Aasandha director claims service not suspended in India’s Amrita hospital

The Amrita Institute of Technology Hospital in Kochi, India has not suspended Aasandha health care services despite reports in local media to the contrary, the scheme’s managing director has stated.

Local media reported yesterday (January 28) that services offered under the universal health care scheme Aasandha had been suspended due to unpaid bills for treatment provided to Maldivians by Amrita hospital.

However, Aasandha Managing Director Mohamed Niyaz told Minivan News today that services had not been suspended.  Niyaz said that Aasandha was instead having to control patient admittance to keep in line with the credit limit recently imposed by the hospital.

“Because of the large number of patients who went to receive treatment at the hospital in December last year and delays in paying those bills, Amrita hospital put a credit limit on the treatment they can offer that is paid for by Aasandha,” he explained.

“We are now controlling the number of patients we are admitting to the hospital in order for Aasandha to not go over the imposed credit limit,” Niyaz said.

An official from Amrita hospital told Minivan News that while it is still treating patients who are covered by Aasandha, there had been a period of four days earlier this month where it stopped admitting patients due to unpaid bills.

“There is a total of 7 million rupees (US$ 130,536) outstanding in payment to be made by Aasandha through Hospital Professional Liability (HPL) insurance, who we deal with.

“We ceased treating outpatients covered by Aasandha for four days, but HPL then paid part of the bill and so we resumed our services,” the hospital official told Minivan News.

The credit cap imposed on Aasandha by Amrita hospital was introduced to match a similar credit cap applied to all other health insurance companies who work with the hospital, the hospital official said.

“Originally we had a special agreement with Aasandha whereby they had no credit cap on the treatment we could provide. However our Financial Controller has now introduced it because it is the same as other insurance companies we deal with,” the hospital official added.

“Even now Aasandha’s credit cap is a lot higher than the other insurance companies. We have a great relationship with the Maldives and we treat our Maldivian patients as our own.”

According to Niyaz, patient treatment is currently being prioritised on a case-by-case basis in order for the service they are receiving to not be “compromised”.

In regard to bill payment, Niyaz claimed there had been a number of factors as to why the money had not been paid to Amrita hospital.

“It takes two to four weeks for the treatment bills to come through after a patient has been discharged from the hospital and then we have to pay for the treatment in US dollars,” he said.

“It takes a further two weeks for us to secure the dollars as we have to buy at a bank rate. We are trying to find ways to work around this problem at the moment.”

During December – a “peak” period for Maldivians wishing to seek medical treatment -Niyaz said there had been some issues receiving money from the Finance Ministry in order to pay the bills.

Finance Minister Abdulla Jihad was not responding to calls from Minivan News at time of press.

Niyaz revealed that Aasandha had experienced similar issues at a hospital in Colombo and three other hospitals in India, but that these have all been resolved.

Free health care of up to MVR 100,000 (US$ 6,476) was initially available to citizens under Aasandha. Changes to the system were made by the government in August last year, after concerns the scheme would run out of money.


OPEC loan for Hithadhoo hospital finalised

A delegation from the OPEC Fund for International Development (OFID) has concluded a visit to the Maldives after signing a US$8.4 million (MVR 129million) loan agreement to finance the Hithadhoo Regional Hospital Project in Addu Atoll.

OFID Director-General Suleiman J. Al-Herbish met with President Dr Mohamed Waheed Hassan to discuss the fund’s current operations in the Maldives as well as further avenues for cooperation.

Suleiman said the new hospital would deliver a wide range of specialized and emergency medical services, benefiting around 76,000 people.

Permanent Secretary at the Ministry of Health Geela Ali said that the work on the 100-bed facility would upgrade the level of healthcare in the atoll to tertiary level.

Currently, this advanced level of healthcare is only provided in Male’s two hospitals – the privately operated ADK hospital and the state-run Indira Ghandi Memorial Hospital (IGMH).

Other than this, Maldivians can receive secondary of care in the country’s six regional hospitals. This includes Raa Atoll regional hospital which the ministry intends to begin renovating.

“This will be a huge project. We are currently seeking government funding for this,” explained Geela.

OFID is a finance institution established by the group of petroleum exporting states to channel aid to less-developed nations.

