Hrev_master Healthcare in Low-resource Settings 2024; volume 12(s1):13032 Understanding river culture to approach health promotion in river management in Banjarmasin, South Kalimantan, Indonesia Herawati,1 Anggi Setyowati,1 Lola Illona Elfani Kausar,1 Soedjajadi Keman,2 Shrimarti R. Devy2 1School of Nursing, Faculty of Medicine and Health Sciences, Universitas Lambung Mangkurat, Banjarbaru, South Kalimantan; 2Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, Indonesia Abstract Cultural customs play an important role in maintaining the well-being of the environment and natural resources. These cultur- al concepts influence thought processes and have a significant impact on decision-making, particularly in protecting the river. Therefore, this study aimed to explore the connection between local culture, specifically values, ways of life, and beliefs, and the promotion of a healthy river environment among residents living along the river in Banjarmasin, South Kalimantan Indonesia. A mixed-method approach was employed to investigate the cultural aspects, including values, ways of life, and beliefs, and the advo- cacy for a sustainable river environment among the inhabitants residing along the river in Banjarmasin, South Kalimantan, Indonesia. The quantitative design evaluated the descriptive statis- tics in terms of the sociodemographics of participants. Data col- lection was carried out using in-depth interviews, observation, and questionnaires. Subsequently, triangulation was performed to ensure trustworthiness. All statements relevant to the phenomenon were identified before the theme was clustered. The results showed that the river culture consists of two themes, namely val- ues and ways of life, and beliefs. In conclusion, it was expected that understanding the culture of the river could be a strategy for conducting health promotion in river management. Introduction The river plays a crucial role in supporting human develop- ment by providing water, transportation, agriculture, and fisheries, forming a close connection with human well-being.1-3 Protecting the river is essential to achieve a healthy river, defined as an ecosystem that enhances human well-being.4 A healthy river con- tributes to achieving Sustainable Development Goal (SDG) num- ber 6, which focuses on providing clean water and sanitation.5 However, numerous studies show that some individuals neglect river maintenance, exemplified by behaviors like improper garbage disposal.6 This also occurred due to population growth and rapid industrialization.7,8 Banjarmasin city in South Kalimantan, Indonesia, is known as the “City of a Thousand River” due to its extensive river network. According to 2015 data from the Banjarmasin City Water Resources and Drainage Sector, there are over 100 rivers in the city. The widest river in Indonesia is located in this city known as the Barito River.9,10 Moreover, a significant portion of the popula- tion in this city resides along the riverside, where the river serves as a vital aspect of their daily lives. This includes engaging in activities such as trading at floating markets, participating in tourism, using it for transportation, as well as for toileting, wash- ing, and bathing.11,12 Human activities in the river have both positive and negative effects. Positive effects can enhance the lives of those residing along the riverside, while negative consequences include a decline in water quality, evidenced by an increase in E. coli levels.13 To safeguard the river, effective management is important, requiring collaboration from various sectors, including human, economic, and cultural.14,15 Previous study emphasizes the significance of multi-sectoral partnerships in addressing river management.6 To foster effective sanitation in the river and proper waste manage- ment for the local community, it is crucial to consider the econom- ic aspect. This can be achieved by leveraging tourism activities along the river.16,17 Additionally, cultural considerations play an important role in supporting river management, as belief systems often ascribe crucial importance to a river, viewing them as insep- arable from life itself. Culture provides a holistic approach to understanding the interconnection between humans, the environ- ment, and spiritual forces.18 This study explored the connection between local culture, specifically values and ways of life and belief, and the well-being of the river among residents living on the riverside in Banjarmasin, South Kalimantan Indonesia. People residing along riverbanks recognize that natural activities in the universe are shaped by living resources and mysticism. They believe that all parts of the environment are interrelated or interdependent. Moreover, this perspective holds that environmental misuse will have adverse effects on the entire system.15 Consequently, cultural customs play an important role in maintaining the welfare of the environment and natural resources. These concepts shape ways of thinking and decision-making to protect the river. Figure 1 shows that Banjarmasin is the city of a thousand rivers. Figure 2 reveals the physical condition of the River is plastics and polluted from household under the houses. Significance for public health Addressing river management is primarily a cultural concern, integral to fostering healthy