Comment: It’s the economy stupid!

There is only one thing on everyone’s mind – the dollar-rufiyaa exchange rate. In a country that imports everything from salt to the accountants that run its businesses, it is no wonder that everyone from the construction worker to the Maldives’ answer to Donald Trump (I’ll leave you to guess whom) is trying their hand at being an economist with a specialty in foreign exchange.

Whether you agree with the politics of it or not, the devaluation was needed. If anything it should have come sooner. The Maldives has been growing its rufiyaa-based economy at break-neck speed. Salary rises across the board, increased government spending and ever increasing infrastructure projects have become the norm over the past decade. By and large this ‘growth’ in the domestic economy has been driven by the public sector (government policy & the civil service) and paid for by printing Maldivian rufiyaa and clever manoeuvres with T-Bills (which the government has used since 2009 to be able conveniently sidestep the charge of printing money). In simple terms: successive governments printed/created money to drive domestic economic growth.

What it didn’t manage to do was increase it’s dollar receipts at the same speed (actually all foreign currency, but I’ll use dollar interchangeably in this article). Yes growth in the tourism industry increased the dollar receipts but nearly not enough to fund the increase of rufiyaa in circulation. The previous government had a spade of one-off dollar incomes by selling resorts, but by neglecting to make sure that these so called developers had the capacity to develop the properties and provide the country with a constant source of dollars, they missed a trick. The consequence: an imbalance in the amount of dollars the country has the capacity of earning and the amount of rufiyaa it is printing/creating and spending. If you increase the supply of rufiyaa without the corresponding increase in dollar receipts, it is inevitable that Maldivian rufiyaa will be worth less. It is simple demand and supply.

So the question is, where to from here? By creating a ceiling at Rf15.42, the government has effectively stopped a steep depreciation in the currency and has minimised the crippling effects of a severe shock to the economy – and it should be praised for that. There is however a cost. This will erode purchasing power in the short term and will hit people’s pockets (albeit tempered by the fact that the dollar was already trading at around Rf 14 in the black market despite the best efforts of the authorities). As always, it is the common ‘Mohanma’ on the street who will bear the highest burden. Prices will inevitably creep up and the inflation will put pressure on wages. Any subsequent wage increases which will lead to further effective devaluations. Let us not sugar coat this – it will be painful.

What the government needs to do is to come up with a credible plan to redress this imbalance and reassure the people that the pain is worth it. There are two fundamental way of doing this: i) reducing the rufiyaa in circulation, or ii) increasing the dollar revenue the country earns. In my mind there is no doubt the answer lies in a fiscal solution to get the economy back on an even keel. The dollar crisis is simply a symptom of deeper economic woes – not the problem itself.

Reducing rufiyaa in circulation

The main levers of doing this are a) reduce government spending – reducing wages and cutting unfunded government projects and/or b) increasing rufiyaa-based taxes.

Reducing government spending is an essential plank of what needs to be done to rebalance the books. This is the path that the UK and the EU (driven by Germany) are already following, and all indications are that the US will announce similar austerity measures after its Quantitative Easing splurge. Cutting too quick and too deep may the tip the economy into recession and that would be very painful – but not doing anything is simply not an option. The consequences are even graver.

The government also needs to ensure that it adopts a progressive taxation system on rufiyaa-based incomes. We need to ensure that the rich share ‘equitably’ in the pain of rebalancing our books. Equitably here means that they pay a much higher proportion of the cleanup costs – in practice this should be a combination of no taxes for the low income earners, close to 50 percent taxes for the ultra high income earners and a corporation tax system which exempts small local businesses.

Increase the dollar revenue

The most appealing of all options as it means no painful cuts. The catch is that this is largely out of the government’s control, at least in the short term. The only two significant sources of dollar income are through fisheries and tourism – and there are challenges in growing both sectors. Investment in fisheries is long over due, but ultimately the sector does not have the scale to solve the problem in the short to medium term – it is simply too small today.

Tourism, the great gold rush of this generation, is a much bigger challenge. Government types tell wonderful stories of 20 percent equity returns and 60 resorts waiting to be developed. The simple truth is that this represents close to US$3 billion of investment in a country where the nominal GDP is around £1.5 billion – an improbability to put it mildly. It is simply not realistic to pin our hopes on some sort of tourism growth bonanza in the short term – we might as well play the Euro lottery every week if this is the only plan.

