- Illustrative photo.
JAKARTA: The recent death of a junior medical resident following months of overtime and verbal harassment has reignited concerns over a culture of bullying in Indonesia’s medical training institutes.
Dr Aulia Risma Lestari, 30, a resident in Diponegoro University’s anaesthesia specialist programme at the Dr Kariadi General Hospital in Semarang, Central Java, was found dead in her rented room on Aug 12.
She is believed to have injected herself with a high dose of an anaesthetic drug.
Police are investigating her death as an alleged suicide and whether depression, linked to alleged instances of bullying that she had documented in her diary, is among factors contributing to her death.
The police added that her diary expressed that she was under stress and had suicidal thoughts, without providing details.
Her text messages with a close friend, which was circulated on social media, revealed that she had spent a lot of money on extra expenses apart from study fees and living costs.
Senior doctors have been known to make their juniors pay for expenses unrelated to study.
On Aug 16, Health Minister Budi Gunadi Sadikin acknowledged that it was “an open secret” that bullying is commonplace in Indonesian medical schools, and has existed for a long time.
He added that the alleged bullying suffered by Dr Aulia was only the “tip of the iceberg”.
“Many (future specialists) want to commit suicide. It’s already a big phenomenon. I make a plea to all stakeholders to stop this practice (of bullying),” he said.
Dr Aulia’s death is not the first fatal bullying case involving doctors that has made news headlines.
In August 2020, another medical resident, 28-year old Albertus Berfan, who was attending Airlangga University’s school of medicine, took his own life as a result of alleged bullying by his seniors.
From July 2023 to early August, the Health Ministry received 356 reports of bullying, including non-physical examples like intimidation, being made to work odd hours and being assigned tasks that were unrelated to work or study.
A health screening, conducted by the ministry in March, also found that 2,716 medical residents, or 22.4 per cent of the 12,121 medical residents surveyed, suffered from depression.
As many as 399 residents, or 3 per cent, also admitted to wanting to take their own lives or engage in self-harm in the two weeks before the screening.
The survey results did not elaborate on the causes of depression, but the ministry later identified a few factors, such as high pressure to finish academic tasks, frequent night shift duties, the financial burden to cover both study and family needs, and bullying.
The financial burdens of junior doctors could be exacerbated by bullying.
In June, Padjadjaran University’s medical school in Bandung, West Java, dismissed two resident doctors in the neurosurgery specialist programme over bullying that prompted a junior medical resident to resign.
The bullying included the seniors making the juniors rent hotel rooms for six months and pay the former’s expenses for various purposes, including entertainment and car rentals.
Each of the junior residents reportedly ended up spending 65 million rupiah (S$5,500) over a few months on these extra expenses.
Indonesian junior doctors are known to work long and odd hours, especially if they are working towards becoming specialist doctors, and all this contributes to mental and physical fatigue.
And the rigid hierarchical structure of medical training programmes can make them vulnerable to bullying, often by seniors who do so under the pretence of instilling discipline or building toughness in the juniors.
Diah Satyani Saminarsih, founder and chief executive of health rights advocacy group, Centre for Indonesia Strategic Development Initiatives, told The Straits Times that the hierarchy within the medical training fraternity can cause people to suffer in silence, afraid to voice their concerns or reject additional assignments as they fear the consequences.
With the long working hours and heavy workload associated with the vocation, the line between one’s basic duties and excessive ones, assigned by seniors or those in charge, can become blurred, she said.
“In the end, everything is thought of as (their) workload and accepted as a norm, (but) there should be boundaries.”
During his four semesters as a resident in an orthopaedic and traumatology specialist programme in Yogyakarta, Marcelius Patria Prabaniswara said he suffered frequent physical and verbal bullying at the hands of his seniors.
This was due to mistakes or infractions he and his fellow junior doctors had supposedly made, such as breaching unspoken rules when interacting with senior specialists, and failing to immediately respond to messages or phone calls.
Physical punishments included being slapped or hit with objects and doing push-ups.
“I could deal with physical injuries. But the trauma had a greater impact. I was scared, thinking the next morning I would meet them again. Trauma is not healed easily,” said Marcelius.
He quit the programme at a public university in Yogyakarta in 2022.
The 31-year-old, who now works in the finance industry, said that he had depressive and suicidal thoughts at the time.
The university acknowledged he was bullied and said it took action against the perpetrators.
Dentist and social media influencer Mirza Mangku Anom has spoken out online against bullying in the medical fraternity.
“It’s true that the specialist medical training requires extraordinary discipline and toughness because (doctors) have an enormous responsibility to take care of the patients.
"As students, the junior doctors may make mistakes and are sometimes unable to meet their seniors’ and consultants’ expectations,” he told ST.
However, the punishments meted out to them should be constructive, and not be superfluous or unrelated to their work.
He said he has heard of instances where junior doctors were made to hold cell phones in their mouths for 15 minutes, or to eat five portions of rice in one sitting, just to appease their seniors.
“Punishments are to help someone become aware of his mistake and to fix it.
"That’s why I strongly disagree with punitive measures that are essentially non-educational,” said Dr Mirza.
Over the years, the Health Ministry has sought ways to tackle the issue of bullying in the medical fraternity.
In 2023, it launched a call centre to receive such reports.
So far, it has taken action – ranging from warning and temporary suspension to dismissal – against 39 medical residents and consultants accused of bullying.
While the authorities are still investigating Dr Aulia’s death, the Diponegoro University’s rector, Professor Suharnomo, who goes by one name, has denied the allegations that she was bullied. Instead, he said she had health issues which affected her studies.
“Diponegoro University’s school of medicine has adopted a zero-bullying policy which has been actively monitored by the Bullying and Sexual Violence Prevention and Management Team since Aug 1, 2023,” he said in a statement.
But the first step to stop bullying begins with organisations being transparent about the existence of bullying in their programmes and institutions, said Diah.
“One life lost is (one) too many. If we want to put an end (to bullying), we have to start acknowledging that it’s a problem.
"Relevant stakeholders should come together to formulate necessary regulatory and cultural changes in these educational institutions to break the chain of violence,” she said. - The Straits Times/ANN
