Several years ago a young man came to see me in my clinic. He told me he was running for his life. He said that he fled his home, because there, homosexuality wasn't just illegal, in some cases it was punishable by death. So when his sexual orientation was exposed, his family rejected him, his boss fired him and angry mobs repeatedly attacked him in the streets. And each time the police arrived only to arrest him, detain and torture him further. And he knew that if he couldn't escape the cycle of violence, he would surely be killed.
Beberapa tahun yang lalu, seorang pemuda menemui saya di klinik. Dia bilang dia lari menyelamatkan diri. Dia bilang dia kabur dari rumah karena di sana, homoseksualitas tak hanya ilegal, dalam beberapa kasus, bisa dijatuhi hukuman mati. Jadi, saat orientasi seksualnya terkuak, keluarganya menolaknya, atasannya memecatnya, dan massa yang marah berkali-kali menyerangnya di jalan. Polisi datang hanya untuk menangkap, menahan, dan menyiksanya lebih jauh. Dia tahu, kalau dia tidak bisa lari dari lingkaran kekerasan, dia pasti akan terbunuh.
So he had to do what he needed to do to survive. He left everything behind. All of his friends, his family, his career. He fled his home, he escaped to the United States and here he applied for asylum.
Jadi, dia lakukan hal yang semestinya untuk bertahan hidup. Dia meninggalkan segalanya. Semua teman-temannya, keluarganya, kariernya. Dia kabur dari rumahnya, lari ke Amerika Serikat dan mendaftar suaka di sini.
But like many people fleeing this kind of persecution, he couldn't carry much. He had some basic ID, barely any money and a few other belongings. He certainly didn't bring official documents from the police who tortured him. No videos from the mob that tried to kill him. He didn't have this kind of evidence to help support his claims, yet here he was, sitting in my clinic, showing me some of the most powerful evidence of his persecution. That was the physical and psychological scars that he brought with him. You see, he suffered from chronic, debilitating pain. He had severe scars scattered over his body, poorly healing wounds that got infected over and over again. He suffered from severe depression and continued to have regular, paralyzing flashbacks and nightmares from PTSD.
Seperti banyak orang yang lari dari persekusi ini, dia tak bisa membawa banyak. Dia punya kartu identitas dasar, sedikit uang, dan beberapa barang lain. Jelas dia tak membawa dokumen resmi dari polisi yang menyiksanya. Tidak ada video dari massa yang mencoba membunuhnya. Dia tidak punya bukti untuk mendukung klaimnya, Namun, di sinilah dia, duduk di klinik saya, menunjukkan beberapa bukti terkuat hasil persekusinya kepada saya. Luka fisik dan psikologis yang dia bawa bersamanya. Dia menderita rasa sakit yang kronis dan melemahkan. Dia punya bekas luka parah di seluruh tubuhnya, luka tak sembuh yang terinfeksi lagi dan lagi. Dia menderita depresi berat dan terus mendapat kilas balik dan mimpi buruk akibat PTSD.
So we continued our work. We met regularly for months, documenting each of these pieces of medical evidence. We went over the details of every attack, photographed his scars, documented his injuries and wounds, and we were even able to start chronicling his slow but steady recovery while under our care. Working closely with his lawyers, I submitted a detailed affidavit, including the findings of this forensic medical evaluation, and we included it as part of his asylum application. And then we waited for several long years while he navigated the courts.
Jadi, kami terus bekerja. Kami rutin bertemu selama berbulan-bulan, mendokumentasikan setiap bukti medis ini. Kami melihat detail serangannya, memotret bekas luka, mencatat cedera dan lukanya. Kami bahkan mulai bisa mencatat pemulihannya yang lambat tetapi pasti selagi di bawah pengawasan kami. Bekerja sama dengan pengacaranya, saya mengajukan afidavit terperinci, termasuk temuan evaluasi medis forensik yang disertakan dalam aplikasi suakanya. Lalu kami menunggu beberapa tahun selagi dia menghadiri persidangan.
And then one day I got an email from him. It said that he was granted asylum. And everyone in the clinic was overjoyed. He said in his email that this was the first time in years that he didn't fear deportation and death. It was the first time in years that he truly felt safe, that he had the security to rebuild his life all over again. And it was only through this medical and legal advocacy that we were able to help restore his legal status and his rights, that he could do that, all through asylum.