Previous loan support from the fund was given to upgrade Male’ international airport in 1999, and again in 2005 to extend Wataniya’s telecoms coverage.

A press release from the fund described the fund’s 35 year relationship with the Maldives during which time is has co-financed projects to strengthen the country’s agriculture, education, transportation a sanitation sectors.

“Under its Trade Finance Facility, OFID has participated under the International Islamic Finance Corporation’s syndication of US$25 million to assist the State Trading Organization, Maldives, in importing refined petroleum products. In addition, grant funding has provided emergency aid for tsunami victims and supported healthcare programs,” read the statement.

Chinese visit

As the OFID visit concluded, a high level Chinese delegation arrived as part of a three nation tour which will also take in Pakistan and Bangladesh.

The delegation is headed by Li Changchun who is China’s fifth highest-ranking leader and has been on the Standing Committee of the Political Bureau of the Communist Party of China Central Committee since 2002.

Chinese state media reported Li as lauding the exemplary nature of the Sino-Maldives relationship as a model for ties between larger and smaller nations.

“The development of relations between China and the Maldivians serves the fundamental interests of the two peoples as well as maintaining the regional peace, stability and prosperity,” Xinhua reported Li as saying upon his arrival at Ibrahim Nasir International Airport (INIA).

Li has since met with President Waheed who thanked him for China’s continuing assistance with the Maldives’ development, whilst welcoming Chinese investors to explore opportunities in the country.

Waheed expressed similar sentiment when paying his first official state visit to China last month during which he finalised a deal for US$500 million in aid, with promises for further assistance in the future.

The President’s Office website has confirmed that the Ministry of Housing has exchanged letters agreeing to a feasibility study for developing a road in the Laamu Atoll Gan to Fonadhoo stretch of islands.

A memorandum of understanding was also signed between the Chinese Ambassador Yu Hongyao and the Ministry of Environment and Energy concerning the provision of goods for addressing climate change.

Chinese relationships with the Maldives was established 40 years ago but has expanded rapidly over the past decade.

China leapfrogged the United Kingdom in 2010 to become the number one source of arrivals for the country’s travel industry.

China opened an embassy in Male’ in time for the opening of the SAARC summit last November, reciprocating the opening of a Maldivian mission in Beijing in 2007.


Touch of life and death

Waiting has never been a strong suit. But when it is for your best friend who has never left your side, you don’t complain.

Early on Monday evening I was with Inayath Shareef (Inoo), waiting eagerly to welcome her new baby brother into the world. Every time the person inside the delivery room called out her mother’s name, we all flocked to the door. I take out my camera and get ready to click. But every time it’s a false alarm. The contractions still have not reached their height. Disappointed, we walk back.

To kill time, we talk and teased two young pregnant relatives in their mid 20’s. One of the girls looks as if the baby is going to pop out of her at any minute. A relative of Inoo say it is time for us to get married and have kids. We retaliate – “C’mon, we are still kids ourselves.”

Silently, I feared for the pain my friend’s mother must be going through behind the closed door. Relatives are not allowed in and the family only knows anything about the delivery through the occasional feedback from nurses.

Meanwhile, I overhear a conversation between Inoo’s aunt and a young man sitting inside the room, waiting for his wife’s delivery. When he was a baby, his birth mother and father abandoned him on the island. The frail, old couple I had seen moments before in the room, had adopted and cared for him like a son. They were never able to have a child of their own so it was a special occasion. They are soon going to be grandparents of a lovely baby girl.

Evening news starts on TVM at 8:00pm sharp. All eyes and ears were on the flat screen on the wall. The top story of the night, as expected, was the death of lawyer Ahmed Najeeb. Listening to the news at the time was strange. I was sitting among his blood relatives. He is the great uncle of my best friend. The tragedy has left the family devastated. When the news finished, they all talked about death penalty as the only solution to stop the henious crimes in the society which had claimed their brother’s life.

“Mara Maru [Death for Death],” my best friend says.

It was 9:00pm. The conversation on the death penalty had ended and we were again sitting idle. Some, including me, had proposed the idea of calling it a night.

The sudden sound of the person inside the delivery room startled everyone. The nurse called out the name. Same drill. Everyone rushed. I had my doubts, so I walked slowly. We were about to leave when the crowd came running in.

