August 12 has painted a grim picture of Indonesia’s medical training.

Young doctor Aulia Risma Lestari was found dead at her studio flat. Aulia, who was only 30 years old at the time, had been studying to become an anesthesia specialist at Semarang’s Diponegoro University. As part of her studies, Aulia was in charge of the patients at the Kariadi general hospital in Semarang. She allegedly had taken her own life due to severe bullying by her seniors.

Aulia had written everything she had gone through in the diary that the police had covered when searching her flat. Aulia’s father fell sick and even passed away 16 days after his daughter’s death. The government has suspended the anesthesia specialist training program at Kariadi hospital for investigations.

What happened to Aulia was only the tip of the iceberg of how bullying had plagued Indonesian medical specialist programs. Wildan was a general practitioner who used to pursue a specialist training program. Just like Aulia, he, too, had to cope with his seniors’ bullying, but decided to quit his studies.

“We were shoved into the bathroom. They slapped us and hit our head,” Wildan said in a recent podcast with celebrity Deddy Corbuzier, while even admitting that he had to pay the seniors’ car taxes. 

Wildan said: “It is not that I’m scared to fight back, [but if I do], they might make it harder [for me to graduate].”

Health Minister Budi Gunadi Sadikin admitted the scourge of bullying in the country’s medical specialist schools.  

According to Budi, data showed that 22.4 percent of 12,000 medical specialist students in Indonesia suffered from depression. Budi claimed that he had spoken with Education Minister Nadiem Makarim to “cure” the chronic disease.

“[Aulia] is not the only victim, because they usually cover it up. It just so happened that the bullying [that she suffered] got exposed to the public. We want to take care of this as soon as possible. … Nadiem and I really want to get rid of bullying [at schools] forever,” Budi said.

The Health Ministry has received almost 1,500 reports related to bullying at medical specialist schools. About 30 percent of the reports were verified as cases of bullying. They have also received 211 bullying reports at Health Ministry-ran schools. The government reported that it had strictly sanctioned the bullies.

“From our investigation against 156 bullying cases, as many as 39 resident doctors and the supervising doctors have received strict sanctions,” the Health Ministry’s spokesman M Syahril said last week.

Some of the most commonly reported types of bullying include inhumane working hours and tasks that are unrelated to their studies. Punishments against the bullies range from demotion, suspension, and dismissal from their positions. Nadia Tarmizi, a spokesperson for the Health Ministry, recently revealed that what happened to Aulia was not the first bullying case at Diponegoro University. The Health Ministry had previously verified three bullying reports taking place at the university in 2023-2024.

Yan Wisnu Prajoko, the dean of Diponegoro University’s faculty of medicine, admitted the bullying case involving Prathita Amanda Aryani. Following Aulia’s death, Prathita had gone viral on social media for allegedly forcing her juniors to finish five portions at once. However, Wisnu said that Prathita had already been sanctioned after bullying her juniors in 2021. Wisnu denied Prathita’s involvement in Aulia’s case.

The Education Ministry and the police are still investigating Aulia’s death. The authorities have already summoned 9 of Aulia’s colleagues, including the head of the study program, the Kariadi hospital’s anesthesia medical staff head, and the administration staff.

But that is not all.

Last year, the Health Ministry gave a warning to the government-run hospitals: Jakarta’s Cipto Mangunkusumo Hospital, Bandung’s Hasan Sadikin Hospital, and Medan’s Adam Malik Hospital due to bullying against the junior students. At the time, a guideline laid out how the juniors had to run errands for their seniors. The stress that accumulated from the bullying affects the quality of Indonesian doctors. In early 2023, a young doctor went viral for treating a patient poorly. It turned out that the doctor lashed out their anger due to stress from being bullied.

A surgical oncologist specialist told Beritasatu.com on conditions of anonymity that they had to work long hours back in 2002. A at the time was a specialist student. the oncologist alongside their colleagues, had to guard the emergency room for 24 hours non-stop, starting from 7 a.m. to the next morning. They were only allowed to rest even if no patient had come.

As the quality of medical specialist education becomes questionable, Indonesia is eyeing to bring in foreign doctors. According to Minister Budi, Indonesia is facing a shortage of specialists. It needs at least 10 years for the country to narrow that gap.

The chronic bullying cases make it no surprise that many Indonesians favor getting medically treated abroad. President Joko “Jokowi” Widodo even revealed that Indonesia had been losing $11.5 billion every year as people went overseas for medical treatment. 

Lawmaker Rahmad Handoyo feared that the bullying could hamper Indonesia’s attempt to nurture the specialist doctor it needs. Handoyo said: “Whoever takes part in the bullying at Diponegoro University must be fired. Without a strict sanction, the bullying will not stop and they will have a new victim.”

Ngabila Salama, a technical staff at the Health Ministry, attributed the never-ending cycle to the seniors wanting to get revenge for having had similar treatment when they were still juniors. Ngabila said: “We need to get rid of bullying [in the medical field] by making sure that the regulations are in place. We also need to set up a proper whistleblowing system.”

According to Ngabila, the 2023 Health Law and the Health Ministry’s 2023 instructions have clearly laid out the regulations related to bullying in the medical field. Victims are asked to report to the ministry. The government will then conduct an investigation to determine the sanctions against the perpetrators.

The executive board of the Indonesian Medical Association (PB IDI) underlined the need to end the cycle of bullying at Indonesian medical schools. IDI’s Junior Doctors Network head Tommy Dharmawan said that improving the specialist education work system could help prevent bullying.

“A better pay for [the specialist students] would be better. Everyone needs to know the definition [of bullying] as well as the regulations and sanctions related to the practice. We should also fix their working hours. Studies have shown that working hours should be capped at 80 hours a week,” Tommy said.

However, it should be up to the government --and not the hospitals-- to regulate the salary and working hours. Tommy also called for the need to establish a hotline and safe mental health services for medical specialist students.

“What matters the most is that we must not ignore this. We should better manage [the specialist education] much better and impose tough sanctions [to perpetrators],” Tommy said.

PB IDI’s chairman Adib Khumaidi said the association respected the ongoing investigations on Aulia’s death. Adib also told the public to not make any speculations before the investigation reaches completion.

“Let us all work together to prevent similar incidents from happening in the future,” Adib said.

__

B-Universe reporters Agnes Valentina Christa, Hendro Dahlan Situmorang, Herman, Maria Gabrielle Putrinda, Stefani Wijaya, Surya Lesmana, and Zhulfakar contributed to the story. Correspondents Muhammad Iqbal Ikromi, Pranoto Susilo, and Widy Wicaksono also contributed to this story.