Comment: The price of an expat life in the Maldives

As a Bangladeshi colleague was wheeled into the operating theatre of Indira Gandhi Memorial Hospital for emergency life-saving treatment, I knew where my thoughts should have been.

We seek to assure ourselves that even in a cynical commercial world, you cannot put a price on life. Is such a phrase anything more than sound logic for those in the privileged position to afford the finest Singaporean inpatient treatment, or the insurance to cover hundreds of thousands of dollars of emergency medical evacuation to tax-payer funded Western healthcare?

Life after all is precious. Yet all too often, the true value of precious things is rarely understood until it, or in this case they, are threatened or lost.

The introduction of the complex and troublesome Aasandha universal health insurance program this year by the government of former President Mohamed Nasheed, so far retained by President Dr Mohamed Waheed Hassan, has started a new era in Maldives healthcare.

Maldivians can now obtain treatment and surgery in their own country without relying on the vastness of their own wealth or savings, the kindness of friends, or the mercy of elected politicians and wealthy resort tycoons.

While the execution of such a system should always be open to scrutiny, there is much to be admired in the concept of ensuring every person in the country will be cared for when at their weakest.

But what of the country’s immigrant population? How are an ever-growing group of people in the Maldives – mainly in the form of unskilled workers from Bangladesh trafficked into the country – to be cared for?

For many of the foreign workers who make up a third of the country’s population, and are expected in coming years to equal the number of indigenous employees, the price of life can be counted down to the very last laari.

This is no more apparent when insurance companies can only reimburse treatments for foreign workers that have already been paid for – no matter the level of upfront expense.

What happens when companies or employers, whether out of negligence or limited finances, are unable to bare the initial costs needed for a life saving operation?

Who is there to purchase and provide these patients with the medicines and saline drips from for hospital staff to administer? In the absence of close friends and family, where is the assistance in journeying to a hospital toilet and what alternate options does a low-income expatriate have? In short, who is there to care?

The concern was born – not altogether altruistically – whilst spending Tuesday night sleeping on the floor of a post-operation ward at Indira Gandhi Memorial Hospital (IGMH) in Male’, in case a signature or saline drip was required.

Thankfully, he is well.

Barring “unexpected complications”, he will recover, as will the company’s finances once it is reimbursed from the employee’s insurance policy – only a recent mandatory requirement for obtaining a visa for foreign workers.

As a company representative, the initial costs for vital surgery, though not insignificant, can be reclaimed and more importantly, have to be met.

As an individual and friend, without the financial capabilities and resources of a company, the alternatives would otherwise be unthinkable.

A friend and room-mate of my colleague later explained that over half of his month’s wages were spent Tuesday morning on emergency medicines, scans and x-rays alone – all just to identify the scale of the problem – even before an operation. The price of life, I realise, is appallingly low for the wrong person.

In the wards, visiting hours are 24/7. Family members must maintain constant vigil over their bedridden loved-ones, taking full responsibility for everything from toilet assistance to buying and supplying hospital staff with needed medicines.

It is anyone’s guess how foreign workers – many of them far from home and family and unable to even afford the upfront deposit for treatment – are able to survive the system.

Ultimately my friend appears lucky. As the days pass, colleagues and acquaintances have, in either desperation or adversity, been transformed into an unusual though much appreciated surrogate family of makeshift nursing staff in the ward.

They have become well acquainted with pharmacies and their respective costs, and learned to recognise when saline solutions for drips are urgently in need of replacement. Some have even had to contemplate how best to preserve a friend’s dignity in toilet situations, that are not “always ideal” in maintaining a professional relationship.

Small blessings indeed.

Contemplating such a situation after days spent outside the operating theatres and waiting rooms of IGMH, perhaps there is much to be said for the hospital prayer room.

We are only human after all, but surely there are few times of feeling as completely powerless than when watching another person’s suffering.

Is it right then, that a person – regardless of skills or social standing – should amidst moments of extreme fear and anxiety have to pray for their economic, as well as physical well-being?

Surely some great deeds are not beyond human intervention.