Tag: IGMH

Health Ministry hand over MVR 68 million to complete new IGMH building

A MVR 68 million (US$4.4 million) project has been handed over to AMIN Construction in order to complete the new 11-storey building of the Indira Gandhi Memorial Hospital (IGMH).

Local media reported that an agreement was signed at a ceremony held at the Ministry of Health by Health Minister Dr Ahmed Jamsheed and Managing Director of AMIN Construction Abdullah Mohamed.

Earlier this month the Anti-Corruption Commission (ACC) had ordered a temporary halt to the construction of the building in order to investigate a matter regarding the project handover to AMIN Construction.

Dr Jamsheed told reporters at the ceremony yesterday (February 18) that construction of the building had been halted for various reasons, and that funds had been obtained to complete the project prior to the handover.

“The project was commenced to build private rooms to solve the problem of lack of space at IGMH. We have made major changes to the project. By the time the changes were made, the main concrete and construction work had been completed,” Jamsheed was quoted as saying in Sun Online.

The money for the project, according to local media, had been obtained as a loan from the Islamic Bank.

President of the ACC Hassan Luthfy said a complaint had prompted the commission to investigate the project handover over claims that the handover was made at an excessive cost.

“We received a complaint that the project was handed over a second time with an increase in cost. The commission is currently summoning and questioning the relevant parties,” he said earlier this month.

Investigations into the handover have now been concluded according to the ACC president.

MD of Amin Construction Abdullah Mohamed however, told local media that work had been halted due to payments owed to the company. Mohamed was quoted as saying that construction on the building will commence tomorrow.

The building was commissioned by the government to alleviate space constraints in the hospital, which was gifted to the Maldives by the Indian government.

Last month IGMH struggled to deal with the influx of patients prompting concerns as to whether the hospital was large enough to cope with the demand for medical care in Male’.

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ACC temporarily halts construction of new IGMH building

The Anti-Corruption Commission (ACC) has ordered a temporary halt to the construction of 10-story building to be utilised by Indira Gandhi Memorial Hospital (IGMH).

Local media reported that the ACC are currently investigating a matter concerning the project’s handover to AMIN Construction at an excessive cost.

President of the ACC Hassan Luthfy said a complaint had prompted investigations into the matter, adding that construction on the project will be resumed once the commission had finished its investigation.

“We received a complaint that the project was handed over a second time with an increase in cost. The commission is currently summoning and questioning the relevant parties,” he said.

“We are investigating how it has happened and the reason for an increase in the cost. We will make a decision regarding the issue very soon,” Luthfy said.

The building was commissioned by the government to alleviate space constraints in the hospital, which was gifted to the Maldives by the Indian government.

Last month IGMH struggled to deal with the influx of patients prompting concerns as to whether the hospital was large enough to cope with the demand for medical care in Male’.

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IGMH operations “back to normal” amidst overcapacity fears

Overcapacity fears at Indira Gandhi Memorial Hospital (IGMH) in Male’ have been temporarily resolved today despite ongoing concerns about its ability to cope with the demand for medical care in the capital, a hospital official has said.

Local media reported yesterday that IGMH staff were trying “desperately” to accommodate patients after every bed within the hospital become occupied after a surge in demand for care.

An IGMH official told Minivan News today that while overcapacity fears had been temporarily resolved – with operations at the hospital having returned to normal – uncertainty remains over whether the same problems could again occur tonight.

The official alleged that the “source” of the overcrowding problem was due to a lack of proper medical services provided on the islands surrounding Male’, which had resulted in more patients coming to the capitol for surgery.

“While it is usually busier during the holiday period, the real problem is that the quality of hospitals and other medical services on these islands is not up to standard. Therefore islanders have no choice but to come to Male’ for treatment,” the source claimed.

“As transportation links between islands and Male’ have increased in recent years, it now means that more people can get here.”

According to the IGMH official, the hospital presently has a maximum capacity of 280 to 300 patients, while its catchment area has a population of 125,000 people.

In order to cope with the recent influx of patients this week, the hospital official claimed that the site had temporarily ceased operating on electives [non-urgent medical cases] in order to focus on those coming in needing urgent surgery.

“Normally we have around five patients waiting for admission in ER, however last night we had 18. We have tried to streamline the whole process by putting non-urgent surgery on wait so we could directly focus on urgent medical conditions,” the source said.

To future alleviate the number of patients coming into IGMH, the hospital source said today that an 11-floor building was to be constructed focussing on “mother and baby” related medical issues.

“About one third of our patients, on most occasions, are to do with paediatrics and gynaecology, so this new building will give us a lot more relief at IGMH,” the spokesperson said.

