Source: Hartal Doktor Kontrak
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KUALA LUMPUR, MALAYSIA — Contract doctors across Malaysia’s public hospitals went on strike on Monday morning (26 July) after Prime Minister Muhyiddin Yassin’s “half-baked” proposal to lengthen their contracts has failed to placate their demands regarding their security of tenure.

In the capital city of Kuala Lumpur, close to 50 junior doctors assembled at the open-air carpark on the rooftop of the Kuala Lumpur Hospital (HKL), holding placards that read “WE ARE YOUR FUTURE SPECIALISTS #JUSTICEFORJUNIORDRS” and “#HARTALDOKTORKONTRAK #TETAP #LAWAN“.

‘Lawan’ is the Malay word for ‘fight’ or ‘resist’, referencing the protest against the government’s purported failure in handling the COVID-19 pandemic and the ongoing State of Emergency due to be lifted on 1 August.

The group has encouraged the people to participate in a larger-scale #Lawan protest this Saturday (31 July).

A group of protestors under the Sekretariat Solidariti Rakyat movement previously staged a flashmob of around 20 people at Dataran Merdeka.

14 black flags and a simulation of five “dead bodies” wrapped in white shrouds were displayed during the small protest to depict the increasing death toll as a result of COVID-19, including of suicides believed to be driven by dismal economic conditions and tight restrictions during the lockdown.

At HKL today, the Malaysian Insight reported that police officers from the Dang Wangi District Police Headquarters had told the group of doctors to disperse just minutes before 11.30 am.

Malaysiakini reported that the strike at HKL lasted for only eight minutes before police ordered the gathering to cease.

Just around two hours after the strike at HKL, Dang Wangi district police chief Assistant Commissioner Mohamad Zainal Abdullah said that investigation papers related to the Hartal Doktor Kontrak movement will be opened, Astro Awani reported.

This is despite Inspector-General of Police Acryl Sani Abdullah Sani’s earlier statement that police have received no indication that the strike will threaten public order.

Human rights lawyer Michelle Yesudas said that police presence at the contract doctors’ strike “exposes the State’s poor understanding of peaceful assembly & expression”.

“The doctors have a clear strategy, demands, SOPs & it goes to show how the authorities don’t even trust doctors to hold a peaceful walk-out,” she tweeted on Monday.

In Selangor, massive walkouts were seen at the Shah Alam, Kajang, Klang, Sungai Buloh, Serdang, Selayang, and Ampang public hospitals.

Medical professionals who went on strike held signs that read “JUSTICE FOR CONTRACT DOCTORS – 23K CONTRACT DOCTORS“, “FIGHT FOR OUR HEALTHCARE SYSTEM’S FUTURE“, “WE WANT CAREER SECURITY“, and “HEALTHCARE WORKERS STAND UNITED“.

Contract doctors in public hospitals outside the Klang Valley were also seen going on strike in line with the Hartal Doktor Kontrak movement.

In Johor, around 20 contract doctors at the Sultanah Aminah Hospital (HSA) participated in a peaceful demonstration, which started at 11.10 am.

Harian Metro reported that the doctors, clad in black like other doctors in honour of #CodeBlack, were joined by other colleagues at the hospital lobby before proceeding to circle around the hospital for approximately three kilometres.

Similar walkouts were also seen in Negeri Sembilan, Melaka, Perak, Penang, and Terengganu.

https://twitter.com/balkis_hesham/status/1419498874763284482

The demonstration at Hospital Seremban in Negeri Sembilan took place after a half an hour delay, The Malaysian Insight reported.

A day before the nationwide strikes took place, the country’s health director-general Dr Noor Hisham Abdullah discouraged junior doctors on contract posts from participating in the demonstrations.

“Remember many lives are on the line and the demonstration could affect their lives and even your career,” he said in a Facebook post.

“I wish to remind all that patient’s safety is our priority. Remember the oath we took sincerely and be there for your patients at the time when they and country needed you the most. We are the last bastion of defence to make a difference to our patients and every life matters.”

Dr Noor Hisham, who is frequently lauded for his leadership in Malaysia’s management of the COVID-19 pandemic, received flak from members of the public for what they perceive to be an insensitive statement from a healthcare professional in a position of authority towards the predicament of junior contract doctors.

Contract extensions merely “a sugarcoating statement to shut us up”: Contract doctors reject short-term proposals mooted by PM, Cabinet

Among the key suggestions earlier put forth by Muhyiddin and the Cabinet regarding the security of tenure of contract doctors include offering a two-year contract extension for medical officers, pharmacists, and dental officers who have completed their compulsory service.

For medical officers and dental officers who have been selected to do the relevant Masters’ programme, the government may grant a four-year contract extension, according to the government’s plans.

In a statement earlier on Saturday (24 July), the Hartal Doktor Kontrak movement said that simply adding more years to such contracts is not a means of solving the problem but merely “a sugarcoating statement to shut us up”.

“We know well how the system works, we are not buying it. Nobody wise enough will accept it. Stop giving us a half-baked solution given by people who are not even in this field, or don’t even know how the system works, or maybe don’t even bother to think thoroughly about it because the problem is not theirs,” they added.

Stressing the importance of offering permanent posts to all contract medical and other healthcare officers, Hartal Doktor Kontrak said that the lack of job security for contract doctors will not be remedied through such proposed extensions.

“A contract medical doctor is forever seen as a second-class doctor compared to their permanent counterparts,” they said.