The long term rebalance

In the long term, the structural solutions are through growth of our industries that translate into real economic growth underpinned by increases in our foreign currency receipts. The government needs to:

  1. Foster an environment where real growth can be achieved for our innovative companies in the fisheries sector (the next Big Fish, Horizon et al), and also create opportunities for Maldivian corporations and SMEs in other sectors to grow into the world market. Investing in revenue growth is more important that building airports on every island. Real growth in the economy driven by the private sector is the road to prosperity – not government spending based on printing money and clever manoeuvres with T-Bills.
  2. Move now to ensure a quick solution to all the tourism development projects stopped because they were awarded to parties with no money or track record. It is bizarre that they have been allowed to hang on to ‘their’ assets without fulfilling their obligations by cajoling the government and the banks. Moratoriums on lease payments or debt repayments may look innocuous enough, but they rob the country of vital growth opportunities and hence ultimately rob the people. We should not stand for it.
  3. Implement an equitable progressive taxation system. It is not fair that the low income people pay the same taxes as the highest earning group – through the flat import duty this means that the poor actually pay a larger percentage of their income as tax than the rich. And it is criminal that the resort owners are sitting in parliament legislating that they should not pay their fair share of taxes on the very substantial amounts they earn. This is a clear conflict of interest and something that needs to be addressed at a national level. The constitutional stipulation that Majlis members shall not vote on issues in which they have a personal vested interest must become more than just a nice idea on paper. The 3 percent tourism GST is simply not equitable enough!

The country’s economic troubles require a bold government that can show leadership and is honest with the Maldivian people about the tough choices ahead. Equally it needs a responsible opposition which accepts the reality of the problem and challenges the government on the merits of its economic policies by proposing viable alternatives. For their trials and tribulations, the Maldivian people deserve it. Whether they are lucky enough to have either, only time will tell.

Ali Imraan is the Director of Structured Finance at the Royal Bank of Scotland. The views expressed here are his own personal views and opinions and do not represent those of the Royal Bank of Scotland and should not be construed to do so in any way, shape or form.

All comment pieces are the sole view of the author and do not reflect the editorial policy of Minivan News. If you would like to write an opinion piece, please send proposals to [email protected]

Likes(0)Dislikes(0)

Opposition protests over managed float of currency end peacefully

Rival factions of the Dhivehi Rayyithunge Party (DRP) yesterday held separate protests against the government’s decision to allow the rufiya to be traded at rates of up to Rf15.42.

The faction led by former President Maumoon Abdul Gayoom last night marched from the tsunami monument and down Ameenee Magu, a main street of Male’, together with the party’s former Deputy Leader Umar Naseer and MPs Ahmed Nihan, Ahmed Mahlouf, Ahmed Ilham and Gayoom’s spokesperson Ahmed ‘Mundhu’ Shareef.

Meanwhile, a much smaller protest led by DRP Deputy Leader Ali Waheed and several senior officials of the Dhivehi Qaumee Party (DQP) made its way down the main street of Majeedee Magu. DRP Leader Ahmed Thasmeen Ali was absent from the march.

Gayoom’s faction marched towards Muleeage’, the official residence of the President, with the intention of handing him a letter from the DRP. However they were obstructed by lines of police blocking streets in some places standing shoulder-to-shoulder. Instead, the marchers headed to police headquarters, where the police were given the letter to hand over to the President.

Both marches ended peacefully, aside from minor confrontations between police and DRP protesters on the route to Muleaage’.

Following a crackdown on the blackmarket trading of dollars at rates higher than the pegged rate of Rf12.85, which was hovering around 14.2, the government on Sunday declared a ‘managed float’ of the currency within a 20 percent band.

Many companies dealing in dollar commodities immediately raised their exchange rates to Rf 15.42, along with the Bank of Maldives. The Bank of Ceylon was selling dollars at 14.5 yesterday, while Habib bank was selling at 13.75. HSBC was selling at 15.4.

