Implementation of BERSABAR Method for Students to Achieve Clean and Healthy Schools in Al Ikhlas Private Elementary School Medan

. Sanitation conditions in the school environment in Urban Village Sitirejo II were not well managed. The school had adequate facilities, but these facilities were not optimally utilized as seen from the unavailability of clean water, unclean toilets, and scattered garbage. These conditions can lead to diseases such as diarrhea and others. The formation of cadres from students needs to be done to overcome these problems. The cadre was named Bocah Cinta Lingkungan or "Bocil" or the Environmentalist Child Cadres, 10 people were selected and formed through "Bersabar" method. The play method used is with the modification of the Snakes and Ladders game, the game is communicative and easy to understand, with eye-catching visualization, attractive, and fun to use as learning media. In addition, snakes and ladders are modified with interesting and full-color illustrated questions and answers. After the cadres are formed, their role is to instill clean and healthy living behaviors for themselves and their peers. Promotive efforts in school children groups can be done with peer education. Furthermore, this program also involves principals and teachers by providing a "Bersabar" method tools to Al Ikhlas Private elemntary School. Teachers have a role to monitor the cadres and then also be able to form the cadres independently


Introduction
Sitirejo II Urban Village, Medan Amplas Sub-district, is a densely populated settlement.It is located on the edge of the causeway and is the gateway to the outside of Medan City (Medan -Tanjung Morawa).The community of Siterejo II Urban Village is a highly active population.As some are migrants, their activities focus on earning money in Medan City.Most of the residents of Urban Village Sitirejo II are self-employed (48%), which requires working from morning to evening.Some of them trade at Simpang Limun Traditional Market.Activities in the Traditional Market not only require time in the morning, but in the afternoon until evening they also still have activities outside the home [1].
People's activities outside the home limit them from paying attention to family conditions, especially paying attention to the condition of children.Many mothers participate in trading at Simpang Limun Traditional Market so they pay less attention to the health and hygiene of their children.In fact, children are an age group that is very vulnerable to health problems.
With parents' busy schedules, they assume that their children's education is left to the school.
Community of Urban Village Sitirejo II has easy access to primary school education for their children.There are seven schools in Urban Village Sitirejo I, namely SDN 060812, SDN 060823, SDN 060827, SDN 064955, SDN 068085, SDS Al Ikhlas and SDS Al Washliyah.Due to their busy schedules and easy access to educational facilities, parents are less concerned about their children's health.
On the other hand, unhealthy school environment conditions can be a source of disease spread.
Diseases that arise from schools are dengue fever, helminthiasis, diarrhea, etc.Many dengue cases occur in the school environment.The study found that 33.3% of a total of 37 students in Grade 6 were affected by DHF.Unmonitored school bathrooms can become breeding grounds for mosquitoes.This of course has a high risk of school children being infected with DHF [2].
The sanitation condition in SDS Al Ikhlas (Al Ikhlas Private Elementary School) environment looks poorly managed.A lot of garbage was found scattered in the school environment.Snack sellers around the school are located very close to garbage dumps and dirty gutters.The school has adequate facilities such as toilets, but they do not appear to be optimally utilized.This is evident from the lack of readily available clean water, poorly managed latrines, and the poor hygiene of the toilets.
The incidence of Soil-Transmitted Helminthes (STH) infection or helminthiasis among primary school students in Indonesia is still very high.Factors causing the high prevalence of STH infections are low awareness of maintaining cleanliness and inadequate sanitation conditions.
According to the study, there is a relationship between the habit of washing hands after defecation with helminthiasis infection in children in the working area of Ranomut Public Health Center.In addition, another study also mentioned that there is a relationship between environmental sanitation such as drinking water sources, physical quality of water, ownership of latrines, habits of playing on the ground to the incidence of helminthiasis in elementary school children [3][4].
To solve the problems in partners, the formation of cadres from students needs to be done.The cadre formation is named Bocah Cinta Lingkungan (Environmentalist Child Cadres) or abbreviated as "Bocil".Elementary school-age children are strategic targets for the implementation of health programs because they are sensitive to stimulus so they are easily directed.They are very sensitive to being instilled with understanding and healthy living habits so it is very effective if education is given at their age.Early planting can be carried over to adulthood so that they can also become agents of change in improving health [5] [6].
The method of forming "Bocil" is carried out using Bermain Sambil Belajar (Play while Learning) method or abbreviated as "Bersabar".Play activities are what children need because through play children will gain knowledge and experience that can develop their abilities.By involving cheap and simple toys in learning activities, children become interested and increase their curiosity.The play method used is a modification of the Snakes and Ladders game.Psychologically, snakes and ladders have been proven to improve children's ability to interact with social life.Snakes and Ladders are a communicative and easy-to-understand game media, with eye-catching visualizations so that it does not cause boredom and boredom, and is fun so that children are not sleepy during learning.In the Snakes and Ladders game in this activity, the snakes and ladders are modified in a merry way accompanied by interesting and full-color illustrated questions and answers [7][8] [9].
After the Environmentalist Child Cadres are formed, they will play a role in instilling clean and healthy living behaviors for themselves and their peers (other students).Based on research, promotive efforts can be made in school-age children through peer education.The study showed that peer education was effective in improving students' knowledge [10].Based on the described above, this community service activity aimed to apply Snakes and Ladders Educational Game Media as a means of early education about Clean and Healthy Schools for elementary school-age children at Al Ikhlas Private Elementary School Medan.

