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 “They realised that once they sign the contract there’s not much they can do [if the allowance is withdrawn].”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.
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