Weighing Covid-19 Risks for Medical Workers
The number of medical workers in Indonesia is still far from ideal. The ratio is still far from the ideal number compared to the population in Indonesia.
Health workers wear protective suits produced by Tri Maharani, a physician at a hospital in Kediri, East Java, as seen on 19 April 2020.
New hope has emerged as recovered cases start to outnumber deaths. This is inseparable from the hard work and persistence of medical workers on the front line of the fight against Covid-19. The pandemic has made it clear that medical workers number far below the ideal in Indonesia.
The Health Ministry daily data on the number of Covid-19 recovered cases and deaths show that the outbreak in the country is grouped into six provincial clusters.
Cluster one has from one to 10 confirmed cases and comprises the nine provinces of Aceh, Jambi, Bangka Belitung, Bengkulu, West Sulawesi, Gorontalo, North Maluku, East Nusa Tenggara and West Papua. In this first cluster, the ratio of medical workers – general practitioners, specialist doctors and nurses – varies greatly for each province.
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Aceh province, for instance, has 1,556 general practitioners, 822 specialist doctors and 10,927 nurses, according to the Health Ministry’s 2019 data. The province has a population of 5,281,314 according to Statistics Indonesia’s 2019 data, so this means that the province has 30 general practitioners per 100,000 people. In other words, every three general practitioners serve 10,000 patients in Aceh, or one general practitioner serves 3,333 patients.
So this means that the province has 30 general practitioners per 100,000 people.
Furthermore, it has 16 specialist doctors and 220 nurses per 100,000 people in Aceh. There are more nurses than doctors because nurses assist doctors in monitoring their patients’ conditions 24 hours a day in shifts, especially at hospitals.
As of 17 April 2020, Aceh had five confirmed cases of Covid-19. In addition, it has four recovered cases and one death. Further studies are needed to investigate other factors behind the low number of cases in Aceh.
Cluster two has between 11 and 50 confirmed cases and comprises the 10 provinces of Riau, Lampung, West Kalimantan, Central Kalimantan, East Kalimantan, North Kalimantan, North Sulawesi, Central Sulawesi and Maluku.
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Medical workers (left) from the Banten Provincial Health Office, conducted a free Covid-19 rapid test to a trader in Bengkok Market, Pinang District, Tangerang City, Tuesday (21/4/2020).
As of 17 April 2020, East Kalimantan had 44 confirmed cases, 10 recovered cases and one death. The province has 887 general practitioners, 488 specialist doctors and 6,487 nurses, according to the Health Ministry’s 2019 data.
East Kalimantan has 30 general practitioners, 13 specialist doctors and 225 nurses per 100,000 people.
Cluster three, ranging between 51 and 100 confirmed cases, comprises the eight provinces, of West Sumatra, North Sumatra, the Riau Islands, South Sumatra, the Yogyakarta Special Region, South Kalimantan, West Nusa Tenggara and Papua. Surges in confirmed cases of Covid-19 have occurred in the Riau Islands, South Sumatra, West Nusa Tenggara and Papua over the past two weeks. The surge in cases began in March in the four other provinces.
Yogyakarta special province remains the only province in Java with less than 100 confirmed cases, much lower than the number of cases found in other provinces on the island. As of 17 April 2020, Yogyakarta had 64 confirmed cases, 25 recovered cases and seven deaths.
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The ministry’s data shows that Yogyakarta has 1,559 general practitioners, 1,386 specialist doctors and 8,975 nurses. For every 100,000 people, the province has 54 general practitioners, 36 specialist doctors and 250 nurses.
Cluster four, ranging between 101 and 500 cases, comprises the four provinces of Banten, Central Java, Bali and South Sulawesi. Bali saw a surge in confirmed cases in the past week after reporting a consistently low number of cases between March and early April.
The ministry’s data on 17 April 2020 shows that Central Java has 304 confirmed cases, Banten has 311 cases, South Sulawesi has 331 cases and Bali has 124 cases. The number of recovered cases is 43 in South Sulawesi, 36 in Bali, 36 in Central Java and nine in Banten. The number of deaths is 34 in Banten, 41 in Central Java, 23 in South Sulawesi and two in Bali.
