Category: Society & Culture

Badminton Association blocks female champion from training after losing court battle

Maldives’ female badminton champion Neela Ahmed Najeeb has alleged the Badmintion Association is refusing to allow her to train with the national team despite a court order to reinstate her membership.

The 25 year-old athlete, who holds a string of championship medals and has competed in several international competitions, was suspended from playing almost two years ago after clashing with her Indonesian coach, whom she said had attempted to make her run for four hours as punishment for missing a training session – something she was physically unable to do at the time.

“The Association unfairly and quite harshly terminated Neela without establishing adequate cause and without giving Neela the opportunity to defend herself,” Najeeb’s lawyer Mizna Shareef told Minivan News after the case was filed.

After three hearings Shareef claimed “the Badminton Association has stalled the case by appearing in court without having prepared their statements.”

The judgement, she said, would be a landmark case in encouraging more female  players to play sport at a professional level, “without fear of discrimination and unfair treatment.”

Prior to her termination, Najeeb had been selected to travel to Greece in June last year for a youth training session conducted by the International Olympic Committee (IOC), however this was scuttled by her dismissal as endorsement from the Association was required.

The Civil Court last month overturned the Association’s termination of Najeeb, ruling that it was against the Association’s own regulations, and ordered her reinstatement within seven days.

The Badminton Association gave her membership for the time she had missed, but she claimed it was now refusing to allow her to train with the national team “as there is no women’s pool.”

“I’ve been training with the guys for eight years and there’s been no other female in the national team. Now they’ve said I can’t start training because there is no women’s pool,” Najeeb said. “The Maldives International Challenge is coming up in June and I need to train in order to participate. But I have to be a man to practice.”

Najeeb said she had sought help from the Ministry of Human Resources and Sports, “but the Ministry said it was not able to help as the decision was up to the association.”

Other players were also facing situations where their athletic careers were being blocked by a lack of support from the Badminton Association, Najeeb said.

“There are players who have sponsors but are losing opportunities to compete outside the country because they are not receiving support from the association.”

A former female badminton player who played the sport for 25 years prior to suffering a ligament injury told Minivan News that the Badminton Association was obligated to provide female players a chance to play “even if there is only one of them.”

“If there are not enough female players for a pool they still have to be given a chance to play,” she claimed, adding that males and females had trained together in the Maldives for a long time.

President of the Badminton Association Ali Ameer said the association had followed the court order to the letter, “and has no further comment.”

Minister of Human Resources and Sports Hassan Latheef told Minivan News that it would be inappropriate for him to comment until he had informed himself on the case, but said he would do so.

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Assault victim dies

Ahmed Mirza, 25, who was assaulted last Monday with an iron bars in Villingili after he allegedly made comments concerning a girl, died early this morning in Indira Gandi Memorial Hospital (IGMH).

Mirza was declared brain-dead after doctors at the IGMH examined him and was kept on life support according to the family’s wishes.

Yesterday Mirza’s sister said that doctors had said they had no hope that he would survive the severe injuries to his head.

Police arrested five persons in connection with the case.

Mirza was attacked last Monday night while he was sitting in a park in Villingili.

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14 death sentences issued in the past 10 years: Criminal Court

The Criminal Court has said that 14 death sentences have been passed in the last decade, however many of those convicted and given the sentence have been rearrested and brought before judges on different cases.

The court said that a total of 9197 persons had been given sentences for various crimes within the past 10 years – approximately three percent of the Maldives’ population.

2950 persons of the total 9197 convicted were banished, while 798 persons were placed under house arrest and 5435 persons were imprisoned, said the Criminal Court.

However, the court said many of the convicts who are supposed to be serving their time were brought before the judges accused of committing further offenses.

Meanwhile, the parliament has commenced its preliminary debate on the amendment presented by Jumhoory Party (JP) MP Ibrahim Muthalib to the Clemency Act, which requires death penalties to be implemented if the Supreme Court upholds a death sentence issued by a lower court or of the Supreme Court itself issues a death sentence.

If the amendment is passed the President will not have the authority to grant clemency for those who are found guilty of any offense that serves a death penalty.

The amendment was originally presented by Maldivian Democratic Party (MDP) MP Ibrahim Rasheed, who withdrew it claiming that he would resubmit it after bills relating to evidence and penal code were passed.

Parliamentary Group Leader of MDP ‘Reeko’ Moosa Manik has now presented the Criminal Justice Procedure Bill, which parliament has accepted and is awaiting preliminary debate.

As MPs present bills to try and control rising gang violence, early this morning a 25 year-old victim died in hospital after an assault two days ago that left him in a coma.