“The baby is delivered! Where is the bag with baby’s stuff?” a relative asks.

Inoo puts the dress for the baby, olive oil, cottons and other necessary post-labor kit into the bag and hurries outside to hand it to the nurse. She was so happy. That moment I realised how long it has been since I have seen that beautiful smile on her face. Life has not been too easy for her, or me.

Outside the labor room, the old relatives were facing a bigger issue. No one has prepared the honey. “How can you forget something so important?” one of the aunt complains.

It is an Islamic tradition to give honey as the first thing when the baby is born. They discuss what to do and finaly sends someone off to buy a bottle of honey.

Meanwhile, as I waited outside the labour room with camera ready, I saw a family rush into the emergency room, just a couple of feet away from labour room. A woman was carrying an unconscious child, about three years old. An accident perhaps, I thought.

However, I was not at the liberty to quench my curiosity because the labor room had just opened. Out came the nurse, carrying my best friend’s little baby brother, wrapped in a soft blue blanket. I switched on my camera and re-focused.

Inoo’s uncle walked in first. He was asked to recite the prayer call near the baby’s ears. Another Islamic tradition. Others followed in. It was such a special moment. Unlike other babies, he did not cry. Despite the bright light above, the baby boy managed to open his eyes wide. He scanned around and stretched out the hand and wrapped his little fingers around my best friend’s finger. He’s a healthy cute little fella weighing almost nine pounds.

The nurse took the baby back to the mother. We walk out discussing who he most resembles. Everyone agreed the boy looks like the father, who was unfortunately still on his way to Male’ from the resort where he worked. As I walked into the labor room showing the pictures from the camera, I accidently bumped into a woman who was crying. I apologised and entered the labour room lobby.

It was a joyous moment for all.  As we ate chocolates and celebrated the birth, a relative came in looking worried: “I think a child has just died.”

We all walk out to see what had happened. Five women stood crying outside the ward next to the labour room. Another curious onlooker told me a child who was brought to the hospital just now had passed away. Immediately, I recall the family rushing into the emergency room and the crying woman I bumped into.

“Oh my God!” was my first response. I followed a relative into the ward.

On the hospital bed, lay a beautiful little girl. I walked closer. Underneath a white blanket covering up to her neck, the girl’s arms were folded. One of the woman standing next to the bed snakes her fingers through the straight locks of her short black hair. “Please wake up,” she cries.

I pat her shoulder, unable to take of my eyes from the lifeless body of the little girl who is no older than one of my nieces.

“How old is she?” I asked.

“Three”, the woman replies. She is the girl’s aunt who had arrived Male’ from the island the day before. “She’s actually a very fair skinned girl,” she continued, as the girl’s skin turns darker with every passing minute. She held the girl’s chin tight, keeping her lips closed. I did not know why at first, but when fluids started to escape out her nose and mouth, no explanation was needed.

“Only if she would open her eyes,” the woman says, between sobs. I touched the girl’s forehead. Near the bed stood a another little girl in tears, no older than 10. The girl on the bed is her younger sister. I notice my best friend had just walked in, so asked her to take the girl outside.

“Where is the father?” I ask, as there was no man to be seen, except for a teenage boy. The woman explained that the girl’s father had abandoned the family a long time ago. Her sister has been raising the two children on her own all these years, with not a penny from the husband who had left her before the girl’s birth.

I could only imagine the mother’s sorrow. She was speaking with two police officers outside the ward. They ask her what happened.

“She was born with a hole in her heart. The doctor said she needed surgery in three months. I could not get enough money to do the operation.” The mother burst into tears.

A policeman asks if she has any complaints with the hospital.

“Why would I have a complaint with the hospital?” The woman cried. “I don’t. I only have complaints with myself. I am the mother. It was my responsibility to keep my children safe and raise them. I failed. It is my fault she is dead.”

Though I am a stranger and have no right to interfere in that family’s matter, I could not stop myself from speaking out.

“Please don’t blame yourself sister. Life and death is beyond our control. It’s not your fault. You did everything you could.”

The grief-stricken mother smiles, and walks back into the room with her elder daughter to say her final goodbyes.

Though I had told her the death of her child was beyond her control, I could not help but think that the little girl would be alive today if she could have had that life-saving operation.

