Stretched and Lean Indonesia Deploys Medical Interns to COVID-19 Front Lines

JAKARTA – Health Minister Terawan Agus Putranto is in trouble due to a recent comment about the dispatch of thousands of medical interns to the forefront of national COVID-19 treatment efforts.

“We still have 3,500 interns and 800 Nusantara Sehat [Archipelago Health program] workers: in addition to 685 volunteers, such as lung specialists, anesthetists, internists, general practitioners and nurses, who are ready to be deployed and help if a larger workforce is needed, ”Terawan said last week.

He said 16,286 interns and volunteers had already been dispatched to COVID-19 reference hospitals and laboratories.

His statement, the last of his comments to attract public criticism, followed reports that more than 100 doctors had died from COVID-19 and growing concern that the nation’s healthcare system was facing collapse.

In the Indonesian system, recent medical graduates are required, after passing a national proficiency exam, to enroll in a one-year internship.

The internship is divided between a hospital and a community health center (Puskesmas), and each segment lasts for six months.

This period of practical study is necessary to obtain a medical license and to be eligible for subsequent residencies of specialization.

In response to the pandemic, the government has shortened the internship period to nine months, decreasing the time they spend in hospitals in an attempt to minimize interns’ exposure to COVID-19. In the program, interns treat patients under the supervision of physicians.

The government pays interns assigned to the western part of the country 3.15 million rupees (US $ 213.79) per month, and those in the eastern part 3.6 million rupees per month. But faced with the uncertainty of the pandemic, many young doctors have decided to postpone their internships.

Additionally, graduates who have tested positive for COVID-19, are pregnant or have comorbidities are currently prohibited from participating in the program.

Only about 60 percent of the quota was met for the first internship cohort of 2020, which began in May, two months after Indonesia reported its first COVID-19 cases, according to the Indonesian Physicians Internship Committee ( KIDI), a team designated by the Department of Health. Ministry to oversee the program.

However, the numbers improved in August and September. Some 3,100 people signed up from the 3,400 interns quota, KIDI President Robby Pattiselanno said.

A 25-year-old future doctor who began her internship last month at a COVID-19 referral hospital in East Java, a hotbed of contagion in the country, said she could have started the internship in May, but had decided to postpone it. .

The intern, who wished to remain anonymous, said she postponed the show after learning it required doctors to be relocated if necessary.

“Personally, I was waiting to see if my friends from the previous batch would have to handle COVID-19 patients directly and if any of them were infected.

And even though some of them eventually handled those patients and got infected, I thought I was still within what I could handle, “he added.

The intern said that at her hospital, confirmed COVID-19 patients had to be cared for exclusively by staff doctors.

But since the interns were assigned to the emergency room, they would have little idea whether the patients they were treating had the virus until the patients were examined.

Although the nation’s emergency rooms have been divided into two sections, one for patients with apparent COVID-19 symptoms and one for patients without symptoms, symptomatic patients don’t always end up in the right place, said the intern, who was assigned a -Section COVID-19.

He said he saw around three suspected or probable COVID-19 cases each shift and that many patients who visited the non-COVID-19 section of the emergency room complained of breathing difficulties.

Although the government requires all interns to attend a two-week virtual COVID-19 training program prior to deployment, the intern said she couldn’t help but feel concerned.

“I will not visit my family [while I’m participating in the internship],” she said.

Hera Afidjati, 24, who will begin her internship in September at another COVID-19 referral hospital in East Java, said that without being certain when the COVID-19 pandemic would subside, she had decided to take the risk.

Hera felt it was her duty to help address the outbreak, but hoped the government would find better solutions, including identifying the root causes of death for medical workers.

“It’s not just about interns. Every life matters, ”Hera said. “One specialist doctor cannot be replaced by several general practitioners.

It takes many more years to study the field and the competencies are different. This is not apples to apples to compare doctors who died with 3,500 interns. “

In Indonesia, a country with 0.52 general practitioners and 0.13 specialists per 1,000 inhabitants, at least 117 doctors have died from COVID-19, 53 of whom were specialists, according to the Indonesian Medical Association (IDI).

The country’s 755 COVID-19 referral hospitals have 793 lung specialists, 484 of which are based in Java.

Four provinces outside Java have a few referral hospitals each, but they only have one with a specialist in each region.

West Papua does not have referral hospitals with specialists, according to data compiled by the Ministry of Health.

KIDI’s Robby said some interns had contracted COVID-19, but did not reveal the number.

He said they all had mild or no symptoms.

He noted that the interns were prohibited from treating COVID-19 patients in isolation wards and intensive care units and defended Terawan’s statement, saying the interns had indeed been deployed, but as support physicians who would be assigned to examine. to patients in emergency rooms.

“Don’t look at it like all these 3,500 interns assigned to isolation rooms.

Services start from screening and triage in the emergency room. In normal situations, a doctor can go from A to Z alone, but now, each stage requires different doctors, ”he said.

But interns have concerns beyond contracting the virus.

They are also concerned about missing opportunities to acquire skills and knowledge. Fewer patients visit hospitals, which means that interns have fewer cases to study practically.

And they cannot work directly on COVID-19 cases.

Robby said doctors always had the option to postpone their internships and wait until the health crisis was over, but acknowledged that it could put them at a disadvantage due to concerns of losing competition.

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For more information on COVID-19, call the DOH hotline: (02) 86517800 local 1149/1150.

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