Another youth, Ahusan Basheer, 21, was stabbed to death last month on a busy street in Male. Ibrahim Shahum, 20, who was released by the court after being held in pre-trial detention for six months in connection with another murder case, was arrested along with two others. An under-aged girl, who reportedly witnessed the crime, was also arrested and kept in pre-trial detention.

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JSC denies arbitrary dismissal of magistrate, blames affair

The Judicial Service Commission (JSC) has told the Civil Court it removed the former Chief Magistrate of Thinadhoo in Gaafu Dhaalu Atoll, Ahmed Shareef, from the bench because of a previous conviction for having an affair.

In court for the third time this year facing allegations of unconstitutional behaviour, the JSC defended its decision to remove Shareef from the bench in August 2010 by providing the court with a detailed account of Shareef’s previous conviction dating back over a decade.

According to the records, Shareef was sentenced to two months under house arrest on July 30 2001, for having an affair. Shareef and the other person had been engaged in a “connection of love” prior to the case being brought to court in 1998, the records state.

The Criminal Court, which handled the case, was in possession of a photograph taken in Shareef’s house where the pair were alone on a bed. The sentencing judge said the court had determined the image depicted a sexual offence. Initial documents submitted to the court by the JSC to the labelled the other party in the affair as male, however the JSC has since claimed the party was female and that this was a typo.

As Shareef was a first time offender the judge suspended Shareef’s sentence for a period of three years. Which means, Shareef has argued, he did not fail the moral standards required of a judge by the Constitution as was wrongfully determined by the JSC.

Shareef is also alleging that there were a total of 37 judges, including himself, with previous convictions. The JSC removed only six of them from the bench, meaning that there are still 31 individuals with criminal convictions on the judiciary’s benches across the country.

In the Civil Court yesterday Shareef’s lawyer Ahmed Zaheen Adam said he is seeking from the JSC a list of all the judges currently on the bench who have criminal convictions to their name.

He also wants the JSC to furnish to the court details of the said convictions as well as the manner in which the JSC considered details of the offences prior to making the decision to allow them to remain on the bench.

According to papers filed by Shareef, the convicted offenders on the bench were – or are – involved in offences relating to misconduct, fraud, bribery and other crimes.

Shareef wants the JSC to explain the criteria it used to determine who should go and who should stay on the bench in what was intended to be the biggest clean-up in the history of the judiciary last August, required by the 2008 Constitution.

Shareef is alleging that the JSC did not, in fact, have a standardised and pre-determined methodology for deciding which judges were qualified to stay on the bench.

Similar to the allegations made recently against the JSC by two failed applicants to the High Court bench, Shareef has accused the JSC of allowing personal opinion and interest to influence its decisions regarding the fate of members of the judiciary.

Shareef alleges that the JSC paid scant regard to the Constitution or statutory law in dismissing him.

The Judges Act, he has argued, states that a member of the judiciary will be seen as failing to meet the required ethical and moral standards if they had served a sentence for a criminal offence in the seven years previous to his appointment.

Shareef’s conviction was 11 years old when he was removed from the bench on August 5, 2010, and his sentence had been suspended.

The Judges Act was being debated in the Majlis at the time of Shareef’s removal, and was passed five days later, on 10 August 2010.

The 2008 Constitution created and mandated the JSC with bringing the judiciary in line with its new standards designed to meet the values ascribed to by a functioning democracy within two years of the Constitution coming into affect. The deadline expired on 7 August 2010.

Had the passage of the Act taken less time in the Majlis, the JSC would have been in possession of detailed guidelines on if, how and when a member of the judiciary can be removed from the bench, the court heard.

Shareef alleges the JSC deliberately decided not to wait for the legislation to be passed by the Majlis and, in fact, expedited the dismissals to suit members’ own personal opinions and interests.

“Speaker of the Parliament Abdulla Shahid is a member of the JSC, and so is Dr Afraasheem Ali, another MP. How can the JSC in all honesty tell this court that it was unaware of the contents of the impending legislation?” Shareef’s lawyer Zaheen asked.

“It is a shame if lawmakers do not know the contents of their own laws,” Zaneen said.

The JSC pointed out that the Judges Act post-dates its decision to remove Shareef from the bench and argued that it cannot be expected to rely on legislation that did not exist. Nor can it be expected, it said, to pay heed to impending legislation.

Shareef is asking the court to reinstate him on the bench and to order the JSC to reimburse his “full salary and privileges” from August 2010 till now. He is also claiming to have suffered great emotional and financial distress as a result of the dismissal and is also seeking compensation for psychological damages.

The case will resume at the Civil Court within the next 10 days, on a date yet to be confirmed.

Correction: Documents provided by the JSC to the court mistakenly labelled the other party in the affair for which Magistrate Shareef was convicted as another male. The  party was female and the JSC has since claimed this was a typo. Minivan has corrected the error for this story.

