Indonesia: Doctors reject patients as COVID cases top one million

Jakarta, Indonesia – Dr Erlina Burhan has been providing medical care for more than 30 years – but now, for the first time in her career, she has been forced to turn away patients.

For the past six months, the intensive care unit (ICU) at her hospital in Indonesia’s capital, Jakarta, has been operating at between 90 to 100 percent capacity as coronavirus infections surge.

“We reject patients every day because there is nothing we can do if the hospital is full,” said Burhan, the head of the COVID-19 team at the Persahabatan National Lung Hospital.

“Even if the patient is in a very bad condition and needs the ICU, if we have no space, we cannot take them and we have to say, [we’re] sorry.”

Indonesia’s confirmed COVID-19 cases surpassed the one million mark on Tuesday, but doctors are warning the reality in their hospitals is much worse – particularly on the islands of Java and Bali.

“There are some regions and cities with a bed occupancy rate of 90 percent – and there are cities with 100 percent occupancy. The consequence of hospitals being overwhelmed is that patients won’t get adequate treatment,” said Hery Trianto, from the country’s COVID-19 task force.

Dr Atok Irawan, from the Sidoarjo Public Hospital in East Java, said the facility has no choice but to use its general section to treat COVID-19 patients because the designated COVID-19 area is already at capacity.

“Last night, we were really overwhelmed … almost all the assigned COVID-19 hospitals are full,” he said. “We have many non-COVID patients that need help too … because of the rainy season, there are patients with typhoid and diarrhoea.”

In East Jakarta, Burhan’s hospital has been adding ventilators and beds in emergency units, but it does not have enough staff to keep up with the demand.

“We receive so many requests and sadly, we have to turn them down,” Burhan said. “I read the files of people referred to our hospital. It makes me so sad … A person who can hardly breathe … but we can’t help them.”

Sick and desperate

To date, Indonesia has recorded some 28,500 coronavirus-related deaths while more than 800,000 people have recovered. Among them was Gena Lysistrata, who experienced body aches, eye pain, diarrhoea, fever and difficulties breathing.

The Jakarta resident was fortunate to receive treatment at Wisma Atlet – formerly, the Athlete’s Village during the 2018 Asian Games but now, a fully functioning hospital for COVID-19 patients – relatively quickly, but she found herself on a desperate search to secure medical care for her elderly parents after they also tested positive for the virus.

“My mother and father started having breathing problems and my dad was shivering and feeling weak,” Lysistrata said. We went to an emergency unit and it was full … there were many people on the waiting list,” she said. “In another hospital, the emergency unit was already full.”

Eventually, her parents were hospitalised because a nearby hospital was able to increase its patient capacity, and they have since recovered.

“I was panicked. I have been watching the news and I saw that many health facilities are full. So I was scared,” Lysistrata said.

Out of desperation, some families have turned to a local COVID-19 data agency to help them find a hospital that will accept their loved ones.

Since August last year, Dr Irma Hidayana from Lapor COVID-19 has been fielding these calls.

“From the cases, we are working on, four people died – one died in a health centre, one died in a taxi after being rejected by so many hospitals … another died in hospital because the ICU was full … and [in] another case, the family had to rent a ventilator but that person died recently,” she said.

The person who passed away in the taxi had tried to get treatment at 10 hospitals – and after being rejected by all of them, died on the way to another one.

“Many sick people can’t get treatment, they can’t even get into the ICU,” Hidayana said. “It’s important for the government to fulfil the rights of the people to get medical treatment.”

Task force challenged

An archipelago of some 270 million people, Indonesia tests only about 40,000 to 50,000 people a day, with about 30 percent of those tested returning positive results.

It is the worst affected country in Southeast Asia but, unlike its neighbours, it has never implemented a strict COVID-19 lockdown.

Meanwhile, many restrictions imposed at the beginning of the pandemic have already been watered down, despite evidence the crisis is getting worse. Current curbs include slightly reduced hours for shopping centres and restaurants and entry restrictions for most foreigners.

This week, President Joko Widodo praised his country’s handling of the pandemic.

“It has caused health and economic crises. We are grateful that Indonesia is one of the countries that can control these crises well,” he said in a briefing.

“The pandemic is still going on and we have to stay alert.”

At the end of another long day at the hospital, Burhan said she hopes the government will do more to lessen the strain on medical facilities.

“Hospitals are in a hectic condition; health workers are tired. We are extremely exhausted … and frustrated,” she said.

“I know the government has made so many regulations – but the implementation is weak and inconsistent.”

She is now used to fielding complaints from patients and their relatives about the quality of care – but her options are limited.

“Healthcare won’t collapse instantly … What we will see is the decline in the quality of service… because health workers are going beyond their limitations,” she said.

“The ones who will suffer are the Indonesian people.”