Health workers in the firing line as pandemic rages

Saving lives from COVID-19 has come at a high cost for medical and health workers in Indonesia, with infections and fatalities commonplace. How can this tragic situation be overcome?

Tragically-high COVID-19 casualties among Indonesian health workers is reflective of sharply contrasting resources in different classes of hospitals, according to researchers.

A research team from the Partnership for Australia-Indonesia Research (PAIR), led by Prof Daniel Prajogo and Prof Ratna Sari Dewi produced a report entitled Occupational Health and Safety: Protecting the Indonesian Healthcare Workforce during the COVID-19 Pandemic.

That report will be discussed in detail on Tuesday 30 November, day 1 of the PAIR Digital Summit 2021.

As documented in the report, Indonesia has one of the highest rates of death for healthcare workers from COVID-19, with the national medical association estimating the toll is at least 718 by early March 2021.

Co-lead Professor Daniel Prajogo from Monash Business School, said while every hospital in Indonesia had high standards, not all of them were able to implement them effectively.

“In general, the OHS policies and procedures are adequate. The challenge is in the implementation,” he said.

Implementation is challenged by two factors, including compliance with the rules and resources.

“Every hospital says you should wear specialist equipment, but not every hospital can afford the protective equipment.

“Sadly some staff have to reuse protective equipment because of very limited resources and there is a discrepancy between hospitals,” Professor Prajogo said.

And some hospitals are more equal than others, with Indonesian public hospitals classed ‘A’, ‘B’ and ‘C’.

Class A is at the top with specialised rooms for COVID-19 patients. But as the pandemic spread, more patients had to go to other hospitals with less resources.

“There is also a difference between public and private hospitals,” he said.

Professor Prajogo said healthcare workers were not only facing the physical threat of virus exposure, but also severe mental strain from seeing their colleagues affected as well as significantly increased workload.

“With physical and psychological strain, this is going to affect the quality of their work,” he said.

The report also noted the need for more training.

“Number one is the basic training in OH&S, that is for all staff and many hospitals need more staff,” Professor Prajogo said.

“But then there always is specific intensive training needed for nurses who are assigned to perform the duties in the COVID-19 isolation area, because this is high risk and it requires a different level of training and different level of equipment.”

The third point is training for temporary appointments.

“Because at some point, the number of permanent staff is inadequate to handle the number of patients,” Professor Prajogo said.

“The government has set a policy to allow a temporary workforce who are mainly healthcare students from the faculties of pharmacy, midwifery and nursing.

“They have a basic knowledge and that is why they are recruited to provide the backup.”

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Professor Prajogo noted important changes in staff attitudes, “especially after they see the evidence that COVID is not a hoax”.

“They see that COVID is real, the impact is real and deadly so that has really changed attitudes,” he said.

“But also for hospital management, they become more aware of the importance of maintaining compliance and monitoring compliance for staff. That is why some hospitals have set up infection control units.”

Cultural change has occurred.

“So if health workers see someone in the hospital without a mask, they say, ‘hey, where is your mask’.

And if someone enters the ‘red’ zone who is unauthorised, they feel empowered to stop them,” he said.

“Management will now take quick action if there is an outbreak in a part of the hospital.”

With the second and more serious wave of COVID-19 having occurred since the research, Professor Prajogo said more research was warranted on how the pandemic had affected healthcare workers.

The topic of occupational health and safety for healthcare workers will be discussed by Prof Daniel Prajogo and Prof Ratna Sari Dewi at a panel on Tuesday 30 November for day 1 of the PAIR Digital Summit.

Read the full research report here.