. cuma da babacirita kwa kong aa ternyata
side effects and dangerous risks. so baku maso to pas depe laki boleh ee ba kase
akang jadi da coba-coba kong bagus capat to,
4. Popularity of PAR Drugs in Woloan 1, kurang da babacirita akang itu daripada mo tahang
Tomohon so saki skali to mo pi kantor” (Participan 6,
Information on the sale of PAR medicine was Desember 2020).
“It had been a long-term consumption. Perhaps it was
given to people who were trusted by the medicine
over ten years. Back then, I was a teacher, same with the
dealer or lived in the same area. The sale of PAR medicine seller’s wife. Well, we just talked. Then, I felt
medicine was carried out in secret because suitable for the medicine. Coincidentally, her husband
previously, there had been raids from the local could give it a try, and then it was good. It was what
government on stalls selling this medicine. This was told instead of having to hold back. It hurt so much
expression appeared in the interview with the second for me to go to the office”.
participant, a village administrator, as follows,
 The information received from the medicine orang so babacirita to dari pemicu samua to itu”
seller’s wife was trusted by traditional elders and (Participan 1, Januari 2021).
made him brave to use this medicine. People would “Well, if there was no special time to tell the story, they
dare to use treatment when they trusted the usually told stories, and then they were linked. During
worship, it was normal for people to gather together, or
information or treatment advice they received from
when they got along, when they usually finished
others[25]. He trusted the PAR medicine information praying, they started telling stories. Sometimes, they
because he knew the medicine seller’s wife and told stories about someone else, not just PAR.
made him brave to use the medicine seller’s Therefore, many topics were told, including this PAR.
prescription or a mixture of medicine. Satisfaction Like in the last time, when someone was sick, then the
with the immediate healing effect of PAR drug made next day when meeting, they told the story. "Eh, are you
him continue to maintain this treatment, even healed?” “Oh yeah, I took PAR medicine.” However,
encouraging him to share information and his not only that, there were other things to talk about, right,
experiences of this treatment with the local or like sometimes baptism or sidi worship (affirmation
of Christian faith readiness) or as a wedding party and
community.
thanksgiving. There was too much food, right. Someone
This traditional elder introduced PAR medicine by has started to say, "Oh, we should borrow today”
sharing his personal experience about the recurrence (expressions like enjoying first for today, do not think
of the disease, the causative factors, and the about taboos). There were many triggering foods, such
as pork, beef, dogs, vegetables, and then packaged
treatments he chose, including PAR drug. People drinks (alcohol drinks). Those were scary” It usually
who have received information about PAR medicine continues, right? For example, "eh bae-bae kage” (be
also shared information at various gatherings, such careful of relapsing later).” It has been something
as thanksgiving, categorical worship, mourning relapsed, but it was not only gout arthritis. It was
services, sidi events, baptisms, family associations, anything familiar triggered disease told by people”.
and other associations. The delivery of this
The local community highly believed in
information usually occurred when people talked
disseminating information on PAR medicine
casually at the end of the gathering, namely when
discussed in various associations. It was also
they entered an eats-up time. The topics discussed in
supported by research by Afrilian, Yulianda &
each association were various. One of the topics that
Afriani (2021), which revealed that there was power
were often discussed was gout arthritis. People
in word-of-mouth to attract someone's attention to
usually discussed the presentation of food and
something. Putri's research (2017) revealed that
drinks, which were considered factors in the
people choose their treatment because there was a
recurrence of gout arthritis. Then, the discussion
sense of trust, a desire to share, acceptance, and
continued on the experience of recurrence of gout to
seeing objective evidence of the results of treatment.
the respective treatment options and the perceived
Furthermore, Setyoningsih and Artaria, 2006 (in
effects of treatment. It was also supported by the
Yanti and Hengki, 2021) stated that evidence of the
expression of one of the traditional elders who
healing experience of sufferers with the same disease
became the first participant in the research, as
was one of the determinants of individual treatment
follows:
choices. Public trust in PAR treatment information
“depe bacirita itu yah nda da waktu biasa dorang disseminated through word-of-mouth was
bicara-bicara kong so tasambung. ato rupa pas strengthened by actual evidence of the speed of
ibadah bagitu to duka biasa orang ba kumpul- healing of PAR medicine in consumers.
