What will the new year bring?

Monday, December 31, 2007

The year ending tonight has been one which has brought much suffering to many of us, not just because of illness, but a lot because of the great many inadequacies in our health system. The cost of human loss cannot be quoted in currency, but the cost of poor health, illnesses and neglect of a system would be beyond comprehension.

Minister Ilyas has failed to deliver an improvement to the health system worth anything more than a few name boards labeled "Health Center" or "Atoll Hospital". His team at the Ministry has managed to hold back the health care standard of the country at the same place as was at a decade earlier. The medical people with him, Dr Abdula Azeez Yousuf, Dr Sheena and Dr Ahmed Razee have done little more than draw 3-4 salaries per month!!!

The truly sick in the islands, die at the hands of either incompetent health care providers or a competent provider rendered incompetent by an inadequate health care infrastructure. We are witness to the desperate cries of those who have been left to tend for themselves, we are among them ourselves.

Our premier health institution, IGMH, has won not our hearts, but our anger and hatred for its display of contempt with our needs and wishes. It is little wonder that IGMH has had within its premises mob violence disrupt its services and physical assault cause injuries to staff. The failings of the administration and the inability of it high ranked officials to discharge their responsibilities were at least partly responsible for these events. Deaths, medical negligence, maltreatment and all sorts of medical errors at the institution have made their ways to the news headlines. It speaks volumes about the intentions of the management of the hospital when 2 doctors were suspended for voicing concerns about malpractices happening within the Hospital. Dr Mohamed Solih, Dr Fathmath Ali Didi, Dr Yasir and Ali Mohamed (Alibe') are responsible for the sickening state of affair at IGMH.

Can we expect anything different in the new year? Realistically the chances of that are very little. The system headed by the same individuals from the very top to the middle management level are corrupt, incompetent, selfish and untrustworthy.

One thing will be different though! We will be less tolerant of their criminal handling of our welfare in the coming year. We pledge that we will do all that we can to make sure that we hold them accountable to the people of this country. We have all suffered enough. We deserve better. We demand better.

No ICU bed for Mishka

Friday, December 28, 2007

Mohamed Irfan Sharaf's story:

"I am now out on the streets, virtually begging to make ends meet." Sharaf said to us at the first meeting of MMW on Against Abuse web community on 25th December 2007. None of us could see it, but sure as the sky above our heads, Sharaf had more than a tear running down his cheek!

Sharaf is the 2nd child born to middle class Male' family where both parents held clerical government jobs to provide for the 4 children and 2 grandmothers. His parents invested heavily, without having a laari to save for the future, in the education of all 4 siblings. They are what they are today thanks to their parents resourcefulness. Enough about Sharaf and his family, the story is actually about Sharaf's 2nd child, Mishka.

Mishka was born 2 months premature after a torrid 7 month pregnancy. She was born at IGMH and spend nearly 6 weeks in the hospital having fought terribly hard during the first 2 weeks of her life for survival. That experience gave us a lot of confidence in the new and upcoming health care providers at IGMH, hope that we were indeed in good hands and that we could expect things to finally take a turn for the better within the often negligence-riddled system.

Mishka was just less than 1.5 kg at birth and was so tiny that we were afraid to touch her, afraid that we may do her harm. Half an hour after her birth, Dr Abdulla Niyaf, the Paediatrician on duty that day briefed us on what had happened at birth, what he and his colleagues were planning to do and what we could expect within the next few hours and days. Apparently little Mishka was not able to initiate breathing on her own after birth and required assistance with breathing. Within a few minutes, she was breathing herself, but apparently not with enough of an effort to maintain good oxygen levels within her blood. She was admitted to the NICU and given mechanical breathing support.

We were already financially broke, having spent all our savings on the multiple hospital admissions for premature contractions and threatened miscarriage. Had it not been for financial support from a close friend, who we now take as a brother, we would have had to beg for money to support the daily cost of medicines for Mishka. Mishka did need very expensive medications during the first day of her life, 2 injections of surfactant had to be given into her airways each costing nearly MRf 2000.

