Tag: IGMH

Indian government commits to $8.4 million renovation of IGMH

The Indian government has announced its intention to finance the complete renovation of the Indira Ghandi Memorial Hospital (IGMH) in Male’. The work is expected to cost US$8.4 million.

The agreement to renovate was made during the visit of Indian Prime Minister Manmohan Singh to attend the SAARC summit in November last year.

Representing the Indian government, P.S. Karthigeyan told local newspaper Haveeru: “This is a special project for India. India still sees IGMH as the most important symbol of the good relations between India and Maldives. Even though we say we are going to renovate the hospital, our plan is to almost entirely rebuild it.”

IGMH was a gift from the Indian government to the people of Maldives, first opening in 1995.

It has been a busy week for Maldivian-Indian ties in which both the foreign and defence ministers travelled to meet with their counterparts in India.

President Waheed is also said to be planning a visit to India next month, whilst former President Mohamed Nasheed is to visit soon after returning from the United States.

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Man stabbed to death near West Park restaurant

A group of men stabbed a man to death near West Park restaurant this afternoon.

Police Spokesperson Sub-Inspector Hassan Haneef said the victim was attacked at about 4:15pm while he was on Boduthakurufaanu Magu, the outer ring road of Male’.

”His body was taken to Indira Gandi Memorial Hospital (IGMH) at 4:15pm,” Haneef said. ”His body was carried to the hospital by a witness and a Maldives National Defence Force (MNDF) officer who was in the area.”

Police identified the victim as Ali Shifan of Fairy Corner in Maafannu Ward.

”His age is not verified yet,” he said. ”According to witnesses, a group of men on a GN model motorbike came and attacked the victim.”

He said the number of assailants had not also been verified yet.

”It could be one, two or even four,” he said.

IGMH Spokesperson Zeenath Ali told Minivan News that she could only confirm the death of the person.

”We do not have clear details at the moment,” she said. ”But he was dead when he was brought to the hospital.”

She said the hospital could not verify the age of the victim.

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Protesters not covered under health insurance schemes: participation “high risk and voluntary”

State television journalist Moosa Naushad has had a successful operation in Colombo for injuries sustained during a protest on Male’ last week, and will return to the Maldives in a few days’ time, according to Maldives National Broadcasting Corporation (MNBC) Director Adam Shareef.

Naushad was attacked outside of MNBC by 15 people while covering an  opposition-led protest on January 23. The aggressors broke his hand and left him with fractures to his shoulder blades and feet, while MNBC editor Thoyyib Shaheem was tasered after trying to intervene. Both sides of the political spectrum blamed the other for the attack, with the opposition alleging that MDP activists mistook Naushad for a VTV reporter.

Since the nightly  protests began on Male’ over two weeks ago a number of journalists, activists and police officers have sought medical attention for related injuries. Although security personnel are covered by their employer, others have discovered that injuries sustained during a protest are excluded from coverage by most available insurance programs, including the government’s recently introduced Aasandha scheme for every Maldivian citizen.

“As far as I know, no insurance scheme in the Maldives would cover somebody injured during a protest,” said Allied Insurance and Aasandha Program Manager Ahmed Shabiq, pointing out that protests are considered high-risk and voluntary.

To fill the coverage gap, Naushad’s injuries have been treated with “a gift from the government, and some contributions from MNBC,” MNBC’s Shareef said. He added that the station tries to cover injuries other journalists have sustained while working, but said that there is no company insurance program.

Some hospital patients have been surprised to discover the caveat, and several have filed queries and complaints with Aasandha. Shabiq pointed out that “that policy is clearly listed in our exclusions section, printed in pamphlets and on the website. But I think people just aren’t aware of those details.”

However, “it’s not so easy to identify if someone was involved in a protest, and if they’re responsible for their injury.”

