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Coronavirus

Indonesia's angry COVID doctors face burnout as colleagues die

Amnesty says fatality rate for health workers among the highest in Asia

A klung specialist examines a COVID-19 patient at an intensive care unit at Bogor General Hospital in the city of Bogor, West Java, Indonesia, on September 7.   © AFP/Jiji

JAKARTA -- Andhika Kesuma Putra was a young, ambitious pulmonologist, and his passion for treating respiratory diseases led him to run a team caring for COVID-19 patients at a hospital in Medan, the largest city on Indonesia's Sumatra island.

Two months after taking the job, Putra started to feel sick. His condition quickly deteriorated and he was rushed to a hospital where he tested positive for the coronavirus.

"There's a possibility that I'll be among the death cases... God willing, I'll die a martyr," the doctor in his thirties wrote in his last text to his wife, a fellow physician, before he died on Aug. 1.

His wife and daughter also tested positive, but have since recovered and returned home.

Putra's story and testimony from his friends and colleagues were posted on laporcovid19.org, a website run by a local watchdog that monitors the coronavirus situation in Indonesia. There are dozens of similar stories from doctors and nurses who have died in Indonesia's uphill battle against the pandemic.

As many as 115 doctors died during the pandemic as of Sept. 12, according to the Indonesian Doctors Association. Amnesty International said a total of 188 medical workers had lost their lives as of Sept. 8 -- one of the highest numbers for health professionals in Asia.

"The death rate among health workers has risen significantly," Usman Hamid, executive director of the Indonesian chapter of Amnesty, said in a news release last week. "In July, when Amnesty International released the global report on health care and essential workers, a total of 89 [Indonesian] health workers had died of the disease. The number has doubled since then."

Amnesty said in mid-July that more than 3,000 health workers were known to have died after contracting COVID-19 in 79 countries around the world.

Such deaths in Indonesia have been increasing along with the recent surge in cases in the world's fourth most populous nation. New infections have topped 3,000 nearly every day over the past two weeks -- the highest daily counts since the outbreak began in the country in March. The escalating situation has forced the capital Jakarta to reinstate large-scale movement restrictions, despite protests by central government officials over the economic impact.

As of Wednesday, Indonesia had reported 228,993 coronavirus cases with 9,100 deaths. The number of infections is the second highest in Southeast Asia after the Philippines, but the country is second only to India in terms of deaths in Asia.

The high fatality rate reflects Indonesia's overstretched health care system, which has been under pressure since the beginning of the outbreak, local observers noted.

Medical workers check tests for symptoms of COVID-19 at North Sumatra University hospital in Medan, Indonesia, on May 6.   © AP

Despite being the largest economy in Southeast Asia, Indonesia's health care capacity lags that of its neighbors.

According to the latest data from the World Health Organization, Indonesia has just 10 hospital beds per 10,000 people -- a similar level to the Philippines but below Malaysia at 19, Thailand with 21 and Vietnam's 32. And there are just four medical doctors per 10,000 -- below six in the Philippines, eight each in Thailand's and Vietnam, and 15 in Malaysia.

Large disparities also exist between provinces in the sprawling Indonesian archipelago. Jakarta's hospital bed capacity, for example, is more than double the national average, but other regions, including immediately adjacent Banten and West Java, are below the average.

Even so, Jakarta's health system is also on the verge of being overwhelmed, according to the capital region's Gov. Anies Baswedan. He said last week that 4,053 isolation and 528 intensive care beds for coronavirus patients there would be full as soon as this week.

His claims have been refuted by central government officials, including Health Minister Terawan Agus Putranto, who on Monday said Jakarta is capable of handling case surges. He added that, nationwide, 16,000 doctors, nurses, lab analysts and other health workers have been deployed to tackle the outbreak, and 5,000 others -- including 3,500 junior doctors -- are ready to be dispatched if needed.

But the question remains whether health workers can endure even more prolonged working days without adequate protection and incentives, especially while facing a high risk of infection and even death.

"Long working hours due to the insufficient number of health workers in the country has taken a toll on medical workers during the pandemic," Amnesty said, citing an Indonesian Doctors Association official. "Aside from the risk of contracting COVID-19, long working hours, psychological distress and fatigue are also of great concern for medical workers."

Some 83% of more than 1,400 doctors and other health workers surveyed from across the country's 34 provinces said they had experienced moderate to heavy "burnout," according to a study by the University of Indonesia medical school conducted between June and August. More than half of them had been handling coronavirus patients, the researchers said.

Meanwhile, just 6% of an extra 87.55-trillion rupiah ($5.9-billion) health budget to tackle the pandemic promised since April had been disbursed as of Aug. 19, which might explain why many doctors and nurses are still complaining about having not received months of overtime pay.

Amnesty noted that the distribution of personal protective equipment for health workers is still slow, and "not keeping pace with the vast increase of COVID-19 cases in Indonesia."

But despite much improvement over the past few months, testing capacity is still limited, That has forced some doctors to pay for their own PCR tests -- some hospitals charge up to 2.5 million rupiah ($168) per test -- while other physicians may be treating patients while unknowingly carrying the virus.

Members of different health workers' associations have spoken of pressure -- direct or indirect -- to keep silent. Still, some are calling on their peers to strike over the government's poor response to their demands.

"The lack of transparency or 'culture of secrecy' at Indonesian hospitals has deprived medical workers and staff of an effective complaints mechanism or a safe space to channel their grievances," said Hamid of Amnesty.

"Amnesty International warns that the failure on the part of the government to fulfill the rights of health workers will lead to more deaths, and further reduce the capacity of the nation's health system to treat COVID-19 patients as the pandemic grows," Hamid said.

Additional reporting by Bobby Nugroho and Ismi Damayanti.

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