Arya News - Six deaths in six months have put the country’s medical internship program under scrutiny, exposing concerns over workloads, supervision and protection for those who speak up.
JAKARTA – After six months of working regular daytime hours at a community health center, intern doctor Nuha Amalia Alkatiri, 24, had to readjust her body clock when she was assigned to a regional hospital and began rotating between morning, afternoon and overnight shifts.
At the community health center, Nuha sees around 40 patients a day. At the hospital, she sees about 20.
“Mondays are usually hectic days, whether I’m at the community health center or the hospital. At the health center, we can see 60 to 70 adult patients in a day,” Nuha said.
Despite the demanding schedule, she said she could still get six to eight hours of sleep a day.
On her days off, she said, she was able to take a genuine break because other doctors at the hospital covered the shifts.
For Nuha, the work has also brought moments that made the long hours worthwhile. She said she found it deeply fulfilling when patients and their families showed heartfelt gratitude as their health improved.
But not all intern doctors have had the same experience.
The medical internship program has come under intense scrutiny after six intern doctors died in the past six months, most from illnesses or other medical conditions.
The first was Kartika Ayu Permatasari, who was assigned to Bina Bhakti Husada Hospital in Rembang, Central Java. She died in the early hours of Feb. 25.
Edgar Bezaliel Hartanto, who was assigned to Bhayangkara Hospital in Denpasar, Bali, died on March 17 from complications related to dengue fever.
Andito Muhammad Wibisono, who was assigned to Pagelaran Regional Hospital in Cianjur, West Java, died on March 26 amid a rise in measles cases.
Myta Aprilia Azmy, who was assigned to KH Daud Arif Kuala Tungkal Regional Hospital in Jambi, died on May 1 after suffering a lung infection. A Health Ministry investigation released on May 7 found indications of overwork in her case.
Muhammad Zulfikar Drakel, who was assigned to Sukadana Regional Hospital in East Lampung, died on July 21 from a medical condition that his family asked the ministry not to disclose.
Siti Zahra Maghfira, who was assigned to Sentra Medika Cisalak Hospital in West Java, died on July 26 after falling from the 18th floor of an apartment building in Pancoran, South Jakarta, where she lived with her mother.
“Health workers need to be able to speak up about what happens to them without being intimidated.” — Fika, intern doctor
When rules changed
Following Myta’s death, Health Minister Budi Gunadi Sadikin instructed his ministry to revise the medical internship regulation to strengthen protections for participants.
A new decree issued on June 8 capped working hours at 40 hours a week, regulated shift schedules, strengthened supervision and established complaint mechanisms and sanctions for facilities and supervisors that violate the rules.
But the deaths continued to prompt broader scrutiny.
At a July 29 press briefing, Health Ministry human resources director general Yuli Farianti said all six cases had been investigated as part of efforts to improve the program’s governance.
“The closest people to intern doctors are their supervising physicians,” Yuli said. “Communication must run smoothly so that any health issues or obstacles faced by interns can be identified and handled immediately.”
Acting Health Ministry inspector general Rudi Supriatna Nata Saputra said recommendations from previous investigations had been incorporated into the new regulation, but recent evaluations showed that implementation on the ground still needed to be strengthened.
The following day, the ministry temporarily suspended the program for 10,564 interns nationwide, requiring them to undergo medical checkups, physical and laboratory examinations, and mental health screenings. The program was scheduled to resume on Aug. 14.
Voice from within
For Fika, a 25-year-old intern who spoke under a pseudonym because she feared professional retaliation, the ministry’s move was welcome. But she stressed that screening alone would do little if the working environment remained hostile to those who speak up.
“Health workers need to be able to speak up about what happens to them without being intimidated,” she said. “Mental health screening is good, but it also needs to be accompanied by a safe and supportive working environment.”
Before the 40-hour cap, Fika endured exhausting 13-hour shifts with as little as two hours of broken sleep.
“Even when you try to sleep, it’s never restful,” she recalled. “I often just slept at a desk or on a chair at the nurses’ station.”
Fika said her hospital had followed the June regulation by eliminating 12-hour overnight shifts, but general practitioners would sometimes leave interns to monitor patients on their own.
Her supervisor later held an evaluation to discuss how the regulation was being implemented, during which Fika and her colleagues raised the issue. But, she said, the following day, some doctors and nurses began treating them differently.
“They said things like, ‘Why are so many interns dying these days?’ and ‘If one more person dies, you’ll probably get off work forever,’” Fika said, recalling remarks she heard from fellow health workers.
The lack of empathy from fellow health workers was harder for Fika to swallow than the physical fatigue.
“Even if I didn’t know those who died personally, they were still my peers,” she said. “How could they say something like that?”
Long work hours
Fika’s experience points to concerns shared by intern doctors in other health facilities.
An April survey of 2,620 active interns conducted by the PIDI-PIDGI Association, an independent association representing intern doctors, found that 326 respondents were still working more than 48 hours a week, with some working more than 59 hours. The association said interns in many regions had been filling gaps in local health services, often taking on heavy workloads with limited supervision.
A separate survey of 5,446 active interns found that 20 percent had faced pressure or coercion during performance evaluations, prompting the association to raise concerns about repercussions for interns who speak up about their working conditions.
Valentinus Dave Sugiharto, an intern serving on the association’s advocacy team, said a key weakness in the current oversight system was the lack of effective whistleblower protection.
“Existing rules don’t spell out clear protections. Whether an intern who files a complaint can be transferred to a safer placement, continue their training elsewhere without penalty, or be protected from retaliation.”
The PIDI-PIDGI Association has proposed an independent 24-hour reporting channel outside hospital administrative structures, backed by anti-retaliation measures to protect complainants from lower evaluation scores or administrative penalties.
The proposal also includes dedicated psychological, medical and legal support for affected interns, as well as guarantees that those relocated for safety reasons retain credit for completed rotations and have their transition periods counted as active service.