Suatu hari, saya mendapat surel darinya. Dia bilang dia sudah mendapat suaka. Dan semua orang di klinik sangat gembira. Dia menulis bahwa ini adalah pertama kalinya setelah bertahun-tahun dia tidak takut akan deportasi dan kematian. Ini pertama kalinya dia merasa aman untuk membangun hidupnya lagi. Dan hanya lewat advokasi medis dan hukum ini, kami bisa mengembalikan status resmi dan hak-haknya lewat suaka.
Now for many people fleeing persecution, they come to programs and clinics like this telling unimaginable tales of violence and different reasons they were persecuted. But one thing is always the same. The violence meted against them was done with complete impunity, sometimes by the hands of the state directly through police or military officials. In other cases, the state just turns a blind eye and condones the acts of paramilitary groups or even violent domestic partners. In other cases, state is completely powerless to protect the vulnerable from powerful gangs.
Banyak orang yang kabur dari persekusi mendatangi program atau klinik semacam ini menceritakan kisah kekerasan dan beragam alasan mereka dipersekusi. Namun, satu hal selalu sama. Kekerasan yang mereka alami sama sekali tak tersentuh hukum. Terkadang dilakukan oleh pemerintah melalui polisi atau tentara. Di kasus lain, negara hanya menutup mata dan membiarkan aksi grup paramiliter atau bahkan pasangan serumah yang kejam. Di kasus lain, negara sama sekali tak berdaya untuk melindungi mereka yang rentan dari geng yang berkuasa.
Now we know that social determinants of health play a huge role in determining the health and well-being of our patients: housing, income, education, race, social inclusion. But the same can be true for equal protection in the law -- due process. Especially in societies for the most vulnerable, the marginalized and even those who are actively targeted, their access to these human rights protections that can mean the difference between sickness and health, and often it's the difference between life and death. And for millions of people who endure persecution and torture, the only way to heal is to acknowledge the human rights abuses that have occurred and to help restore the rights and protections that were so violated.
Kami tahu bahwa faktor penentu sosial kesehatan berperan besar dalam menentukan kesehatan dan kesejahteraan pasien kami. Rumah, pemasukan, pendidikan, ras, penyertaan sosial. Namun, hal itu juga berlaku bagi kesetaraan perlindungan hukum, proses hukum. Terutama dalam masyarakat yang rentan, terpinggirkan, bahkan bagi mereka yang disasar secara aktif, akses mereka ke perlindungan HAM bisa membedakan antara sakit dan sehat, dan seringnya, antara hidup dan mati. Bagi jutaan orang yang mengalami persekusi dan penyiksaan, satu-satunya cara untuk sembuh adalah dengan mengakui adanya pelanggaran HAM dan membantu memulihkan hak dan perlindungan yang telah dilanggar.
After the atrocities of World War II, the asylum system was set up as one pathway to that kind of relief. But these days it seems like that pathway has turned into an obstacle course, setting people up to fail. Asylum seekers oftentimes don't know how to start, let alone complete the process that can drag on for years. They're not entitled to lawyers, so they don't know their rights. Increasingly, they're even being barred from setting foot in places of potential refuge. They're arrested or prosecuted, even deported before they ever get to see an asylum officer. And even if they do make it through the process, asylum grant rates can be as low as 20 percent and far worse for some. It's almost like the system was designed to keep people from exercising their right.
Setelah kekejaman Perang Dunia II, sistem suaka dibuat sebagai jalur bantuan. Namun kini, jalur itu sepertinya malah menjadi penghalang, yang menggagalkan orang-orang. Pencari suaka sering tidak tahu cara memulainya, apalagi menyelesaikan proses yang bisa memakan waktu bertahun-tahun. Mereka tak berhak mendapat pengacara, jadi mereka tak tahu hak-haknya. Maraknya, mereka bahkan tidak boleh masuk ke negara kemungkinan suaka. Mereka ditahan atau dihukum, bahkan dipulangkan sebelum bisa bertemu petugas suaka. Kalaupun mereka lolos ke prosesnya, kemungkinan mendapatkannya hanya 20% atau lebih rendah. Sistem ini sepertinya didesain agar orang-orang tak bisa menggunakan haknya.
