1st Dengue Death for 2008 ?

A 7 year old girl, native to HDh. Hanimaadhoo, living in Male' has passed away within a few hours of arriving at IGMH Emergency Room (ER) from what is believed to be Dengue Hemorrhagic Fever with Shock.

A family member, who wish to remain anonymous, was contacted by our team on 27th January for details of what had happened. Our informer was clearly unhappy with what had transpired at IGMH and at home in the lead up to the child's death.

According to our informer 7 year old Ifaasha was first taken to IGMH ER on 25th of January because of fever for two days and severe vomiting with a very severe abdominal pain. Unfortunately, Ifaasha was taken to the hospital by a relative who did not know the details of her illness. Our informer suspects that this probably was one reason for the sad end to the story. In the ER, Ifaasha was seen by a junior doctor and given an injection for vomiting and sent home on Panadol doses for fever. Our informer reports that not much attention was given to Ifaasha's history and that she was rushed out of the ER and sent home without a full examination or investigations.

We were able to talk to 2 doctors, who also spoke to us on the condition of anonymity, from IGMH ER who gave a different version of events. According to the doctors, Ifaasha was brought to the ER by a distant relative who gave a history of fever for less than one day and abdominal pain. At examination, they report that, Ifaasha had no abdominal pain and the fever was mild. The rest of the examination was normal according to the doctors. This was the reason, they claim, that Ifaasha was sent home without any investigations. MMW notes why history was not taken from Ifaasha herself. She was big and mature enough to give a full history herself. The doctors reported to us that Ifaasha went home well on the 25th january and that the family was advised to bring the child back if there were any other problems.

Our informer reports to us that since returning home, Ifaasha continued to complain of severe abdominal pain. He also reported that after a few hours of returning home the vomiting had become worse and Ifaasha was unusually weak and sleepy. The parents however, did not worry much as they were assured by the ER doctors that what Ifaasha was having was Gastritis (gas- vaige undhagoo).

On the 26th January, less than 24 hours of the first visit to ER, Ifaasha fainted at home and looked really sick. Her mother, now concerned for Ifaasha's life rushed her to IGMH ER. When they arrived in ER for the second time, our informer reports that, Ifaasha was conscious but clearly very weak. She was made to lie in a bed and a junior doctor examined her while a nurse checked her blood pressure. Our informer reports to us that, his impression was that Ifaasha was too pale; "death pale" he had said.The ER doctors and the nurses then quickly swarmed around her and got an IV going. One of the doctors talked to the mother and said that they were unable to get Ifaasha's blood pressure and that they felt that Ifaasha was bleeding somewhere within her abdomen.

The ER doctors reported to us that Ifaasha was received in ER on 26th in shock with no recordable BP and was extremely pale. They suspected internal hemorrhage and tried to get urgent blood for transfusion.

In about 20 minutes of arrival in ER, Ifaasha was reportedly seen by a Pediatrician [Dr Sunil] and advised to be transferred to ICU for management of suspected Dengue Hemorrhagic Fever with Shock and hemorrhage.

Our informer reports that when transferred to ICU, Ifaasha was almost dying. He had himself lost all hope.

Within a couple of hours of Ifaasha being transferred to ICU she died from bleeding into her lungs and intestines. She had blood coming out of her mouth, when our informer last saw Ifaasha alive.

The ER doctors reported that Ifaasha may have been saved if they had blood available for immediate transfusion, blood bank was out of stock of O- blood. They also said that the history given to them on the second visit; fever for more than 4 days, had not matched with the first history given on 25th. This was the reason why investigations were not done on first visit, and diagnosis missed.

We were told by family members that that they accept the efforts of the doctors on the 26th of January, as they did everything they could to save Ifaasha. They were however, very bitter about the way Ifaasha was managed on the 1st visit. They felt that, a proper examination and investigations could have save Ifaasha.

One nurse from ICU reported to us that even at the time of death, no reports were available to confirm what Ifaasha had died from. The lab had taken too long to give the results. She told us that the reports, although not 100% diagnostic, were highly suggestive of Dengue Hemorrhagic Fever with internal bleeding.

Could this death have been avoided? Has the hospital started an internal evaluation into how the case was handled? Has the family been given a good enough explanation of what had occurred? When would IGMH administration consider setting up a mechanism to evaluate mortalities and major morbidities promptly, even if a complaint is not lodged? [Dr Solih repeatedly disconnected our call and as usual Dr Yasir is unavailable for comment].