All injured individuals are treated on the assumption that they did not engage in high risk behavior until evidence to the contrary is presented. Shabiq claimed hospitals are asked to determine the individual’s level of involvement in any high-risk behavior, while another Allied official said police reports are used to clarify responsibility.

Private practitioner at Central Medical and Clinic, Dr Ahmed Razee, agrees with the policy: “Insurance should not cover intentional injuries. If you jump off the roof of a house you jump off the roof of a house!” he said.

However Dr Fathimath Nadia at Indira Gandhi Memorial Hospital (IGMH) believes the scheme’s policy leaves room for skepticism.

“I think injuries should be covered, but then again if you go to a protest I guess you have to expect that something could happen. But it’s difficult for a medical staff member to know if a person has been injured because of something they did or not.”

Dr Nadia suggested that the policy could have a preventative impact.

“At a protest you should expect that injuries could happen, so if you’re not going to be covered then maybe you won’t go, or you’ll be very careful,” she supposed.

In a separate case, Dr Nadia pointed out that some of the most important partnerships exist in the no-coverage grey zone.

“Three days ago I saw a 22 year-old boy who had had a diving accident. He needed a decompression chamber so we wanted to send him to Bandos but Bandos isn’t part of Aasandha so he wouldn’t be covered,” she explained, adding that the high cost of decompression chambers – of which only one of the Maldives’ five is not operated by a resort – effectively reserves them for the elite.

“It’s a problem, because we see a lot of dive- and sea- related injuries. The boy is now paralysed from his waist down, but what to do?”

However, Dr Nadia pointed out that Bandos had seen the boy and to her knowledge the family had kindly not been billed.

Health insurance programs around the world have their limits. The Maldivian public appears keen to find out first-hand just where those limits lie.

In a previous article Minivan News reported that hospital traffic had increased dramatically since Maldivians became eligible for up to Rf100,000 (US$6500) in free health care annually.

Public health expert and Chief Operating Officer at Male’s ADK hospital, Dr Ahmed Jamsheed, noted in a January 16 blog post that during the scheme’s first two weeks ADK had seen a 50 percent increase in specialist consultations and a 100 percent increase in demand for basic services.

In addition, 41,000 individuals sought health care at ADK – 11 percent of the country’s population – costing the scheme millions and raising serious concerns over its sustainability, Dr Jamsheed observed.

“In the absence of an ongoing epidemic, statistically and epidemiologically speaking, it is unlikely that so many people would be sick needing health care simultaneously,” he wrote, later noting that some patients are seeking multiple and even extraneous appointments.

At IGMH, Dr Nadia has also seen the appointment book fill up. She suggested that repeat appointments stem from a public belief that bi-monthly check-ups are merely proper maintenance – you can’t have too much of a good thing.

However, she noted that the validity of a person’s complaint could be hard to gauge. “It’s difficult to know if a person will receive correct medication from the pharmacy staff, and what they will do with that medication. We can’t follow them to find out,” she said.

In Dr Razee’s opinion, multiple visits to the doctor are important, even if only to put one’s worries to rest.

“Medically speaking, it’s not a waste of time or money,” he said.

“Many people are coming in with complaints that they couldn’t afford to address before. And they are seeing several doctors in succession because they want to get a second, even third, opinion, or they are looking for a doctor they feel comfortable with, or they were unable to tell everything in the short period of time they were first given with the doctor and they want to finish the story,” he said. “It’s normal human nature.”

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MNBC journalists beaten, tasered during protest

State television journalist Moosa Naushad was attacked by approximately 15 individuals while filming the opposition-led protest outside Maldives National Broadcasting Corporation (MNBC) last evening.

Naushad was struck down from behind. After showing his media badge the badge was taken from him and he was continuously kicked and beaten while lying on the ground, MNBC Director Adam Shareef said.

MNBC Editor Thoyyib Shaheem intervened by showing his own media badge, but was tasered in the stomach. Naushad was taken to Indira Ghandi Memorial Hospital (IGMH) at 1:00am on January 24 where he was treated for a broken hand. Shareef said the journalist had sustained fractures in his shoulder blades and feet, but had no internal damage. Naushad had not been released from IGMH at time of press.