Outraged, I told the policeman to find the father. “He should be held responsible,” I contended.

Inoo later told me that she had taken the elder daughter out for a walk. The girl told her: “My father will be very happy my younger sister is dead.” We both were dumb-struck.

It was time for Inoo’s mother to be transferred to the maternity ward. I conveyed my condolences to the family and followed my best friend. She was finally able to hold her baby brother. Everyone looked so happy.

I remained confused. I caressed the baby’s soft cheeks and walked out, leaving the family to welcome the new member into their home, as another family outside were preparing for their little girl’s funeral.

In one night, I had touched life and death.


Police investigate security guard suspected of filming girl inside IGMH toilet

The police are investigating a security guard of the state owned Indhira Gandhi Memorial Hospital (IGMH) for allegedly taking indecent images of a 16 year-old girl inside the hospital’s toilet.

The incident was reported to the police on May 3, according to local news Sun.

The police media official said that no arrests have been made yet, but the investigation is ongoing.

The girl was reportedly visiting her father admitted at the hospital.


Q&A: Former CEO of IGMH Cathy waters

CEO of Indira Gandhi Memorial Hosptial (IGMH), Cathy Waters, left the Maldives on Friday after more than a year at the helm of the country’s largest hospital. Waters, along with Nursing Director Liz Ambler and Medical Director Rob Primhak were recruited in January 2011 by UK-based NGO Friends of Maldives (FOM) and the Maldives High Commission to improve the quality of local healthcare. Ambler and Primhak have also left. Minivan News spoke to Waters prior to her departure.

Waters provided detailed briefing notes on the state of the hospital to accompany this interview (English)

JJ Robinson: What was the state of the hospital at the time of your departure?

Cathy Waters: There are now systems and processes in place so key decisions can be made. People know how to make those decisions and know where the systems and accountability now lie. Patients may not see that initially as a benefit, but we were making sure the foundation and systems were right.

I’m confident those in now in place. Clinical systems to ensure patient care are now there, and there are things such as a proper patient complaint system.

Equally we have introduced a zero tolerance policy to protect staff. We’ve noticed the number of verbal and violent attacks against staff has gone up. I don’t know why – but certainly over the last few months we’ve seen an increase in violence against staff. Now if you go into IGMH you’ll see posters and leaflets in Dhivehi and English.

JJ: One of your main innovations was the introduction of triage. Was this a hard concept to introduce?

CW: Maldivians tend to panic about things you or I would describe as fairly minor healthcare issues. If you were to cut your finger and it bled, you would probably hold a tissue on it, wrap something around it and deal with it yourself. Here, people panic at the slightest bit of blood.

A really good example of this was when we had some of the casualties coming in from the recent protests. A little bit of blood and people wanted to bypass the triage and go straight into the emergency room, when perhaps all they needed was to put a wad of padding over it and have it stitched up in time. There was no urgency about it, but people panic.

The most challenging part has been persuading people that they don’t need to be in the actual emergency room – that it’s acceptable to wait if it’s not something urgent. That has been so difficult to get across. But it is working, and was brought into place in November 2011. Now it’s been in place for a few months we know there are alternations we need to make it more effective.

JJ: You said earlier that you’ve had politicians ringing you up to bypass triage and go straight to emergency?

CW: Absolutely. I think they see it as their right to get access to treatment and the [in-patient] rooms really quickly, and I think in the past that’s why the triage system has failed, because people back down and say ‘OK, come straight to the emergency room.’

We’ve stuck to our principles and said we have to do this properly, because if we start letting politicians in or whoever just because they think they should be in, the whole purpose falls apart. very clear stick to principles.

JJ: Were you able to train triage staff to the point where they could resist that pressure?

CW: Yes, we had to do quite a lot of work, and there’s still a lot to do. We had instances when there were quite a few people waiting and instead of being triaged, they were just waiting for treatment. Then the doctors said let’s just cancel triage and let people into the emergency room. That defeats the whole purpose.

It’s about explaining to people. The most difficult area was when parents come in with children they believe are very sick, when actually it’s not urgent and they just need to see a doctor. But they panic, and that’s the area with the biggest problems. A lot of it is education and helping people realise that they don’t always need to come to hospital – that there are straightforward, basic things they can do.

JJ: How has the Aasandha scheme (universal healthcare) impacted IGMH?