There were times during the first 2 days when we though we would loose Mishka. We shed many a tear each time we saw her in the NICU. She was, we are sure, looked after very well but for us common people seeing several tubes coming in and out of the little baby was a sight that pained us greatly. It was a very mixed experience overall, some days we would be buoyed by the changes in her condition and the professionalism shown by the treating doctors, while on others we would struggle to talk to other doctors who were sharing the responsibility of caring for Mishka.

When Mishka was a week old, we were given a longer than usual briefing on her progress and plans for the next few days. She had stable breathing parameters and was apparently showing good effort of breathing. Dr Niyaf said that Mishka was needing only a little bit of assistance from the breathing machine. She was doing as well as they were expecting and that they hoped that Mishka would be able to come off respiratory support soon. Our prayers were answered.

The next day, Dr Niyaf and Dr Zumra gave us the happy news, Mishka was off the machine and doing very well. That was a relief. We had heard of terrible stories of medical misadventures at IGMH that we were terribly afraid that similar things could happen to our little Mishka. But Mishka was indeed in good hands. Even the foreign doctors with whom we had some tension were caring towards Mishka; Dr Balaji was himself, but a cauldron of knowledge. I know that it was a team effort, the key players just making sure that the team stayed focused. My wife fondly remembers a couple of Nurses who made her a part of the care-team. The cheerful chatter-box, Sheeza and the sweet smiling Jeba were her favorites.

We made it thorough the tough time, Mishka fighting for her life and winning the battle thanks to Allah and the efforts of a team, we learned to respect. We often complained during the last 3 weeks of our hospital stay, when Mishka played yo-yo with her weight. We were warned that this period would be long, we didn't expect it to be quite that long though.

Finally, we were given a 2.2kg and healthy Mishka to go home. We were in a hurry to go home that day and we forgot some very important things. We went back to IGMH the very next day and thanked Dr Niyaf, Dr Balaji, Dr Zumra and even Dr George; someone who would later break our hearts.

The IGMH experience, a largely good experience had cost us well in excess of MRf 50,000. We didn't have that kind of money. Letters from IGMH doctors helped secure financial assistance that helped pay most of the bill. We were happy, broke yes, but still happy. Even if we had to spend every laari ourselves, we would have, a child is worth whatever it takes!

That was the happy experience that Sharaf narrated to us before his face turned gloomy. We knew it was coming. We could see the dark clouds hidden behind the happy shimmer in his eyes.

Mishka had spent 6 months growing well and showing no signs of having been the tiny baby with several tubes coming in and out of her little body and attached to machinery to sustain her life. Her big brother was just getting used to having her around the house and getting over the jealousy sibling rivalry when we were hit by a lightening bolt.

Since discharge from hospital, we had made a terrible mistake. It wasn't easy to get an OPD appointment for our favorite doctors, the ones who gave us back a healthy Mishka. After the first 2 follow-up consultations one with Dr Niyaf and the other with Dr Balaji, we opted for "experience" and ease of getting an appointment. We consulted Dr George as advised on a monthly basis. With Mishka turning 6 months, we were scheduled to consult Dr George for the 5th time, when she had what we thought was a mild fever.

We didn't take any chances though, we took Mishka to IGMH and showed her to Dr George. Mishka was not herself that day, she didn't allow a good examination. We know Dr George struggled to see her properly. We were a bit concerned about how Mishka was breathing and mentioned it to Dr George. He dismissed our concerns rather off-handedly. We found that a bit odd, but thought that the doctor would know better.

Mishka was being given all 4 medications as advised, not a dose was missed. Her mother made sure of this. But something was not right with Mishka. She really wasn't breathing normally. It was the 3rd day of treatment and late in the evening. Mishka was breathing a bit heavily. Her cough had also become more chesty. The fever was gone though. We got an appointment to see Dr Vanitha at ADK.

Mishka was a bit restless in the doctors room and a thorough examination was not possible. The doctor said that she was having a severe form of cold and there was some "chest cold". She asked us to change the medications including the antibiotic we were prescribed before. She assured us that Mishka would get better soon.

That night was terrible for us. Mishka did sleep, perhaps because of the Phenergan that was prescribed for her. We stayed awake in shifts because Mishka tossed and turned a lot and slept fitfully.