But there is something that many of these people can do. Something that can potentially increase their chances of success to 90 percent or more. So what makes the difference? Getting a lawyer and having a medical evaluation. It's as simple as that. The man who came to my clinic and won his asylum case. Doctors and lawyers working together to present all of the evidence, including the medical evidence, to the courts allows judges to make informed and just decisions.
Namun, ada satu hal yang bisa mereka lakukan. Sesuatu yang bisa meningkatkan kemungkinan sukses hingga 90% atau lebih. Jadi, apa yang membedakannya? Mendapatkan pengacara dan evaluasi medis. Sesederhana itu. Pria yang datang ke klinik saya dan memenangkan kasusnya. Dokter dan pengacara bekerja sama untuk memberi semua bukti, termasuk bukti medis ke pengadilan agar hakim dapat memutuskan dengan adil.
And it's this kind of medical-legal partnership that's now more important than ever, because we live in a time of epic, forced migration due to violence and conflict. In 2018 there were 70 million people worldwide forcibly displaced due to war, conflict and persecution. It includes 40 million internally displaced, 25 million refugees and three million asylum seekers. Here in the United States, we see the impact of escalating violence in places like El Salvador, Guatemala and Honduras, where murder rates can be as high as those in Syria and Afghanistan. Where police corruption and gang violence are on the rise, where poverty and child abuse are widespread and tolerated, where basic systems of governance -- public safety, child protection -- are ineffective.
Kemitraan medis-hukum inilah yang sangat penting sekarang, karena kita tinggal di masa migrasi paksa akibat kekerasan dan konflik. Pada 2018, ada 70 juta orang di seluruh dunia yang terpaksa pindah karena perang, konflik, dan persekusi. Termasuk 40 juta pengungsi dalam negeri, 25 juta pengungsi, dan tiga juta pencari suaka. Di Amerika Serikat, kita melihat dampak dari meningkatnya kekerasan di El Salvador, Guatemala, dan Honduras, di mana tingkat pembunuhannya bisa setinggi di Suriah dan Afganistan. Tempat korupsi polisi dan kekerasan geng sedang meningkat, di mana kemiskinan dan penyiksaan anak tersebar luas dan ditoleransi, di mana sistem dasar pemerintahan, keamanan publik, perlindungan anak menjadi tidak efektif.
It's no surprise then that many of the most vulnerable in some of these societies -- children, women and other targeted groups -- they're growing increasingly desperate and fleeing in unprecedented numbers. Like over the past 10 years, the numbers of unaccompanied children trying to seek safety at our southwest border has increased 18-fold, from 3,300 in 2009 to over 62,000 this past year. That's in addition to nearly half a million people traveling as families. Men, women and children trying to seek refuge at our borders, but who are stranded in a humanitarian crisis.
Tidak mengagetkan bahwa mereka yang paling rentan di sana -- anak kecil, wanita, dan kelompok lain yang disasar menjadi semakin putus asa dan kabur dalam jumlah besar. Selama 10 tahun terakhir, jumlah anak tanpa pendamping yang berusaha berlindung di barat daya AS telah meningkat 18 kali lipat dari 3.300 di tahun 2009, hingga lebih dari 62.000 setahun terakhir. Itu belum termasuk setengah juta orang yang datang sebagai keluarga. Pria, wanita, dan anak-anak ingin mencari perlindungan di perbatasan kita, tetapi terjebak dalam krisis kemanusiaan.
And what makes matters worse is that they're caught in this fog of claims and counterclaims about who they are, what they've experienced, where the proof is and what they deserve. Do they deserve our help? Sometimes people make claims that they're not fleeing human rights abuses but are simply economic migrants. Others say these children are actually being exploited and trafficked by their parents. Others say they're not even children at all; they're hardened criminals, they're gang members trying to infiltrate our country.
Parahnya lagi, mereka terjebak dalam benang kusut klaim dan klaim balasan tentang siapa diri mereka, pengalaman mereka, letak bukti, dan apa yang layak mereka dapat. Apakah mereka layak dibantu? Kadang, mereka mengeklaim tidak kabur dari pelanggaran HAM, melainkan karena ekonomi. Yang lain mengatakan, anak ini sebenarnya dieksploitasi dan dijual oleh orang tuanya. Yang lain bahkan berkata mereka bukan anak-anak; mereka penjahat, anggota geng yang berusaha menyusup ke negara kita.