The movement added that the short duration of extensions is absurd, given that it usually takes “many years” before medical officers are accepted into the Master’s programme.

“An extension of contract for a maximum of 4 years for those accepted into the Master’s programme also seems bizarre, as the duration of the programme itself is a minimum of 4 years,” Hartal Doktor Kontrak noted.

“This shows the (ministers’) lack of understanding in our local specialist training,” they added.

On the eve of the slated strike, Hartal Doktor Kontrak on Sunday outlined “ground rules” for the strike, including maintaining physical distancing of one-metre between individuals, wearing masks at all times, avoiding any violent behaviour, and displaying placards.

Doctors are also advised to return to their workplaces when necessary, as caring for patients will remain a priority, said the movement.

For the same reason, doctors participating in the strike must also pass over their duties to medical officers remaining at the workplace, said the group.

CodeBlue reported the group as saying that medical officers assigned to COVID-19 hospitals will not be mobilised on the day of the strike unless precise arrangements can be made.

“We understand that the pandemic is a national emergency. The goal of the strike is to get what we have demanded but at the same time, we do not want to jeopardise our patients’ health — that is the last thing we want to do,” Hartal Doktor Kontrak spokesperson Dr Mustapha Kamal A Aziz was quoted as saying.

Sticking to its previously announced stance, the Malaysian Medical Association (MMA) said that it will not be supporting the strike, but will continue to advocate the absorption of more contract doctors into permanent posts.

While the proposed contract extensions by the government may work as “immediate short-term steps”, MMA president, Prof Dr Subramaniam Muniandy said that lengthening the duration of contracts “is not a solution to the problem”.

“The current proposal of a contract extension also needs to be reviewed, as other factors that may delay specialisation should be taken into account,” he added.

In an earlier joint statement with Section Concerning House Officers, Medical Officers, and Specialists (SCHOMOS), MMA said that while the Health Ministry had informed them that a proposal of an extended contract was in the works, no decision or outcome has been announced to this date regarding the matter.

“Even while warding off death in the COVID-19 wards, our junior doctors are still waiting for a fair decision and clarity from the government if they are able to continue working when their contract expires and if they are able to undergo training for their specialisation,” they said.

The current contract system, said MMA and SCHOMOS, is “messy, biased and a failure”, as it feeds into the anxieties of junior doctors by giving them “uncertainty in their employment in the government service and in their future as healthcare professionals”.

Strike a “last resort” action; contract system does not provide real direction for career progression

Reiterating their stance on proceeding with the nationwide strike, which was announced weeks ago, Hartal Doktor Kontrak said on Saturday that the need to carry on with the strike — an action of last resort — is born out of their ignored pleas and negotiations with the government.

‘Hartal’ is a Gujarati word for ‘mass protest’ or ‘strike’.

Previously, Hartal Doktor Kontrak said that the current model of contract terms for junior doctors does not provide a real, clear direction for their career progression.

Contract doctors are also exempted from work benefits offered to public servants in permanent positions such as study leave, the ability to apply for housing loans, and entitlement to time-based promotions.

The absence of rights for study leave often leaves contract doctors in a situation where they have no choice but to resign and fund their own training.

The contract system was only originally put in place as a stop-gap measure in the face of a large number of medical graduates and the government’s lack of capacity to take in the high number of new medical officers, said the movement.

Hartal Doktor Kontrak noted that there have only been 786 medical officers who have been appointed to a permanent role since 2016. The rest remain on a contractual basis after the end of their housemanships.

“According to figures given in the Health Minister’s feedback, only 3.4 per cent (of junior doctors) were hired as permanent staff. The last of such appointments were made in the 2017 appointment cohort,” they said.

Hartal Doktor Kontrak stressed that the issue of the contractual work arrangements junior doctors are subjected to is a crucial one to attend to, as it concerns the future of Malaysia’s healthcare system.

The movement reiterated two of its demands from the government, namely:

  • Offering permanent positions to all medical officers on contract; and
  • Releasing a detailed explanation of the criteria for such permanent appointments.

Contract doctors’ strike: Ethical in a pandemic?

Certain quarters of society have expressed concerns regarding the nationwide strike and how it will affect the wellbeing of patients, particularly in the midst of the raging pandemic and astronomical rise in the number of daily COVID-19 cases.

Malaysia’s Ministry of Health reported a record 17,045 new cases on Sunday. The total number of cases in the country surpassed the one million mark at 1,013,438.

The Malaysian Philosophy Society, however, argued that it is possible for contract doctors intending to go on strike to do so “while mitigating harm caused to patients”, based on precedents set by their counterparts in the United Kingdom, South Korea, and Nigeria.

Reuters reported in late August last year that close to 16,000 interns and resident doctors in South Korea went on a three-day strike over the government’s plans to increase the number of medical students over several years.

This is in addition to setting up public medical schools, allowing government insurance to cover more Eastern medicine, and introducing more telemedicine options.

The doctors who protested stressed that the extra funding should be channelled into providing better pay for existing medical trainees, among other possible improvements.

In an Instagram post on 16 July, the Malaysian Philosophy Society said that the strike will benefit Malaysia’s population as it will “push for a quicker resolution to the current issue”.

The strike, it said, is not for doctors’ mere personal gain, but a means of demanding “equal and affordable healthcare services” which cannot be achieved without more “permanent doctors in the healthcare system”.

“In the long run, the lack of public hospital specialists and brain drain inflicted on doctors will interfere with the people’s autonomy to seek optimal and affordable public healthcare,” said the Malaysian Philosophy Society.

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