Early morning the next day we went to IGMH and tried to see if we could meet Dr Niyaf, Dr Zumra or Dr Balaji, the very people who helped us before. It was Dr Niyaf's "off-day", Dr Zumra was busy in the NICU with a sick child and Dr Balaji was out of station. Just our luck. We saw Dr George in the corridor and requested him to see our Mishka as soon as possible. He asked us to sit outside room 37 and that he would be there shortly.

It was 9:30AM when we saw Dr George. He said that She needs admission for treatment and that he suspects that Mishka has a chest infection, he called it Pneumonia. By now Mishka was grunting and breathing terribly noisily. We were given a slip to get a chest x-ray, which would later show a large "pneumonic patch" and a "pneumothorax". After a look at the x-ray Dr George, still in room 37 said "it looks OK" but told us to get admitted anyway.

On the way to the admission desk, we met a family friend who was a close friend of Dr Razi. He took the x-ray from us and went to show it to Dr Razi, who was apparently in an OPD room too. Our friend would return to tell us that Dr Razi said it looked very bad and that he would recommend immediate admission.

We quickly got Mishka admitted. Dr Ismail Shafeeu was very helpful. He quickly started treatment. Mishka's condition was clearly critical. Dr Shafeeu had said that Mishka needs ICU care and that she may need mechanical support for breathing. It was a scary thought. We had already started making plans to take Mishka to Colombo as soon as possible. My brother was making all arrangements for that while we were in a new struggle for Mishka's life.

Sadly though, IGMH could not afford an ICU bed for little Mishka. It was full. All 8 beds in the "immense" ICU was full and not even one could be moved out. I saw how hard Dr Shafeeu and the junior staff tried to get a bed in ICU. But it just didn't happen.

Because of our experience when Mishka was in NICU, we were able to understand what the numbers on the monitor to which Misha was connected to meant. Her oxygen was way low, 85% at the best of times, with full oxygen by mask. She was agitated and very irritable. Preparations were already made by Dr Shafeeu to have a tube inserted into Mishka's chest to remove the "pneumothorax". Meanwhile my brother was able to get seats for us on Srilankan to Colombo to fly out in 4 hours. This new plan prompted the surgical team, who came to place the chest tube, to do what they called "needle drainage".

With Mishka struggling "needle drainage" was done in the treatment room. Mishka remained the same though. Dr Shafeeu wanted to have the chest drain in place for the air-travel but the surgical team though the needle drainage was sufficient. We didn't know what to think. It was beyond our comprehension. We were eager to get Mishka to an ICU; in Colombo if IGMH could not get one for us. She needed that. We needed to give that hope for her.

We flew out that day with Mishka hanging on to dear life, just so only. The 4o minutes or so travel time went off ok, Mishka didn't collapse that is. The nurse who accompanied us kept checking on Mishka every few minutes to see if anything extra needed to be done.

Our luck ran out on the ambulance ride from the airport to Apollo hospital. Mishka's breathing became ragged. She looked pale in the face, her hands were dusky and she was gasping for air. The doctor or male nurse on the ambulance worked frantically to assist Mishka to hold on till we reached Apollo Hospital. Mishka had fought hard.

We were shattered. Mishka was pronounced dead on arrival at the emergency room of Apollo Hospital. We couldn't believe it. I couldn't even cry, Mishka's mom fainted. Mishka, our lovely Mishka had left us and traveled to heaven.

Sharaf was sobbing now. He couldn't say anything more. The rest of us felt the pain and the anguish. We offered our support to Sharaf and pledged to fight on till things improve in our health care system.

Corruption within the recruitment process

I paid US$2000 to employment agent in India and then US$1000 to agent in Male' to get a job as a nurse in Male'. [Name withheld, Received by Email]

One senior, lady at Department of Medical Services at the Ministry of Health took money from me as commission for giving me my job in Maldives. [Name withheld, Received by Email]

We have heard of staff shortages in the health sector of the country for many years. There have been rumors that many of those who apply for posts, in response to advertisements in foreign newspapers are prevented from getting a contract unless a bribe is paid to Maldivian and expatriate "agents".

