A nine-month-old baby boy was able to have a life saving heart surgery after his family created a Facebook appeal for donations to fly him to India for treatment.
Akiyal’s father Farhan, an engineer from the Maldives, decided to make a Facebook page after the family was unable to able to get any funding in Maldives for the operation, reported the Deccan Chronicle.
After launching the Facebook campaign back in July 2013, and undergoing three open heart operations, Farhan has announced that Akiyal has now recovered and they will be returning to the Maldives in a few days.
Akiyal was born with a rare heart condition known as double outlet right ventricle (DORV), a condition in which the blood vessel that carries oxygen-rich blood from the heart, is located in the wrong place.
“It was a complex surgery in the sense that the child was born with one side of the heart not developed, undeveloped left pumping chamber and a large hole in the heart along with a blockage of the artery going to the lung. He required a complex repair job, which wasn’t being done in the Maldives,” says the child’s doctor, Adil Sadiq, Head Cardiothoracic Surgeon at Sakra World Hospital in Karnataka.
Farhan told the Deccan Chronicle, “It was not possible to get funds in the Maldives, so my family and I decided to go online and ask for help from the social media. We went ahead with creating a Facebook page for our son.”
“We promoted the page by paying five dollars, which implied that 20,000 Facebook users would see the page,” says Farhan.
“The money that we used to promote the page time and again was less than 100 dollars, but we were able to raise Rs 8 lakh over the course of the year,” adds Farhan.
According to the article, the Facebook page received donations from anonymous altruists in Sri Lanka, Belgium, Maldives and Bangalore.
An abandoned baby girl who was discovered inside a bag at a residence in Maafanu, Malé, has been pronounced dead today.
The baby was discovered at midnight last night, police told Minivan News, estimating that the she had been left inside the bag since yesterday.
Police then took the baby to Indira Gandhi Memorial Hospital (IGMH), where the child was pronounced dead at 1pm today. Local media have reported the incident to have been infanticide.
The mother of the baby has not yet been taken into custody, added police, who declined to give any other information about the mother and father of the child.
Local newspaper Haveeru has reported family members as saying that the cause of death was suffocation.
Sources from the family, who had not been aware of the pregnancy, were also reported to have said the 18-year-old had given birth alone in the bathroom of her residence on Friday.
“From her stomach, or her actions, we were not aware that she was pregnant. However we previously questioned her about her not getting her menstruation periods,” a family member told the paper.
“She replied then that her periods are irregular, and that it is the norm to have three or four month delays. She was agile and often climbed up the stairs to the third floor with bottles of water and things quite easily. However, it raised suspicions that on Friday she was often clutching her belly,” the family source continued.
The family member said that people in the household had questioned her out of concern on Friday as she was bleeding profusely. The girl, however, refused to admit anything was wrong though the family eventually took her to hospital.
“She didn’t admit to anything even after she was taken into hospital on Friday. However, doctors kept questioning her about her marital status,” a young female member of the girl’s family told Haveeru.
“Then yesterday she confessed that she gave birth alone and flushed the baby down the toilet. The people of this house were sleepless with fright when today she said she gave birth and put the baby into a suitcase in the room.”
Family reported the matter to police after the girl’s confession. The mother is still hospitalised.
The family is said to have expressed regret about the incident, stating that they would have taken care of the infant if the girl had confessed rather than resorting to infanticide.
Issues regarding a lack of support services for women with unwanted pregnancies in the Maldives have been well-documented in the past.
The report identified, “clear indicators of the imperative need to provide access to information on sexual reproductive health and reproductive health services to the sexually active adolescents and youth population.”
Infanticide also appears to be increasing, as demonstrated by media reports cited in the study, which included several new born babies and few premature babies abandoned in parks, buried in secluded places, or thrown into the sea.
“These are clear indications for the need of life skills programmes and reproductive health education,” the study suggested. “Access and utilisation of contraceptives to avoid unwanted pregnancies must also be advocated to minimise these issues.”
The High Court has today (March 20) ruled in support of the Family Court decision to return the five month old baby of Ahmed Sharuan and Tanja Sharuan to the mother.
Details of the case revealed in an online petition launched by the mother claim that she was being accused by Sharuan of attempting to raise the child as a non-Muslim, despite having converted to Islam.
The High Court previously released a temporary injunction halting the Family Court order until the appeal case submitted to the superior court by Sharuan reached completion.