CW: Now Ashanda has been opened to ADK and private health clinics, it’s created major problems for IGMH, because we still have loads of patients coming to IGMH, but we also know that those patients are also going to ADK and private clinics. The dilemma for us is that a lot of the private clinics are run by doctors who work in IGMH. That a fairly difficult area.

JJ: So the doctors end up working less at IGMH?

CW: They would probably argue this, but I would say the difficulty for us is commitment. The average Maldivian doctor will get a third of his income from IGMH, and two thirds from a private clinic. There is a huge incentive for them to do more and more private clinics.

For example, anecdotally a doctor in IGMH may see 6-20 patients in a clinic session. Apparently some of those doctors are seeing 70-75 patients in the same session at a private clinic.

It’s a big problem and the government needs to think about it. If you want doctors to be 100 percent committed to IGMH, you need to do something about increasing their salaries or minimising the amount of time they can do private work.

JJ: How sustainable do you think universal healthcare is in its current incarnation? Does there need to be a monetary barrier to entry?

CW: My view is that it was introduced far too quickly without thinking about what checks and balances needed to be in place. Some patients have already spent their Rf 100,000 (US$6500) entitlement. People see it as their right to spend Rf 100,000, and there wasn’t a public education campaign beforehand so people understand how to use it properly.

There are reports of people going from clinic to clinic and seeing more than one doctor in a day. If they’re not quite happy with what they got from one doctor, they’ll go to the next.

At IGMH the number of non-attendances for appointments has increased because people aren’t paying for it any longer. The patient doesn’t feel they are losing anything, although they are because they are using up their Rf 100,000. We have gaps in our clinics because patients have suddenly got an appointment at a private clinic quicker. And of course we have to work on our appointment system and how people access the hospital.

JJ: We have previously reported on tensions between local and foreign doctors over pay and allowances, such as accommodation. Were these resolved?

CW: It’s still an issue. The problem is that there are lots of inequities. Expat doctors get accommodation, Maldivian doctors don’t. But Maldivian doctors have the ability to do private work, which the expat doctors don’t, so there are some tensions.

Having said that, there are teams of doctors who work really well together. One of the things we have been doing is making sure the clinical heads of department meet once a fortnight, to try and make sure people are working together.

JJ: You have spoken about a contract IGMH had with the State Trading Organisation (STO) to supply medical equipment and consumables, at four times the going rate. What was behind this?

CW: The contract was initiated well before I started at IGMH. It was done for good reasons because there were huge problems with supplying medical equipment, but what we found was that we were paying hugely over the odds for goods we were receiving. Some of the issues with supply are still there, but generally speaking it has radically improved.

We had to do a lot of work on our side. Doctors had been stockpiling, so we have to educate them now that there is no need to stockpile, because it is increasing our expenditure.

It was also a major battle to understand our financial situation. When I first started people were spending money left, right and centre, and there was no financial control. Now we are are very clear about where we are – we don’t like where we are, because it’s not a very good financial position – but at least we know where we are. We are trying to enact a financial recovery plan, but we haven’t been able to go as far with it as we’d like.

JJ: What about the Indian promises to pump money into IGMH? Did you feel they were persistently interested in it?

CW: They came and pledged this money a considerable time ago. The project was supposed to start in April, but it slipped and slipped. It desperately needs to happen. The building is old and bursting at the seams, it is not able to cater to the needs of patients it has, and when it rains it leaks like a sieve. Things like the electric wiring are very old – it all needs to be redone.

JJ: You initially signed for another year, but mentioned concerns about job stability. How did things change at the hospital after the recent political turmoil? Should that be affecting a hospital?

CW: I don’t think it is – the Finance Ministry said, the same as the previous government, that we could not change salaries or appoint new people. So we have vacancies and we have to hold those [closed], with the exception of clinical staff. We argued that we needed to replace senior doctors if they leave. But we are carrying an excess of admin staff we desperately need to reduce. But the previous government stopped us doing that. To enable us to become a more effective organisation we need to do that.

JJ: What was it like working at the hospital, personally? Did you face challenges as a foreigner?