One email that we received did mention a senior level official at DMS, whose name was not mentioned in the email, taking heavy bribes from potential employees before confirming their contracts. Our team made inquiries from contacts within DPH and MoH if there was any truth in these stories. Our contacts were able to confirm that such rumors are rife even within the office. They were however unable to confirm for sure if such activities indeed happen, they said, "the senior level officials would know, but then again- they maybe the people involved too".

One senior doctor, who wished not to be named for obvious reasons, working at a regional hospital talked to a member of the Medical Investigators Team on 27th December 2007 and confirmed that he had to bribe the head of the institute and an official from DMS to renew his contract. He said that every expatriate doctor known to him working in Maldives pays some sort of "fee" or "commission" to officials to ensure their contract was renewed. He swore that to get his first post in Maldives he had paid 2 lac Indian rupees to an agent in India and MRf 10,000 to a Maldivian "agent" upon arrival in Maldives.

We were made to understand that DMS is the government department responsible for recruitment of all medical staff to institutions other than IGMH, which has its own recruitment department Personnel department within IGMH.

The staffing situation at IGMH is also woeful. Several of the key medical departments are chronically short staffed and stretched. There have reportedly been spats between medical staff and the officials at the Personnel department over the pace of the recruitment process including accusations by many of corruption within the recruitment process.

Two doctors from IGMH that we contacted refused to either refute or confirm whether they experienced such procedures when they applied for work at IGMH. Their refusal to discuss the issue and allegations does make one believe that they may have been victims of a similar scam.

The stories that we received may make us believe that high level officials within the Ministry of Health and IGMH are involved in a racket to make money out of the recruitment process. Our contacts within MoH and IGMH share the views.

Expatriate doctors, nurses and paramedical staff have stories to tell. Many of them have allegedly paid bribes and "commisions" in order to get a contract or extension of contract to high level officials.

[We continue to investigate these allegations in order to identify the people involved in the racket]

Non-standard ultrasonography

Thursday, December 27, 2007

My wife was 6months pregnant at that time when we went to Kulunu Medical Services for a scan appointment. The sonologist on duty was Dr Fathmath Ali Didi. The scan was done. The only thing she said to us was that "baby was normal" and that "everything was fine". Two and a half months later when baby was delivered, he had gross multiple physical anomalies!
[Received by Email]

Dr Fathmath Ali Didi is the Director of Medical Administration at IGMH, an MBBS graduate who has risen through the ranks initially because of her influential family and now because of the ease with which she can be manipulated by policy makers.

We have been able to confirm that for the past many years she has been a practicing sonologist performing the "job" of PG Radiologists both at the government setup and in private practice. She is however, not a radiologist and has nothing more than the experience of attending a single certificate course on basic ultrasonography years ago. We have been told, and we believe too, that she has over the years acquired skills in operating the ultrasound scan machine and is able to do basic scans.

Nevertheless, lets us not be fooled into believing that she is at all qualified to do complex sonography. The scan referred to in the email had missed fairly gross physical anomalies that should have been seen by the sonographer. We wonder how many such errors had resulted from scans performed by herself and fellow wannabe-radiologist Dr Yaganegi.

We called IGMH to find out what post Dr Fathmath Ali Didi holds within the radiology department. The PRC girl said "she is a consultant". Our contact within the Personnel Department was able to confirm that she held no official post in the radiology department at IGMH. Her posts include Director of Medical Administration and Registrar in Internal Medicine. We have also learned that her qualification is listed as MBBS only. She is not a specialist physician and her post of Registrar in Internal Medicine came as a shock to us. We were made to understand that these types of extra posts were common for high level administrative staff and that it was a way of them earning a higher salary. Incidentally- Dr Yaganegi is also only an MBBS graduate.

One of staff at IGMH reported that Dr Fathmath Ali Didi only does scans when there is a shortage of Radiologists and that she is "usually quite Ok" with obstetric scans. The truth became apparent when we called CEOs office, where her office is. The person who answered said that she was on scan duty at the time and to call later!