To cut through some of this fog, my colleagues and I conducted a study. We looked at data from children seeking asylum who had medical evaluations. And this is what the evidence told us. 80 percent of these children had evidence of exposure to repeated physical violence: assault and torture. 60 percent of the girls and at least 10 percent of the boys had evidence of repeated exposure to sexual violence. One young girl, telling a story and having corroborating evidence of being detained, beaten and raped over the course of three years, trafficked to other men and even having the threats of the murder of her entire family if she should ever escape or try to seek help. 90 percent of these children had evidence of psychological harm from indirect violence, including such severe threats, but also witnessing untold atrocities with their very eyes.
Untuk mengurai benang kusut ini, saya bersama kolega melakukan penelitian. Kami melihat data dari anak-anak pencari suaka dengan evaluasi medis. Dan ini yang kami dapat dari bukti itu: 80% dari mereka memiliki bukti terdampak kekerasan fisik berulang: penyerangan dan penyiksaan. 60% perempuan dan sedikitnya 10% lelaki punya bukti terdampak kekerasan seksual. Satu anak perempuan bercerita dan punya bukti kuat bahwa dia telah ditahan, dipukuli, dan diperkosa selama tiga tahun; dijual ke pria lain, dan bahkan diancam keluarganya akan dibunuh jika mencoba kabur atau mencari bantuan. 90% anak-anak ini memiliki bukti luka psikologis dari kekerasan tak langsung, termasuk ancaman keji tadi, dan juga akibat menyaksikan kejahatan secara langsung.
One young boy described the terror and the grief and the utter fear of seeing the mutilated bodies and faces of his younger brother, his aunt, his uncle, his cousin, all killed in a single gang attack meant to send the community a message.
Satu anak pria menjelaskan kengerian, kesedihan, dan ketakutannya saat melihat tubuh dan wajah yang termutilasi milik adik lelakinya, bibinya, pamannya, dan sepupunya. Semua dibunuh dalam satu serangan geng untuk memberi pesan ke masyarakat.
And of course the psychological toll is immense. 19 percent of these children had signs of anxiety disorder; 41 percent, depression and 64 percent, PTSD. 21 percent also had signs of suicidality as children. To put this into some perspective, returning combat veterans, they have PTSD on the order of 10 to 20 percent. These children at three to six times more likely to have PTSD than a soldier returning from war.
Tentu beban psikologisnya sangat besar. 19% anak-anak ini memiliki gelagat gangguan kecemasan; 41% depresi, 64% PTSD, dan 21% kecenderungan bunuh diri. Untuk perbandingan, veteran yang pulang dari perang memiliki kemungkinan PTSD 10-20 persen. Anak-anak ini tiga sampai enam kali lipat lebih mungkin mendapatkan PTSD daripada tentara yang kembali dari perang.
Now despite this burden and despite this trauma, there are many others, still. Children who come to seek safety and enter into our immigration system only to find further abuse and even torture reminiscent of the places that they fled. You might remember some of those headlines, some of those images this past year. Children being ripped from the arms of their parents. Toddlers, infants in cold and unsanitary cages. The absence of food, water clothing and even soap. There's also increasing reports of medical negligence, preventable complications, child abuse, sexual abuse and even child deaths in US custody. Sadly, many of these abuses and crimes aren't new. Some date back many years and even across administrations. But something's changed. The scope and scale of these abuses and crimes, the systematic and seemingly purposeful endangerment of asylum seekers and also the impunity with which it's being done has raised the harm to an entirely new level.
Meski dengan beban dan trauma ini, masih banyak lagi hal lainnya. Anak-anak pencari keamanan yang memasuki sistem imigrasi kita mengalami kekejaman dan penyiksaan lagi yang mengingatkan mereka akan kejadian dahulu. Anda mungkin ingat beberapa berita utama dan foto-foto setahun belakangan. Anak-anak direnggut dari orang tuanya. Balita dan bayi di dalam kurungan yang dingin dan kotor tanpa makanan, air, pakaian, dan sabun. Ada pula peningkatan laporan kelalaian medis, komplikasi yang bisa dicegah, penyiksaan anak, penyiksaan seksual, dan bahkan kematian anak dalam pengawasan AS. Sayangnya, penyiksaan dan kejahatan ini bukan hal baru. Beberapa sudah ada sejak lama bahkan lintas lembaga pemerintah. Namun, sesuatu berubah. Cakupan skala penyiksaan dan kejahatan ini, ancaman terhadap pencari suaka yang sistematis dan tampak disengaja, juga tindakan nirpidana telah meningkatkan bahayanya.