The protesters, including opposition Progressive Party of Maldives (PPM) MPs Ilham Ahmed and Ahmed Mahlouf, allegedly made violent gestures with stones and wooden sticks while advancing on the MNBC building. MNBC have asked why their offices and staff have been targeted, “as if MNBC was ruling this country.”

MDP supporters were also reported protesting near the judiciary, before heading south towards the Haruge and clashing with opposition supporters.

“Over the past several nights our reporters have been verbally abused, threatened and warned they would would be killed by hanging or drowning,” said an MNBC official.

Shareef said he had “no idea” why the media organisation has been targeted, but “we are a government company so perhaps that’s the reason.”

The opposition has claimed that the attackers came from the MDP Haruge and attacked Naushad after reportedly mistaking him for a VTV reporter.

Last night marked the tenth consecutive demonstration since two minority opposition party members were questioned for “hate speech” against the government. The situation developed after military forces took Chief Judge Abdulla Mohamed into custody on January 16, after the government accused him of endemic corruption and political favoritism.

Although journalists have been targeted for the past several nights, Naushad’s beating was the most severe instance, Shareef said.

A photo of the attack on Naushad taken by a bystander

According to Shareef the two sides have not had any direct communication over the situation: “the opposition doesn’t want to talk to us, they are boycotting us as a state broadcaster. But we don’t want to speak with them either,” he said, adding that Maldives Journalist Association (MJA) and the Broadcasting Commission have released statements on the matter.

President of the MJA Ahmed ‘Hiriga’ Zahir on Wednesday said that the MJA had released a statement condemning both the attack on Naushad and damage to the offices of DhiTV as soon as he learned of the attacks.

President Mohamed Nasheed’s Press Secretary, Mohamed Zuhair, meanwhile blamed the attack on opposition parties and condemned them for “lurching towards violence, thuggery and intimidation in order to achieve their political ends.”

In a statement, he called on opposition parties to “respect journalists’ right to report the news free from fear or intimidation.”

While MNBC journalists “are not afraid”, Shareef said the state broadcaster will no longer be covering anti-government protests on-site.

“I don’t want to lose my staff. If possible we will have a live feed, but in any case we will cover the whole story, every point,” he said.

Police estimated that between 300 and 400 protesters turned out last night, and claimed that aside from the attack on Naushad only “a few minor injuries” were sustained. After being dispersed at midnight the crowd spread “throughout the city, between the Maldives Monetary Authority building and the [ruling] Maldivian Democratic Party (MDP) Haruge.”

Police understand that another protest is scheduled for 9:00pm on Tuesday evening.

As the protests continue opposition leaders are calling for extreme measures.

Speaking during last night’s protests, firebrand opposition politician Umar Naseer said bloodshed was not beyond the group’s means, according to MNBC reports. The station also reported that the Adhaalath Party’s Sheik Imran Abdulla, another protest leader, had called for jihad. Hours earlier Sheikh Imran had stated that “non-stop protests are maybe not the best way, even if it’s fighting for the citizens’ rights, as their time and businesses are affected” at a press conference.

PPM MPs Mahlouf and Illham were not responding to calls at time of press.

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“Begging for medical care is at an end”: President Nasheed

The practice of “begging for prescriptions” has come to an end with the introduction of a universal health insurance scheme on January 1, President Mohamed Nasheed said today.

Free universal health insurance is one of the five core campaign pledges of the ruling Maldivian Democratic Party (MDP).

Speaking to press during a visit to the Indira Gandhi Memorial Hospital (IGMH) to observe arrangements for the free health care service, Nasheed said he expected services at the main referral hospital to improve.

He added that private clinics that agree to the terms of the ‘Aasandha’ programme could be included in the scheme.

