ADK doctors perform first successful surgery to remove brain tumour

Three Maldivian doctors at the private ADK hospital have successfully removed a brain tumour in the first time the surgical procedure was performed in the Maldives.

ADK managing director Ahmed Affal told local media yesterday that neurosurgeon Dr Ali Niyaf, and general surgeons Dr Abdulla Ubaid and Dr Ibrahim Moomin performed the surgery on July 4.

The patient was a 47-year-old Maldivian woman. She has since been released and is in good health, Affal said.

The patient did not suffer common side-effects such as speech impediment and facial paralysis, he noted.

The first successful removal of a brain tumour in the Maldives represents significant progress for the local health sector, Affal said.

The hospital is now equipped with facilities to perform neurosurgeries, he added, and will be performing similar procedures in the future.

Affal expressed concern with the government’s health insurance scheme ‘Aasandha’ not covering brain surgeries performed in the Maldives.

Aasandha, however, covers the costs of performing brain surgeries overseas, including travel expenses.


ADK Hospital to increases prices by 10 percent

Privately owned ADK Hospital is to increase services by ten percent starting on February 22, Haveeru has reported.

“We haven’t increased prices since the government health insurance policy Aasandha started. But the prices of the goods have increased. So we had to increase the prices of the services offered too,” ADK Managing Director Affal Mohamed told Haveeru.

The change in prices would not affect the coverage afforded by national health insurance scheme Aasandha, Affal said.

ADK has renewed contracts with Aasandha for the year, but newly introduced services including orthoscopic surgery and neurosurgery are not yet covered.

Affal said the hospital is currently in talks with the government to provide coverage for orthoscopic surgery and neurosurgery at the hospital.


Road race competitor dies after heatstroke

A doctor has died after suffering heatstroke during the annual Dhiraagu road race on Friday, reports local media.

Dr Abishek Singh, who worked at Malé’s private ADK Hospital, passed away yesterday (June 8 ) reports Haveeru.

The 8th road race – this year dedicated to raising awareness of child protection issues – involved either one or two circuits of the 5km route around the outskirts of the capital. It was not revealed which category Dr Singh was competing.

3000 runners were said to have registered for this year’s race.


Expat worker injured in fall

A Malaysian national, working on the construction of the new parliament building in Male’, has sustained head injuries after falling three stories, , local media has reported.

The safety near the first floor broke his fall. That’s why the injuries weren’t that serious. He suffered head injuries because it hit the metal pipe of the safety,” an official from the construction company involved told Haveeru.

The man, said to have fallen at 10am today is reported to be in a stable condition at ADK hospital.


Government pledges Aasandha health scheme “will not collapse”

The government remains committed to running the Aasandha universal health insurance programme initiated in January, claiming the scheme “will not collapse” despite the present economic difficulties facing the country.

State Health Minister Thoriq Ali Luthfee told Minivan News that there was “no cause for alarm” about the future of the scheme, following the revelation that it has yet to settle four months of unpaid premium charges it owes to cover medical treatments.

Aasandha is a public-private partnership with Allied Insurance. Under the agreement, Allied splits the scheme 60-40 with the government. The actual insurance premium will be paid by the government, while claims, billing and public awareness will be handled by the private partner.

Aasandha Managing Director Mohamed Shafaz has claimed that the government had failed to cover weekly premium payments as agreed under the Aasandha contract since March.  He alleged that while the scheme was continuing to run, the shortfall in state funding was creating some difficulties for service providers such as hospitals and pharmacies both in the Maldives and the wider South Asia region.

Thirty day target

Without detailing specifics, State Health Minister Luthfee said that the government was presently involved in consultations to clear outstanding bills. He added that a target of 30 days had been set to try and settle outstanding debts to creditors such as Aasandha’s management.

“The important factor is the scheme is continuing,” he said. “The country is going through a difficult time economically and ongoing consultations are currently taking place to clear our bills. We are trying to do this right now. The system is not going to collapse.”