It reminds me of one of the girls in the study who told us how she pleaded with one of her attackers, asking him to stop, asking why she was targeted. And do you what his response was? He says, "We can do this, because there's no one here to protect you."
Saya ingat seorang gadis di penelitian, yang bercerita bagaimana dia memohon pada penyerangnya, memintanya berhenti, bertanya mengapa dia yang diincar. Dan tahukah Anda balasannya? Dia bilang, "Kita bisa melakukan ini karena tidak ada yang melindungimu."
We can't let this be true of children and other asylum seekers trying to find help at our borders. But what do we do? As a physician, I'm often dealing with difficult decisions with some of my sickest and most complex patients. Of course we want to keep our focus on their health, their well-being, their quality of life, but sometimes it requires a deeper exploration of their values to really understand how to move forward. In a similar way, our nation is facing a crisis with the increasing number of asylum seekers at our borders and in our communities, and it compels us to re-examine some of our own fundamental values.
Kita tidak bisa membiarkan ini terjadi pada anak-anak dan pencari suaka lain di perbatasan kita. Apa yang akan kita lakukan? Sebagai dokter, saya sering membuat keputusan sulit dengan para pasien saya yang sakit parah dan kompleks. Tentu kami ingin fokus pada kesehatan, kesejahteraan, dan kualitas hidup mereka. Kadang, kami perlu memahami prinsip mereka lebih dalam untuk tahu cara bergerak maju. Negara kita juga tengah menghadapi krisis dengan bertambahnya pencari suaka di perbatasan dan komunitas kita. Ini memaksa kita untuk mengkaji ulang prinsip dasar kita.
What does it mean when we value health and safety? What does it mean when we value security, life, liberty, the life of children? What about this one -- what does it mean when we say we value law and order? Does that also include respecting due process rights for an asylum seeker?
Apa artinya menghargai kesehatan dan keamanan? Apa artinya menghargai keamanan, kehidupan, kebebasan, hidup anak-anak? Bagaimana dengan ini -- apa artinya kita menghormati hukum dan ketertiban? Apa itu juga termasuk menghormati proses hukum pencari suaka?
Now for some, when they hear these terms they immediately gravitate towards wanting to build more walls, deploying more border patrol, deporting more people even if it means separating children from their families, subjecting them to psychological torture or deporting them to places where they might die. All in the name of security. All in our name.
Setelah mendengarnya, beberapa orang langsung ingin membangun lebih banyak tembok, menyebar patroli perbatasan, dan mendeportasi lebih banyak orang meski artinya memisahkan anak-anak dari keluarganya, menempatkan mereka dalam siksaan psikologis, atau mendeportasi mereka ke tempat di mana mereka bisa mati. Semua atas nama keamanan. Semua atas nama kita.
But for me and for many others, when I think of these values, that pushes me in an entirely new direction and renews my commitment to try to meet the needs of these asylum seekers with every tool I have at my disposal. So that when we say that we value life and liberty, we'll see these people who have taken unimaginable risks to flee imminent danger and harm to try to find safety. We'll meet them where they are and provide food, water, shelter, clothing. And we'll certainly meet them with medical care and mental health care that they so desperately need. When we say that we value the rule of law, and not just the privileges it provides a few but the responsibilities it requires of all of us, we'll make sure that we have a functioning immigration system. We'll make sure that we have trained judges. We'll make sure that we're not settling for the illusion of law and order that maybe a tall wall or a militarized border might provide us. We want the real thing. We want judges to be able to evaluate the evidence, including the medical evidence, and we want them to administer justice ... fairly.