The scheme offers treatment worth Rf100,000 a year for all Maldivian citizens with valid national identity cards and does not require registration.

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Aasandha scheme doesn’t cover private clinics

The treatment from private clinics will not be covered in the universal health insurance scheme “Aasandha” commencing on January 1, 2012.

State Minister Ibrahim Waheed said the “Aasandha” scheme will not include private clinics as the government wants to establish a mechanism that would allow patients to receive all kinds of treatment from a single place, according to Haveeru.

“We haven’t planned to include private clinics in Aasandha in 2012. The government doesn’t want everyone to set up clinics in their houses but rather wants the people to be able to receive treatment from a single place,” he was quoted as saying in Haveeru.

According to Aasandha website, the scheme will initially cover treatment from IGMH, ADK Hospital, IMDC Hospital in Addu and other hospitals and health centers currently operated by state owned health corporations.

Under the parliament-approved scheme, all Maldivian citizens will receive government-sponsored coverage up to Rf100,000 (US$6,500) per year, including further provisions to citizens who require further financial assistance.

Expatriate workers are also eligible for coverage providing their employers pay an upfront fee of Rf1,000 (US$65).

The Aasandha program was officially signed at Artificial Beach on December 22 with hundreds of Maldivian citizens in attendance.

Aasandha is a public-private partnership with Allied Insurance. Under the agreement, Allied will split the scheme’s shared 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.

The service will cover emergency treatment, including overseas if the treatment is not available locally, inpatient and outpatient services, domestic emergency evacuation, medicine under prescription, and diagnostic and therapeutic services.

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Proposed switch to generic drugs would improve transparency of medical system, say doctors

A proposal currently under review would allow doctors to provide medication directly from health centers, bypassing the prescription process which often leads patients on a wild goose chase around Male’s pharmacies.

State Health Minister Ibrahim Waheed yesterday announced that the proposal is being discussed with health corporations, and that prescriptions could be ruled out by next June at the earliest.

He further suggested that a large pharmacy would be established in every atoll hospital, and would supply products to other health centers across the atolls.

Health Minister Aminath Jameel reportedly did not respond to most questions posed by MPs regarding health corporations at a committee meeting yesterday. Speaking to Minivan News today she said the proposal fell under the ministry’s remit but that she did not have the details and was unable to comment.

Other officials and offices at the Health Ministry had not responded to phone calls at time of press.

Generic drug-based systems which include hospital-centered distribution are commonly practiced in other countries, sources say.

The World Health Organisation supports the use of generic drugs, particularly in developing countries.

In a speech earlier this year, WHO Director General Dr. Margaret Chan said, “Generic products are considerably less expensive than originator products, and competition among generic manufacturers reduces prices even further. Generics serve the logic of the pocket. An affordable price encourages good patient compliance, which improves treatment outcome and also protects against the emergence of drug resistance.”

CEO of Indira Ghandi Memorial Hospital (IGMH) Cathy Waters said the hospital had not been officially informed of the proposal, but noted that pharmacies were generally not well-stocked and that there were multiple available brands.

Medical Director at Male’ Health Service Corporation Dr Robert Primhak said he “would welcome an improvement in pharmaceutical supply and prescribe system.”

According to Primhak, doctors currently prescribe drug brands rather than generic medications. Shifting to a generic drug-based system would mean that a list of nationally-approved drugs would be available for the first time in hospitals, clinics and pharmacies, a “major improvement” that would improve the medical system’s transparency.

However, such a shift would also require “robust quality control” and a centralised import and supply system, Primhak said.

These reforms could take the edge off of the medical import and supply business.

“There’s no business advantage in stocking medications that are not commonly used,” Primhak explained. “For example, a baby who is born with a heart problem needs a specific drug to keep a vessel open. We might get that case three times a year. But instead of stocking these specialised drugs which are only rarely used, the retailers prefer to stock common drugs and brands that will sell, because they know that they can get a turnover.

