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Trainee doctors pushed to the front line of Indonesia's COVID-19 disaster

ABC News - July 14, 2021

Max Walden – The COVID-19 ward at the Jakarta hospital where resident doctor Amira* works is over capacity, but patients continue to arrive at the emergency department around the clock with coronavirus symptoms.

"During night shifts, it feels like patients keep arriving without stopping," she said.

The 30-year-old spoke to the ABC on the condition of anonymity as she feared speaking out could jeopardise her career.

"In the non-COVID ward it is not uncommon to find patients whose condition is deteriorating, and finally a [swab test] shows they are positive for COVID," she said.

It's a disaster playing out at hospitals across Indonesia. The South-East Asian nation hit yet another a daily record on Tuesday, reporting 47,899 new cases.

As its fragile health system is overwhelmed, young medical graduates and trainee doctors are being recruited to the front lines of Indonesia's COVID-19 fight – especially as senior colleagues die.

"All of us have to treat COVID patients," Debryna Dewi Lumanauw, a Jakarta-based doctor, said. "Indonesia is so full of COVID now."

Indonesian doctors dying 'almost every week'

At least 434 Indonesian doctors have died from COVID-19, the Indonesian Doctors Association reported on July 5.

Weeks on from the Eid holiday, many parts of the world's most populous Muslim-majority country are seeing ballooning coronavirus cases.

Five of them were resident doctors. Days after these figures were reported, yet another resident doctor passed away.

Aliy Akbar Hasan Al Buyani, a 29-year-old resident doctor from the obstetrics and gynaecology faculty at Airlangga University in Surabaya, died of COVID-19 last Thursday.

His father – also a doctor – died of COVID-19 three days prior, while Dr Al Buyani's brother had also tested positive for coronavirus, the university said.

Classmates described him as "diligent" but also cheerful and always wanting to make his friends laugh.

Dr Lumanauw, who is also 29, said the work was taking a toll.

"All my friends are falling down. All of us are sick, or were sick. Everybody who works along with us [are] collapsing.

"We have to continue doing our jobs [but] when we work more than we can we are actually exposing ourselves to more danger.

"That also means we are exposing our family, the people that live in our house," Dr Lumanauw said.

Amira said it caused worry and anxiety that "almost every week there is news of another doctor who died".

"But it is undeniable that we are getting saturated with the news," she said. "[We are] starting to become resigned to the situation."

Andi Khomeini Takdir Haruni, head of Indonesia's Junior Doctors Association, said: "The stress and anxiety of this pandemic is being felt across almost all provinces, especially in the cities.

"Of course we grieve every time we hear news about one of our doctor colleagues dying," he said.

"Sometimes we feel mentally down, burned out, and our workloads are huge. But we continue to support each other. "We pray that the pandemic will soon be under control."

According to World Health Organization (WHO) data, Indonesia has just 4.65 doctors per 10,000 people – compared with 37.6 in Australia.

"Indonesia can't control the pandemic like in Singapore, Thailand, where they have good health systems," Jane Soepardi, a Jakarta-based epidemiologist, said.

There are public health restrictions in place, including stay-at-home orders on the islands of Java and Bali, but Dr Soepardi said many people in the community were still not complying.

"There are regulations, but the enforcement is poor, very poor," she said.

Government provides incentives for young doctors

Early on in the pandemic, many young Indonesian doctors working on the front lines of the fight against coronavirus were not even being paid.

Results from an Indonesian health survey indicate almost half the entire population of Jakarta have antibodies against COVID-19, indicating greater spread of coronavirus than officially reported.

Indonesia's resident doctors – medical graduates training to become specialists – do not generally receive a salary. Instead, they pay high fees to their universities while doing placements at hospitals.

During the pandemic, however, senior doctors and academics have pushed for the government to pay the trainees, and now they are provided financial "incentives" to work with COVID-19 patients.

In May, the government announced it would boost the incentive payment to 12.5 million rupiah ($1,150) a month.

"It won't bring back the lives or health workers themselves, but it's a sign of appreciation from the government," Health Ministry spokeswoman Trisa Wahjuni Putri said.

Dr Soepardi said medicine graduates were being recruited to work in hospitals even before they had a chance to undertake a residency.

"They're being recruited for working in hospitals that are overloaded, especially in Jakarta," she said.

"They're not forced to work, but because they want to be admitted to residency programs later, they are afraid not to sign up."

Moderna boosters for healthcare workers

The United States announced 3 million doses of the Moderna vaccine arrived in Indonesia this week, with the jabs to be used to provide third booster shots to healthcare workers.

At least 10 out of 26 Indonesian doctors who died of coronavirus in June had been vaccinated with the Chinese Sinovac vaccine, which has been approved for emergency use by the WHO.

"With new variants emerging, vaccinating as many people as possible – as quickly as possible – is critical," US ambassador Sung Y Kim said.

The US has promised a further 1 million Moderna doses to Indonesia through the WHO's COVAX program.

Medical workers have also reported shortages of oxygen, personal protection equipment (PPE) and other equipment. "Me and some friends just bring our own PPE so we can change it every day," Amira said.

Australia this month announced it would urgently send medical equipment, including 1,000 ventilators and 700 oxygen concentrators, to Indonesia, as well as 2.5 million AstraZeneca doses before the end of the year.

Australians stuck in Indonesia are worried about their safety, as Indonesians in Australia struggle to help loved ones from afar.

But given the country's shortage of healthcare workers, some say medical personnel are needed too.

"The district [health systems] are very weak," Dr Soepardi said. "We need technical assistance. We need people to come – from Australia, from the US – to help at the sub-national level."

For Dr Lumanauw, however, the needs of Indonesian doctors are more immediate. "What we need most right now is probably just sleep. We have not slept for a long time," she said.

[*Name has been changed to protect their identity.]

Source: https://www.abc.net.au/news/2021-07-14/trainee-doctors-on-the-front-line-of-indonesia-covid-disaster/10028580