The Personal Sacrifices Of Junior Doctors In A Pandemic

A contract house officer struggled with the dilemma of whether to attend her grandmother’s funeral or to save her precious leave days, even as she grieved for her patients who died from Covid-19.

KUALA LUMPUR, July 12 — Anna, a 26-year-old contract house officer at a public hospital in the Klang Valley, comes home from work at 10pm. Then she eats dinner, her first meal of the day, before she goes to sleep and starts work at 5am the next day.

Anna (not her real name) works six days a week. She starts her day taking morning blood for all 12 to 15 of her patients and looks up their results from the hospital’s internal pathology database. She checks on their recovery progress and does physical exams for patients as part of morning rounds.

She then joins and assists her medical officers (MOs) for MO rounds, and then specialist rounds after that. After all the rounds are over, she carries out treatment plans — more blood-taking, requesting imaging scans, referrals to other departments, and attending to ward emergencies.

In between, if new patients get admitted into her wards, she has to attend to and clerk them thoroughly, as well as take their admission blood and set up their IV lines — the whole admission process takes about an hour to complete. In the afternoons, she assists in afternoon rounds and the cycle repeats. On her off day, she still comes to work sometimes to finish off administrative duties she was not able to complete on work days.

If her ward is converted into a Covid-19 ward — something Anna and her colleagues will only be informed of hours in advance — all the patients she receives and manages for the day would be Covid-positive patients, who tend to come in droves.

Junior housemen like Anna have been deployed to Covid-19 wards to assist with unmanageable workloads at the Ministry of Health (MOH) hospital Anna is working at. Anna claimed that she and her coworkers were not provided a formal briefing on protecting themselves with personal protective equipment (PPE).

Instead, the trainee doctors at the public hospital were allegedly only given two PDF documents: one on how to don and doff PPEs and one containing a table of what constituted as appropriate PPE when meeting patients-under-investigation (PUIs) or confirmed Covid-19 positive cases in different settings, as seen by CodeBlue.

In January, Health director-general Dr Noor Hisham Abdullah announced through an internal circular that house officers will be recruited to assist in managing Covid-19 patients. However, this recruitment was only limited to senior house officers in their fifth and sixth postings, who have undergone or are undergoing their medical posting, have passed their assessment and completed their logbooks in the respective departments, possess a full license to practice, and without disciplinary issues. Anna is only in her third posting and is still serving under a provisional licence.

“We’re in the middle of a war. The pandemic is a war — a war that isn’t bearing any fruit. All of us are giving our 200 to 300 per cent at work and neglecting and abandoning our families for our patients. We’re tired. We’re so, so, so tired. Everybody else is already KO-ing, but we’re still going on because…we still kesian our patients,” Anna shared with CodeBlue.

Junior doctors are not just physically tired from the increased workload caused by the unrelenting Covid-19 epidemic in Malaysia, with surging infection and mortality rates despite a total lockdown lasting almost six weeks to date.

They are also battling emotional exhaustion from grieving for the increasing number of patients who succumbed to Covid-19.

“It’s very hard to describe that feeling of loss to someone who is not in the medical field. They don’t understand why you are grieving for your own patients when you’ve done everything you could.”

Anna (not her real name), junior contract house officer at a public hospital in the Klang Valley

At the same time, junior contract doctors like Anna do not have time to attend to, nor process, personal crises.

“During [my grandmother’s] funeral, I was already thinking, ‘How many days of leave do I have left? How many days do I want to take for emergency leave? When you’re in a contract position, you constantly have to think, ‘Is it really worth it to sacrifice this many days? Will I have enough leave left for an MC?’ I have to calculate all of that before I can take into account my feelings at the time when my grandmother died.”

Anna managed to attend her grandmother’s funeral but returned to work two days after, while she was still painfully grieving.

Contract trainee doctors only have eight days of leave for a four-month posting, inclusive of applied leave, emergency leave, and sick leave. If housemen test positive for Covid-19, their quarantine period is deducted from their eight days’ of leave, and the balance will count towards an “extension” of their posting.

“At this point in time, I don’t even know how I’m going to move on in life because I don’t even have time for myself. I only have time to come home, feed myself, and get some sleep. If I have to take care of my baby, of my husband… I don’t know how people do it.”

Amid work fatigue, Anna is plagued by worries about her future. As a contract doctor, she has no job stability and zero chances for career progression unless she gets a permanent position or leaves the country. Her monthly salary of about RM5,000 will stagnate and will not be enough to support both her parents and her future family, when she gets married.

The young woman is currently struggling right now just to support her parents, her brother, and herself as sole breadwinner, to pay back their housing loans, groceries, her rent, her personal loans, among other expenses.

She shared that she is tired and frustrated with her situation, as are her colleagues.

“Everyone’s tired. The threshold is so low that if I should scream that I want to go on strike right now, I bet 10 people would follow me for sure. Everyone is so tired, so exhausted. What do we have to lose? Absolutely nothing,” Daniel (not his real name), a contract house officer at a Klang Valley university hospital, confessed to CodeBlue.

The Hartal Doktor Kontrak campaign plans to organise a nationwide strike on July 26 for some 23,000 contract doctors dissatisfied with the lack of permanent posts for them in the public sector. The Ministry of Health (MOH) simply gave existing contract doctors a “one-off” one-year contract from December 5, 2021 to December 4, 2022, according to a Malaysiakini report last July 6.

“If you ask me, I don’t believe in Hartal’s objective in getting permanent positions, but I believe their strategy is the way to do it, which is a strike. You can’t win wars without a fight. Every war needs to have a battle. This is the battle; this is the fight.”

Daniel (not his real name), contract house officer at a university hospital in the Klang Valley

Daniel pointed out that the people planning to participate in the strike are all contract doctors whose contracts are about to expire, and so they have nothing to lose.

“If you want to prove a point, this is the way to go,” Daniel said, “Because when that happens, the system will collapse. It is only when the system does collapse can we truly build a better health care system.”

On the other hand, Ruben (not his real name), a contract house officer in Sabah, disagrees. “Honest to God, I don’t know which doctor would go on strike knowing their patients are in bad condition. It goes against your instinct as a human being to help someone else.”

Ruben told CodeBlue he only heard about the Hartal and the Malaysian Medical Association (MMA) CodeBlack movement last weekend when his friend showed him social media posts.

MMA’s CodeBlack movement is merely a social media campaign — which encourages doctors to go to work in black clothing and to change their personal profile pictures to monochrome colours — that is unaffiliated with Hartal. MMA, the largest association of doctors in the country but is not a workers’ union, does not condone a strike by health care workers during a pandemic.

“You know the first thing my colleague said? ‘Do you really think this is going to work?’” a skeptical Ruben said. “Don’t try to change something that doesn’t want to be changed. There’s no point.”

However, he does admit that he is not entirely pessimistic. “I always give the benefit of the doubt for everything. I have hope that… I do hope that whatever these guys are doing at CodeBlack, can actually help out.”

MMA announced in a Facebook post last Wednesday that they had a meeting with MOH and were informed by Health Minister Dr Adham Baba that a solution for contract doctors’ issues will be sent to the Cabinet for approval this week.

CodeBlue is keeping the identities of the three house officers interviewed anonymous due to the government’s gag order on civil servants.

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