“The drugs that are imported are the ones they want to sell, not the ones we want to prescribe.”

MPs yesterday voiced concern that the proposed system would incur huge losses for pharmaceutical importers.

Minivan News asked Primhak if medical decisions in the Maldives were driven by business interests and ought to be re-directed towards serving the people. “Yes, to both points,” he said.

Chief Operating Officer at ADK Hospital and former head of the Center for Community Health and Disease Control (CCHDC), Ahmed Jamsheed, believes the proposed change would engender a stronger monitoring system by default.

“The new system would move towards generic drugs which would make it easier to monitor drug quality and standards, and bring down the price,” he said.

It would also improve patient convenience. “Now, a medication prescribed by a doctor in ADK may not be available in the hospital pharmacy, so the patient has to hop around to different pharmacies to get the prescription filled.”

Jamsheed believes the change would benefit the Maldives’ medical system but agrees that the focus should be on people, not corporations.

“Currently, there is a big network of pharmacies, most of which are privately owned. It is known that most pharmacies are poorly monitored, and the authorities are unable to control them. Many prescription-only drugs not meant for over-the-counter sale are actually available to anyone who asks. That carries a huge risk for the patient community.”

Usually, Jamsheed said, a small country like Maldives only needs one or two sources for importing the drugs. But he said the MPs have a point: standardised markets don’t foster high profit margins. “But at the end of the day, the government has to consider whether the system is best for the country and its people,” he observed.

Under the proposed 2012 state budget, Rf2 billion is allocated to the health sector; Rf638 million of that amount is to be used for developing mechanisms providing easy access to health care. Another Rf543 million is designated to developing atoll health centres under Public Private Partnership.

The budget also allots R720 million to the universal health insurance scheme, due to take effect in January 2012, while Rf100 million is to be spent on health corporations’ capital investments, which are made to improve their services.

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More than 1000 cases of child abuse reported in 2011

Between December 2010 and October 2011, 1,138 cases of child abuse were reported to the Gender Department from atoll family and children service centres.

1,005 cases involved minors while 133 cases involved victims aged 18 and above.

A majority of cases (348) involved children aged 11 to 15; 30 percent of these cases were classified as sexual abuse.

Approximately one-third of the 81 cases involving children less than one year old involved neglect. Sexual abuse was reported in a quarter of the 192 cases for age group one to five, and in a fifth of the 230 cases age group five to ten.

Acting Head of the Child and Family Protection Services Aishath Ahmed said the report said more about the record keeping system than the issue itself.

“I would say the statistics show an improvement in the reporting system because people are more aware of how to file a report. I don’t think the situation is getting better, as far as I know the number of cases is increasing,” she said, explaining the report only accounted for cases reported.

However, Ahmed said people are less hesitant about filing reports than they were five years ago.

“Back then people didn’t want to report the cases, they didn’t want to get involved in other people’s business. But now they can report anonymously,” said Ahmed, explaining that island residents were also filing reports more regularly.

“Before, some people believed that only sexual penetration constituted child abuse,” she explained. “Now, they know more about the different kinds of abuse. The definition of sexual abuse is also clearer, so they can distinguish.”

Child abuse cases are divided between four categories: sexual, physical, psychological and neglect. Statistics show that 57 percent of abuse cases reported were physical. Ahmed said the second most common form of abuse was neglect (17.4 percent).

Family problems such as domestic violence, runaways and complications due to divorce were identified in 14.1 percent of the cases. Behavioral problems including teen pregnancy, self-mutilation, attempted suicide and anger management accounted for another 14 percent of reported cases.

In it’s own report, Human Rights Commission Maldives (HRCM) yesterday said its offices had received 500 complaints of human rights violations in the past year, 74 of which involved the social protection of children, elderly and disadvantaged people.

HRCM is one of several organisations with which individuals may file a report on child abuse in the Maldives.

