Tag: Health

Comment: Dengue fever, a problem for everyone

Although the MNDF has been drafted in to help combat the problem of dengue fever that is affecting Male and several other atolls, it is important that people don’t stand back and think that this action alone will solve the problem.

Experience in many other countries has shown that a ‘top-down’ or vertical campaign against dengue fever is only part of the solution to preventing outbreaks of the virus from getting worse.

Most people know that dengue fever is spread by a mosquito that takes the blood of an infected person. The blood contains a virus that causes dengue fever and this is passed on to a new person when they are bitten in turn by the mosquito. The mosquito seems fine – but people infected by the virus may become very seriously ill and a small proportion may die.

Most action to prevent the spread of dengue fever is aimed at the mosquito itself. If the mosquitoes are stopped from breeding then the transmission of the dengue virus from person to person will be interrupted and no new cases will occur. Often the strategy against the mosquito relies on spraying chemicals and treating water storage containers. But without having fully integrated community involvement, this strategy has failed almost everywhere in the world that it has been tried. The mosquitoes will always find ways to outwit their human adversaries unless locally tailored eradication programmes are implemented.

Community involvement is key to the success of the eradication programme and every member of the community should be involved in understanding the problem of controlling the mosquitoes (vector control). Within each community the local community leaders should be involved in forming a dedicated steering committee that can create formal task forces or community working groups that will undertake environmental management. The working groups will need to know in detail exactly what they are supposed to be doing and precise training sessions need to be organised. Every locality is different so each community task force needs to identify the exact local conditions in which their mosquitoes will be breeding. Precise local knowledge is the most important resource for beating the disease. In particular waste water needs to be evacuated efficiently; water pipelines and water storage containers must be protected and communal waste collection improved.

A research programme in Cuba compared the usual ‘top down’ ways of combating dengue fever with a community activist approach as described above. They found that the community based environmental strategy was much more effective that the usual eradication programme. You can read more about this research on:

http://www.bmj.com/content/338/bmj.b1959.full

Garbage: a special problem throughout the Maldives

The mosquitoes love little collections of water. When I was in the Maldives as a volunteer for the Friends of Maldives health programme I noticed that outside almost every house there is a little collection of garbage. This includes plastic drink containers, tins, discarded tyres, containers and invariably a pile of half coconuts. These are ideals breeding sites for the mosquitoes that carry dengue fever. Unless each and every one of these piles is cleaned up, dengue fever will continue to be a problem throughout the Maldives in urban and rural areas.

Mosquitoes love the little collections of water that form in garbage piles.

Dr Tom Heller is a Senior Lecturer in the Open University’s Faculty of Health and Social Welfare.  He has previously visited the country as a medical volunteer for the UK-based NGO, Friends of Maldives.

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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Allied Insurance claims Maldives first with international health coverage plan

Allied Insurance has claimed to have launched the country’s first international health coverage policy that it says will allow individuals, families and businesses to access hospital services anywhere in the world.

Speaking at a launch ceremony in Male’ yesterday, the company, which has been providing insurance services since 2003, said that the new services will cover up to US$1 million in medical expenses for certain treatments, depending on the package chosen. Allied Insurance said that although it has worked to provide coverage suitable for all types of income, the international coverage have been devised for higher income earners in the country.

The company has claimed that the packages launched this week were accessible to both local people and foreigners in the country and could be added to existing local or regional coverage policies as a top up.

Provision of the services are said to have been made available through a collaboration with London-based international banking organisation Lloyd’s and the US-based Global Assurance Group.

While regional health policies for destinations like Singapore and Sri Lanka have been available for some time in the country, Allied claims that its premium packages will now allow for coverage everywhere in the world including the US and Canada.

Health insurance is becoming an increasingly important issue for state enterprises in the country, with the Maldivian government claiming it is forging ahead with efforts to offer universal coverage for Maldivians.

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Four children dead in two days from dengue fever complications

A fourth dengue fever fatality in just two days has prompted meetings between Male’ City Council and the Ministry of Health to discuss “immediate steps” to reduce the number of mosquito breeding grounds in the capital.