Aasandha’s MD Shifaz said that several general meetings had been held with the government about the issue of back payments – charges he claimed were not contested by authorities.

“I’m not sure the reason for the delay, but the outstanding amounts have not been disputed. It appears they are having difficulty in making payments,” he said.

He did not reveal the exact amount of premium charges presently owed by the government.

When questioned on the impact that failure to pay debts might have on the scheme’s stability, Shafaz claimed that Aasandha’s future was directly tied to service providers such as hospitals and pharmacies, particularly smaller enterprises in the outer atolls.

“The difficulties right now are for the service providers. If they can accept the credits terms we are offering right now, then perhaps they can manage,” he said.

Shafaz said that pharmacies and medical centres on smaller islands were more likely to suffer as a result of failure to secure government payments for the scheme.  He added that certain hospitals in Sri Lanka and India also affiliated with Aasandha would need to cover expenses accrued under the universal health system.

Privatised concerns

Back in April, Parliament’s Finance Committee proposed ceasing the provision of universal health care in private hospitals, stating that the scheme would not be economically viable unless private hospitals were excluded.

The proposals were made in a report published by the committee, that recommended the Aasandha service only be made available at the state-run Indira Gandhi Memorial Hospital (IGMH) and other government health centres and corporations around the country.

Calls to limit Aassandha have so far proved divisive in the Majlis and the coalition government. Ahmed Thasmeen Ali, head of the government-aligned Dhivehi Rayyithunge Party (DRP), has previously been an outspoken critic of limiting the provision of universal healthcare at private premises.

Thasmeen told local media at the time that the amendments forwarded by the parliamentary Finance Committee were not the “right way to go” to bring about changes to the scheme, alleging they could undermine parliament’s role in holding the government to account in future, Haveeru reported.

He added that should amendments to the scheme need to be made, he did not want to see the cessation of free healthcare to the public.

Both Thasmeen and DRP Deputy Leader Ibrahim Shareef were not responding to calls by Minivan News at the time of press today.

The Aassandha service was initially intended to cover emergency treatment, including treatment overseas if not available locally, along with all inpatient and outpatient services, domestic emergency evacuation, medicine under prescription, and diagnostic and therapeutic services.

However, Aassandha Managing Director Shafaz said that consultations were set to take place over the possibility of amending the main contract signed between the government and the health scheme’s provider to include an extended number of private practices under the project.

He stressed that there remained “huge concern” at present that such an extension would actually serve to exacerbate the present shortfall in government payments.


Despite these extension talks, one private doctor not affiliated with Aasandha raised concerns that an apparent “deluge” of patients to IMGH and the private ADK hospital in Male’ were overburdening hospitals linked to the universal coverage scheme.

Conversely, the same doctor contended that large numbers of other health centres and laboratories had seen patient numbers plummet, endangering their long-term existence.

Dr Ahmed Razee, a former Director General of IGMH hospital presently serving as an internist with special interest in diabetes and kidney diseases across Male’ , alleged that under the current agreement, Aasandha had served to create a “grossly unfair monopoly”. Dr Razee added that the scheme had created an environment where even established practitioners were losing regular patients to an “inferior behemoth”.

“When ADK and IGMH pharmacies give you free drugs, why would go to any other pharmacy? I am afraid only Aasandha registered prescriptions are honoured,” he said. “These are available only at IGMH and ADK. Who will go any further – and pay also in the bargain – to another pharmacy?”

Dr Razee contended that when the scheme was launched during the administration of former President Mohamed Nasheed, government promises of a fair share of service provision for private health centres saw a number of enterprises – not just ADK – investing millions of rufiya in health provision.

“With the current monopoly that the government has created, these clinics, pharmacies and labs – representing over a thousand jobs – are going bankrupt,” he claimed. “The deluge of patients on ADK and IGMH is creating too much work for staff and is reducing standards and causing mistakes and making the waiting period entirely too long, and thus expensive, for people from the islands.”