Police – having previously launched a search for Sharuan – ceased the investigation following the High Court order.
Speaking to Minivan News on Thursday afternoon, Tanja expressed joy at having received custody of her child.
“I am very happy about the High Court’s decision. I have always had faith in the Maldivian law. As a Muslim mother, I am more than happy to have my baby back in my arms,” Tanja said.
She further expressed gratitude for the “wonderful support given from [her] Maldivian friends”.
Three days ahead of Thursday’s court hearing, Tanja launched an Aavaaz petition seeking support in her case to gain custody of her child.
“My daughter is only five months old and she was abducted by her father from our then home in Zurich and he ran away with her to the Maldives. I am German but now in the Maldives and have submitted a case to the Family Court,” read the petition.
“The Family Court on Monday issued an injunction to my husband Ahmed Sharuan to hand over the baby to me within 24 hours, by 3pm Tuesday 11th February 2014.”
“However, he refused to obey this court order and went into hiding for several days. Whilst in hiding, he arranged a lawyer and submitted an appeal to the High Court to cancel the Family Court injunction. The High Court on Sunday 16th March, suspended the injunction of the Family Court without even hearing my side of the story and without a hearing,” it continued.
“I need all your support to achieve justice in this case. I am hoping that the Maldives justice system will deliver a fair judgement and give me the custody of my child according to the law,” concluded the petition, which has received over 600 signatures at the time of press.
Police have launched an investigation into an incident that occurred in Vilimale’ where a one month baby was found dead.
“Police were informed of the death of a baby and we are investigating the case,” a police media official told Minivan News, before declining to provide further information.
However, the official did say that police were not investigating the murder of a baby, as reported by some media outlets, but was investigating the death of a baby in Vilimale’.
Speaking to Minivan News today Director of Vilimale’ health centre, Ahmed Zahir, said that the dead body was brought to the health centre at 2:20pm yesterday.
“It was a female and one month old,” he said. “The baby was bleeding from her nose and mouth when it was brought to the health centre.”
He said the baby was then taken to Male’ after examining at the health centre.
“The baby’s mother and father was arrested as far as I am concerned,’’ he said, adding that he did not have further information on the incident.
According to local media, the incident occurred yesterday (24 March 2013) in Vilimale’, the fifth ward of Male’ city.
People who had witnessed the baby being carried to the health centre have told local newspapers that the baby was bleeding from the nose and mouth and that parts of the infant’s body were swollen in blue colour.
The papers reported that the mother of the baby had told the neighbours that the baby died after she accidentally crushed it under her body.
Sun Online quoted a member of mother’s family as saying that they knew about the incident when the baby’s mother told them the baby was dead yesterday afternoon.
The family also told the paper that the baby’s body was very hard when they touched it before it was taken to the health centre.
They also told the paper that the family members overheard the couple arguing the night before.
According to the paper, the baby was the couple’s first child and both the mother and father have previous drug related offences recorded with the police.
The corpse of a premature baby boy was discovered in Vilimale’ in May 2011, concealed inside a Coast Milk tin.
At the time police arrested a 30 year-old woman from Noonu Atoll who was the suspected mother of the baby, and a 24 year-old woman from Kaafu Atoll who was alleged to have assisted her deliver the baby prematurely.
The parents of a baby girl born with an usually large black birthmark across her face are seeking donations for surgery to remove the scar.
The baby’s parents are from the island of Meedhoo in Dhaalu Atoll in the Maldives.
The father of the baby said doctors had advised him to go abroad to seek further medical assistance as there was little they could do to help in the Maldives.
“Doctors advised me to go for a plastic surgery,” wrote Ahmed Shareef on Facebook, posting a picture of his newborn.
“But plastic surgery is not available here in Maldives. And it costs a huge amount. Please help me in anyway you can if it is possible. Even I will appreciate your good prayers too,” he adds.
The picture has gone viral across Maldivian social media since it was posted on Thursday, and has been shared by over 5000 users. The local community – both online and offline – are rallying to raise money to help the girl.
Speaking to Minivan News on Sunday, Shareef said he had been in touch with doctors from abroad who had given a preliminary diagnosis of Congenital Nevomelanocytic Nevus (CNN).