A medical worker in a hazmat suit takes a nasopharyngeal swab from a woman in self-isolation at her home in Ahmedabad, India, on 7 April 2020.
Central Java has 6,644 general practitioners, 4,628 specialist doctors and 47,470 nurses. The province has 17 general practitioners, 14 specialist doctors and 133 nurses per 100,000 people.
Meanwhile, Banten has 11 general practitioners, 12 specialist doctors and 76 nurses per 100,000 people.
The number of medical workers in this cluster is highly unbalanced, especially considering the provinces’ coverage of vast areas and regencies across challenging geography. Most specialist doctors work in the cities.
Cluster five, with between 501 and 1,000 confirmed cases, comprises the tow provinces of West Java and East Java. As of 17 April 2020, West Java had 632 confirmed cases, 41 recovered caes and 56 deaths. Meanwhile, East Java had 522 confirmed cases, 94 recovered cases and 46 deaths.
West Java and East Java have the two highest populations on Java at respectively 48.6 million and 39.5 million.
The ministry’s data shows that West Java has 5,926 general practitioners, 3,625 specialist doctors and 37,837 nurses, or 11 general practitioners, seven specialist doctors and 77 nurses per 100,000 people.
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This ratio is low compared to West Java’s huge population. However, it is worth noting that a large part of the province’s population, such as those in Depok, Bogor and Bekasi, tend to seek medical treatment in Jakarta.
Meanwhile, East Java has 6,599 general practitioners, 5,434 specialist doctors and 51,845 nurses, or 22 general practitioners, 14 specialist doctors and 132 nurses per 100,000 people. The ratio is slightly higher than in West Java.
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A nurse in protective gear carries a newborn wearing a face shield on 20 April 2020 at the Tambak Women and Children’s Hospital in Central Jakarta. Face shields protect their wearers from contact with nasal and oral droplets, the preferred transmission vector of the Covid-19 virus.
Cluster six comprises just one province with more than 1,000 confirmed cases: Jakarta. All other provinces had less than 1,000 confirmed cases as of 17 April 2020, while Jakarta had 2,815 cases.
The capital city has 204 recoved cases and 246 deaths. Reporting daily surges in confirmed cases and with its high number of cumulative cases, Jakarta is the epicenter of Indonesia’s Covid-19 epidemic.
As the nation’s capital, Jakarta has the highest ratio of medical workers per 100,000 population compared to other provinces. For its 10.4 million residents, Jakarta has 6,602 general practitioners, 7,165 specialist doctors and 28,856 nurses. The number of specialist doctors in Jakarta even outnumbers general practitioners in other provinces.
Jakarta has 65 general practitioners, 68 specialist doctors and 285 nurses per 100,000 people. In other words, it has 6-7 general practitioners and specialist doctors per 10,000 people.
While Jakarta has more medical workers and facilities than other provinces, it still has the highest number of confirmed cases and deaths nationwide.
The number of confirmed cases in the capital will continue to increase if its residents do not adhere to the government’s large-scale social restrictions (PSBB) and do not wear masks when going out.
A health worker sprays disinfectant at a migrant worker who just arrived from Malaysia, before entering a quarantine center at Soewondo Air Base in Medan, North Sumatra, Indonesia, Thursday, April 9, 2020.
The large number of people venturing outside, riding together on motorcycles and not wearing masks indicates that they are not complying with the government’s PSBB policy. This is highly worrying, as it may cause a spike in the number of confirmed cases.
Other than Indonesia, dozens of developed countries in Europe and America have suffered massive economic losses, as they have been powerless in the face of the Covid-19 pandemic. This is despite the fact that many European and American countries have more sophisticated medical facilities and much better ratios of medical workers per population, meaning that they were better prepared to manage their local outbreaks. Unfortunately, even developed economies have been paralyzed by the Covid-19 pandemic.
The pandemic serves as an occasion for the government and the people to unite. The government must make efforts to increase the number of medical workers, such as doctors and nurses, so that the nation will be better prepared for future health emergencies.
The people must obey the regulations and prioritize their health, follow government protocols and practice physical distancing until the epidemic is over and the economy has recovered.
(KOMPAS R&D)