CW: Our chairman said it was not about me as a foreigner, it was about management. There was a general resistance to administration, which I detest. We have tried to bring together management and clinical staff, so we have a stronger team. What was happening before was that you would have different departments working in silos. Yes there’s been resistance – I came in with different ideas, trying to bring in a different style of working, empower staff to make decisions and come up with the solutions. They have the answers.

The language barrier was very frustrating. I was very vocal about not being politically driven, and saying what I thought. But at senior meetings in the Ministry of Finance they would always make a big thing about saying ‘Sorry, we are holding this meeting in Dhivehi’ – even though these were senior people with a good understanding of English.

At one particular meeting they spent most of the meeting slagging off IGMH. Fortunately I had taken another member of staff who was frantically writing things down. They would ask for a response but I couldn’t argue as I didn’t know what had been said. I found it really frustrating and I felt they used it sometimes.

JJ: You said you were keen for a Maldivian to take over after your departure? Is that capacity available locally?

CW: I think that given another six months we would have had a number of people ready to take it on. I had appointed a director of operations, who potentially could.

I made clear in my final comments to the new health ministers that they need to get the right person, and not necessarily make a political appointment, because it is such a key job driving change in the health system. Ultimately it’s their choice, though.

JJ: What do you feel like you’ve got out of the experience personally?

CW: I think I’ve become much more tolerant and patient, and politically aware – with a small and a large ‘P’. Diplomacy skills have been honed greatly. I also had my eyes opened about living in a small place where everyone knows everyone else. If someone was in the same classroom as the President, they think nothing about calling the President and telling him what they think of you.

It also really opened my eyes to the complete lack of confidentiality. People don’t think twice about leaking highly confidential information to whomever.

JJ: What are the top three areas the hospital needs to focus on right now?

CW: Firstly, getting to a stable financial footing, be that through the health insurance scheme, although it is not bringing in enough to allow IGMH to stand on its own two feet.

Secondly, the government needs to decide whether IGMH is a public or a private hospital. That’s a fairly difficult tension they need to resolve.

Third, let whoever is running IGMH run it, and have the confidence to run it, and stop all the political interference. That was the number one frustration – not being allowed to get on and do my job. We’d have a plan, then something completely unrelated would come in from the side and stop something I tried to enact. It was so difficult to keep people motivated when that happened.

There are some fantastic staff at IGMH. Liz the nursing director was also leaving, and we had an amazing leaving do, in traditional Maldivian dress. There are some really special people there.

If I can add a fourth priority: to continue to try and change the work ethic so people only take sick leave when they are genuinely sick.

Some of the senior team are very good, and have taken no sick leave – I haven’t had a day off sick the whole time I’ve been at IGMH. It never crossed my mind to take sick leave unless I was genuinely sick. But people just take loads of sick leave – they see it as their right.

I will miss it. It’s been a fascinating experience.

Biographical note: Cathy Waters arrived at IGMH in Feburary 2011, first as General Manager, and then CEO. In June/July 2011 she was asked to take on the role of Managing Director of the Male’ Health Services Corporation (MHSC). She has 32 years experience working in health care and health care systems, and has previously worked in the UK’s NHS as a CEO and as a Director of a small consultancy company specialising in organisational development and change management.


Hithadhoo hospital start date awaits funds

Construction of a Rf385 million hospital project for Hithadhoo of Addu City will begin in early 2012, pending funds.

The project will provide new buildings and services to Hithadhoo Regional Hospital, Haveeru reports.

Construction will begin once funding has been secured.

The government last week announced its intention to sign an agreement with Islamic Development Bank (IDB) during the upcoming SAARC summit. The agreement would provide a US$25 million loan to the new project.

Addu City infrastructure is currently being upgraded to accommodate the 17th annual SAARC summit between November 10-11. The new convention center where the summit will be held is the Maldives’ largest building.


Antibiotics “most misused drug in the Maldives”: ADK COO

Over-prescription and sale of over-the-counter antibiotics is leading to a rise of resistant super-bugs, the World Health Organisation (WHO) has warned, with the Maldives no exception.

“Antibiotics are the most misused drugs in the country,” ADK Chief Operating Officer Ahmed Jamsheed told Minivan News today. “People are becoming resistant, and in certain cases they might not even need the antiobiotics.”

The WHO is discussing the overuse of antibiotics and growth of superbugs at the 64th meeting of the Regional Committee for South-East Asia, in Jaipur this week.