kumpul ato rupa pas rukun bagitu biasa abis berdoa
sudah so babacerita mar itu kwa bacirita laeng le Dissemination of information about PAR medicine
bukang cuma PAR jadi banya ja bacirita termasuk did not only appear in associations but also became a
PAR ini, rupa lalu ada yang saki to depe beso story passed down from generation to generation in
bakudapa "eh so bae? ohiyo da pake PAR" mar nda the family. This expression appeared in the interview
cuma itu ada le laeng ja babacirita dang. ato rupa of the fourth participant, who was one of the
laengkali dang ibadah baptisan ato sidi to rupa traditional elders and a consumer of PAR medicine,
pesta kaweng, pangucapan sama deng apa jo kwa tu ”kenal obat PAR yah dari orang tua” (We knew PAR
sagala makanan to kong so "eh pinjam hari dulu" medicine from our parents) (Participant 4, December
nah itu kan makanan pemicu banya sagala rupa 2020). This phenomenon proved that disseminating
babi, sapi, rw to blum le tu sayor-sayor kong information about PAR medicine in Woloan 1 also
minuman paket doh dapa tako, itu biasa ja ta lanjut- occurred in daily interaction. Then, it was used as a
lanjut no, rupa e e "eh bae-bae kage" somo ada yang story for generations. It has made the dissemination
jadi to mar bukang cuma asam urat dang cuma biasa
 of information on PAR medicine more widespread [2] Bawiling NS, Kumayas M. Hubungan Konsumsi
and made PAR medicine more widely known in Alkohol dengan Kejadian Gouty Artritis pada Pria
Woloan 1 of Tomohon. di Puskesmas Motoling Kecamatan
Motoling. KESMAS. 2017;6(2).
AUTHORS’ CONTRIBUTIONS
[3] Tamboto RR, Sahelangi O, Robert D. Pengaruh
The conclusion of this research revealed that access Konseling Gizi Terhadap Asupan Makanan Tinggi
to information on self-medication with PAR medicine Purin dan Kadar Asam Urat pada Pasien Gout
for people with gout arthritis in Woloan 1 of Tomohon Arthtritis di Puskesmas Rurukan Tomohon. Jurnal
started from the relationship between a traditional elder GIZIDO. 2016 Nov 1;8(2):12-21.
and a medicine seller who combined this PAR medicine.
Dissemination of PAR medicine information occurred [4] Sholihah FM. Diagnosis and Treatment Gout
in daily interactions, namely word-of-mouth and Arthritis. Jurnal Majority. 2014 Dec 7;3(7).
gatherings such as thanksgiving, categorical worship, [5] Neogi T, Chen C, Niu J, Chaisson C, Hunter DJ,
mourning services, sidi events (affirmation of faith Zhang Y. Alcohol Quantity and Type on Risk of
readiness in Christianity), baptism events, family Recurrent Gout Attacks: An Internet-based case-
gatherings, and other associations. Discussions about crossover Study. The American journal of
PAR medicine usually began when people entered the medicine. 2014 Apr 1;127(4):311-8.
eats-up time after the program. People usually talked
about the causes of gout recurrence, the feeling of pain [6] Aung T, Myung G, FitzGerald JD. Treatment
when it relapsed, and treatment options, including PAR Approaches And Adherence to Urate-Lowering
treatment. Dissemination of information about PAR Therapy for Patients with Gout. Patient preference
medicine was not only disseminated at particular and adherence. 2017;11:795.
gatherings or moments but was also passed down into
[7] Joesyiana K. Pengaruh Word Of Mouth Terhadap
stories from generation to generation to this day.
Keputusan Pembelian Konsumen pada Media
This research still needs updating or improvement Online Shop Shopee di Pekanbaru. Jurnal
with contributions from other fields of science to reveal VALUTA. 2018;4(1):71-85.
more fully the problem or phenomenon regarding PAR
drugs. Suggestions for further research was that future [8] Kasmawati K, Muharram S. Faktor-Faktor yang
researchers hopefully can collaborate with various Mempengaruhi Sikap Masyarakat dalam Memilih
disciplines such as pharmacy to explore more about the Pengobatan Alternatif Bekam. BIMIKI (Berkala
explicit content in PAR medicine, the reasons for the Ilmiah Mahasiswa Ilmu Keperawatan Indonesia).
difference in the medicine color in each package but 2019;7(1):19-30.
with the same function, as well as the duration of use or [9] Tombeg, L. Bahaya 'Obat Par' Dijual Tanpa Resep
the average time of medicine use by consumers until
Dokter. Tribunmanado.co.id. Tribun Minsel. 2017
medicine side effects appeared to death in medicine
Mar 12. Access on:
consumers.
https://manado.tribunnews.com/2017/03/12/bahaya
-obat-par-dijual-tanpa-resep-dokter.
ACKNOWLEDGMENTS
[10] Sitindaon LA. Perilaku Swamedikasi. Jurnal Ilmiah
The author is grateful and expresses many thanks to Kesehatan Sandi Husada. 2020 Dec 31;9(2):787-
the Lord Jesus, family, mentors, reviewers and all 91.
parties involved in the research.
[11] Lolo WA, Yudistira A, Datu OS. PKM pada
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