The International Monetary Fund (IMF), which has been critical of the government’s growing expenditure despite a large budget deficit, praised Sunday’s decision as a step towards a mature and sustainable economy.

“Today’s bold step by the authorities represents an important move toward restoring external sustainability,” the IMF said in a statement. “IMF staff support this decision made by the authorities. We remain in close contact and are ready to offer any technical assistance that they may request.”

The government’s move, while broadly unpopular, acknowledges the devaluation of the rufiya in the wake of increased expenditure and its inability to overcome the political obstacles inherent in reducing spending on the country’s bloated civil service.

However the Maldives relies almost entirely on imported goods and fuel, and many ordinary citizens will be harshly affected by short-term spike in prices of up to 20 percent as the rufiya settles.

“We do not really know, based on the breadth of the domestic economy, what the value of the Maldivian rufiyaa is right now,” Economic Development Minister Mahmoud Razee admitted at a press conference on Monday.

Likes(0)Dislikes(0)

UN security council favours anti-piracy court formation

The UN security council has pushed for the formation of international courts and prisons – as well as new laws to support their formation – in an effort to combat piracy that has spread from the coast of Somalia to regions like the Indian Ocean, according to news reports.

Agence France-Presse (AFP) has reported that the security council has this week approved a resolution forwarded by Russian delegates to try and curb huge levels of international piracy stemming from Somalia.

Fears have risen during the last year that the territorial waters of Indian Ocean nations like the Maldives could become a realistic target for pirates.

Security officials like the Maldivian National Defense Force (MNDF) last month claimed that there had been no recorded attacks by Somali pirates on vessels in the country’s territorial waters.

However, the AFP reported that the passing of UN security council resolution 1976 has led delegates to praise the initiative as a step towards installing a specialised anti-piracy court.

UN Secretary General Ban Ki-moon was also called upon by the council to prepare recommendations over the next few months on establishing a court system to focus on suspected acts of piracy.

Likes(0)Dislikes(0)

Police celebrate 78th Anniversary

Police last night held a special function at Dharubaaruge to mark its 78th Anniversary.

President Mohamed Nasheed, Commissioner of Police Ahmed Faseeh and ministers were present at the special function.

Commissioner Faseeh pledged to control the gang violence in the Maldives if concerned authorities cooperated with the police.

Expressing concern at the number of juveniles involving in crimes, Faseeh called on parents to cooperate more with police in reforming the juveniles committing crimes.

President Nasheed also addressed the people at the function.

Nasheed urged businessman not to reject teenagers from employment for having a criminal record on their police report.

Instead he called on businessmen to give them the opportunity to work “for the sake of the nation.”

He also said that he did not wish to have “even a single Maldivian behind the bars.”

Likes(0)Dislikes(0)

Man in a critical condition after assault with metal bar in Villingili

A man is undergoing treatment at the Indira Gandi Memorial Hospital (IGMH) after he was assaulted and suffered a deep head injury, reports Haveeru.

According to Haveeru, attackers used metal bars and such other objects to assault him.

Police have arrested two men in connection with the case, according to Haveeru.

Likes(0)Dislikes(0)

Ferry prices of Villingili and Hulhumale’ rises

The MTCC has announced that its ferry prices will be increased next month, reported SunFM.

SunFM reported that the Villingili ferry will cost Rf5 per ticket and Hulhumale’ ferry will cost Rf8 per ticket, starting from the 15th of next month.

Currently Villingili feryy costs Rf3 per ticket and Hulhumale’ ferry Rf5 per ticket.

Likes(0)Dislikes(0)

DRP factions plan concurrent protest marches against managed float of rufiya

Rival factions of the main opposition Dhivehi Rayyithunge Party (DRP) have announced concurrent protest marches in Male’ tonight to demonstrate against the government’s decision to allow the rufiya to be traded within 20 percent of the pegged rate of Rf12.85 to the dollar.

Mohamed Hussein Shareef “Mundhu”, spokesman for former President Maumoon Abdul Gayoom, told press yesterday that the ‘Gayoom faction’ will choose a different route to DRP Leader Ahmed Thasmeen Ali’s faction to avoid possible clashes. The largest opposition party has been engulfed in factional strife following its dismissal of Deputy Leader Umar Naseer.