Director General Dr Margaret Chan said, “we have taken antibiotics and other antimicrobials for granted. And we have failed to handle these precious, yet fragile medicines with appropriate care. The message is clear. The world is on the brink of losing its miracle cures.”

Jamsheed said he has seen patients with headaches prescribed with powerful antibiotics, such as ciprofloxacin. He says a lack of systematic supervision allows pharmacists, who are not educated in medicine, to give antibiotics to anyone who asks regardless of a prescription.

“We have a very rudimentary diagnostic capacity in the Maldives,” said Jamsheed. “Hospitals and physicians are not properly monitored, and patients have a lot of independence to choose the drug they want. There are few national guidelines.”

According to Jamsheed, hospital diagnoses are compromised by inadequate facilities. He said that as organisms  mutate, doctors are not able to keep up. Bacteria samples are usually outsourced, and communication can take weeks. “In some cases, we may not be able to recognise and diagnose a disease until we’ve already lost a few patients,” he said.

Superbugs, or super bacterium, are bacteria that carry several resistant genes and are difficult to treat. When a disease is inappropriately or excessively treated with antibiotics, the body develops an immunity which encourages the bacteria to grow stronger.

Dr Chan said many non-communicable diseases, such as heart disease and cancers, are triggered by “population ageing, rapid unplanned urbanization, and the globalisation of unhealthy lifestyles.”

Chan also noted that “irrational and inappropriate use of antimicrobials is by far the biggest driver of drug resistance.” As communities become more drug resistant, treatments could become more complicated and costly.

ADK Managing Director Ahmed Affal said education was important. “There is an increasing number of antibiotics being prescribed in the Maldives, and we need to talk more. Research shows that there will be problems, as organisms become more resistant.”

Affal said that the majority of cases at ADK are fevers and infections, although heart disease, hypertension, and renal infections are on the rise. “Antibiotics are commonly used for lung infections, and sometimes are given as a preventative measure,” he said.

Speakers at the WHO conference suggested that climate change could accelerate the growth of superbugs. Jamsheed told Minivan News that Maldivians could be more at risk for dengue fever and chikungunya, as well as viral diseases. He predicted that if these diseases were to become more common, the misuse of antibiotics would increase as well and people would become more drug resistant.

“The Maldives is not isolated,” Jamsheed said. “We import almost everything, and any bacteria that is growing elsewhere in the region and the world will certainly be transmitted here.”


“No ambulance on Fridays”: Villigili man takes wife to hospital in garbage cart

An elderly man named Ali Waheed living in Villingili, a residential island that is the fifth district of Male’, has claimed he had to carry his wife to hospital in a garbage cart after the island’s health centre said there was no ambulance available “because it was Friday”.

“I called the police and asked for help, but they said all their vehicles had been damaged and taken Male to repair,’’ Waheed said. “The health centre said that because it was Friday there was no doctor or health worker available, and when asked if one could be made available as it was an urgent case, they said it was not the health centre’s policy.’’

Waheed’s house is located near the garbage pile on the island, and he found a wheel-cart nearby which was used to carry trash.

“I carried my wife on the wheel-cart to the Villingili-Male’ ferry and wheeled her to Indira Gandhi Memorial Hospital (IGMH).”

Waheed said he had informed Health Minister Aiminath Jameel of the incident by “sending more than 50 text messages to her mobile phone.”

“But so far she has not responded to any of those texts. It is very sad that this is the current situation in Villinigili,” he added.

He said doctors and other staff working at the health centre were themselves frustrated due to low wages and because they did not receive any overtime payments.

“They are frustrated and it affects the citizens of Villingili,” he said.

Minivan News spoke to Director of Villingili Health Centre Ahmed Zahir, who said that while Waheed had asked if an ambulance was available to take his wife to the ferry terminal, staff were not made aware that her condition was urgent.

Zahir said an ambulance and doctors were available on Fridays in urgent cases, but said there had been recent cases of the ambulance being called to carry boxes to the ferry terminal in lieu of a taxi.


Dengue hospital situation “stable”, despite high patient demand

Hospitals in the capital have said they continue to screen significant numbers of patients for dengue fever, yet claim that the situation remains “stable” as authorities raise fears that an ongoing outbreak of the virus may be more persistent than originally thought.

