INDONESIA: In a startling revelation, the Ministry of Health has received a staggering 91 reports of alleged bullying targeting medical trainees, including Co-Assistants (Co-Ass) during their internships and participants of the Specialist Doctor Education Program (PPDS) under a month.

The Ministry’s Inspector General, Murti Utami, disclosed that the Ministry initiated action on these grievances following the issuance of Ministerial directives on July 20, 2023.

As of 15 August, out of the total complaints, a distressing 44 cases pertain to suspected incidents of bullying within hospitals under the Ministry’s purview.

These reports encompass 17 complaints from General Regional Hospitals (RSUD) across 6 provinces, 16 from medical faculties in 8 provinces, and 6 from university hospitals (RS).

Additionally, one report emerged from a Military Police Hospital and another from a private hospital.

Murti Utami confirmed the validation of the 44 complaints related to bullying incidents within the Ministry’s hospital environment during a virtual press conference on Thursday, 17 August.

For cases occurring outside of these hospitals, the Ministry will refer them to the relevant authorities for appropriate action within their jurisdiction. Of the 44 cases, 12 have undergone investigation, while 32 are still under scrutiny.

Murti Utami, the Inspector General of the Ministry of Health,

“Majority of the received reports revolve around bullying in the form of undue financial demands unrelated to educational needs, services, or research requirements. This also includes tasks such as excessive working hours beyond reasonable limits,” Murti emphasized.

Murti revealed that 12 of the reported cases originated from three specific hospitals.

Consequently, the Ministry has issued recommendations to the Director General of Health Services, Azhar Jaya, for further action.

Azhar himself confirmed sending reprimand letters to the directors of the concerned hospitals, namely RSUPN Dr Cipto Mangunkusumo Jakarta, RSUP Dr Hasan Sadikin Bandung, and RSUP Haji Adam Malik Medan.

He urged these hospital heads to promptly implement the recommendations derived from the Ministry’s investigation.

“We expect the directors to take necessary measures to prevent further instances of bullying,” he urged.

Azhar also encouraged victimized doctors not to hesitate to report incidents of bullying through the Ministry’s dedicated hotline on WhatsApp or its website, ensuring confidentiality and anonymity.

“Rest assured, if you choose to report, we will ensure protection. No report will go unaddressed,” Azhar assured. He added that the Ministry aims for this reprimand to be the last, but firmly stated that serious action would be taken if future bullying cases arise.

Budi Gunadi Sadikin, The Minister of Health.

Further delving into the issue, Minister of Health, Budi Gunadi Sadikin, recounted the origins of bullying cases within the PPDS program at hospitals. Budi disclosed that bullying was exposed after a video highlighting poor service at RSUP H Adam Malik circulated on social media.

Upon investigation, it was discovered that the doctor responsible for the subpar service attributed it to stress caused by maltreatment at the workplace.

“A doctor provided exceptionally poor and rude service to patients. After a thorough examination, it was found that the individual in question was a specialist trainee who was subjected to undue treatment, leading to extreme stress caused by the treatment and excessive working hours far beyond the norm,” explained Budi.

Budi went on to reveal that discussions with PPDS participants aligned with facts that corroborated the claims. “When we opened the channel for reporting, the reports flooded in. We then looked for evidence. I was astonished to see that what the President had mentioned was indeed happening, and we could witness the evidence firsthand,” Budi shared.

Investigations exposed a multitude of instances of bullying, ranging from offensive language to the existence of inappropriate guidelines unrelated to the education of PPDS participants.

“The language used was shockingly offensive, involving references to animals when addressing children. There were racially insensitive remarks as well. Furthermore, there were guidelines that we found completely inappropriate and irrelevant to education,” Budi added.

Expressing his distress over the findings, Budi underscored that such practices demean human dignity.

“I cannot allow practices within hospitals owned by the Ministry of Health that go against the cultural values and noble character of Indonesia, but instead are filled with racial slurs and derogatory language, even going as far as addressing juniors by the names of animals,” he lamented.

Addressing punitive measures, Budi firmly stated that the Ministry would not hesitate to apply sanctions ranging from mild to severe for those found guilty of bullying.

“Initially, mild sanctions will be issued in the form of written warnings. These warnings may be directed towards educators, hospital directors, or senior trainees, considering that the bullying often stems from senior trainees,” Budi declared.

Budi added that moderate sanctions would be implemented for repeated offenders. Potential penalties might involve revoking access privileges or suspending the education of senior trainees involved in bullying.

“For educators, we will suspend them for three months for moderate sanctions. Even the hospital director will face suspension, as they fall under my purview,” Budi clarified.

In cases of severe misconduct, specific individuals will face heavy sanctions. These penalties will be enforced for Ministry of Health employees, resulting in a demotion by one level for a period of 12 months, followed by possible dismissal.

“As for educators, since they are not Ministry employees, we will request they refrain from teaching at our hospitals and instead teach at other facilities. For university trainees, severe sanctions involve expulsion from our education programs; they will not be allowed to participate in teaching and learning activities at Ministry-owned educational hospitals,” he added.

Budi highlighted that the government’s firm response to combat bullying ultimately aims to relieve trainees of undue burdens and create a safe environment for their education.

This approach ensures that future doctors can provide optimal and professional healthcare services while setting a positive work culture and acting as role models for healthcare providers nationwide.

Additionally, Budi acknowledged that bullying within the training environment of government-owned educational hospitals persisted due to inaction from various stakeholders.

He maintained his belief that many specialist doctors, educators, and senior trainees uphold positive behaviour, and are dedicated to guiding and imparting knowledge to their junior peers.