A nevus – the medical term for a birthmark – larger than 20 centimetres in diameter only occurs once in every half a million newborns. This is the first such case reported in Maldives, which has a population of around 350,000 people.
The scar went undetected during ultra sound scans throughout the pregnancy, Shareef explained.
Although the scar is believed to be benign, there is risk of it further spreading across the baby’s face and causing complications as serious as cancer, according to the family.
“There is a chance of the scar spreading. Or even it may become cancerous. So most of the doctors are saying go for surgery,” Shareef explained.
The young couple, who also have a four-year old son, say they are extremely worried about their daughter’s future.
“Just imagine how can a girl will live here with that. Think about her future,” he said. “The only way I can help my baby is to take her abroad, consult a specialist and do the surgery. But my wife and I cannot afford the travel and costs of the treatment. Please help me,” he begged.
Shareef is a primary school teacher while his wife is a clerk at the island council office, earning less than US$800 a month between them.
Shareef said his wife also had a heart condition requiring prescriptions and regular check ups.
“Despite all this, my wife is very strong. I am doing everything I can to help my wife and daughter,” Shareef said, thanking the public for its generous support so far.
While Shareef is struggling to raise money, little support is available from the state as the national health insurance scheme does not cover expenses for plastic surgery.
The Maldives has a culture of families and friends helping to raise funds for medical treatment to save loved ones, increasingly through social media.
Recently, a young woman launched a search for a Maldivian donor for her husband whose kidneys had both failed. She recently announced that two matching donors had been found.
Similarly, parents of a child born with cleft lip and palate ran a successful campaign called “Help Lisa Smile”. The family raised money through T-shirt sales, in addition to generous donations, and the operation was successful.
A mother arrested this week after her baby was found abandoned on a pavement in Male’ has requested custody of the child, Police have said.
According to the Head of Family and Child Protection Hasssan Shifau, the mother of the abandoned baby is still in police custody. Authorities have added that any decision to hand over the child would be made by the Gender Ministry.
State Gender Minister Aishath Rameela told local media on Friday (December 28) that a decision on whether to grant custody of the child to the mother had yet to be made.
Rameela stated that the ministry would have to find out if the mother had suffered any physical or psychological trauma before she abandoned the infant.
“Either way we will hold the woman responsible for negligence. So for the time being we will not handover the baby to her,” Rameela said.
According to local newspaper Haveeru the child is to be taken to a children’s shelter in Villimale after being released from hospital.
A baby was discovered abandoned on the side of a road in the Maafannu Ward of Male’ early this morning, police have announced.
According to the Maldives Police Service, the child was discovered at 5:45am today on the pavement in front of a house called Release.
Local media has reported that the child, thought to be female, was discovered by a woman in the house after she had heard its cries. The baby was claimed to have been discovered placed on top of a plastic bag.
Authorities have confirmed that police officers were called to the scene early this morning before taking the child to Indira Gandi Memorial Hospital (IGMH) in the capital.
A police statement has said that the child was found to be in a healthy condition by doctors at IGMH. The Police Family and Child Protection Department is now investigating the case, while no arrests in connection with the incident have been made at present.
Earlier this month, a 26-year old male and 20-year old female were reportedly arrested in connection to the discovery of a five month-old foetus buried on a beach on the island of Maradhoo Feydhoo in Seenu Atoll.
Meanwhile in June, police recovered the body of a newborn infant buried in the outdoor shower of a house on Shaviyani Feydhoo island. The baby’s mother was identified as a 15-year old school student.
Over the last two years, three other newborns have been found dead in the country. Over the same period there has been two separate incidents where newborn children were discovered abandoned but alive.
Deputy head of police Serious and Organised Crime Department Inspector Abdulla Nawaz told media today that police had arrested a 30 year old woman from Noonu Atoll who was the suspected mother of the baby, and a 24 year old woman from Kaafu Atoll who was alleged to have assisted her deliver the baby prematurely.
Nawaz said that police were now examining the body of the 30 year old woman after she confessed to giving birth two days ago but was unable to tell police where the baby was.
The 24 year old had meanwhile confessed that she had assisted Shaira in delivering the baby prematurely, Nawaz said.
Abortion is illegal in the Maldives, although an unreleased 2007 by the International Planned Parenthood Foundation (IPPF) found the practice was believed to be widespread due to the social stigma faced by a woman bearing a child out of wedlock.