cities and ensuring the well-being of the environment and natural resources. The themes of this study shape ways of thinking and affect decision-making to protect the river. A well-maintained river contributes to achieving Sustainable Development Goal (SDG) number 6, which aims to provide clean water and sanitation. [page 26] [Healthcare in Low-resource Settings 2024;12(s1):13032] Non -co mmerc ial us e o nly Materials and Methods Ethical approval was obtained from the Health Research Ethics Committee Faculty of Nursing Universitas Airlangga, Indonesia (number: 1850-KEPK). In this study, a mixed method was used. A qualitative design was used to explore the connection between local culture, specifically values and ways of life, beliefs, and health of the river among residents living along the riverside in Banjarmasin, South Kalimantan Indonesia. It also to understand phenomena related to culture.19 A quantitative design was used to evaluate descriptive statistics: frequency and percentage of socio- demographics of participants. The sociodemographics of partici- pants are shown in Table 1. Data were collected using in-depth interviews, observation, and questionnaires. Previous studies related to culture associated with a healthy river include extracting information on value, ways of life, and beliefs.6,18 The interview process was documented through audio recording, transcribed in the Banjar language, and subsequently analyzed manually using thematic content analysis.20 To ensure trustworthiness, triangulation was used. Subsequently, the identification of all the statements that are relevant to the phe- nomenon was carried out and the theme was clustered.21,22 Data were collected from August to June 2020, and a total of 30 samples were obtained. The sample was people who live on the riverside in Banjarmasin, South Kalimantan, Indonesia, such as Antasan Segera River, Baguntan River, Tungku River, Banyiur Ampera River, Pekapuran Laut river, and Guring river. Results and Discussion Sociodemographic Table 1 shows the sociodemographic of participants, totalling 30 individuals. The gender distribution shows 53.3% female (16 participants) and 46.7% male (14 participants). All participants belong to the Banjarese Ethnic group, with ages ranging from 20 to 63 years. In terms of education, the majority completed senior high school (40%), and 50% of participants identified as house- wives in terms of occupation. This study was carried out in the Banjarmasin area, known for its numerous rivers and a population residing along the riverbanks for over a decade. Consequently, a distinct culture connected to a river has flourished within this com- munity. The results of thorough interviews and observations showed that culture along the river, including values, lifestyle, and beliefs, plays a significant role in shaping approaches to health promotion within river management. Value and the way of life Human life in society is never separated from values and norms.1 This study uncovered the significant value attributed to the river, showing its integral role in the lives of the people in Banjarmasin City. The following is an excerpt from one of the par- ticipants’ statements: “We live in the City of a Thousand Rivers, a reflection of our people’s deep cultural connection. We residing along the riverside not only need the river but also feel it as an integral part of our identity”… (M1.05) “The river is needed and important for our daily lives, and it is more like our best friend”… (M4.18) Based on the results of the in-depth interview, the majority chose to reside along the riverside due to a sense of comfort and the various advantages derived from the river. In addition, this preference for riverside living was often inherited from preceding generations. The observations in communities showed that the river in Banjarmasin was used to conduct daily activities, recre- ation such as fishing or playing (Figure 3 and Figure 4) as well as for religious activities (Figure 5) and household activities, such as washing dishes, clothes, or toileting (Figure 6). Some residents also use the river as a transportation route (Figure 7) (Observation Notes, December 2020 to March 2021). 4th International Nursing and Health Sciences Symposium Figure 1. Banjarmasin is the city of a thousand rivers (photos by Herawati, 2020). Figure 2. The physical condition of the River is plastics and pol- luted from household under the houses (photos by Herawati, 2020). Figure 3. Fishing on the riverside (photos by Herawati, 2020). [Healthcare in Low-resource Settings 2024;12(s1):13032] [page 27] Non -co mmerc ial us e o nly Belief Certain Banjarese individuals hold beliefs connected to the rivers, such as the notion that the river serves as a location for dis- pelling diseases among children, referred to as the “belabuh” tradi- tion. This perspective is evident in the following statement: “The Belantingan ritual, locally known as “belabuh,” is a practice aimed at warding off diseases among children by using the river as a means of purification”… (M4.19) “The tradition, known as “belabuh,” is believed to have the power to ward off illnesses from children when they are sick”… (M4.20) Some residents perceive living along the riverside as a symbol of wealth, associating it with boat ownership (Figure 8). This can be seen