The march will begin at the tsunami memorial area at 9:00pm, “and we are consulting with police to determine the roads we’ll take,” Mundhu said.

At a rally last night to launch “DRP’s Main Office” near the artificial beach, dismissed Deputy Leader Umar Naseer echoed Mundhu’s appeal earlier in the day for opposition supporters not to join Thasmeen faction’s march.

Both Mundhu and Umar dismissed the rival faction’s planned protest as “a walk by Thasmeen’s family.”

Mundhu further claimed that Thasmeen had refused to authorise DRP protests in the past.

Unlike previous protests, said Umar, tonight’s “peaceful march” would not involve gathering outside presidential residence Muleeage or the Maldives National Defence Force (MNDF) headquarters, both restricted areas under freedom of assembly regulations and which have previously resulted in violent clashes between authorities and opposition supporters.

Rival rallies

Addressing supporters at last night’s rally, Umar accused the DRP Leader of splitting the party, claiming that DRP members were behind former President Gayoom and calling on “everyone working with Thasmeen to get behind Zaeem [Maumoon].”

If DRP members shun activities planned by the Thasmeen faction, Umar said that support for the embattled leader would “wither away.”

Deputy Leader Ilham Ahmed argued that if the party’s presidential candidate for 2013 had been chosen through a primary during the DRP’s third congress in March 2010 the current split could have been avoided.

“If it had been done through a primary we wouldn’t have this dissatisfaction among us,” said the Gemanafushi MP. “Therefore, I would say, even if some people are unhappy, we will have a primary. God willing, we will do that before too long.”

Vowing to “cut them down to size,” Ilham alleged that senior DRP members were “making secret deals with the government.”

Thasmeen and his allies should be “ashamed” to talk about the dollar shortage, said Ilham, as a deal had been stuck to raise the value of the dollar “inside [Speaker] Abdulla Shahid’s chambers” when the 2011 budget was passed.

Thasmeen faction’s concurrent rally was announced at press conference yesterday by Deputy Leader Ali Waheed.

While Gayoom factions members have been boycotting its meetings, the DRP Council reportedly passed a resolution last night to require the party’s secretariat approval before using the DRP logo or official seal.

However a defiant Ilham has since told local media that the council did not have the authority to ban a practice not explicitly forbidden in the party charter.

“I am a Deputy Leader elected by ordinary members of the party,” he said. “There is nothing in the party’s charter that says a Deputy Leader can’t use the party’s logo and seal.”

Likes(0)Dislikes(0)

Mahlouf submits resolution to delay parliament’s recess until critical bills are passed

Dhivehi Rayyithunge Party (DRP) MP Ahmed Mahlouf has submitted a resolution to the parliament to delay its recess until parliament concludes the Criminal Justice Procedure Bill, Evidence Bill, Parole Bill, Amendment to Children’s Act, Amendment to Gang Violence Act and Crime Prevention Bill.

Mahlouf told Minivan News that he presented the resolution in the hope that MPs will hasten their work and put more effort to pass those bills as soon as possible.

”The crimes occurring in the Maldives are now a very big concern for the citizens and they have expectations from the parliament,” Mahlouf said. ”I think the parliament should pass these bills before going to recess, which will play an important role to curb the gang violence and crime at the same time.”

The parliament is scheduled to go on recess on the first of next month, he said.

In parliament today Maldivian Democratic Party (MDP) Parliamentary Group leader MP ‘Reeko’ Moosa Manik presented the Criminal Justice Procedure Bill to the parliament.

The bill consisting of 229 articles and was drafted well, said Mahlouf.

”Although there might be some amendments that should be brought, I think the parliament should shorten the preliminary debate and pass it,” he said. ”Such bills often get politicised, but these are bills that need to be passed soon.”

He added that he fully supported any bills presented to the parliament if it will benefit the citizens, regardless of whether they were submitted by MDP.

Mahlouf recently resubmitted a resolution cutting a controversial Rf 20,000 committee allowance for MPs, which had originally been submitted by MDP Chairperson and MP Mariya Ahmed Didi. Mariya was forced to withdraw the amendment after the MDP Parliamentary Group voted that she do so.