“The Finance Ministry, President’s Office and the Health Ministry are trying to get the loan [for the construction of the building], and when that comes through it is expected that the construction will take around five months,” the hospital official said.

Minister of Health Dr Ahmed Jamsheed Mohamed was not responding to calls from Minivan News at time of press.

IGMH concerns

Earlier this month concerns were raised about treatment received at IGMH by relatives of a mother who had given birth to a five-month-old foetus that was alleged to have been incorrectly diagnosed as deceased by hospital staff.

While the hospital maintained it had correctly pronounced the foetus as deceased before sending it to a cemetery in Male’ for burial, relatives expressed concerns about how the hospital had dealt with the matter.

The Ministry of Health told Minivan News at the time that a review would be undertaken of policies at state-run hospitals in the Maldives and their handling of such situations.

This week IGMH was required to commence a separate investigation into the case of a woman who had her uterus removed due to damage caused during the delivery of her baby, local media reported.  The child had been stillborn, according to reports.

A family member told Sun Online that the 24 year-old woman was admitted to IGMH last Friday where, despite advice from specialists at another institution who advised for a caesarean, she was asked to wait to see if she gave birth naturally – despite the umbilical cord being wrapped around the baby’s neck.

Twelve hours later, the family were told the baby had died in the womb.

COO of IGMH Dr Ismail Shafeeu told Sun Online at the time that a case related to a woman whose baby died during delivery was currently under investigation.

“Something like that has happened, we are looking into it. There are plenty of problems related to IGMH, some of which involve negligence by the staff. They’re all under investigation,” he said.

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Five month-old foetus correctly pronounced dead: IGMH

Indira Gandhi Memorial Hospital (IGMH) has said that a five month foetus born prematurely yesterday (January 1) was correctly pronounced deceased before being sent to a cemetery in Male’ for burial.

Local media reported yesterday that the foetus had been incorrectly diagnosed as deceased by staff at the state-run hospital after showing signs of life at the cemetery.

A spokesperson for IGMH today claimed that the foetus, which was born severely malformed, was believed to have been mistaken as alive by cemetery workers after a “reflex” action gave the impression of signs of life.

Relatives of the mother had expressed concerns about their treatment and how they felt IGMH had dealt with the matter, the hospital spokesperson confirmed.

The Ministry of Health has meanwhile announced it would be reviewing policies at state-run hospitals in the Maldives and their handling of such situations as details of the case emerged today.

The parents of the foetus were also shown to have shown concern about their treatment by the hospital, accusing staff of negligence. The matter was said to have been reported to police, according to the Sun Online news agency.

Police Spokesperson Sub-Inspector Hassan Haneef was not responding to calls at the time of press concerning the matter.

The IGMH spokesperson told Minivan News this evening that the foetus, which has been born under inducement from drugs, had a severe malformation where the walls of its skull had not been developed fully.

Staff at the hospital claimed that for the mother’s safety, doctors had decided to induce labour with drugs on the basis that the severity of the condition would have given the foetus a very limited chance of survival as well as severe brain damage.

A spokesperson for IGMH confirmed that after the foetus had been returned from the cemetery, staff did not find a pulse or heartbeat. No treatment could be offered, the hospital source claimed.

Inquiry

Minister of Health Dr Ahmed Jamsheed Mohamed confirmed to Minivan News today that he had initiated an inquiry into the incident, which would then be used to enact any potential recommendations or action needed to be taken by hospital staff in future.

Dr Jamsheed said he was not able to discuss the nature of some of these changes before a review had been completed.

“The changes would depend on the findings and recommendations. The issue would be looked at jointly by the Ministry of Health and IGMH,” he said. “The policy decisions and regulatory measures would be common to all state hospitals, but would also depend on the level of hospital and respective services provided.

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Government pledges Aasandha health scheme “will not collapse”

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

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

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

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

Thirty day target

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

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

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

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

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

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

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

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

Privatised concerns

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

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

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

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

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

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

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

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

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

“Deluge”

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

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

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

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

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

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

Budgetary factors

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

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

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

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

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

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

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

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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.

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Bangladeshi construction worker dies after fall

A Bangladeshi expatriate construction worker has died after falling six stories in the Maafannu area of the capital Male’, local media has reported.

The fall was reported to have occurred at around 8:15AM this morning. The man was rushed to Indira Ghandi Memorial Hospital (IGMH) before succumbing to his injuries at around 11:45AM.

Police are said to be investigating the circumstances surrounding the accident.

Bangladeshi expatriates make up a significant number of workers in the Maldivian construction industry.

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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.

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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.

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