Medical workers in Indonesia bear burden in virus fight

Indonesian doctor Berkatnu Indrawan Janguk was determined to become a specialist in internal medicine, but was robbed of the opportunity.

The 27-year-old died on April 27 of Covid-19 after coming into contact with a patient at Dr Mohamad Soewandhie General Hospital in Surabaya – Indonesia’s second-largest city – in East Java.

“At that time, the emergency units for Covid-19 patients and those suffering from other illnesses were not yet separated,” Madam Inriaty Karawaheni, Dr Berkatnu’s mother, told The Straits Times over the phone from her home in Muara Teweh, Central Kalimantan.

“Initially, he only used a surgical mask, and only later wore full personal protective equipment (PPE),” said the mother of two, who also lost her husband to Covid-19 two months after her son died.

The disease has taken a heavy toll on healthcare workers in Indonesia. Dr Berkatnu was one of 105 doctors who succumbed to Covid-19, and the National Nurses Association of Indonesia said at least 71 of its members have died.

The country’s Covid-19 mortality rate for doctors is the highest in South-east Asia, the Indonesian Medical Association (IDI) said.

Amnesty International put Indonesia in third place, after Russia and Egypt, for the countries with the highest Covid-19 mortality rates for health workers.

A shortage of PPEs was a huge problem in the early days of the pandemic, but IDI deputy chairman Adib Khumaidi said a new set of factors, such as the huge workload and the absence of infrastructure at most hospitals to tackle infectious diseases, is now contributing to the deaths.

“It’s important to manage working hours and assign a number of hospitals to specifically handle Covid-19 patients, as that will reduce the exposure of all health workers to the virus,” he told The Straits Times.

Even before the pandemic, doctors were already under tremendous pressure in the world’s fourth most populous nation, with 270 million people. Some 184,000 doctors were struggling to cope with patients at hospitals, especially public ones.

Dr Berkatnu, for instance, could be supervising up to 90 patients in an eight-hour shift, according to his mother.

Dr Sutrisno, chairman of IDI’s chapter in East Java, which has the most doctor deaths across all of Indonesia’s 34 provinces, echoed Dr Adib’s views, saying: “The greater the load of patients, the higher the concentration of the virus. Health workers potentially have a higher risk of getting infected with long exposure to it, no matter how healthy they are.”

Dr Tri Maharani, head of the emergency unit at Daha Husada Hospital in Kediri, East Java, noted that doctors could not reject anyone who went to a hospital.

“We are like in a jungle, not knowing if patients are positive or negative (for the virus),” said Dr Tri, who is a Covid-19 survivor.

105

Number of doctors in Indonesia who have died of Covid-19. 

71

Number of nurses in Indonesia who have died of Covid-19.

Amnesty International Indonesia director Usman Hamid noted that the number of Indonesian health workers dying has doubled since mid-July.

“Their rights to life and health are clearly neglected. We urge the government to protect their rights to safety at the workplace more seriously,” he said in a statement.

Epidemiologists warn that the battle against Covid-19 in Indonesia will be long and tough, six months after the country declared its first cases.

The number of cases has spiked since June, when social restrictions were eased. As at yesterday, the country has reported 194,109 infections and 8,025 deaths, with daily cases surpassing 3,000 since last Wednesday.

A nationwide survey of 1,461 health workers conducted by the University of Indonesia’s Faculty of Medicine found an overwhelming number, or 82 per cent, reporting that they had experienced a moderate level of burnout.

Indonesia’s Covid-19 mitigation task force spokesman Wiku Adisasmito said his team has tried to ensure the safety of health workers by making sure they have access to internationally standardised PPE.

“We also remind each hospital to provide full protection to health workers tackling Covid-19 patients by way of limiting work hours to avert exhaustion leading to reduced immunity,” he told The Straits Times.

Last Saturday, citizen coalition Lapor Covid-19 launched a digital graveyard to pay tribute to the health workers who have lost their lives in the pandemic.

The site will urge the government to better protect health workers and step up its efforts to control the pandemic.

It also hopes to educate the public on respect for health workers, and to stop stigmatising them or their families and take the pandemic more seriously, said Mr Ahmad Arif, one of the coalition’s initiators.

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