Was this really the 1st Dengue death for the year?

Update:

1. Our informer reports that the family are considering sending a letter to IGMH and MoH to complain against the way the case was handled.

2. Over heard by an IGMH staff: The case is being discussed by the Department of Pediatrics and ER to see if case could have been handled differently. Initiative taken by Dr Zumra, not by hospital administration. The process is not likely to yield a report.

3. The lab reports were not delayed in the lab? Our sources at the hospital confirm that the samples were sent to the lab late, reports were generated as urgent, delay in collecting reports by ICU to blame for delayed availability of reports to treating doctor. MMW: with the new database system at IGMH, is it still not possible to view lab reports from ICU and other intensive care areas? When will this happen? Would having the reports available change the treatment?

4. Reports: we showed the report values to our team: thrombocytopenia, severe anemia, elevated liver leaked enzymes are all suggestive of DHF; and based on the clinical course: DHF with Shock and Hemorrhage are plausible diagnoses.

5. Case reported to DPH, officially, as a case of Dengue. DPH sources confirm that if proven (an internal review at IGMH is expected) this would indeed be the first Dengue death for the year. Our DPH source also reports that there is a small but significant increase in the number of cases of Dengue being reported in the past 1 month.

Life saving surgery?

This report is based on an unpublished article written by a Maldivian doctor stationed overseas reporting on an incidence that happened at IGMH. We received the article from Minivan News reporter who wishes to remain anonymous. The article was refused publication by the Minivan News Editorial team for unknown reasons despite the Minivan News reporter confirming authenticity of the events.

In October 2007 a baby born at IGMH was diagnosed to have Congenital Diaphragmatic Hernia, a condition in which the muscular sheath (diaphragm) separating the abdominal cavity from the thoracic cavity has a defect in it that allows intestinal loops and other abdominal content to herniate into the thoracic cavity. The condition is potentially life-threatening as the intestinal loops in the thoracic cavity would occupy the space that would otherwise have been occupied by the lungs. Depending on the severity of the herniation, the lungs could be compressed preventing respiratory functions.

The baby was admitted to the Neonatal ICU where investigations confirmed the diagnosis. The child remained stable even with the potentially life threatening internal deformity.

Cases of Congenital Diaphragmatic Hernia have been diagnosed at IGMH in the past as well. Reportedly, in the past 3 years, none of the previous cases had died. The procedure that was followed over the 3 years referred was to stabilize the patient and have them transfered to Trivandrum or Colombo accompanied by Pediatric doctors. Reportedly, in 2007 a total of 4 babies were transfered for varying surgical and severe medical conditions (including one with Congenital Diaphragmatic Hernia) under medical care of a Pediatrician. They all survived.

IGMH does not have a Pediatric surgeon. Neither does it have a general surgeon with enough expertise and experience is surgeries of the newborn. This is not to say that a general surgeon would be unable to undertake any life-saving surgeries at IGMH for newborn surgical conditions.

The baby in this case was in a stable medical condition, Pediatric orders for referral abroad were made and discussed with parents when the case was seen by Dr Mohamed Firdous and his puppet team of surgeons. He clearly wanted to "have a go" to see if he could add "did a correction of CDH" to his resume'. To make this possible, the parents were misinformed by the surgeon and a new Pediatric Head of Department Dr A.C. Bhagwat that the child was in a critical state and that unless surgery was done urgently child would die!

Left with no choice, the parents consented to surgery. The relatives were made to sign a "high-risk" surgery consent form. Clearly; a common practice by all surgical specialties at IGMH, attempting to reduce liability.

Details of surgery are sketchy. Surgery was done by Dr Firdous himself. Documents were never given to parents; they were given just a Death Certificate. MMW was able to confirm from IGMH theater staff that the child arrested during the surgery and could not be revived. However, on the orders of Dr Firdous, death was not declared. The lifeless body of the baby was transfered back to Newborn ICU and connected to a mechanical ventilator.

To our shock, we were told that the lifeless baby (no cardiac activity, breaths given by machine) was kept on "life support" for several hours before declared dead. The parents were lied to and the truth of the events hidden. The surgeons shamelessly declared the surgery a success; claiming to have repaired the diaphragm!