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Villingili assault victim on life support after gang attack causes serious head injury

A 25 year-old man who suffered severe head injuries in an assault by a gang in Villingili two days ago has been declared brain-dead and is currently on life support at Indira Gandi Memorial Hospital (IGMH).

Police Sub-Inspector Ahmed Shiyam said that police had received a report that the man had died, however this was not confirmed by the hospital.

”We can’t confirm whether he is dead, we have not yet received any official document yet,” Shiyam said, adding that five men had been arrested in connection with the attack.

IGMH Spokesperson Zeenath Ali told Minivan News that the victim’s condition was critical and that no progress had been observed since he was admitted to IGMH.

”The attack caused a very serious head injury,” she said. ”He is currently in a coma and on life support.”

Several media outlets have identified the person as Ahmed Mirza from the island of Maalhendhoo in Noonu Atoll.

Mirza, who works in a shop in Male’, was attacked on Monday night and rendered unconscious by his attackers. He was attacked while he was sitting in a park in Villingili.

Police have suggested the attack involved a gang, while Minivan News has received unsubstantiated reports that the assault was prompted following comments made about a girl.

A family member of the victim told local newspaper Haveeru that doctors had lost hope that Mizra would survive.

“He’s still on life support, hospitalised in the ICU because of the family’s request”, she told the paper. ”It’s like he’s gone, only with a pulse.”

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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]

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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.

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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

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Maldives grapples with difficult dengue outbreak

The Maldives is battling a growing epidemic of dengue fever which is believed to have contributed to the deaths of at least five people this year.

More than 300 cases were reported in the first two months of 2011, compared with 737 cases and two fatalities reported last year. Many cases have been reported in Male’, although most of the fatalities have been islanders. One patient died during transit to Indira Gandhi Memorial Hospital (IGMH), and the more serious cases have disproportionately affected children.

Dr Ahmed Jamsheed, who until recently headed the Centre for Community Health and Disease Control (CCHDC), observed that 2011 had seen higher instances of dengue shock syndrome, where the mosquito-borne parasite causes blood pressure to drop so low that organs cannot function.

“Our initial theory was that this was a new strain of dengue,” he said. “There are four different strains, and strains one and three have been most prevalent. We took samples and sent them abroad but I had left the office by the time the results came back. I’m told out of the samples we sent a few tested positive for dengue one, which means no new strain.”

Instead of a new strain, Dr Jamsheed suggested that the growing number of dengue fatalities could be related to lapses in managing the disease, due to the high turnover of foreign doctors “particularly on the islands.”

“Usually dengue management in the Maldives is quite good, but new doctors are not very well orientated for dealing with dengue, and cases are being referred to Male’ quite late. It would be hard to say for sure at this point unless we did a case-by-case audit, to see where we’re going wrong,” he added.

IGMH Registrar Dr Fathimath Nadia noted that at least two of the fatalities this year involved children, “although these were quite complicated cases.”

Nadia said that health services had previously printed and issue a handbook on managing dengue to every incoming doctor and conducted briefings of incoming doctors, but was not sure if this was still carried out.

The CCHDC and the Maldives National Defence Force (MNDF) in February this year conducted spraying of mosquito breeding sites in Male’ and the surrounding islands, but reported difficulty obtaining access to residential and construction sites.

Minivan News also understands that a international mosquito expert brought in to exterminate breeding habitats at a resort had last month pinpointed the source of Male’s mosquito-breeding to pools of stagnant water in building sites across the city. However she was also reportedly unable to obtain the required permission to inspect the properties.

“The boom in the construction industry has created a huge number of mosquito breeding grounds,” Dr Jamsheed explained. “In Male’ when the Council gives planning permission it requires management of mosquito breeding grounds, but have so far failed to enforce it or conduct inspections. My experience in Male’ was that when our teams visited construction sites there was often nobody at the site to communicate with in Dhivehi or English.”

While the teams might be contact with the construction company responsible for the building, often those working at the site were employed under layers of subcontracting which made it difficult to place responsibility, he added.

Private and community rainwater tanks were also prime breeding grounds, he said, a particular problem on many islands.

“IGMH has a large underground water tank and we even found that full of mosquitoes,” he said. “They had not taken measures to make it airtight, although I think it’s been corrected now.”

Malaysia, which has had nearly 50,000 cases of dengue reported already this year, is currently working with France pharmaceutical company Sanofi-Aventis to develop a vaccine. The country has also launched a nationwide campaign to encourage people to destroy breeding grounds on their private property.

Early symptoms of dengue include fever, joint paint and a distinctive rash and headache, although it can be difficult to distinguish from the milder Chikungunya disease which can last for up to five days. However even healthy adults can be left immobile by dengue for several weeks while the disease runs its course.

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