Methods
The community service activities through the implementation of "Bersabar" methods to Environmentalist Child Cadres were carried out through 3 stages, namely planning and preparation including analysis of the problem situation, team coordination with partners, target planning, preparation of snake ladder educational game media, preparation of tools and materials, preparation of supporting infrastructure, and technical field planning.
The implementation of the activity was carried out on Tuesday, July 16, 2019.This activity was carried out for students of Al Ikhlas Private Elementary School which is located on Jl.SM.Raja Gg.Jadi No.1 Sitirejo II Village, Medan Amplas District.This activity involved the principal, teachers, and 10 students as the Environmentalist Child Cadres "Bocil" cadres.The school was very receptive to this activity, because "Bersabar" method is one of the programs that is being widely implemented in elementary schools.The cadre candidates were planned to be selected from the fifth grade.However, due to the small number of students in this school, the selected cadre candidates were a mixture of third, fourth, and fifth graders, totaling ten people.The implementation stage of the activity includes remarks from the school and the service team, pretest of selected cadres, atmosphere building for cadres, increasing knowledge with "Bersabar" method, post-test of selected cadres, awarding and inauguration of cadres, handover of a set of "Bersabar" method tools to the supervising teacher.
The flow chart of the stages of implementing community service activities can be seen in Figure 1 as follows.

Result Discussion
The preparation stage of service activities is carried out by adjusting the problems faced by partners.The SD-BS snakes and ladders game media as in figure 2, is a modification of the snakes and ladders game which contains 50 boxes with various questions about 13 clean and healthy living behaviors.This snakes and ladders game is carried out with the following steps.
1.The roles in each team are divided into two, one serving as a pawn and the other as a dice thrower.
2. To determine the order of players, a representative of each team takes one of the cards in order 1-5 randomly provided by the facilitator.Then, each team.
3. Gets its turn to play according to the game sequence number.Each team also gets a sequence number attached to their clothes as a sign.
4. Before the game starts, all the pawns are outside the snakes and ladders board.
5. The child who acts as the dice thrower throws the dice, then the child who acts as the pawn steps and stands on the box according to the number of dice that appears.
6.Not all boxes on the snakes and ladders board contain questions.Each box that contains an image has a question.If a team gets a box that contains a question, it must answer the question correctly.Each team works together to answer the questions received.Teams that answer correctly get an additional score of 10 points and advance 2 steps, while teams that answer incorrectly do not get a score.Before the game started, the participants were asked to do the pre-test questions as shown in Figure 5 first.The service team also invited participants to sing the PHBS song.After the conditions and situation of atmosphere building have been successfully carried out, participants are asked to take a lottery number for group division and introduce themselves first as shown in the Figure 6.Participants with the same lottery number will become 1 group.Furthermore, the service team will explain the SD-BS snakes and ladders game guide as shown in Figure 7.After the playing activities were completed, cadres conducted a post-test to determine the extent of their knowledge after the training intervention with the "Bersabar" method as in Figure 9.Ten cadres who have received training intervention with the "Bersabar" method will be officially inaugurated as the Environmentalist Child Cadres.They are directed to become agents of change who will socialize clean and healthy living to other friends, school residents, and families.In addition to the inauguration, the best cadres will be rewarded for playing and learning.Each cadre will also be given a pin badge and a gift.Pin badges are given to cadres to increase their confidence so that they can be optimal in campaigning for clean and healthy living and other students will also be interested in joining the next cadre.The cadres will also be given posters of clean and healthy living behavior as campaign materials for the cadres.As their duty as the Environmentalist Child Cadres, they must campaign for clean and healthy living with the help of PHBS posters.

Figure 1 .
Figure 1.Flow chart of community service activities

7 .
At the end of the activity, the 2 best teams are chosen, namely the team that reaches the last box first and the team that gets the highest score.8.The facilitator records the score obtained by each team and records the time duration of the game from the beginning to the end of the activity.

Figure 2 .
Figure 2. Clean and Healthy Schools snakes and ladders game media

Figure 3 .
Figure 3. Opening remarks from the Principal of Al Ikhlas Elementary School and the head of the service team

Figure 4 .
Figure 4. Handover of a set of "Bersabar" methods Games

Figure 7 .
Figure 7.The service team explains the game procedure

Figure 8 .
Figure 8.The game starts cheerfully

Figure 9 .Figure 10 .
Figure 9.The cadre candidates working on post-test questions