Pi'uranga: Study of Cia-Cia's Nifas Period Treatment in the Bahari Village of Sampolawa District of South Buton Regency

This research aims to find out the types of diseases that arise when the mother nifas does not do pi'uranga and how to perform pi'uranga on the Cia-cia in the Bahari Village. The theory used to read the data is Hippocrates' Humoral Pathology theory of healthiness or pain occurring depending on the balance of "humour" (fluid) in the body. The study used ethnographic methods, data obtained through engaged observations, and in-depth interviews. The results showed that: (1) A disease that arises when the mother nifas does not do pi'urangawas known by the term puanaka, which consists of an old puanaka and a young puanaka. Symptoms of old puanaka include chills, difficulty standing, abdominal pain, and headaches, while young puanaka is characterized by loss of consciousness, cysts, and serious illnesses. (2) The way the implementation of pi'uranga in the Cia-cia in Bahari Village was done traditionally, through several stages; beginning with the mother nifas sorted by the shaman, the first bath after childbirth, the use of octopuses, the use of fireplaces, the use of folk remedies, to the sauna.


INTRODUCTION
Health is one of the basic human needs other than food, settlement, and education (Daban et al., 2020). Only in good health can man live, grow, and work better (Princess, 2018). Besides, health is also an essential part of human life, so many countries in the world prepare a sizeable budget for the health aspect (Lozano et al., 2020). In the absence of good health, one is unable to carry out his obligations so that it can be a burden both for himself and for others. Health information becomes very urgent for everyone (Ge et al., 2019).
About the above that to achieve a healthy degree, one will always respond to stimulus-related to illness and disease, health care system, food, and the environment (Marimba 2009;Olsen et al., 2020). The response varies, usually triggered by cultural factors in which the culture is produced (Gakuya et al., 2020;Mirzaie et al., 2020). Therefore, health as an integral part of the culture, so human beings in tackling their health problems sometimes differ from one another, between regions with other regions, areas that are one another, which even this applies almost all over the world (El Hajj et al., 2020).
Indonesia, as a multicultural country; for example, each of its ethnic groups has different ways and views on health care in the past. As in Acehnese, the treatment of the nifas period is known as sale, where the mother nifas sleeps on a couch made of wood or bamboo rods that are cracked. Under the sofa, a furnace filled with hot charcoal is placed to speed up the process of thinning the stomach and uterus, close up the feminine organs, and warm the body of the mother nifas (Reiza, 2018). In Javanese, the treatment of the nifas period is done by giving herbs to the mother nifas made of bitter leaves such as jawer katok, papaya leaves, and so on, so that the mother nifas quickly recover and fresh fit (Hidayah et al., 2015). While in the Badui Dalam tribe in carrying out the treatment of the mother nifas by bathing in the river. Nifas's mother walked with the paraji shaman to wahangan (river) to be cleaned. The herb is channeled throughout his body, consisting of a mixture of koneng tinggang, cikur, lempuyang, which is mashed by pounding. After washing, the stomach is massaged so that the uterus returns to its position. So that the mother's stomach is not swollen, then the ash of burning firewood wrapped in leaves is then affixed to her stomach (Ifa et al., 2017).
Similarly, the Buton people in Southeast Sulawesi, especially the Cia-cia in The Marine Village of Sampolawa District of South Buton Regency, also know the treatment of the nifas period given the term pi'uranga. Initially, this tradition was done because women in this village used to be hard workers such as gardening, lifting water from well to house, wooden whisk, and so on, which was done when their husbands went sailing. For their body to always be healthy, fit, and not easily sickly, then when the nifas period, the way to be done is with pi'uranga. By doing pi'uranga, It is believed that the mother of nifas will be spared from nifas disease known as puanaka.
Departing from the above, so for the Cia-Cia in Bahari Village, consider that pi'uranga is very important, even regarded as obligatory to be done by every mother nifas, both who give birth or who have suffered a miscarriage. So important that if there are families who are overseas in a pregnant state, let alone contained is the first child (cumpe), then when approaching the birth in questions repatriated to the hometown. After giving birth, having to carry out pi'uranga for 40 days, with a draining treatment process such as under-going a fireplace, burning stones, consuming lancau (herb), and so on regularly.
Suppose the Cia-Cia elders in Bahari Village used to be very tenacious or diligent in running pi'uranga, and are very afraid to leave at the time of nifas. In that case, the same is the case with the current condition. Since medical medicine is present amid people's lives with various types of drugs, the adherence of nifas mothers to do pi'uranga begins to decrease. There are even some mothers in this village who do abort obligations to the parents or the family. As a result, some of them suffer from nifas disease.
Previous research relevant to this study, conducted by Fitrianti (2015) on Gayo traditional medicine for nifas mothers. His research found that Gayo's traditional treatment system for mothers consisted of outside medicine and deep medicine. External treatment is carried out by smoking behind the back and smearing spices on the body. In contrast, the internal treatment is carried out using herbs by drinking and inserted into the intimate organs of the mother nifas. Further research was conducted by Rahayu et al. (2017) on cultural factors in the care of mothers nifas. As for the results of their study, namely the discovery of experience in nifas treatment in the form of madeung or sale (burning), toet battee (stone burn), kusuk (massage), abstinence from eating, and drinking. Besides, there are herb, process or way, intensity, duration, or frequency and benefits of performing nifas treatment. Services of nifas treatment include traditional Keluarga Berencana (KB) or Family Planning, skin becomes beautiful and clean, and the body becomes thin. The conclusion is that the culture of nifas care has a positive impact on the participants. The positive effect in question is that the body feels comfortable, looks swing set, skin becomes whiter, the role will quickly improve, and one of the most important things is to be able to set the distance of pregnancy. Naningsi (2014), with her research on Traditional Care for Mothers who give birth to Muna people in Kambawuna Village, Muna Regency, found that maternal care is carried out by shamans (sando) within 40 days. During the treatment period, there is abstinence (parangi) to be done, i.e., eating tubers and fish. The treatment, using various potions and bathing using hot water to avoid various uterine diseases, restore stamina, and restore the aura of the face.
In some previous studies, no one has yet studied the specific disease that arises if the mother nifas does not perform treatment during nifas. The goal that is to be achieved in this study is to know and describe the type of disease that arises if the mother nifas does not do pi'uranga. Besides, similarly want to know how to implement pi'uranga on the Cia-cia in Bahari Village.