Cathy Waters is the new Chief Executive of Indira Gandhi Memorial Hospital (IGMH), the main hospital in the Maldives. She is one of three foreign medical experts brought out by the UK-based Friends of Maldives NGO and the Maldives High Commission to improve the country’s standard of medical treatment, alongside Medical Director Dr Rob Primhak and Nursing Director Liz Ambler.
JJ Robinson: How did your role at IGMH come about?
Cathy Waters: I’ve been on holiday to the Maldives many times, but it’s been a very different experience living and working here, compared to the sanitised version [of the country] you get at the resorts.
I knew nothing about Friends of Maldives – instead a friend of mine sent me an advert in the Health Services Journal, and said “This is the job for you.” I thought it was interesting, was interviewed in December and found myself out here very quickly, in February.
My background is 28 years working in the UK’s National Health Service (NHS), starting as a clinical nurse and working my way up. For the last 15 years I’ve been working in management, and the last eight as Chief Executive of a primary care trust, which commissions health care services.
I’ve had lot of exposure training and working in hospitals, as well as the broader healthcare system. I left the NHS three years ago and worked in a small management consultancy in the UK, which involved going into companies that were facing problems, and working with them to solve those and bring about change.
My last big contract involved working with big local authority in London than needed a transformational change. In reality it meant making significant savings – we had to make 80 people redundant.
JJR: What was your understanding and knowledge of what the position involved before you arrived?
CW: I understood that IGMH is one of five entities that comes under the umbrella of the Male’ Heath services Corporation (MHSC), IGMH being the largest entity, at about 90 percent.
I knew they needed to make significant changes to patient care, and the overall environment for patients. I knew IGMH needed change, which was part of attraction for me as it was somewhere I could utilise all the skills I had to bring about that change.
I also knew it was a hospital that people care passionately about. There’s a real sense that it belongs to the community and that we should be providing high quality services.
One of the things I noticed early on was that staff morale was very low, and people were unsure about what was happening with the organisation and had all sorts of concerns about the future. One of the things I did when I started was observe what going on and try to be very visible as a chief executive, spending time with the doctors and in the labour ward.
A new executive nurse director Liz Ambler is already here, and a Medical Director Dr Rob Primhak will be joining in July, so together we want to be able to demonstrate importance of management staff and clinical teams working closely together. We need to break down some of those barriers and reduce the divide between management and clinical services.
JJR: You arrived three months ago on the tail end of the collapse of the Apollo deal, a 15 year agreement signed in January 2010 with India’s Apollo Hospital Group to manage IGMH. What actually happened?
CW: I did read about Apollo. My understanding was that they wanted to bring about significant change but they wanted significant resources to do that, and that wasn’t an option. One of the things I’m very clear about is that we need to bring about significant change, but within the existing budget. That might involve reviewing everything we do as an organisation.
Unless we can find resources elsewhere we have to work within the budget we’ve got. That’s quite a challenge, because previously there may not have been the same budgetary controls [there are now]. We have to be careful how we utilise our very precious resources.
JJR: What parallels have there been so far with your earlier experience?
CW: Working in an organisation where there are significant financial challenges, and working in an organisation where patient needs are very clearly evident. The population is very vocal about what they want and need – some of that is about manging expectations.
One of the things I know we need address is that people can’t access doctors as quickly as they want. We need to increase outpatient appointments. At the same time there is no system of triage, or prioritisation of the emergency room, which we are now developing.
JJR: It’s true that many people claim the quickest way to get an appointment is to have the mobile number of a friendly doctor.
CW: We have a Maldivian ER consultant in training who is coming back to develop a triage system and ensure those patients who need to be urgently seen are seen straight away, or that those with minor ailments are seen by someone else, or not as quickly.
From what I understand there isn’t a word in Dhivehi that translates into ‘urgent’. We have quite a lot of work to do to make sure patients get to the right place at the right time.
One thing common to people working in the NHS and IGMH is that staff are passionate about what they do. We have to channel that in a positive way. We need to engage staff in decisions rather than it being a top-down management style.
This means helping them to be part of the decision making process, which can be difficult to get your head around. The key groups are patients and staff – happy patients mean staff are pleased they are doing a good job, equally, happy staff are more likely to perform well.
Sometimes it’s very simple stuff – such as saying ‘Thank you, well done.’ I don’t think that’s happened here very often. It doesn’t take a lot to say thank you.