Budgetary factors

Beyond the implications for healthcare, the Maldives has also come under increasing pressure from international organisations to make widescale cuts to state funding.

While recent Maldives’ Inland Revenue Authority (MIRA) figures for May showed national revenue had increased f 9.5 percent compared with the corresponding month in 2011, the figures were not substantial enough to shrink the present national budget deficit.

Governor of the MMA Dr Fazeel Najeeb recently stated that the Maldives was “in a dangerous economic situation never before seen in recent history.”

The International Monetary Fund (IMF) has expressed its concern over the country’s dire balance of payments situation which has been estimated by the Majlis’s Financial Committee to be 27 percent of GDP this year.

The 2012 budget was initially estimated to be around 9.7 percent of GDP, but in May was revealed to be much larger after significantly reduced expenditure and increased expenditure was taken into account.

Spending unaccounted for in the 2012 budget following the controversial change of government of February 7 has included the promotion of a third of the police force, lump sum payments to military personnel, Rf100 million (US$6.5 million) in fishing subsidies, reimbursement of Rf443 million (US$28.8 million) in civil servant salaries following cuts by the previous administration, the creation of two new ministries, and the hiring of international PR firms to counter negative publicity.

Former President Mohamed Nasheed had previously criticised President Waheed and his government for attempting to introduce fees for Aasandha, claiming the administration had squandered funds marked for development on the police and military.


Currency crisis may affect purchasing of medical supplies, hospitals confirm

Senior figures at Male’s two major hospitals have claimed the institutions could “run into difficulties” supplying certain medicines and services if the current currency crisis in the country continues, although stocks are currently sufficient.

Amidst a controversial government decision to devalue the rufiya against the US dollar in order to address the black market dealings for foreign money, businesses such as flight providers have also claimed to be facing difficulties in providing their services.

In this market place, ADK Hospital Managing Director Ahmed Afaal said that ADK Enterpises, the hospital’s parent company, had raised concerns about the availability of dollars to purchase certain medicines for its pharmacy operations.

“At the moment, the hospital has stock for our needs. Yet if we cannot get enough because of a lack of dollars we may run into difficulties in the future,” he said. “For the time being, we have enough medicines to treat patients, although some medicines may become difficult to find at our pharmacies.”

Cathy Waters, Chief Executive of Indira Gandhi Memorial Hospital (IGMH), agreed that concerns over the availability of dollars may hamper the hospital’s efforts to purchase medical goods and services in the short to medium-term, though she believed payment of the expatriate workers vital to running health centres was a greater problem at present.

“My biggest concern is how [this financial situation] may impact our ability to employ expatriate workers, as well as pay for certain goods,” she said. “We are particularly dependent on an expatriate workforce at the hospital and these workers are particularly aware of the dollar situation in the Maldives.”

According to Waters, expat staff had already raised concerns about difficulties they have experienced in sending dollars abroad to support their families – a key reason many initially accepted work in the Maldives.

Waters said she believed the hospital could also face ongoing problems in covering the costs of imported medicines and other services, despite supplies currently meeting needs.

Requests had been made to national health authorities to try to find ways to alleviate possible short-term and medium-term supply and payment issues, she added, although she said she had not yet been informed as to what measures might be taken.

The Ministry of Health was not responding to Minivan News at  time of press.

However Dr Jorge Mario Luna, World Health Organisation (WHO) representative to the Maldives, told Minivan News that at present there had not been any requests from health service providers in the country concerning possible procurement problems as a result of a shortage of US dollars.

Dr Luna said that the WHO itself did not procure drugs or treatments outside of public health medicines for certain illnesses like tuberculosis or filariasis, yet it was ready to assist health services if required.

“As of today, we have not received any request for emergency medicines due to a procurement problem,” he said. “In case we receive a request, we stand ready to assist.