A report submitted to the United Nations by HRCM in July this year found that physical discipline in some schools qualifies as abuse.

“For instance, the investigation carried out by HRCM on Lale’ International School (2010) made apparent that number of students experienced physical and psychological abuse in the school. Some of the findings include abuses such as strangling and whipping children with belts. The findings of HRCM were further validated when the Criminal Court in August 2010 found the former principal of the school, guilty of assaulting children and sentenced him to pay Rf200 (US $12.97 ) as fine under article 126 of the Penal Code.”

Staff of Lale’ School, including the deputy principle, fled the Maldives in 2010 over allegations of child abuse and other misconducted, which was investigated by HRCM.

Article 10 of the Law on Protection of the Rights of the Child states that punishment in schools should be age-appropriate and should not affect them physically or psychologically.

According to Ahmed, child abuse has a lasting impact on the individual and the community.

The aftermath of abuse can vary by the age of the victim and the severity of the treatment. “If a child has experienced repeated sexual abuse, then as the child approaches sexual maturity she or he may have a difficult time adjusting within the age group. Physically abused children may also develop violent habits in their own marriages later in life,” said Ahmed.

Abusive behavior can also impact children’s social development. “It affects education as well. Children who have been abused sometimes can’t cope with their peers, and they might lash out or withdraw. They may have a hard time paying attention in school,” she explained.

HRCM’s report said the Ministry of Education (MoE) acknowledged that school monitoring and inspection was insufficient.

“Due to the fact that corporal punishment is existent in the education system, it is important that the MoE come up with a discipline policy where it could provide clear guidelines disciplinary actions/corrective measures in schools. It is equally significant that all staffs, including teachers are sensitized to the rights of the child and other related rights that are relevant while working in the education sector.”

HRCM’s action plan includes the public outreach campaign ‘Every Neglect is an Abuse’. The commission has also released handouts informing citizens of the United Nations’ Convention of the Rights of the Child (CRC) and the Convention on the Elimination of Discrimination against Women (CEDAW), of which the Maldives is a signatory.

Last week, the Maldives recognised “World Day for Prevention of Child Abuse: Every Neglect is an Abuse“. Children’s festivals were organised by government groups and NGOs including the Child Abuse Prevention Society (CAPS), HRCM, the Ministry of Education, the Department of Gender and Family, Maldives Police Service, Care Society, Maldives Autism Association, Maldives Red Crescent and Tiny Hearts.

Vice President Dr Mohamed Waheed, who attended both events, said the efforts to raise public awareness of child abuse was an indicator of Maldivian society’s growing concern over the issue. Listing the four categories of abuse–physical, sexual, psychological and neglect–he urged parents not be overly-critical of their children.

When asked if there were sufficient resources for the Maldivian community to address child abuse, Ahmed said the network is growing.

“People can contact the police, NGOs, HRCM, and there’s a Family Protection Unit in IGMH [Indira Ghandi Memorial Hospital]. The cases are also forwarded to us, and we review them to see how best to address them,” she said.

Ahmed explained that a series of interviews, visits and follow-up reports are conducted to evaluate a claim. Sometimes the situation is not as severe as initially reported. “We may close a case when we feel there is no further assistance we can provide, but we rarely close a case.”

Child and Family Protection Services will be working to create more awareness throughout the year. A more specific action plan has not yet been drawn up.

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IGMH to introduce triage system to prioritise urgent medical care

The Indira Gandhi Memorial Hospital (IGMH), the main referral hospital in the Maldives, has announced the introduction of a triage system to prioritise emergency treatment for patients who require urgent care.

In a press statement today, the government hospital explained that patients at the waiting room would have their vitals checked to determine urgency of treatment.

Under the new system, a team of doctors and nurses will check the patient’s blood pressure, heart rate and oxygen levels in two minutes and those requiring immediate treatment would be rushed to the emergency room.

The system was changed as patients who do not require urgent medical attention were being treated at the emergency room.

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