A joint statement by the medical professional organization on March 27, 2020, appealed to the state to guarantee the appropriate Personal Protective Equipment (PPE) for every medical worker assigned to serve the public in the current COVID-19 outbreak. In the last 10 days there have been 10 Indonesian doctors who died from a total of 102 deaths (March 28, 2020 update). It makes 9.8% of deaths due to COVID-19 in Indonesia.
Doctors and nurses fighting on the frontline in handling COVID-19 are the parties most at high risk for exposure. If the appropriate PPE is not fulfilled, the COVID-19 patient care measures cannot be done while keeping the safety of the medical workers themselves. There was no “strike” word in the statement. So is the joint statement of the medical professional organization wrong? Is the problem that simple?
Purpose of using PPE
Procurement of PPE for medical workers is something that must be carried out before they start working because: (1) Hospitals are the largest source of Coronavirus transmission for both patients and health workers. (2) The use of PPE in medical workers is an effective step to cut the chain of transmission. (3) Protecting officers and their families from the threat of viruses. (4) Infection to medical workers will directly reduce the ability of hospitals to help COVID-19 patients.
Understanding current health system
Health is a basic right that must be protected by the state. It has been stated in amendment IV of the 1945 Constitution. If the state ignores, it means that the state violates the constitution. Hope arose when BPJS was established. BPJS is here to promise universal guarantees to all Indonesians, but after running for 6 years, its problems do not seem to be over soon, such as the inability to patch the deficit, the difficulty to pay claims on time, the inability to cover claims from funds collected by the BPJS to the difficulty of the government to cover the deficit BPJS funds every year. Though the facts in reality are different.
The rates set by the government (BPJS) for health services, medical treatment, hospitalization, medical staff salaries and others are far below the standard and even seem inhumane. An even more worrying problem is treatment, action, and examination are determined by the standards set by the BPJS (oriented to reduced cost) not in accordance with medical rules. Likewise, if there is an outbreak or disaster with financial risk like the current COVID-19 outbreak, then that risk should be the responsibility of the state. The hardest part is that the Indonesian people do not have sufficient financial reserves to deal with it all.
Sir Michael Marmot (WHO) stated that the health system is a vehicle for a better life. Health is the end of all the country’s problems in the form of poverty, access to education, social inequality, the environment, infrastructure, lifestyle changes, technological leaps and most importantly is the country’s political will. There are three things that must be considered in health services, quality, accessibility, and affordability. BPJS is only a matter of fees and paying management. Logically, how will we determine the price if the quality of the goods (medical services) has not yet been measured? The financial failure of healthcare services, including the provision of PPE for health workers, is a result of our collective failure to respond to the challenges of the times.
Will doctors go on strike to serve the patient?
According to one of my teachers, there are three kinds of doctors in this world. First, skillful doctors, doctors who are smart and skilled. We are talking about cognitive and psychomotor excellence, nothing more than that. For what and how he uses his intelligence, that’s different matter. Second, good doctors. They are clever, diligent, skilled, obey the rules and uphold ethics. We will feel safe and comfortable working with them. Third, true doctors. Not only good, they also have affective advantage, high nobleness and love life. They never leave their patients in any circumstances. They are the ones who will provide the best things for human life as well as for his nation and country. Only to them can we leave our nation’s future.
He advised, “As a doctor you will enter a new life that you may not fully understand. There are many other things outside of your profession that need your understanding more. As a doctor, you will work with your hands, your mind and your intelligence. But more importantly, work with your heart. ” Human value does not lie on cleverness, but also commitment. No matter how smart a human if he only works for his own interests, he will only be parasitic. No matter how smart a human if he does not have commitment, he does not have value.
Right now we are fighting an unseen enemy, very dangerous, and we do not know how long this plague will last. More than one hundred thousand doctors who work with heart with minimal and modest PPE are fighting at the forefront of the war risking lives for this nation. Indonesian doctors have no tradition of “running to the arena”, abandoning patients. The public do not need to worry and think in that direction because all Indonesian doctors are true doctors. We will never break our oaths, always put the people’s interests first and fight on the side of the people.
Jagaddhito Probokusumo, dr.
Cardiovascular and Vascular Resident FKKMK UGM-RSUP Dr. Sardjito
Center for Indonesian Emergency Doctors Association (PDEI)
Management of IDI Surabaya Branch