Likes(0)Dislikes(0)

The price of healthcare in the south

A team of retired Royal Air Force personnel are trying to raise money to help a small community in the Indian Ocean gain access to the vital healthcare they need to subsist. Inspired by this group’s determination to help this impoverished community in the Maldives – a land oft-associated with luxury – Donna Richardson travelled to the Addu region to uncover the real state of medical care on an island that used to enjoy free, first class medical care while the island was a Cold War staging post.

Because of its geography, it is easy to cover up the poverty-stricken side of the Maldives’s inhabited islands. The Maldives is seen as a luxury holiday resort destination, but in fact there is hardly a place where the contrasts between rich and poor are so pronounced. While millionaires sup their cocktails, the indigenous peoples barely scrape by on a dollar a day and many are priced out of the most basic medical care because of the rising cost of health.

The RAF have long left Addu Atoll (‘RAF Gan‘) in the Maldives where they were stationed during the 1970s, but for some servicemen such as Richard Houlston and Larry Dodds, Addu has remained close to his heart. Upon returning to the island during a memorial visit last March, he saw first hand how locals are suffering and denied access to even the most basic of medical care. He decided to see how he can help a community which he loves dearly. Along with a former colleague Phillip Small, they have been trying to establish a Gan Medical Fund to help to raise awareness of the issues the island faces, provide medical equipment, and eventually if there is enough funding when it takes off, to train the future generation of doctors.

When British Forces left the region, the hospital as well as the expertise and knowledge also vanished (allegedly the equipment all moved to Male), and with the establishment of a dictatorial government regime, Addu stepped ten steps back in terms of their medical facilities.

Based in the south of the country, Hithadhoo Regional Hospital (HRH) is the main public provincial health care facility providing curative public health services and is the only government hospital in the province. The hospital is located in the capital of the south atoll, in the furthest corner of Addu Atoll, and covers seven districts over two atolls. It serves 50,000 patients, including the inhabited islands of Hulhumeedhu and Fuvahmulah, but has only 50 beds.

Lack of funding, limited expertise and treatment for only those who can afford it – this is the picture of government health in Addu, but things are improving, according to the new director of the recently-formed Southern Healthcare Corporation Hussein Rasheed.

“The biggest challenges are most of all the lack of equipment, then patient load, then the quality of doctors, but we are changing things,” Hussein Rasheed said.

Now run under the 100 percent government-shared trust, the hospital also hopes to leverage revenue from the new national health insurance schemes to cover its costs and to help raise vital cash for the departments.

For some years now medical facilities for those living in Addu Atoll and its far-flung neighbour, Fuvahmulah, in Nyaviyani Atoll have been overstretched and in short supply. Many of the problems are hereditary. The aging 26-year-old hospital building is a relic of the Gayoom regime. It is in bad shape, with crumbling walls, unstable voltage, barely enough beds and no air-conditioning. Post operative patients swelter in temperatures akin to a sauna and the hospital is in desperate need of improvement. There are plans to build a new 100-bed hospital with a government loan and charity funding, but it will take a year to secure the funding and then to find a site.

Due to its previous funding constraints, HRH is currently understaffed and runs more like a general surgery practice found in most developed countries. Although it does have practically all the departments required to make it a hospital, most areas are understaffed and in need of vital equipment from donors and charities. As a public hospital it is appealing to charities and non governmental organisations to help it to serve its community and restore public confidence in its services.

At present there is still not enough basic equipment for the hospital to function. It was not even able to provide basic X-rays at the time we visited. Since the last one blew up due to faulty voltage in the building, a new X-ray machine was purchased but has stood in a box because of the risk of damaging the new equipment.

While HRH does have basic outpatient clinics including dental, ear nose and throat (ENT), gynecology, internal medicine, ophthalmology, orthopedics, paediatrics, reproductive health, diagnostics imaging services, and ultrasound scanning and physiotherapy services, there are not enough specialists to staff these departments or the right equipment to provide full services under these remits.

Previously most equipment was donated by NGOs and charities such as World Health Organisation, United Nations Children’s Fund, JICA and the Japanese as well as the Chinese and Australian governments. They have pledged to continue to work with the Ministry of Health and Family to procure equipment.