from the following statement: “I’ve heard that culture showed that people living by the river- side have a lot of money, isn’t that right? Maybe he had a boat like that in the past. Maybe if I look here the houses are tens of meters from the edge of the river... according to our perception, that is wrong. As long as the community remains undisturbed and the river’s flow is unaffected, I believe it is acceptable. This is my per- sonal opinion, acknowledging that deviation from established rules might not always imply wrongdoing”… (M1.01) The belief system in Banjarese culture includes myths about the river, including the existence of a supernatural entity referred to as “dangsanak,” which is associated with familial ties. According to residents, dangsanak is a ghost and sometimes appears like a crocodile. This can be seen from the following state- ment: “The water’s ghost resembles a tree trunk as the bamboo piece rises and falls—a spectral presence. In Ba’ah’s water, there are crocodiles”... (M4.18) “There used to be gaduhan (red: pet) crocodiles...but now there are none”… (M1.04) According to several participants, the existence of this myth can be used to approach the community in protecting a river, but this belief is starting to disappear. This can be seen from the fol- lowing statement: “In fact, if we go back to the local wisdom of Banjar culture, there is the term pamali (ed: sinful), such as pamali throwing away ratik (ed: rubbish), throwing rigat (ed: dirty) into the river. This practice is discouraged due to the presence of dangsanak (red: family/relatives). The cultural approach that prohibits throwing rubbish into the river is considered right in the context of Banjar 4th International Nursing and Health Sciences Symposium Table 1. Sociodemographic of Participants Participant ID Sex Age Ethnic Education degree Occupation Residence Time (years) Name of River M1.01 M 28 Banjarese Senior high school Private employee 28 Antasan Segera M1.02 M 57 Banjarese Elementary school Dust man 31 Antasan Segera M1.03 F 51 Banjarese Elementary school Housewife 51 Antasan Segera M1.04 M 36 Banjarese Junior high school Housewife 14 Antasan Segera M1.05 F 26 Banjarese Junior high school Housewife 26 Antasan Segera M2.06 F 51 Banjarese Senior high school Housewife 18 Baguntan M2.07 F 39 Banjarese Junior high school Housewife 15 Baguntan M2.08 F 42 Banjarese Elementary school Housewife 18 Baguntan M2.09 F 44 Banjarese Senior high school Housewife 20 Baguntan M2.10 F 54 Banjarese Senior high school Housewife 19 Baguntan M3.11 F 49 Banjarese Senior high school Seller 49 Banyiur Ampera M3.12 M 59 Banjarese Elementary school Seller 50 Banyiur Ampera M3.13 M 45 Banjarese Elementary school Seller 40 Banyiur Ampera M3.14 M 41 Banjarese Senior high school Dustman 41 Banyiur Ampera M3.15 F 48 Banjarese Senior high school Neighborhood 48 Banyiur Ampera M4.16 M 36 Banjarese Elementary school Private employee 11 Pekapuran Laut M4.17 F 32 Banjarese Elementary school Housewife 10 Pekapuran Laut M4.18 M 37 Banjarese Junior high school Unemployment 37 Pekapuran Laut M4.19 F 39 Banjarese Junior high school Housewife 11 Pekapuran Laut M4.20 F 20 Banjarese Junior high school Housewife 10 Pekapuran Laut M5.21 M 48 Banjarese Elementary school Security guard 25 Tungku M5.22 M 60 Banjarese Bachelor degree Self-employee 24 Tungku M5.23 F 39 Banjarese Bachelor degree Housewife 39 Tungku M5.24 F 46 Banjarese Senior high school Housewife 30 Tungku M5.25 F 52 Banjarese Senior high school Housewife 25 Tungku M6.26 M 63 Banjarese Elementary school Tailor 20 Guring M6.27 F 33 Banjarese Senior high school Housewife 33 Guring M6.28 M 45 Banjarese Senior high school Self-employee 35 Guring M6.29 M 46 Banjarese - Private employee 40 Guring M6.30 M 58 Banjarese Senior high school Self-employee 34 Guring [page 28] [Healthcare in Low-resource Settings 2024;12(s1):13032] Non -co mmerc ial us e o nly culture. According to the language of the ancients, it is viewed as a sin to dispose of items like ratik in the river because of the pres- ence of dangsanak, emphasizing the responsibility to care for these living creatures in the water. Dangsanak means that there is a liv- ing creature that was created for us to look after, and care for. There are indeed dangsanak in the river”… (M5.22) “There is local wisdom which often includes myths, such as those about crocodiles in the river. One myth suggests that if you defecate in the river, your stomach will swell—an imaginative way to discourage actions that might harm the water. Additionally, cau- tionary tales about big snakes in the Sabilal region contribute to the cultural emphasis on respecting and protecting the environ- ment. That’s what they say if we pass this region and don’t respect the river, thereby you will be eaten by crocodiles. That’s a myth. It used to protect the river... maybe”...