The way patients condition was mis-informed and parents misled before the surgery, during surgery and following surgery (surgical death) the parents had no way of understanding the grave injustice that was done to them. They weren't even aware of the devious scheme. Dr Firdous's misadventure, on this occasion and certainly on several previous occasions, were covered up by IGMH.

The case, as was done for previous cases, should have been transfered abroad when the child was in a stable condition.

Note: MMW was informed by the Minivan News reporter that parents were advised on possible legal action that could be taken.

Chaos and confusion at IGMH!

It was a particularly busy day at IGMH today. The IPD atrium was filled with people of all ages. It appeared as if something was going down at the hospital. Something big.

We had arrived at the hospital at around mid-morning with a friend who was scheduled to consult a doctor at the OPD. Incidentally, a dead body was brought to IGMH by the Maldives Police Services and there was a buzz around the place. Had we not waited a while longer, we would have sworn that everyone was talking about the Bagladeshi national who had apparently taken his own life. We did wait and so did we find out that the story on everyones lips was different. The muffled sounds were for something entirely different.

Yes, IGMH had begun introducing their new patient database and the registration process was causing a few glitches. The crowd at the counters were very well-mannered and patient. They were warned of possible delays and inconveniences. All the counters and service stations were very slow in delivering the services. There was chaos like never before. Everyones patience was tested.

Surprisingly, but thankfully, the vast majority of the people bore the difficulties, accepted the delays and cooperated in the difficult and time consuming process. If the new system was going to make things better in the days to come they were apparently willing to wait patiently for now.

The second ID attempt.

News:

IGMH administration has announced that they will be introducing shortly a patient identification card that would expedite the provision of services to its clients. Any attempt by the hospital administration to improve the speed of service delivery must be acknowledged as a positive change.

We are nonetheless a bit more apprehensive in celebrating the story prematurely. We are reminded of a system of patient identification cards that failed 5 years ago. If implemented this would be the 3rd time IGMH is attempting to introduce patient identification cards.

At the time when IGMH started its services, well before the official inauguration, every patient was given an ID card and files of patient data were stored in the OPD appointment station. The system seemed to be going well during the pilot phase until the number of files increased and maintaining physical files became virtually impossible for the staff. That experience failed and the patient ID cards were phased out and maintaining individual patient records abandoned. Shifa, the first patient database of IGMH was thus abandoned.

Then in 2001-2002 IGMH again attempted to introduce another ID card system to coincide with the launching of their new patient and medical records database; a ready made and exorbitantly costly medical records database software that was superficially customized for IGMH. The ID cards this time were printed -in blue and white- at the time of registering for services at the OPD or IPD counters. The non-laminated pieces of paper carrying the identification information were easily damaged and lost. The system crashed in 2005 when the patient database got overloaded.

At present the system is riddled with multiple hospital medical record numbers allocated for every single patient. Every time a patient visits the OPD clinics he is given a different "hospital number"! Every time the patient reaches the casualty he is also given a different "hospital number". This has led to some of the more frequent visitors to IGMH having up to a hundred, or even more, hospital numbers!

The only area where the records tally a bit better is the inpatient medical records where thankfully patient records carry the same hospital number; allowing for retrieval of old files for reference where needed. This is not easy because of the poor filing system employed, nonetheless it is possible.

We hope that the new ID card system is a well planned system where the problems and difficulties of the past are addressed. For the new ID cards to be successful the medical records database has to be purged of the excessive, and potentially confusing data generated over the past 3 years.

It is our hope that the new ID cards would indeed improve service provision at IGMH. We urge Dr Mohamed Solih and those under his leadership to bring about changes that are more than cosmetic. Unless the actual medical services are improved, the institution fails to deliver.

Information on the past experiences of IGMH provided by an ex-IGMH IT staff who was witness to the events that are described herein.

Report filed by Huzam Ali

Self-medicating on Pethidine; an anesthetists story.

We were alerted to the story by a patient who underwent surgery at Hulhumale' Hospital. This story is shocking.

Athif (not real name) was admitted for surgery (details withheld as these minor details may be easily used for identifying our source) sometime last year. After the surgery had finished, and declared a success, Athif regained consciousness to the agony of excruciating pain at the surgical site. His family members who were with him asked the expatriate nurse on duty whether any medication could be given for the pain. Her blunt answer was "NO". Pressed for a reason, she reported that "very strong pain medication" was given at time of surgery and that more doses cannot be used.