But the hospital urgently needs a CT scanner, MRI machine and incubators plus vital surgical instruments such a chest stapler and cannulas for performing tracheotomies. Each and every department needs more equipment.

Two rusty ambulances sit grounded on the parking lot. All gifted by various NGOs and nations, these vehicles need parts which are unavailable in the Maldives. One is a Japanese vehicle donated by the Japan Council of International Schools (JCIS) which requires expensive parts, and the other is a converted minibus with the seats relaxed to make room for stretchers.

Two more vehicles sit rusting in the garage. While these are in better shape they need parts and technicians to service them. The only functioning ambulance is an old ‘green goddess’ type vehicle gifted by the Australian government, which is used infrequently.

The Casualty and Accident and Emergency unit has just two beds. A serious road traffic victim was brought here just last week had to be transported to Male’ by Maldivian Air Taxi at his own cost. In cases such as this, if there are no seats, or medical insurance does not cover the patient, they simply cannot receive the vital care they need. It becomes a ‘pay and display’ system of healthcare.

Even the labour suite is ill-equipped for delivering babies. One small baby was fighting for his life in intensive care at the time of visiting. The infant’s parents said they could not afford the transportation to give birth in Male‘. The hospital urgently needs an incubator and does not even have a paediatric ventilator to aid distressed infants.

While the hospital does have an operating theatre with one operating room there are no specialist surgeons to perform vital operations and just two general surgeons.

Collectively this means that the hospital is unable to function to full capacity and the public is losing confidence in the medical care available in the atoll. While there is a surgical theatre, there are only two qualified general surgeons whose knowledge extends only to hernias and small operations.

These conditions and the need for basic equipment are urgent issues and the hospital is appealing for outside help and funding to solve these shortages.

A question of confidence

Another challenge the hospital faces isthe need to restore public confidence in its services. Facing huge waiting lists, patients with serious health conditions opt to travel to Male’ or India for treatment if they can afford it, and the hospital stays stuck in a rut. Yet these ‘health tourists’ face great perils amidst cases of organ trafficking and alleged substandard treatment in southern India.

A young girl from Hithadhoo told us how her family were forced to sell their car and personal possessions to pay for her mother to go to India for a leg operation. Her brother also has eye problems and needs to attend regular eye clinics, which the hospital does not yet have, although there are plans to introduce under the Madhana health scheme.

“My mother suffers from arthritis and rheumatism and needed to go to India for treatment,” she said.

“She was very ill and needed treatment and we have lost faith in the hospital here in Hithadhoo so we decided to go to India where the treatment is better value for money.”

Travelling for medical treatments is a costly business. Patients must pay for the airfare, accommodation and treatment, but people believe that the care they receive overseas is better and so the cycle of health tourism continues.

One of the ways that Hithadhoo Regional Hospital wants to counter this health tourism is to introduce ‘telemedicine’, whereby customers can be confident that their results will be seen by qualified medical specialists from around the world, and also to introduce visiting surgeons and hold specialist surgery days.

Rasheed admitted: “People are not happy with the level of care. Right now we don’t meet the basic requirements so many people decide to go to Male’ for treatment and when they don’t see any difference in services, they go to India.”

He warned of the dangers of travelling abroad to India for treatment. The practice of medical tourism there is not regulated and patients organise the travel plans themselves.

“While there are many good quality doctors in India, there are also huge problems with cheating in India, particularly in the south,” he said. “Someone recently went to India for surgery and ended up having a kidney removed. Health tourism is a very risky business,” he added.

Another patient told how his father in-law has been regularly travelling to India to receive palliative care for lung cancer. Put simply, there is no care of this type available in the Maldives.

Until now talk of cancer has been taboo, although cancer and heart disease are some of the biggest killers in the Maldives. But with no oncology or cardio department, or even an ECG machine, many people are forced to travel farther afield to receive treatment. In the past, limited information has been available about preventative measures so many people die earlier than they should.

There is no palliative care in the islands and only limited care for cancer patients even in Male’, and no facilities to perform open heart surgery or brain surgery.

Rasheed himself is interested in studying more about cancer and its causes to help to inspire health promotion campaigns and attract more doctors to the region.