This case highlights a serious breach of trust that should exist between service provider and patients. Individuals working in professional capacities well beyond their capabilities and medical qualifications is a serious issue. It could cause serious damage and grievances for patients. From the email, it is evident that it has already happened.

No oxygen in health centers and hospitals

Wednesday, December 26, 2007

A sick newborn transfered from Gn. Fuvahmulah Atoll Hospital to S. Hithadhoo Regional Hospital bacause of lack of oxygen at the former health facility. [Translation; Minivan Daily]

This report was very concerning. We alerted our team to do a quick investigation and below are our findings.

The story is factual. The baby was transfered to HRH (Hithadhoo Regional Hospital) because baby was having respiratory distress and the oxygen supply at Fuahmulah Atoll Hospital was running out. Our affiliates at HRH confirm that the baby was received at the regional hospital and that the baby is improving.

On a more concerning note though, we can confirm that the lack of oxygen is a problem across all government health facilities including IGMH. Our affiliates within IGMH confirm that apart from a few cylinders, IGMH is running very low on oxygen.

STO and Maldive gas are the suppliers of oxygen to IGMH and DMS (Department of Medical Services). Apparently a financial conflict between the suppliers and the institutions is responsible for the grave situation. Overdue invoices and mismanagement of stock maintenance has put the health of many of our most vulnerable in jeopardy. Jazeera Daily is the only local paper to report on this issue.

As Dr Yasir was unavailable for comment, we tried to call Dr Solih (Executive Director General, IGMH) to inquire about the situation. As custom, his phone was also in silent mode! We were told that Alibe' (Director General, IGMH) was the next in command at IGMH. He and 2 other senior executive, we were told were unavilable at this time, as they were at the Peoples Majlis.

In the atolls, the situatation is different at different centers. At most places there was no oxygen available anyway, because they never had any. However, at most of the health centers report that they have enough oxygen (some reportedly have one extra cylinder on standby! That is 2 cylinders in total).

If the situation does not improve over the next day or so, we will see patients being transfered abroad for oxygen! "Patients in IGMH ICU are high risk of oxygen deprived brain injury in the next 48hrs if things do not improve" said one staff working there. It is a scary thought and a scandalous statement and she may be right too.

The incompetence, corruption, mismanagement and poor planning at IGMH, MoH.....across the board in our health services is putting our lives at risk.

Foreign spouse and Thalassaemia

On the pre-text of combating Thalassaesmia, Dictator Gayoom introduced discriminatory bars against Maldivians with foreign spouses, a cowardly act to cling on to power at any cost. [DO political article, 2nd sentence of the 5th paragraph]

Is this true? We couldn't find any documentation of this anywhere (our team has access to a limited amount of records). Anyway, we decided to get a medical position on this statement.

We called National Thalassaemia Center to get their opinion. Dr Farzana was not available for comment and the person who answered the phone said "there is no one else who can provide information" at the center.

We then called Ministry of Health, even though we have insiders, to get an official word. The girl who answered the call said that neither Dr Sheena (Director General of Health Services) nor Dr Azeez (Deputy Minister) were available for comment.

We then called IGMH where we were told, by PRC counter, that the only person allowed to communicate with the media was their spokesperson. That turns out to be Dr Yasir. It appears his mobile phone is on mute, as he was apparently unaware that we were calling him repeatedly.

At SHE, we were told to talk to Ms Jeehan, a counselor. She could not be contacted either.

Left on our own, we turned to a team of doctors affiliated with the Medical Investigator team. We posed the question to them.

There apparently is no truth to the inference that marrying foreigners would increase the incidence or disease burden of Thalassaemia in the Maldives. On the contrary, everyone agreed that diluting our Thalassaemia riddled gene pool with foreign genes would benefit the Thalassaemia situation.

The justification or reason for the "foreign spouse bar" is not correct! It is unlikely to be the documented reason for the legal clause. Medical opinion is that the inference is false.

And Yes: being un-contactable is a fashion!


We shall not tolerate mistreatment, maltreatment, negligence, medical errors, corruption, mismanagement and abuse at our health institutes!

Be warned, our eyes are on you. Play it safe, do what is right.....or else......