MATERIALS AND METHODS
This research has been conducted in the Marine Village of Sampolawa District of South Buton Regency with the consi-deration that the people in this village still make pi'uranga as a treatment for nifas mothers. Pi'uranga is considered a mandatory treatment and cannot be abandoned during the nifas period (40 days). Therefore, if there is a mother nifas who was negligent in doing pi'uranga, then it will be a lip by neighbours or people around her. The informants in this study were selected in purposive sampling (Spradley, 1997), i.e., the determination of informants deliberately according to the needs. This technique was chosen because informants are perceived to be able to provide information on research topics. The data collection method uses ethnographic methods by way of engaged observation and in-depth interviews. The data was analyzed using the Theory of Hippocrates Humoral Pathology (Foster and Anderson, 1986), which describes healthy or sickness occurring depending on the balance of "humour" (fluid) in the body.

Types of Diseases That Arise When Nifas Mothers Do Not Pi'uranga
As explained earlier that the disease that can arise or attack the mother nifas in Bahari Village if not doing pi'uranga is known by the term "puanaka. "Based on the people's assumption, puanaka is also triggered by the mother's mistake in doing pi'uranga named "salauranga" by the Cia-cia. There are two types of puanaka, namely puanaka morunga (young) and puanaka mocuka (old), both of which have different symptoms.

