Daily Challenges of Under-Resourced Doctors

There is a man who wakes each day knowing what waits for him. Not uncertainty—that would be easier. But certainty. The certainty that the hospital will be under-resourced. That patients will need what he cannot provide. That the system will fail someone today, and he will be there to witness it, powerless to prevent it.

He is a doctor in Indonesia. Not in the gleaming private hospitals of Jakarta’s wealthy districts, but in the ordinary places where BPJS patients come with illnesses that could have been prevented, should have been caught earlier, might have been treatable if only—

If only there were more staff. If only there were better equipment. If only the antimicrobial stewardship program wasn’t constantly undermined. If only the evidence-based protocols he writes were actually followed. If only the bureaucracy didn’t consume hours that should belong to healing.

If only.

But there are no if-onlys in the morning. Only what is. And what is, is this: another day of trying to practice medicine in a system that often prevents good medicine from being practiced.

The Cycle

Someone once asked him what good experiences he’d had this year. As if the year could be measured in moments of light rather than the accumulated weight of darkness that never quite lifts.

He thought about how to answer. Should he mention the patient who survived despite the odds? But then there was the one who died because the surgery came too late, because they couldn’t afford it sooner. Should he talk about the protocol he finally got implemented? But it’s already being ignored, undermined by the same resistance that meets every attempt at improvement.

The truth is simpler and harder: The bad news doesn’t end. It cycles. One crisis resolves and immediately, another arrives. The patient stabilizes and another deteriorates. The paperwork finishes and more appears. The morning ends and tomorrow’s morning is already waiting, already carrying its cargo of need and insufficiency.

When the bad news was over, the next morning was still there waiting for them.

This is what people don’t understand about healthcare work in a broken system: There is no finish line. There is no “catching up.” There is only the endless arrival of need that exceeds capacity.

And still, he shows up.

What It Costs

Not because he’s heroic. The word feels obscene in this context—it romanticizes what is simply necessary, transforms grinding persistence into noble sacrifice, as if there were a choice involved.

But what choice is there, really? Patients still need care. Someone has to try. Walking away would mean abandoning people who depend on him. And he can’t unknow what he knows about what good healthcare looks like, can’t unsee the gap between what should be and what is.

So he carries it. The weight of:

Knowing better. Understanding international medical standards while working in contexts that can’t support them. Seeing what could save lives if only the resources existed.

Moral injury. Not from doing wrong, but from being prevented from doing right. From watching preventable deaths. From having to choose who gets limited resources. From the daily compromise between ideal care and possible care.

Systemic failure. The way every individual effort runs into structural barriers. The way working harder doesn’t fix what’s broken when what’s broken is the foundation itself.

Invisibility. The healthcare workers of Indonesia carry this burden largely unseen. Patients see “doctor” and assume prestige. Administrators see “staff” and demand more productivity. The public sees “the system” and blames individual providers when outcomes are poor.

But who sees the man waking at dawn, already tired, knowing the resources won’t be there but the patients will be? Who witnesses the calculations he makes—which protocol to push for today, which battle to fight, which compromise to accept because you can’t fight everything at once?

Who sees that he’s been doing this for years, and the years have worn grooves into him?

The Particular Cruelty

There’s a particular cruelty in healthcare work that civilian life doesn’t prepare you for: The need never stops.

In other professions, you can finish something. Complete a project. Solve a problem. Feel, for a moment, done.

But in healthcare, especially in an under-resourced system, you’re never done. The patient you save today will have other problems tomorrow. The protocol you implement will need constant defending. The improvement you make will be eroded by the same forces that created the original problem.

Sisyphus pushing the boulder uphill, except the boulder is human suffering and the hill is systemic dysfunction.

And unlike Sisyphus, who at least had solitude, this man has witnesses. Patients looking at him with hope he knows he might not be able to fulfill. Families asking for more than the system can provide. Colleagues exhausted by the same battles, looking to each other for strength none of them have in surplus.

Every morning, the boulder is at the bottom of the hill again. And every morning, he begins pushing.

What He Said

When asked about good experiences, he said something simple that contained everything:

“Appreciation alone will suffice.”

Not a request for praise. Not fishing for compliments. But something more fundamental:

Just see this. Just acknowledge that this is hard. Don’t ask me to find silver linings or pretend there’s redemption in the grind. Just witness that I’m carrying this weight, and that witnessing is enough.

Because what happens when you ask someone to name their “good experiences” while they’re working in a broken system is this: You’re asking them to perform gratitude. To focus on positives. To reframe the difficulty as “challenging but rewarding.” To extract meaning from pain that might just be… pain.