The government has meanwhile claimed that fluctuations caused by the managed float of the rufiya will stabilise in three months as the market adjusts.


Private healthcare group contemplates Maldives’ cancer treatment limitations

HealthCare Global Enterprises (HCG), an Indian-based supplier of specialist cancer treatments, is in the Maldives this week to consult with authorities and private medical companies over possible partnerships to treat the disease, an area of medicine that health officials is limited locally.

Speaking today to Minivan News, Bhavani Shankar, head of international marketing for HCG, said the company was in the early stages of consulting private and public healthcare providers in the country, along with the operators of Male’s ADK hospital and Indira Gandhi Memorial Hospital (IMGH) over a number of potential opportunities for cancer treatment.

“Basically there is no cancer treatment here. Only a few facilities are there; medical oncology, chemotherapy and some small investigation procedures are available in the Maldives,” he claimed. “Most people are flying to India [for cancer treatment], about 600 to 750 people are doing this each year.”

Claiming to operate more than 18 specialist centres across India and South Asia either directly or through partnerships , Shankar said that the company was experienced in providing specialised surgeries and state of the art cancer treatments throughout the region.

“We have a variety of facilities and technologies such as the ‘CyberKnife’ robotic radio surgery, radiotherapy as well as offering other surgical procedures,” he said. “We can offer screening in the country before considering flying people out to India for treatment, which is the easiest option.”

In contemplating potential healthcare roles or business opportunities within the country, the HCG spokesperson said the company was keen to work with both private and public partners in terms of supplying technical knowhow or training for doctors and nurses alongside NGOs. Given the limitations of Maldivians in the country travelling abroad for health reasons due to income, Shankar said he believed that there were a number of treatment options it could make available for the population.

“We are focusing on both kinds of things [private and public cooperation], we are trying to help even the people who cannot afford treatments as well. We have different options actually, but this depends on what the hospitals and health bodies can manage,” he added. “We are open; whether the government is able to fund a small cancer care centre or through work with a private partner, we are looking for both [opportunities].”

At present, the Maldives’ State Minister for Health, Abdul Bari Abdulla, said that there was no budget in the country specifically for cancer prevention, with any possible funding being supplied under a wider national health act.

“The cancer programme we have is currently led by IGMH, but we don’t have the capacity for treatments or screening,” he said.

The State Health Minister claimed that the main challenge for the nation regarding cancer prevention related to a lack of technical expertise.

“Cancer treatment within the country requires state of the art techniques,” he said.

In considering strategies for trying to combat cancer within the Maldives, Bari said that health was one area that the government was looking into the possibilities of private and public partnerships and the potential benefits that may be available.

So-called ‘medical tourism’ to countries such as India and Singapore is very common in the Maldives among those able to afford it, and is major expense for many families unable to afford it but who do so anyway because of low confidence in local services for surgery and serious ailments.


ADK to offer mammography and digital x-ray services

Private hospital ADK in Male’ introduced mammography and digital x-ray services for the first time in the country, reports Haveeru.

The service was launched by former employee and Male’ MP Ahmed ‘X-ray’ Athif at a ceremony at the hospital yesterday.

According to CEO Ahmed Nashid, the new equipment cost about Rf10 million (US$778,210) and a foreign specialist has been brought in to operate the machines

While the hospital will charge a Rf600 fee for the service, it will be offered for free to the first 25 customers as part of an inaugural promotion.

Speaking at the ceremony, Managing Director Ahmed Afaal said that the use of digital x-rays will reduce the impact on the environment caused by the chemicals used to produce the films.

Statistics show an upward trend in the incidence of breast cancer in the Maldives.


New ADK hospital building to open next year

The new eight-storey ADK Hospital building will be operational next year.

According to Miadhu, construction work on the building is already complete.

The new hospital would have 43 private rooms and provide many services which is expected to ease the pressure on the only two hospitals in Male’.