(M1.04) The Banjarese people still have a “river culture”, which can be defined as a way of life for people who live close to the river. Making the river a “way of life” and shaping the character of the community. The river culture is characterized by the existence of riverside settlements, floating markets, and jukungs, and the social interactions that occur.23 Furthermore, it also means that the river has traditionally been the lifeblood of the community. The river as the lifeblood of the Banjarese people (also of Banjarmasin City), includes physical aspects (the physical quality and quantity of the river); ecological (the river ecosystem), economic (transportation, floating markets, fishing, irrigation), and social.24 4th International Nursing and Health Sciences Symposium Figure 4. Playing on the riverside (photos by Herawati, 2020). Figure 5. Mosques on the riverside (photos by Herawati, 2020) Figure 6. Fishing on the riverside (photos by Herawati, 2020). Figure 7. Banjarmasin is the city of a thousand rivers (photos by Herawati, 2020). Figure 8. The physical condition of the River is plastics and pol- luted from household under the houses (photos by Herawati, 2020). [Healthcare in Low-resource Settings 2024;12(s1):13032] [page 29] Non -co mmerc ial us e o nly A river serves as more than just waterways; they are vital con- nections that link humans with diverse forms of life and embody cultural values.18 According to Subiyakto, the Banjarese people are described as a “river-oriented” society, showing that their activities and community life revolve around the deep significance of the river in their culture. The river holds significant traditions for the Banjarese people, embodying practices that have endured over time and seamlessly integrated into the life of the community.25 According to Linton, an Anthropologist, cultures such as values and beliefs are difficult to change and difficult to replace with oth- ers.26 To maintain the welfare of the environment and natural resources, specifically the river, support implementation of public policies is needed. The role of stakeholders as authority holders and the community becomes an important thing. Therefore, the relationship of mutual support greatly influences the implementa- tion of the policy(Fauzi & Sompa, 2021).27 Of course, it is neces- sary to involve the community with their culture as a local wisdom.13 Participation or support in the community is also influenced by cultural values, such as the values, norms, and beliefs that consti- tute social.28 The cultural approach in policy implementation relies on the values and perspectives of local communities, emphasizing the viewpoint of the natives in the process. The cultural approach is also often referred to as the bottom-up approach. Through this cultural value or local knowledge approach in the river manage- ment system in Banjarmasin City, it becomes possible to promote health and protect the river from waste, thereby fostering positive values essential for river maintenance. Conclusions In conclusion, cultural customs are needed to maintain the wel- fare of the environment and natural resources. This study showed two key themes related to the cultural significance of a river: val- ues, and ways of life, as well as beliefs. Using this approach, health promotion efforts can be implemented to protect the river from waste. Furthermore, this study emphasizes the importance of respecting local wisdom, particularly in understanding the inter- connected relationship between humans and a river. Regulatory measures should take into account this diversity for effective envi- ronmental management. References 1. Abbas EW, Jumriani J, Syaharuddin S, Subiyakto B, Rusmaniah R. Portrait of Tourism Based on River Tourism in Banjarmasin. Kalimantan Soc Studies J 2021;3:18–26. 2. Chan NW. Managing urban rivers and water quality in malaysia for sustainable water resources. Internat J Water Resour Develop 2012;28:343–54. 3. Grizzetti B, Liquete C, Pistocchi A, et al. Relationship between ecological condition and ecosystem services in European rivers, lakes and coastal waters. 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Conflict of interest: the author declares no potential conflict of interest. Funding: this study was financially supported by the Ministry of Education, Culture, Research and Technology/National Research and Innovation Agency Ethics approval and consent to participate: ethical approval was obtained from the Health Research Ethics Committee Faculty of Nursing Universitas Airlangga, Indonesia (number: 1850-KEPK). Clinical trials: not applicable. Conference presentation: part of this article was presented at the 4th International Nursing and Health Sciences Symposium, from 27th-28th of October 2023, Universitas Brawijaya, Malang, East Java, Indonesia. Acknowledgment: the authors are grateful to residents who live in river- side Banjarmasin for their participation in this study. Received: 3 November 2023. Accepted: 8 June 2024. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2024 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2024; 12(s1):13032 doi:10.4081/hls.2024.13032 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [page 30] [Healthcare in Low-resource Settings 2024;12(s1):13032] Non -co mmerc ial us e o nly 10. South Kalimantan Provincial Health Office. South Kalimantan Health Profile 2017. South Kalimantan: South Kalimantan Provincial Health Office; 2018. 11. Abbas EW, Handy MRN, Shaleh RM, Hadi NTFW. Ecotourism of Martapura River Banjarmasin as a Learning Resources on Social Studies. 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Soc Sci Med 2015;128:95-104. 4th International Nursing and Health Sciences Symposium [Healthcare in Low-resource Settings 2024;12(s1):13032] [page 31] Non -co mmerc ial us e o nly