The death of a junior doctor in Indonesia has reignited a national debate over pervasive bullying in the healthcare industry, with experts warning that such toxic practices remain deeply rooted in the country’s medical schools.
“I think there is a tendency to normalise and see bullying as being natural because of the high amounts of pressure and demands of specialised medical education … but this shouldn’t be normalised or tolerated,” Diah Satyani Saminarsih, founder and chief executive of advocacy group Centre for Indonesia’s Strategic Development Initiatives, told This Week in Asia.
Aulia Risma Lestari, a 30-year-old resident in the anaesthesia specialist programme at Diponegoro University in Semarang, was found dead in her living quarters on August 12. Reports suggest that she may have injected herself with a lethal dose of an anaesthetic. Police are investigating her death as a possible suicide, and are looking into whether bullying documented in her diary may have contributed to her depression.
WhatsApp conversations between Aulia and several senior residents at Kardinah Hospital in Tegal City, shared on social media, revealed troubling claims. They suggest she faced pressures from senior doctors to cover expenses beyond her tuition and living costs, including demands for food, entertainment, and even car rentals.
In the wake of Aulia’s death, the Health Ministry suspended the hospital’s anaesthesiology residency programme until a police investigation is concluded.
Responding to the incident, Health Minister Budi Gunadi Sadikin called bullying an “open secret” in the country’s medical institutions and labelled it a “huge phenomenon”.
“I will push for legal action to ensure maximum punishment for the perpetrators and to create a deterrent effect,” Sadikin said on Wednesday, vowing to implement better monitoring and reporting measures.
Meanwhile, Diponegoro University’s rector, Professor Suharnomo, has refuted allegations of bullying in a statement, asserting that the junior doctor faced health issues that affected her studies.
Suharnomo also stated the university would cooperate with police in their investigation, adding that the school has implemented a zero-bullying policy, actively monitored by the Bullying and Sexual Violence Prevention and Management Team since August 2023.
Seniority sanctified
Indonesia’s health ministry said it had received 356 formal complaints related to bullying between July 2023 and August this year, with reports of verbal and physical abuse, financial coercion, and intimidation, where senior doctors pressured junior colleagues to take on additional responsibilities outside work hours.
The ministry has investigated 156 of these cases, resulting in warnings, temporary suspensions and full dismissals, with 39 medical residents and teaching doctors facing sanctions nationwide, according to spokesman Mohammad Syahril.
“The Health Ministry will always take stern action against the bullies. Their names will also be flagged in the system as perpetrators,” he added.
Agung Purnama, a 29-year-old medical student specialising in oncology surgery during his residency at a hospital in Bandung, West Java, told This Week in Asia that he had experienced pressure from senior doctors to work long hours.
“Or else they would say we will not get a good grade, or we are not worthy of becoming doctors,” said Agung, who requested the use of a pseudonym to protect his identity.
The more junior you are, the higher the risk is that you will be exposed to bullying
“You feel like [you] have no choice but to do as they say … I spent so much time and money to get to this point [in my studies] so it feels like you don’t want to do anything to risk that,” he added.
Reports of bullying have also emerged at Padjadjaran University in Bandung over the past few weeks, following local media coverage of a distressing incident within the institute’s neurosurgery training programme.
Junior doctors at the university have alleged they endured both physical and verbal abuse from seniors, who coerced them into covering costs for food, drinks, car rentals, and accommodation.
In response, the university has terminated the studies of two doctors linked to the bullying, issued warning letters to the heads of the department and the neurosurgery programme, and imposed penalties on seven other alleged offenders, requiring them to repeat classes or lectures.
According to Diah, the hierarchical nature of medical education exacerbates these issues, fostering an environment where seniority is prioritised.
“The more junior you are, the higher the risk is that you will be exposed to bullying,” she said.
A ‘cycle of violence’
A health screening conducted by the Health Ministry in March revealed that 22.4 per cent of more than 12,000 medical residents surveyed had experienced depression, with about 3 per cent admitting to having thoughts of self-harm or suicide in the two weeks before the screening.
The ministry identified bullying as a contributing factor, alongside intense pressure for academic success, frequent night shifts, and the financial burden of balancing study with family obligations.
In April, the ministry proposed incorporating anti-bullying regulations in the Health Bill to ensure legal protection for all healthcare workers, including medical students. The new provisions aim to enhance reporting mechanisms for students in distress and empower doctors and other healthcare staff to halt services if they face mistreatment.
Health rights advocate Diah said the proposed regulations as a positive first step and a “benchmark” for necessary reforms. However, she emphasised that the root of the issue must still be addressed.
We are in this [medical] practice to help other people, so we also deserve help
“There is a cycle of violence that needs to be broken, and the first step is acknowledging that it exists,” she said, stressing that responsibility lies with the teaching hospitals, medical centres, and faculty members.
Access to counselling and mental health support is crucial, she said, adding that these services must be reliable and ensure safety and anonymity for students seeking help.
Agung echoed this sentiment, saying that such resources could significantly benefit junior doctors like himself.
“Many of my friends face depression and anxiety and harm and bullying, but we want to feel like we can talk to someone about it … without getting in trouble,” he said.
“We are in this [medical] practice to help other people, so we also deserve help.”
If you have suicidal thoughts or know someone who is experiencing them, help is available. In Hong Kong, you can dial, 18111 for the government-run Mental Health Support Hotline. You can also call +852 2896 0000 for The Samaritans or +852 2382 0000 for Suicide Prevention Services. In the US, call or text 988 or chat at 988lifeline.org for the 988 Suicide & Crisis Lifeline. For a list of other nations’ helplines, see this page.