Puanaka Morunga (Young )
This type of disease usually appears or is experienced by the mother nifas in the early days of pi'uranga, namely the second, third, and subsequent days after childbirth. It is believed that the cause is because, at the time of pi'uranga, the concerned did not do it as it should. As for some of the symptoms of this disease, among others, bhibi (chills), marasai tade (difficult to stand), molaha hawa (abdominal pain), and molaha pocu (headache).
Bhibi (chills) experienced by the mother nifas in this condition, the symptoms are almost the same as shivering in general that starts with a cold feeling in the whole body. However, symptoms of chills in this condition are generally felt by the mother nifas at night in the early days of the pi'uranga period. The Cia-cia in Bahari Village has the view that when the nifas period, the body of the mother nifas, especially on the abdomen, is in cold conditions so that the air or cold at night bias causes the health of the mother nifas disturbed. If in that condition, it is not anticipated with pi'uranga, then the body of the mother nifas will quickly feel the cold, then shiver. Therefore, the shivers that attack the mother nifas at the time of puanaka morunga can be neutralized by doing the fireplace.
There is an understanding here that the cold that causes mothers to shiver at night can be prevented or restored with treatments that can send heat to the body, where hot properties counter cold properties. As explained in Hippocrates humour pathology theory in Foster and Anderson (1986) that the healing efforts of disease should be based on the cause of the disease. Illnesses caused by hard work are treated with rest. Diseases caused by excess food are treated with fasting. So what the Cia-cia did in the Bahari Village to remove the chills on the morunga puanaka is by doing the fireplace.
In addition to shivering, marasai tade (difficult to stand) is also commonly experienced by mothers nifas at the time pi'uranga. Symptoms of the disease are widely felt at the beginning of the nifas period, according to the informant that the cause of various diseases is because shamans do not directly sort the mother who gives birth. At the time of childbirth, the mother's uterus usually drops. Therefore, if the condition is left and not immediately dealt with by sequencing to restore the uterus to its original position, then over time, the mother nifas will be challenging to stand.
Another symptom of the disease commonly experienced by nifas mothers in Bahari Village is molaha hawa (abdominal pain). The pain felt by the mother nifas is almost the same as the abdominal pain felt by women towards and during menstruation, even more problematic. According to the informant, the symptoms of abdominal pain in puanaka morunga, caused by nifas blood that has not come out or still exists in the uterus. This is usually felt after waking up in the morning around 04:00 at the beginning of the nifas period. Abdominal pain in this state, that is, the stomach feels wrapped around as if someone walks in the stomach.
Molala pocu (headache) is also one of the symptoms of puanaka morunga, which is often experienced by nifas mothers at the time of pi'uranga. Headaches in this condition have typical symptoms, which differ from head-aches in general. Although initially, the pain is a bit mild, if not anticipated by doing pi'uranga, then the problem will get worse, which causes the mother nifas daze. According to the informant, the mother of nifas who is not or is poorly cared for at the time of pi'uranga as well as not doing the fireplace plus no more doing the sauna, then this can result in white blood rising or spreading to the head. This condition is the trigger so that headaches can arise.

Puanaka Mocuka (Old)
The old puanaka is the opposite of a young puanaka. If the young puanaka is felt by the mother nifas while still undergoing pi'uranga, then it is different from the old puanaka. Symptoms of this disease arise when the period of pi'uranga is over; some are one month, two months, some even appear after one year. The illness of young puanaka triggers the condition because it is not anticipated immediately during the period of pi'uranga. The symptoms of this type of disease, according to the informant, are; sala emani (loss of consciousness), kima (cyst), and pinaki marilalono (serious illness).
Sala emani, or loss of consciousness, is a situation where the sufferer loses conscious-ness so that his condition looks like a mentally ill or insane person. This is caused by maternal negligence after childbirth, so white blood rises to the head. As experienced by the informant Ibu Wa Supiana, because when she gave birth to her third child in 2004, she did not do pi'uranga until a long time ago she experienced sala emani. Because of his illness, he was once supplied by his family because it was considered insane.
In addition to sala emani, kima (cyst) is also categorized as one type of puanaka mocuka disease caused by not doing pi'uranga. The mother who had a cyst in Bahari Village because, at the time of the miscarriage, the concerned did not do pi'uranga as it should. There is a presumption from some mothers that when having a miscarriage, there is no need to do the treatment as does the person who gives birth typically. As a result, the remaining blood during a miscarriage will settle in the uterus and become a kima (cyst).
Another symptom of the disease that belongs to the old puanaka is panaki marilalono (an infection in or complication). The condition is considered severe by the CIA because it is difficult to identify what type of disease it is. The initial symptoms of the disease are characterized by headaches and constant chills in the afternoon and evening. They consider that the disease is difficult to cure, so in its treatment, in addition to being done traditionally, it is also combined with a doctor's medicine.

How to Implement Pi'uranga
Pi'uranga treatment of cia-cia in Bahari Village is still done traditionally. This period of treatment is usually done with the help of bhisa, or carried out directly by the mother nifas with control or assisted by her family. In the care of pi'uranga relies on the power of fire as its primary medium. This can be seen from the use of fire, in addition to warming the body of the mother nifas, heating hotwater for bathing and drinking mother nifas, to cook the herb (lancau), also for the burning of stones that will be used at the stage of pisoropu (sauna).
The implementation of the pi'uranga consists of several stages in different ways. Therefore, for more details on the methods of pi'uranga in the Ciacia in Bahari Village will be spelt out in the following sub-subtitles:

