Almost a year into the COVID-19 pandemic, Siti Jubaedah can only smile weakly whenever she hears someone downplay the seriousness of the crisis. The 47-year-old nurse battles fear and anxiety daily. Jubaedah has been caring for patients in a hospital in Jakarta since March 2020, when the pandemic officially began in Indonesia.
“I fear becoming the patient,” she said. “I’m also scared of bringing this disease home and infecting our family.”
Jubaedah lives with her 54-year-old, diabetic husband, her children, and her toddler grandchildren. Amid a shortage of human resources, she, like many frontline health care workers, was forced to care for the sick with minimum equipment.
“We started treating patients without any provision,” Jubaedah said. “We also had to quickly study what few books and literature were available.”
A double shift
It didn’t help that, after a stressful workday, she still faced a second shift at home. Jubaedah and her eldest daughter are in charge of the kitchen, on top of their other chores.
Amid Southeast Asia’s largest outbreak, Indonesian female health care workers like Jubaedah and her peers face an unrelenting struggle at work and even at home.
Wen Kusuma, 35, a laboratory staff in charge of polymerase chain reaction tests in Cilegon, Banten Province, constantly battles the feeling of isolation. Kusuma stays alone in a rented room near her lab, over 700 kilometers away from her parents who live in Pacitan city, East Java. She has been even more distraught since a close colleague died from the virus recently.
“I want to visit my family, but I can’t,” Kusuma said in a phone interview. “So I just cry it out, or I write it down on paper.”
Most of Kusuma’s colleagues are women. Every day, she hears them talk about the fear of infecting families at home, a fear they share with Jubaedah. Both Jubaedah and Kusuma have no access to counseling services.
“Women, being a greater proportion of frontline workers, are therefore disproportionately at risk of indirect impacts resulting from punishing schedules and burnout as well as direct risks of the virus,” a team for Asia-Pacific Gender in Humanitarian Action Working Group wrote in their brief. About 79% of nurses in Southeast Asia are women, 2019 data from the WHO showed. In the Western Pacific region, the figure is 81%.
A “higher risk” group
Female health care workers have been mentally strained from day one. A study by a group of Indonesian researchers published on BMC Public Health in January 2021 found a higher percentage of depressive symptoms, anxiety, and burnout among health care workers in the higher risk group. They suffer loneliness, sleep disturbances, difficulty in concentrating, and inability to initiate activities.
The study was conducted one month after the COVID-19 outbreak on a total of 544 respondents — 420 females and 124 males — from 21 provinces. It surveyed general practitioners, emergency doctors, doctor specialists, dentists, nurses, midwives, and other professionals working in public and private hospitals, clinics, and community health centers. The participants considered to be in the higher risk group were overwhelmingly female: 219 compared to 72 male participants.
Female health care workers also encountered gender bias when they first entered the field. As the pandemic progressed and shortages of human resources grew, though, those barriers faded.
Debryna Dewi, a doctor serving at a private hospital in Jakarta, said she experienced gender bias when she first volunteered to care for COVID-19 patients back in March last year. “At the time, women medical workers were seen as less capable than men,” she said. “Now that we have proven ourselves, I think those biases have gone away.”
Barita Ulina, a psychologist at Sulianti Saroso Infectious Diseases Hospital, said the main stressor for health care workers in the current stage of the pandemic is dominated by workload: the sheer number of patients that keeps on increasing.
Wanted: more psychologists
“Our hospital is full, so we had to make additional rooms,” said Ulina. “Before we only had to care for five patients each; now it’s 15 patients or more.”
The dual role for female health care workers is an additional burden, Ulina said. Her conversations with the subjects confirmed that most female health care workers still have to take care of the children, cook, clean the house, and do other household chores when they get home from work.
“I have experienced it myself,” Ulina said. “I have to work from morning till evening, then go home and help my children with their homework and give them attention.” Some female healthcare workers do all of this on top of the additional work of taking care of their parents.