The President’s Press Secretary Mohamed Zuhair said cabinet had also launched a program to counter the dengue outbreak and appointed a committee to oversee mosquito reduction efforts.

Haveeru reported that a four year old child from Muraidhoo in Haa Alif Atoll became the fourth death in two days, dying this morning while in transit to Kulhudhuffushi Regional Hospital.

The cause of the death was dengue hemorrhagic fever, the newspaper reported.

A two year old infant died at 3:00am this morning while being treated in Indira Gandhi Memorial Hospital in Male’. Haveeru reported a relative as claiming that the infant had to be transferred from ADK due to lack of availability of a blood transfusion machine.

A six year-old girl and a nine month-old baby died yesterday after being transferred to Male’ from Meemu Atoll.

Health Minister Dr Aminath Jameel, replying to a question from MDP MP Ali Waheed during yesterday’s parliament session, said the ministry was providing information to islands through teleconferencing and stressed that controlling mosquito breeding grounds was key to combating the rise in dengue fever across the country.

“Mosquitoes don’t travel very far,” she explained. “Therefore, it’s mosquitoes from nearby areas that are spreading it. Controlling mosquito [breeding] is needed from the public and individuals as well. We are working together with island councils and the Male’ city council.”

She added that the Addu City council had taken initiative and organised activities to combat the spread of the disease.

“An additional problem that we encounter is the quick turnover of doctors in the country’s hospitals and health centres,” she said. “So they are not very familiar with the protocol here. We are facing that problem as well. But as I’ve said, this can’t solved without controlling mosquito [breeding].”

When People’s Alliance (PA) MP Abdul Raheem Abdulla asked if she was considering resignation “since based on what is being said here your sector has very much failed,” Dr Jameel replied that she did not believe that was the case.

The Maldives has been battling a growing epidemic of dengue fever this year, with 300 cases and five deaths reported in just the first two months of the year.

There has been a spike in the number of cases reported in Male’, however most of the fatalities have been islanders who died in transit to regional hospitals. Many of the most serious cases have affected children.

Early symptoms of virus 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. Even healthy adults can be left immobile by dengue for several weeks while the disease runs its course.

The government and health authorities have expressed concern about mosquito breeding grounds developing in stagnant water in the city’s many construction sites.

“The boom in the construction industry has created a huge number of mosquito breeding grounds,” former head of the Community Health and Disease Control (CCHDC), Dr Ahmed Jamsheed, told Minivan News in April.

“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.

Zuhair told Minivan News today that the problem was exacerbated by the large number of unfinished buildings where construction had ceased.

“For example, one proposed seven storey-building has [ceased construction] at four storeys, and has pools of stagnant water on top,” he said, adding that it was sometimes difficult to pinpoint who was responsible for the building site due to the layers of subcontractors involved.

Many islands had sought to combat the problem by borrowing fogging equipment and expertise from nearby resorts to kill their mosquito populations, but this also killed beneficial insects, he said.

“It is common for resorts to loan fogging equipment and technical assistance to local islands, but this has negative side effects: it kills all the other insects, which prevents pollination and impacts agricultural activity,” Zuhair explained, adding that human intervention and the elimination of breeding sites was the main priority.

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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.

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Preventive medicine is better than cure, says President on decentralising health sector

Decentralising public health services will promote preventative medicine in the Maldives, President Mohamed Nasheed said today announcing that the health sector would be the first to be decentralised.

”We always hear that this hospital is lacking this machine, or that hospital is lacking doctors, or complaints that islanders cannot access adequate health facilities,” said Nasheed. ”This government’s objective is to prevent people from falling ill, because prevention is better than cure.”

At a press conference today, Nasheed said the government was trying to organise the health sector in a way that newly-elected island councilors could supervise the health sector of each island.

”We want to make sure that all persons that require special assistance are provided with that special assistance,” he said.

Islanders in at least one division have already expressed concern that many of the elected councilors were not capable of handling positions of responsibility.