Pipisi (Mother Nifas Process Sorted)
Pipisi is the first treatment that will be taken by nifas mother in pi'uranga. The pee was done by bhisa, but also by nifas' mother. Bhisa will do her job for three consecutive days to bathe and massage the mother who gave birth. Bhisa is very instrumental in the process of pi'uranga, especially in order, ranging from the stomach to the waist, everything is sorted. Bhisa is not even reluctant to do a massage by using the legs to massage the groin, to facilitate the exit of dirty blood that is still contained in the uterus.
The people of Bahari Village still strongly believe in the ability of bhisa, not only at the time of birth but also in the process of pregnancy. In general, midwives in the village only control the use of tools or the use of drugs for patients. At the same time, bhisa can sequence and know the position of the baby without doing an ultrasound check to see how the baby forms in the womb and can rotate the work of the donated baby.
The sorting done by the mother nifas will be done after the process of sorting bhisa is complete. The sequencing of bhisa is carried out 1 or 2 times, after which it will be done directly by the mother nifas for 40 days of the pi'uranga period. Mother nifas sequencing generally uses hot ingredients that are grated ginger mixed with turmeric and other traditional ingredients. In addition to making it easier for the blood to come out, the use of folk remedies is also to speed wound healing. Also, because of the main work of the people in Bahari Village as fishermen, the mother nifas at the time of pi'uranga usually have to be independent in taking care of themselves, both in the process of ordering and in the process of using traditional medicines.

Pibaho (Bath)
After the mother nifas is finished dipipisi or sorted, then the residual water from the sequencing is used or used for the first bath after childbirth. The first bath process is done by the mother nifas in the room (place of delivery) using the remaining water and the water used is still in hot condition. If the water has turned cold, then the family of nifas mothers usually adds more with the hot water that they have provided at the time of the mother nifas in the process of childbirth. The use of hot water for bathing, carried out continuously until pi'uranga is finished. Because Bahari Village is a coastal village adjacent to the sea, then on the fifteenth day of pi'uranga, before bathing, especially in the morning, nifas mothers usually swim in the ocean. They believe that seawater can refresh the body and heal wounds from childbirth.

Octopus Use
After cleaning herself and changing the sarong, the mother nifas was told to wear the octopus immediately. Octopuses used by nifas mothers at the time of pi'uranga are generally made of scabbards or used fabrics that are no longer used. Then the scabbard or material is rendered elongated, which is understated by the size of the mother's nifas body. Octopus use is done by wrapping around the abdomen of the mother nifas, extending from the lower abdomen to near the centre. Mother nifas typically open up octopus use in pi'uranga. If the octopus already feels loose, then the octopus opened, then repaired and then used again. The use of pulp by the mother nifas is not only intended to shorten or dimple the stomach but also to prevent the womb from descending.

Pirarai (Doing the Fireplace)
After the mother nifas wears octopus on her abdomen, then the mother nifas must immediately do pirarai. Pirarai is the essential part of pi'uranga, whose treatment must be immediately and cannot be delayed by several hours, let alone delayed until the wait tomorrow. Therefore, when the mother nifas has started changing sarongs, then wearing octopus, then the family of the postpartum mother has begun to busy providing some necessary equipment when pirarai in the room. The tools needed in the pirarai include a fireplace, some wood, and other supporting tools that can help in lighting fireplaces such as matches and kerosene. Another thing that needs to be provided is twothirds of the young coconut stems cleavage as a furnace baser. This pirarai furnace is made of scrap metal drum pieces that have been cut at the bottom and are also made of an unused iron baking sheet (broken).
After the furnace is lit, the family of nifas mother or parents of nifas mother immediate-ly conveyed even emphasize to the mother nifas to pirarai. Pirarai is done first is by the way the mother nifas sits behind the fire with such a close distance, then the scabbard she wears is stretched down on the back of her body. It was done so that the pelvis of the mother nifas could be directly subjected to heat from the fire.
At the beginning of the nifas period, the first day to the fifteenth day of the pi'uranga period, pirarai is almost done 24 hours a day. Pirarai is done at any time from morning to evening as the fireplace should always be guarded. In this condition, the bedtime or break of the mother nifas is very limited. In the evening, can only sleep around 23.00, then at 02.00 or 02.30 in the morning, the mother nifas must wake up again to do pirarai. This is the case during the day; usually, the mother nifas had a chance to fall asleep but only briefly, sometimes sleeping in her sitting position because while pirarai. To swiftness available, the blood, the pirarai was taken by the mother nifas in pi'uranga, is also rendered by standing. Where the mother nifas stands on the furnace with the position of both legs stretched out.

Use of Lancau (Folk Remedies)
The use of lancau is the use of traditional selfmade drugs such as hereditary herbal medicines that are usually used for people who give birth. Treatment of the use of lancau consists of 2 types, namely the use of bandaged and drunk. The use of sass done by wrapping is to flex stiff muscles due to childbirth. It can be that the people of Bahari Village use turmeric and ginger, which are wrapped all over the body while ginger is covered at the bottom of the abdomen. This traditional treatment has been practiced for a long time and passed on to their posterity so that it still survives today. The Cia-cia people still practice as a remedy to neutralize stiff muscles and are useful for resolve fatigue during childbirth. The use of bandaged drugs can reverse the condition of the mother who gave birth as it was once. As for care by drinking the herb that has been inherited by this older adult is done to prevent the rise of white blood on the head, dry the deep wounds, dispense dirty blood, restore stamina, and close up the vaginal wall. The herb is made from turmeric mixed with ginger and pepper that is drunk almost every morning.