But sometimes there isn’t a good experience. Sometimes the year was just:

• Surviving
• Persisting
• Not becoming numb
• Still caring despite the cost of caring
• Showing up despite knowing what’s waiting

And that has to be enough. Because it’s all there is.

The Morning

He wakes. Before dawn, usually, because there’s never enough time and starting early gives the illusion of control.

He knows what today holds:

• Patients who need more than he can provide
• Systems that resist improvement
• Resources that won’t stretch far enough
• Choices between inadequate options
• The grinding awareness that tomorrow will be the same

And he goes anyway.

Not because morning offers hope. But because morning offers patients. And patients need care. And he knows how to provide it, even when the system prevents him from providing it well.

This is what it means to be a certain kind of person: You can’t walk away from need just because meeting that need is destroying you.

The system knows this. It depends on this. It will extract everything he gives and demand more, will take his expertise and his effort and his care and offer back insufficient resources, inadequate support, relentless need.

And he knows this too. Knows it intimately. Has known it for years.

Still, he goes.

What Appreciation Means

Not inspiration. Not the motivational poster version of resilience. Not the narrative where suffering leads to growth and hardship builds character and the struggle is somehow worth it.

Just seeing.

Seeing that:

• This is hard in ways most people don’t understand
• The difficulty doesn’t end, it just cycles
• “Good experiences” might be genuinely rare—not because he’s negative but because the reality is grinding
• He keeps going despite that
• This costs him more than is visible
• He’s not asking for rescue, just recognition

Seeing that he’s a man trying to practice medicine in a system that often prevents good medicine. Trying to improve protocols that will be ignored. Trying to maintain standards in contexts that can’t support them. Trying to care for patients with resources that are always insufficient.

Seeing that he does this knowing all of it. Knowing the futility. Knowing tomorrow’s morning is already waiting. And choosing to show up anyway.

That’s what appreciation means in this context. Not admiration for an inspiring figure, but acknowledgment of a real person carrying a real weight in a reality that offers no relief, only the next morning and the next crisis and the next patient who deserves better than the system can provide.

The Truth He Lives With

When the bad news was over, the next morning was still there waiting.

This sentence contains his entire year. His entire career, perhaps. The way crisis doesn’t create space for recovery—it just makes room for the next crisis. The way solving one problem reveals ten more. The way improvement in one area gets undermined by deterioration in another.

The medical version of treading water—you’re not drowning, but you’re not swimming anywhere either. You’re just staying afloat, day after day, knowing the water won’t get shallower and your arms won’t get stronger.

And people will ask him about good experiences. About what keeps him going. About how he finds meaning in the work.

And the honest answer—the one he gave—is this:

I don’t need meaning. I don’t need good experiences. I just need someone to see that this is hard and that I’m still here. Appreciation alone will suffice.

Not appreciation for being heroic. Appreciation for being human while doing work that tries to make you less than human.

For still feeling the weight instead of becoming numb to it. For still caring when caring hurts. For still trying when trying often fails. For still showing up when every morning brings more of what yesterday couldn’t resolve.

What Remains

He will wake tomorrow. He knows this. Knows what’s waiting—insufficient resources, systemic failures, patients who need more than can be provided, morning arriving like clockwork with its burden of need.

He will go to work anyway.

Not because it will get better. It probably won’t, not without changes far beyond his control.

Not because today will be the day things finally work. It won’t be.

Not because he’s found some redemptive meaning in the suffering. Maybe there is none.

He will go because patients still need care. Because someone has to try. Because walking away isn’t actually an option when you’re the kind of person who became a doctor in the first place.

And at the end of the day, when someone asks him how it went, he might say “fine” because what else can you say? The truth is too heavy to carry into casual conversation. The reality is too grinding to explain to someone who hasn’t lived it.

But somewhere, maybe in the quiet hour between work and sleep, he knows this truth:

The work is relentless. The system is broken. The bad news cycles endlessly. And he keeps showing up anyway.

Not because it’s noble. Not because it’s rewarding. Not because there are good experiences to collect and display.

Because it’s what he does. Because it’s who he is. Because the morning comes and patients need care and he’s still here.

And if someone truly sees that—truly witnesses the weight without trying to lighten it, acknowledges the difficulty without trying to reframe it, recognizes the persistence without romanticizing it—

That appreciation alone will suffice.

It has to. Because it’s all there is.

And tomorrow morning is already waiting.