Category:

Expatriate doctors are deserting the Maldives because of poor facilities and uncertainty over their pay, according to a doctor working at Indira Gandhi Memorial Hospital (IGMH).

“We’ve lost five expat doctors in the internal medicine department in the last four months,” said Dr Ibrahim Shiham. “Only one has been replaced, and from an island so not a new recruit.”

Foreign medical staff are vital to the country’s health services and comprise 85 per cent of the country’s doctors, according to Shiham, most of whom come from India with some from Nepal and Pakistan.

Many are showing reluctance to renew their contracts, Shiham claimed, because the latest round of cuts to government salaries have added to the uncertainty that followed the efforts to standardise civil servant renumeration in January.
“What actually happened was a lot of pay scales were streamlined, and doctors’ basic salary, including allowances, was ultimately down 30 to 40 per cent. So what [the government] did was invent another allowance to take it to the original break-even level. But the extra allowance has no legal standing, and in theory doctor’s salaries got a major decrease.”

With their salaries “propped up and not in the rulebook”, many expatriate doctors “started talking about leaving and looking for other opportunities,” according to Shiham.

“People who’ve been working [in IGMH] for 14-15 years have begun leaving in the last four months,” he added, when their contracts come up for renewal – something he says was rare in the past. “They realised that once they sign the contract there’s not much they can do [if the allowance is withdrawn].”

Deputy Director of the Health Ministry, Abdul Samad Abdul Rahman, said three specialists and six medical officers had left the Maldives in the last two months, and that replacements were declining offers because of the lower wages. CEO of IGMH, Zubair Mohamed, meanwhile told daily newspapers Haveeru that departures from the hospital were a “normal occurrence” and that “doctors are always leaving because their contract has expired.”

Because of its reliance on expatriates staff, particularly from India, the Maldives is also competing with the burgeoning Indian medical sector to attract staff.

“Even in Indian government hospitals, which have to compete with the private sector, a medical officer in Delhi undergoing training would get 52,000 Indian rupees, around 16,000 -17,000 Rf,” Shiham said.

Moreover, Male in particular was proving an unattractive destination for foreign staff because of high living costs and the need to leave families behind. The lack of facilities was also professionally unsatisfying, a particular issue for attracting senior staff, he explained.

“Here [at IGMH] I am only able to do 30-40 per cent of what I am trained to do because of a lack of facilities – out on an island, maybe five percent. Even equipment for kidney biopsies or needle for taking bone marrow samples. Doctors’ skills are underutilised and referrals overseas are common practice.”

Impact

The loss of medical staff is placing pressure on those who remain and affecting the amount of time doctors have to see patients, Shiham said.

The rule is we see four patients an hour, 15 minutes for each,” he said. “If we start seeing a patient every 5-6 minutes, then the patient is not being seen properly, even if he might be happy he’s seen a doctor. The level of documentation will also go down, and that will later attract a lot of litigation. The patient loses, the doctor loses and the system loses.”

Appointments were starting to being made through contacts, a situation Shiham describes as “embarrassing.” The pressure to thin the growing queues of patients was also leading to staff being recalled from other critical roles.

“I cannot stomach it when a medical officer is pulled off ICU (intensive care) to see a few more flu patients just because people are starting to shout outside. We don’t have a doctor on duty 24/7 in our critical care unit,” he said.

Likes(0)Dislikes(0)

The president’s office has said it will reassess article 14 of the Child Sex Abuse (Special Provisions) Act, which some have argued could provide a means of evasion for paedophiles.

The long overdue Act categorises child sex offences for the first time in the Maldives and contains harsh sentences of up to 25 years for those convicted.

But under article 14, if an adult is legally married to a child under Islamic sharia, none of the offences specified in the Act will be considered a crime. 

Although the Act was ratified earlier this month, the contentious article has elicited a strong reaction from NGOs and children’s rights activists for potentially providing a loophole for child sexual abuse.

President’s Office Press Secretary Mohamed Zuhair said today the government would reconsider the article as the Maldives was signatory to international treaties such as the Convention on the Rights of the Child (CRC). 

“It’s a concern for us and the government will work to revise it and overturn it,” said Zuhair.

Loophole

Although MPs did not deliberate the contentious article during the parliamentary debate on the bill, it was brought to public attention on Thursday by Mansoor Ali, Unicef representative to the Maldives, and Vice President Dr Mohamed Waheed.

“MPs like everyone are scared to approach any subject to do with religion and refute anything to do with religion,” explained Zuhair.

At an event to mark World Day for Prevention of Child Abuse, the vice president said he hoped article 14 would be re-examined. “If someone tried to take advantage of a loophole in the law to do this, it’s an even bigger crime,” he said.

Mansoor told Minivan News today that during his speech on Thursday, he appealed both to the government and to MPs to review the article, which he believed was in conflict with the CRC.

“I am not trying to challenge religion. My concern is that this goes against the spirit and content of the CRC,” he said.

He added the legislation should be linked to the Family Act, under which child marriage is admissible.

While the national age of marriage is 18 in the Maldives, as a Muslim country, girls below this age can marry with parental and state consent.

Child marriage

For many who Minivan News spoke to today regarding article 14, child marriage was the larger issue at stake. For the president, said Zuhair, child marriage was a matter of great concern.

Former Attorney General Azima Shukoor said she supported Unicef’s appeal for the article to be re-evaluated although not necessarily deleted.  
Azima said the chief judge of the family court had recently expressed concern about young girls being taken out of the Maldives for marriages which were not recognised inside the country.

“How can a 12 or 13-year-old give consent to being married? My concern is that it defeats a lot of the purpose of the bill,” she said.

In July, four local NGOs made recommendations to a parliamentary committee reviewing the bill.

In their recommendations, Maldivian Detainee Network, Rights for All, Madulu and Transparency Maldives, called for the removal of article 14.

The NGOs said that as consent for sex was required even within a marriage, any kind of non-consensual “touching” of a child should be considered an offence under the Act.

Family Act

But, MP for Kulhudhufushi South Mohamed Nasheed, who submitted the bill, told Minivan News today, that legislation could not “encroach into a lawful marriage”.

As underage marriages are permitted, “child marriage cannot be put under a child sexual abuse bill,” he said, adding that there was no legislation for marital rape in the Maldives.

Nasheed said that it would be necessary to find out the number of underage marriages and how many of them were to children below the age of 16.

“If it’s a serious concern and we realise there are people marrying young children for a short time for a certain purpose, then we have to revise the Family Act,” said Nasheed.

In agreement was Mohamed Shaheem Ali Saeed, state minister for Islamic affairs, who said article 14 was not in conflict with the law.

While the ministry would strive to combat child abuse, he said, underage marriage was legal in the Maldives.

“The principle in Islam is that the child has to mature physically and sexually and there has to be the financial means to look after the family,” said Shaheem.

Likes(0)Dislikes(0)