One islander from the central region of the Maldives recently told Minivan News that on his island, only two of the five elected councilors had finished their GCE O’Levels.

”Because they ran as candidates for the seats under different parties, supporters of those parties have voted for them for the sake of promoting their party,” he said. ”Votes were not made with consideration for how educated the candidate is, or how capable the person, just by what political party he belongs to.”

At this morning’s press conference, Nasheed said that ministers and senior government officials from different areas including the health ministry had begun visiting different islands to conduct workshops and to provide information to the new councilors about their role in decentralising the health sector.

Addressing the concerns of the International Monetary Fund (IMF) regarding the cost of the new layer of government, expressed in a recent notice published at the conclusion of the organisation’s Article IV consultation with the Maldives, Nasheed acknowledged that “the short-term cost [of decentralisation] is likely to be high.”

The salaries alone for the island and atoll councils are expected to cost the Maldivian state an extra Rf173 million (US$13.5 million) a year, on top of the country’s 21-22 percent budget deficit.

“Although the short-term cost is high, it should be obvious to the IMF and other donors that in the long term decentralisation will reduce costs,” Nasheed said.

There was, he said, a public appetite to decentralise, which was “a cornerstone pledge” of most political parties in the country.

“It is very obvious to the government that providing services at a local level is cheaper than centrally-imposed services [with disregard] for local conditions. All over the world decentralisation is expensive to start, but highly cost efficient when it starts running.”

Nasheed also sent his condolences to the mother and family of the child who recently died during labour, forcing doctors to resort to surgery to save the mother’s life.

“We can’t say this is something that should happen, or something that we can say is right,” Nasheed said.

There was bill on medical negligence pending in parliament, he added.

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Kundabados ‘human circle’ marks Maldives World Diabetes Day focus

Maldivian associations and individuals representing all walks of life are said to have taken part in a special event held earlier this month on Kundabados to mark yesterday’s World Diabetes Day.

More than 800 people representing the Maldives’ police and defense forces, resort workers, fitness groups and tourism industry figures gathered on the island to form a human blue circle using umbrellas to mimic the Unite for Diabetes logo.

The event was organized by the Diabetes Society of Maldives – a local campaign group – in order to raise awareness in the country regarding the impact the disease can have on lives in the atolls as part of a wider international promotional campaign to play up the blue circle logo of Unite for Diabetes.  The day also saw a number of fitness programmes being offered to attendees at Kundabados.

In attempts to raise awareness about the importance of healthier lifestyles in helping prevent complications linked to the disease, the Diabetes Society of Maldives says it has supplied special awareness material to local media in recent months to better inform people.

Similar events regarding playing up the links between the blue coloured circle emblem and awareness of the disease have been held all over the world to commemorate World Diabetes Day.

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Malnutrition impeding children’s growth

Malnutrition is the biggest impediment to the healthy growth of children here, the Health Ministry has said.

A 2009 survey by the Community Health and Disease Control Unit showed substantial percentages of children not achieving the expected height, strength or weight for their ages, reports Haveeru.

A programme was launched in seven atolls four years ago to monitor the growth of children who could not achieve the desired height as a result of malnutrition. The programme also includes teaching parents to make nutritious meals from locally sourced products.

Haveeru sources, however, noted that the programme had not had much impact.

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Why feet hurt after wearing high heels: research report

High heels shorten calf muscles and make Achilles tendons thicker and stiffer, according to a report by team of researchers led by Marco Narici, Professor of the Physiology of Ageing at Manchester Metropolitan University in UK.

“Wearing high heels places the calf muscle-tendon unit in a shortened position. As muscles and tendons are highly malleable tissues, chronic use of high heels might induce structural and functional changes in the calf muscle-tendon unit,” says the report.

“So should women give up wearing high heels?” asks writer for The Journal of Experimental Biology, Kathryn Knight. “Narici doesn’t think so, but suggests that fashion addicts may want to try stretching exercises to avoid soreness when they kick off their heels at the end of the day.”

Kathryn Knight’s article

Full Research report

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