The work that went into planning for mass causalities for the Friday of the recent protests was great. It was a really great example of working as a team and getting everything ready for an influx of casualties.
I recognised the hard work that had gone in so I made sure I came in on the Friday and was part of what was going on, so staff felt supported, and afterwards I wrote a thank you memo. Simple stuff like that makes people feel valued for what they are doing.
JJR: What have been some of the key cultural challenges?
CW: There is a very, very different work ethic to the UK. Some of the things I’ve found very different and very frustrating are about how people manage their time, and motivating people to work. That’s a huge issue.
Getting people to plan ahead and put processes together is challenging. One exciting project is expanding the intensive care unit – I said we need a proper process and justification of the expansion, a proper plan about how we are going to do this. For me there’s a discipline to this, but it’s not always the way things have been done.
Also different and very distinct to IGMH is the lack of use of email – staff still attempt to use memos. I’m trying to encourage the use of email, and encourage people to think ahead and write agendas for meetings.
JJR: On other side of the cultural question, what has been the reaction among staff to a foreigner coming in as a top-level manager?
CW: Inevitably there’s been a degree of suspicion at someone new coming in, at someone from the UK coming in and imposing their views. For me what has been important is how we work with people and lead. I firmly believe that how you lead is important – working with staff, rather than telling them what to do. You do need boundaries and parameters, but people need a sense of direction, and permission to do things themselves.
The other issue is that my contract is for a year with the possibility of extending to two years. Whatever I do, I will feel I’ve failed if I haven’t managed to find someone in IGMH to transfer leadership skills to, and leave a positive legacy. The worst thing would be for me to do would be to go back to the UK and for things to tumble down. That would be an absolute failure on my part.
JJR: How did these obstacles come across? Were there initial difficulties?
CW: People have been very accommodating and very welcoming. I’ve convinced people that they don’t need to stand up when I walk into the room, which was very traditional, and I don’t expect people to call me “ma’am”. People generally been very welcoming. There’s been a few challenges with language barriers, although this has proved less of a problem than I thought it would be. I have very good support in meetings- I might do an overhead presentation, and it is translated into Dhivehi. Unfortunately I’m failing miserably at learn Dhivehi words. Generally people have been helpful and make sure I’m involved in what’s going on.
JJR: What are some of the unique characteristics of the Maldivian hospital-going public?
CW: They are very demanding, and very quick to blame the doctors if things go wrong. Inevitably in a hospital things go wrong, by the very nature of the work we do. And because IGMH is the country’s main hospital, we inevitably get the more complicated and high-risk cases. People are quick to be cutting.
Equally the general public should demand good care, and rightly get that care.
We need to work to enhance communication. One of the things I’ve noticed that is quite different from UK is that different departments still work in silos. We’re trying to break down these silos and get people to work across the organisation.
JJR: There has previously been conflict and misunderstandings between Maldivian doctors and foreign doctors working at the hospital, amid the cultural challenges of having a high turnover of foreign medical staff. Is this something you have observed?
CW: It fascinating that the hospitial talks about ‘Maldivian doctors’ and ‘foreign doctors’ as though they are completely different. Part of the problem I think for the Maldivian doctors who are very dedicated and are here for the duration is that they don’t get some of the benefits expatriate doctors get, such as support with their accommodation. Inevitably that brings some degree of conflict.
Expat doctors are also here for a short time, and I’m making a huge generalisation, but the commitment of some of them may not be as high as that of the Maldivian doctors. Some of that is the sort of contract we have for expatriate doctors, and that needs to be reviewed. Some of the expatriate doctors see IGMH as a staging post to get broader experience and go off to somewhere else, which must be quite annoying for the Maldivian doctors.
We’re trying to move to a position where as much of the workforce as possible is Maldivian, but inevitably that takes time.
JJR: What about the training of local staff, such as nurses?
CW: We have a good relationship with the Faculty of Health, and more Maldivian nurses are coming back into the system. Liz [Ambler] is very keen on in-service training to make sure we are training effectively, and Dr Rob [Primhak]’s background is in education so I’m sure he’ll be keen to ensure high standards of education and training when he starts in July. It’s an area we’re developing.
JJR: How have you found living in Male’?
CW: We’ve settled in well. My husband is semi-retired; he used to be a director of Mental Health Services. He’s made a decision not to work at the moment – he’s a diver and he’s doing his diver master training and really enjoying it.