In its favour, HRH does have an ISO-certified laboratory which is fairly advanced and offers some patient services including intensive care units and neonatal intensive care departments.

The hospital is also working on its health promotion,  including child immunisation and growth monitoring, vector control, food hygiene and sanitation, disease surveillances and epidemic control, family planning, sexual transmitted disease clinic and turboculosis and leprosy control.

The hospitals’ three-year plan includes building a new hospital within a year, improving services in all areas, focusing on preventative health and education and introducing exchange programmes for doctors to visit the hospital and to partner with the private hospital in the region.

Rasheed said he has removed some of the ‘dead wood’ and de-motivated staff from HRH and replaced them with more high-energy staff. He hopes to turn the hospital’s reputation around in three years.

“When I took over the hospital here, we inherited a bad system, de-motivated staff and dated equipment,” he said. “In the past the doctors here were neglecting the needs of the patients. They knew they could do operations, but they were so de-motivated that they decided they could not do it and on many occasions we sent patients away,” he revealed.

These conditions and the need for basic equipment are urgent issues and the hospital is appealing for outside help and funding to solve these shortages.

There is also a need to distribute medicines for psychiatric patients, improving antenatal care and introducing an electronic record keeping system. At present patients with mental health issues are being released into the community without proper care and attention.

In addition, some elderly patients who have been abandoned by their families have taken up residence in the hospital.

However, things are starting to improve at the hospital after a change of management. Over the last three months since taking over the hospital trust, Rasheed has been making major strategic changes. In part this is due to a government reorganisation, which has placed all Maldivian hospitals under a new structure – which will operate more like a business, taking fees and charges from patients covered by the health insurance system.

“In the last couple of months we have managed to improve the level of confidence – for example, allocated a special day for general surgery where we have seen a couple of hernia patients, and we have been getting some good feedback. News spreads through word of mouth here,” he added.

With a limited budget to hire qualified doctors, the hospital is considering hiring visiting practitioners and surgeons. They are also appealing for the humanitarian services of voluntary, retired or semi-retired surgeons and specialist doctors to spend some time at the hospital in exchange for free accommodation, air fare and a share of commission from the profits gained from the operations they perform.

In the last month, the hospital hired a new Maldivian surgeon, a former classmate of Rasheed, who has performed basic operations. Just the other week they performed two hernia operations and feedback from the local community has been quite positive, according to Rasheed.

The two surgeons, Dr Fuammi Moustaffa and Abdulla Adsa, admitted that they were limited to small cases because of lack of equipment. Their remit includes appendicitis, hernia operations, cyst and gall bladder removal.
“We want to do more, but we don’t have the equipment or the specialists to perform other operations,” admitted Dr Moustaffa.

In January, the Israeli Eyes from Zion charity visited the hospital and removed cataracts from patients. There are plans for more visiting practitioners over the next few months.

Due to increasing demand for tertiary services in the provinces, with more funding it is planned to develop a specialised service centre for trauma treatment and the development of their service portfolio, as well as to improve provision of quality health care services.

The areas that they want to focus on include advanced diagnostic services such as MRI, telemedicine and treatment of kidney/renal conditions (including dialysis services) and establishing a provincial Emergency Medical Service (EMS) to international standards.

The hospital needs full time paramedics, fully-fledged ambulances, development of intensive care services and the development of a provincial medical emergency coordination centre.

Meanwhile, there is a private hospital called IDMC (run by the Simdi group) aimed at paying customers and those under the Madhana health scheme, such as civil servants. This hospital, run by Mariyam Shakeela, a former Hithadhoo resident, aims to provide first class medical care, but also requires more doctors to propel it to national standards. The hospital is currently campaigning to become an NGO called the Hawwa Trust to help alleviate some of HRH’s problems.

Eventually, once the basics are in place, Addu wants to develop medical tourism to attract patients to the Maldives. But for now this ambitious plan is limited until they come up to scratch on the other areas which are seriously lacking.

Donna Richardson is a freelance travel writer based in the Maldives.

For more information on Hithadhoo Regional Hospital visit www.shsc.com.mv

Likes(0)Dislikes(0)