Pisoropu (Sauna)
From several stages of pi'uranga, the part that is considered necessary also for the Cia-Cia in the Bahari Village, in addition to pirara (fireplace), is pisoropu. Pisoropu is a sauna activity conducted by nifas mothers that are done twice in one day, namely morning and afternoon or evening, using stones as the primary medium. Therefore, the first thing that is done before pisoropu is the process of burning rocks. The early stage in burning this stone is to light a fire first. After the fire is lit, the next step is the stone that will be used for pisoropu directly placed on the embers.
The stone was placed in the middle of an ironand fire. The burned stone is the stone of the times. For the Cia-cia in Bahari Village, the stone is considered very suitable for pisoropu. This is in addition to the weight of the rock this time, which is deemed to be acceptable; also, the stone times have a moderately resistant component, which is burned on the embers continuously or repeatedly, will not be easily cracked. Besides, hot stones if sprinkled or watered, it is not easy to remove components that can injure the eyes, skin, or other limbs.
The time used in the process of burning coal depends on the embers being ignited. If the stone has changed colour somewhat oddly, then the stone can already be used for pisoropu. Before the stone was lifted, the family prepared some necessary equipment in the pisoropu, such as chairs, a basin filled with water, and several sheets of the sarong. After that, the stone is immediately lifted, which is usually using a pan cover. Then the stone was placed next to the basin, which had been prepared earlier.
The second process after the stone burning process is completed, then the mother nifas directly performs pisoropu by adjusting the seat position. The sitting work of the mother nifas is like being squatted by resting on an existing seat, then a stone and basin containing water is placed on the front of it and will be covered in the scabbard she wears.
After the mother nifas felt quite comfortable with the sitting position, then the family immediately took some sarong or cloth to then wrap on the body of the mother nifas. After that, nifas's mother immediately did pisoropu. The pisoropu is done using the mother nifas watering the water in the basin onto the hot stone little by hand, which is done repetitively until the water runs out. Now and then, the mother opens her eyes, but if she feels hot enough during the wrapping, then her eyes are usually closed.
Pisoropu done by watering water little by little can make the mother's body nifas sweat. The outing of the volume of work can make the body of the mother nifas feel light and light. An effort that is a residual material on the mother's nifas body gets lost, so the health impact is much supposed. Next, mom nifas feels new and light on her body. After the mother nifas finished pisoropu, the pisoropu stone was reused for mother nifas sequencing. The stone is first wrapped in cloth, and then used to sort on the abdomen. She's legs are angled with the baring position on she's back, and both hands hold the stone while moving his stomach from side to left. This makes the blood that clumps in the stomach liquid and comes out little by little. Besides, with treatments like this, the stomach is slim back and does not look enlarged (distended).

CONCLUSION
Pi'uranga, which is the legacy of the ancestors of the Cia-Cia in Bahari Village, is still done and even used as mandatory care for every mother nifas, both who have suffered miscarriages, let alone new births. The treatment is done not without reason; the essential thing for the Cia-Cia people in Bahari Village so that pi'uranga must be carried out by nifas mother that is to avoid disease called puanaka. Puanaka is considered a dangerous condition for the health of the body because the symptoms are not felt at the time of nifas (still pi'uranga). There are two kinds of puanaka, namely puanaka morunga (young puanaka) and puanaka mocuka (old puanaka). Puanaka morunga appears about a month or two after giving birth. Meanwhile, puanaka mocuka seems after a long period of childbirth, usually after the annual postpartum. These two kinds of puanaka symptoms are not felt at the time of nifas.
Several stages must be passed or per-formed by the mother nifas during pi'uranga. At which the pi'uranga step relies heavily on the heat power of the fire as its primary medium. This can be seen from the fire used for the mother's nifas bath (hot water), the lancau cooking process, the pirarai process (fireplace), as well as the process of burning stones to be used in the pisoropu (sauna) stage.
There needs to be socialization about pi'uranga, its dangers, or diseases that arise if the mother nifas does not do pi'uranga and its ways. The socialization is not only for mothers, but also for the younger generation, especially women, both who have not, want to, and are married. Bhisa can be a midwife partner in maternal care, including in health socialization activities. In this case, the government should create a unique program related to the health of the nifas mother. The program is not only medically reviewed modern but also based on the culture of the local community.