Indonesian female health care workers suffer loneliness, sleep disturbances, and difficulty in concentrating, according to a January 2021 study.
In April 2020, the Ministry of Health recruited four psychologists to be stationed among 532 health care workers at the Wisma Atlet Emergency Hospital. But it’s not enough.
Ulina admitted that concerted efforts to meet the actual needs are still limited, even though many individuals from the profession have attempted to build awareness. Her hospital is one of the very few across the nation that offers free counseling services for both male and female infected medical workers.
Even when faced with a greater burden owing to the social and cultural strain, female health care workers are not necessarily reporting more burnout than their male colleagues.
A study conducted by the Risk Mitigation Team of the Indonesian Medical Association, together with a team from University Indonesia, State Islamic University, and the Health Ministry, found that high emotional fatigue among female health care workers reached 37%, and 35% in males. There was also a decrease in work efficiency, affecting 55% of female medical personnel and 50% of male medical personnel during the COVID-19 pandemic.
Aly Lamuri, a doctor who was part of the research team, noted the statistical difference between men and women is small, showing that both population groups have the same psychological vulnerability.
As of February 20, 2021, a total of 317 doctors have died of COVID-19, data from Risk Mitigation Team from the Indonesian Medical Association showed. Male doctors accounted for most deaths (86%) compared to female doctors (14%). “The reason is that male doctors outnumber the latter in caring for COVID-19 patients,” Adib Khumaidi, chief of the risk mitigation team, explained.
After a stressful workday, the female health care workers start yet another shift. They are burdened with the care and feeding of their families.
A long way to go
Data compiled from the Indonesian Midwives Association, Indonesian Pharmacist Association, Indonesian National Nurses Association, and the Indonesian Association of Medical Laboratory Technologists showed that 108 midwives — all females — along with 32 dentists, 258 nurses, 13 pharmacists, and 19 laboratory personnel of both sexes have lost their lives to the disease.
“We are very tired because our friends, more health care workers, have begun to fall victim to COVID-19,” Jubaedah said. “We want this pandemic to end soon, so we can get together with family, relatives, and friends like we used to.”
Sadly, Indonesia’s female healthcare workers are in for a long wait. As of February 22, 2021, there were 1.27 million cases and more than 34,000 deaths in Indonesia. The country has vaccinated around 1.7 million people. That’s a long way from the more than 180 million people that the government seeks to inoculate by the end of the year, reports Bloomberg.
On February 23, 2021, the vaccination rate is 61,486 doses per day, on average. At this rate, it will take more than 10 years to cover 75% of the population with a two-dose vaccine, according to Bloomberg. ●
Antonia Timmerman is an independent journalist in Jakarta. She reports on topics such as migrant workers, LGBTQ communities, and art and culture for outlets such as The South China Morning Post, VICE, and The Diplomat.
Caring for the carers
By Asia Democracy Chronicles
“The pandemic has placed extraordinary levels of psychological stress on health workers exposed to high-demand settings for long hours, living in constant fear of disease exposure while separated from family and facing social stigmatization,” notes the World Health Organization. A recent review of health care professionals found that:
● At least one in five healthcare professionals report symptoms of depression and anxiety.
● Almost four in ten healthcare workers experience sleeping difficulties and/or insomnia.
● Rates of anxiety and depression were higher for female healthcare workers and nursing staff.
The WHO calls on all Member States and relevant stakeholders to take the following steps to improve the mental health and psychological well-being of health care workers.
1. Establish policies to ensure appropriate and fair duration of deployments, working hours, rest breaks, and minimizing the administrative burden on health workers.
2. Define and maintain appropriate safe staffing levels within health care facilities.
3. Provide insurance coverage for work-related risk, especially those working in high-risk areas.
4. Establish a “blame-free” and just working culture through open communication and including legal and administrative protection from punitive action on reporting adverse safety events.
5. Provide access to mental well-being and social support services for health workers, including advice on work-life balance and risk assessment and mitigation.