Namun, bagi saya dan banyak lainnya, memikirkan nilai-nilai ini mendorong saya ke arah baru dan memperbarui komitmen saya untuk membantu para pencari suaka dengan tiap alat yang saya punya. Jadi, ketika kita berkata kita menghargai kehidupan dan kebebasan, kita melihat mereka yang mengambil risiko besar untuk kabur dari bahaya genting dan mencari keamanan. Kita akan mendatangi mereka, dan menyediakan makanan, air, tempat tinggal, pakaian, dan tentunya juga perawatan medis dan perawatan kesehatan mental yang sangat mereka perlukan. Ketika kita menghargai aturan hukum, tidak hanya hak-hak istimewa bagi sebagian orang, tetapi juga tanggung jawab kita semua, akan memastikan sistem imigrasi kita berfungsi. Memastikan hakim kita terlatih. Memastikan bahwa kita tidak puas dengan ilusi hukum dan ketertiban yang diberikan tembok tinggi atau perbatasan militer. Kita ingin hal yang asli. Kita ingin hakim yang mampu menilai bukti, termasuk bukti medis, dan kita ingin mereka menjalankan hukum dengan adil.
When we say that we value health and well-being, that we don't want to perpetuate harm, then we'll deploy trauma-informed strategies at all levels of the immigration system. It might start with retraining border patrol agents or immigration officials, but it needs more medical, mental health and child welfare experts across the whole system.
Ketika kita menghargai kesehatan dan kesejahteraan, bahwa kita tak ingin melanggengkan bahaya, barulah kita akan menerapkan strategi tanggap trauma dalam semua tahap sistem imigrasi. Ini bisa dimulai dengan pelatihan agen patroli atau imigrasi, tetapi juga perlu ahli medis, kesehatan mental, dan kesejahteraan anak di seluruh sistem.
And when we say that we value justice, we won't let ourselves be turned into the torturers that many of these children and other people fled. We'll open up our detention centers and our courts to experts and advocates to hold ourselves accountable. And we may find that we need to shut down most of them and close these camps.
Dan ketika kita menghargai keadilan, kita tidak akan berubah menjadi para penyiksa yang ditakuti banyak anak-anak dan orang lain. Kita akan membuka pusat penahanan dan pengadilan kita kepada para ahli dan advokat agar kita bertanggung jawab. Dan mungkin kita perlu menutup sebagian besar kamp yang ada.
I believe that by working in effective partnerships with lawyers, doctors, human rights advocates and many others, that we can work together to meet these asylum seekers' needs, that we can meet our historical, humanitarian and legal obligations to them. And when we do, I think something powerful will unfold. Not only will these asylum seekers -- like the man who came to my clinic and won his asylum case, like the children in the study or the many thousands of others seeking a new life, they'll be able to find that safety and security. We'll recognize the abuses that have occurred, and we'll restore the rights and protections that were lost. And I think that we'll be in wonder when we see them in the fullness of their humanity. Not just their strengths and weaknesses, their hopes and joys, not just the trauma that we acknowledge, but we'll also stand with them and we'll be inspired by their resilience. They'll blossom, and they'll add to the richness of this nation.
Saya percaya, dengan bekerja sama secara efektif bersama pengacara, dokter, advokat HAM, dan lain-lain, kita bisa bersama-sama memenuhi keperluan pencari suaka, kita bisa memenuhi kewajiban sejarah, kemanusiaan, dan hukum untuk mereka. Dengan itu, saya pikir sesuatu yang luar biasa akan muncul. Tak hanya pencari suaka-- seperti pria yang datang ke klinik saya dan memenangkan kasus suakanya, seperti anak-anak yang kami teliti, atau ribuan lainnya yang mencari kehidupan baru, mereka akan bisa menemukan keamanan. Kita akan mengakui pelanggaran yang terjadi, dan mengembalikan hak dan perlindungan yang hilang. Saya pikir kita akan senang ketika mereka menjadi manusia yang utuh. Tidak hanya mengakui kekuatan, kelemahan, harapan, kebahagiaan, trauma, kita juga akan berdiri dengan mereka dan terinspirasi oleh kegigihan mereka. Mereka akan mekar dan menambah kekayaan negara ini.
I think by staying true to our fundamental values in the way that I've described, that's how we build a sane and humane immigration system. That's how we remain the golden door. And that's how it happens that we remain the shining light of the world.
Dengan berpegang teguh pada prinsip dasar kita seperti yang telah saya jelaskan, kita bisa membangun sistem imigrasi yang sehat dan beradab. Itulah cara kita tetap menjadi pintu emas. Itulah cara agar kita tetap menjadi cahaya bersinar bagi dunia.
Thank you.
Terima kasih.
(Applause)
(Tepuk tangan)