As officials today confirmed that a 41 year old man from Addu Atoll had become the eighth person to have died during the latest dengue outbreak, health care representatives in the capital have said that they remain “busy” dealing with cases and had not yet seen significant declines in patients coming through their doors suspected of contracting the virus.

After declaring this week that the current outbreak of the virus around Male’ and several islands was being treated as an “epidemic”, the government has since established a task force to try and coordinate its ministries, the military and NGOs in preventing further spreads of dengue. The task force was originally budgeted to run for seven days, by which time the situation was expected to be under control.

However, upon admitting yesterday that the suspected number of dengue cases in the country had slightly risen after a perceived fall in infection rates earlier during the week, a media spokesperson for the task force suggested that the operations were now likely to run beyond the original seven day time-frame.

Meanwhile, for hospitals on the front-line of dealing with the “epidemic,” the Clinic, a Male’-based private hospital, has said it has been busy collaborating with the task force in trying to identify infection cases.

A spokesperson for the Clinic, which begun offering free dengue fever screening services on Tuesday (July 5), said it was continuing to receive a steady number of patients looking for dengue testing and had been working to the emergency protocols recently imposed by the government.

“At the moment I don’t think we are seeing the number of patients [with suspected dengue] going down,” she said. “From the first day [of the screening service], we have received large number of pediatric enquiries regarding dengue infections among children, though adults are coming for testing now in large numbers.“

Panic fears

The Clinic spokesperson revealed that the medical centre remained concerned about the impact panic was having on the general public.  She said this this concern reflected the limited amount of knowledge about the symptoms and severity of dengue fever within Maldivian society as a whole.

“Trying to create knowledge [about dengue] among the public is one of the main challenges we are facing. People who may have symptoms are sometimes sitting at home and relaxing trying to overcome the fever, which means that some cases of the virus are being missed,” she said.

“Dengue fever has to be better managed by people. Members of the public with the virus need to take more fluids, but they are lacking awareness of this.”

The spokesperson added that the Clinic was currently working to put together a leaflet that she said would try and provide more details about the virus.  During the current panic over dengue infections, the Clinic spokesperson suggested that some members of the public were staying at home instead of coming to be checked.

Despite concerns that the public may begin inundating hospitals beyond their capacity as a result of panic over the virus, Cathy Waters, Chief Executive of Male’s Indira Gandhi Memorial Hospital (IGMH) said that increased patient numbers were to be expected during an outbreak like that presently taking place in the country.

“We have seen a lot of children being bought in by relatives because of the virus. I think that some panic is to be expected as people are concerned about dengue, but the situation is definitely stable here at the hospital,” she said. “I think the message has got out about the virus and its symptoms and people are responding to this.”

In trying to treat patients found to be suffering from the effects of dengue, Waters said that the hospital had moved to adapt additional wards and services to dealing specifically on trying to deal with the ongoing dengue outbreak, yet she added that the overall situation was under control.

“At the moment we would describe the situation as relatively stable, but definitely very busy here,” said the hospital chief executive. “We have set up an additional fever clinic, which means people can be seen relatively quickly for testing and then be given the necessary treatment.”

Waters added that the current dengue situation had required the hospital to develop contingency plans to allow for the provision of increased bed capacity as well as bringing in additional nurses to cope with demand.

The hospital chief executive said that this had in certain cases meant that some surgeries had to be cancelled to accommodate dengue testing and treatment, a situation that would continue to be reviewed regularly to ensure patient demands were being met as best fitted the situation.

The government taskforce has said that it is expecting to address members of the media concerning the latest developments later this evening.

While pledging to support efforts to try and cut dengue infection rates in the country, opposition politicians have been critical of the speed by which the government has responded to the present outbreak.

Ibrahim ‘Mavota’ Shareef, Spokesperson for the opposition Dhivehi Rayyithunge Party (DRP), saidthat he believed that the government had “bungled” their response to trying to control dengue fever.

“From what we have seen the government is just not doing enough. We don’t believe they have been willfully negligent, but there has been negligence in their approach [to dengue outbreak],” he claimed. “They have not responded fast enough, which could be inexperience on their part. But I think this will be a wake-up call for them to change policy in dealing with these type of situations.”