One of my worries at the hospital is that we haven’t got the facilities to care for patients at the acute stages of mental health problems, and we haven’t necessarily got the right staff.
JJR: What do you think of the relationship the hospital has with the community, and what did the outcry over the widely reported ‘baby decapitation’ incident tell you about that relationship (the head of a deceased newborn had to be surgically removed during labour after its shoulders became stuck during delivery, endangering the mother).
CW: I had only been here a few weeks when that happened. Without going into the details, what surprised me was how quickly quite confidential details about the patient and the case were spreading like wildfire across Male’.
Understandably there was a lot of anger and concern, and fear generated. One of the key learning points for IGMH was how we need to handle that more effectively with the media – we didn’t handle that very well at all. It’s in the hands of lawyers now – it was a tragic and very unfortunate case, and a very emotive situation. From the hospital’s perspective we did all the necessary investigations that we needed to do.
JJR: Does it come back to this recurring mistrust of doctors?
CW: That’s one of the things I’ve picked up on – there is this mistrust. We still have to rebuild that, because we have some fantastic doctors and clinical staff in IGMH, and inevitably when we have high profile cases like that it creates more damage for the medical profession, which bore the brunt of that incident. We need to be more proactive about how we talk about some of the great things that happen in the hospital.
I’m not sure Male’ is ready for it, but I’d like to start a patient involvement group – a number of people from the community who work with us to improve what we do in the hospital. We do that a lot in the UK, but I’m not sure people here would be interested in doing that yet. It does help people understand the challenges we face as an organisation on a daily basis.
The President has appointed an envoy to work with the hospital. He has already brought through some significant changes in terms of the environment. It’s looking much better when people come in, and the outpatient area is now air-conditioned.
We need to focus on what we need to do to implement quality of care and improving access – there are hundreds of things need to do, but have to manage expectations.
One of the things we want to introduce is catering – at the moment patients’ relatives have to bring food in for them. That’s so different to the UK – nutrition is so important to a patient’s recovery. We want to try and introduce a catering service before the end of the year, so patients get a better service.
JJR: What are the hospital’s key strengths and weaknesses at the moment, aside from the shortage of mental health support you mentioned earlier?
CW: One area we do need to improve on is diagnostic capacity, and tools for helping diagnose. We are going to get a mammogram machine, which will have the facility to do biopsies, and we are going to get an MRI scanner which will improve diagnostics.
One of the key problems we have is access to equipment and medical consumables. We’ve put new processes and deals in place which will hopefully improve that, but I didn’t realise until I lived here that absolutely everything has to be imported. We are reliant on things coming in a timely way, and I don’t think that just affects us.
We also have a hospital kindly donated by the Indian government, but inevitably the building itself is in need of renovation. It was fit for purpose then but with the influx of people living in Male’ the need for services is huge. We have 500-600 patients a day, sometimes more, and the building is almost too small now. We have to look at how we take care of it and develop a more modern facility.
One of our big concerns in relation to the operating theatre is lack of anaesthetists. We have to pay a premium for them to come, as there’s international shortage. That’s a real problem for delivering key services.
Those are some of the key areas. We have a good team paediatricians, and a very busy but effective neonatal intensive care unit with 20 cots.
JJR: Is it difficult to attract people to come and live and work in the Maldives?
CW: I think it’s becoming more difficult now because of the dollar situation, and the cost of accommodation in Male’. The MHSC provides accommodation to doctors as part of their package, but nevertheless food prices and living expenses are going up.
A big problem is paying people in rufiya – the expats who come and work in the Maldives want to send part of their salary home but banks are struggling to enable them to send dollars. That seems to be a very major problem at the moment.
The big thing is making sure there is the right commitment from expatriates to stay and make a positive difference. There’s got to be some way of making the working conditions right for the Maldivian doctors as well. They are the life of the organisation, and we are dependent on making sure they don’t move elsewhere.
We are in the process of expanding inpatient facilities, and renovating the old staff quarters into more private facilities. We will have 56 beds finished in late summer, and we have also signed an agreement with the 11 storey building next to IGMH to provide 72 beds. This time next year we will have a significant increase in the number of beds, but that brings its own problems, such as where we are going to get staff. We’re trying to make sure there is joined-up thinking going on.