After what Athif described to us as "ages" the nurse arrived at the bedside with a special prescription, described to us as "a bluish thin, foil-like piece of paper with a stamp" {we understand this to be controlled drug prescription} and asked his family member to buy "this injection". The injection was bought and taken to the nurse, who took it and placed inside a locked cupboard. Athifs' family member surprised that the medication was not being prepared to be given to Athif asked the nurse why she was not giving the injection to the patient. The nurse informed that it was a "replacement" for the pain medicine given in theater. The medicine we later found out was Pethidine; a morphine derivative.

Hours after surgery, the pain had apparently become unbearable and Athif was, he told us, begging his family members to do something for him. At that time the nurse at the counter was a Maldivian. The girl received an earful from the family that day. Her response was an accusation, one that we have now proved as the truth. The anesthetist apparently uses the Pethidine to inject himself, while injecting plain water to the patient!!!

Communicating with Athif via email, we were able to identify the Maldivian nurse who made the accusation. When we approached her for information, she initially refused to talk to us. We had to convince her that this was something that needs to be told if we were to improve things at Hulhumale' Hospital. She agreed, on the condition of anonymity.

The nurse told us, in person, that the hospital administration including the in-charge, Mr Mohamed Yousuf Fulhu, was aware of the practices of the new Anesthetist. She told us that she believed that Fulhu had already reported the issue to the Minister and Dr Sheena. Apparently, everyone at the top level at DMS and MoH was aware of this before the staff of Hulhumale' Hospital. The anesthetist was previously working in another island hospital, where similar things had been reported.

The nurse reported that the doctor would "steal" "narcotics" from the "locked cupboard" and use it himself and report it as having been used for a patient. She also tell us other trick were used by the doctor to get the injections. Many times he had asked the nurses in the theater to go out to bring something and in their absence pocket the injection "ampule" and fill a syringe with "water for injection".

It was believed that most surgical patients would have been tricked like this in the past many months. The nurse told us that she was told by the pharmacist at the hospital that the doctor also purchases narcotics from the pharmacy on prescriptions with patients names on them.

We called Mr Mohamed Yousuf Fulhu at his office. His staff who spoke on his behalf claimed that no such thing was happening at Hulhumale' Hospital and that our source was making it all up. We have not got a word from Fulhu despite us leaving messages on his mobile [7771889].

We understand that the doctor has an apparent medical condition of his leg which he claims to be the reason for using narcotics. His colleagues however say that whatever the reason, he is addicted to Morphine and Pethidine.

Our concerns are that medications intended for patients in need are being used by this anesthetist by stealing them, he is forging prescriptions to buy narcotics, he maybe "high" on drugs during critical periods at work at the hospital and that his acts are causing physical suffering to the patients and financial losses as well.

We fail to understand the rationale why such a doctor is being allowed to practice anywhere in the country.

Report filed by Ali Ashraf

Calling for Dr Fathmath Ali Didi to resign!!

Indira Gandhi Memorial Hospitals' Director of Medical Administration Dr Fathmath Ali Didi should resign from her post with immediate effect! She has failed the institution and the general public who she is supposed to serve.

Dr Fathmath Ali Didi has been the head of the medical services at IGMH during its most turbulent and incompetent period in recent times. Failure, scandal, and mismanagement has lead to the hospital being viewed with utter disgust by the man on the street in Maldives. To add to this an obnoxious attitude and gross incompetence in her own professional career has hurt the image of this supposedly "premiere" medical institution of the country.

We, at MMW, have received several emails discussing how she has misinformed and discredited genuine complaints against her staff and institution by many individuals who have suffered the effects of maltreatment and negligence.

Ahmed Naushad whose father was recently admitted at IGMH under her deputy, Dr Yasir, received just 15 minutes of his "precious" time in over 2 weeks of hospital stay. He was tended to by junior doctors and other specialists on the Internal Medicine Department. Unable to and unwilling to tolerate this kind of neglect, Naushad had gone to the CEOs office to complain to Dr Fathmath Ali Didi. Initially he was refused an appointment and was told that F.A. , as she is called in the office, was busy. With no option left, Naushad had barged into the office the next day demanding to be heard. He was heard alright. Neither his complaints nor his fathers medical condition received any attention. Dr Yasir refused to see the patient. Naushad, desperate for adequate medical care for his father, left the hospital and traveled abroad with him.

That is just one story. Naushad's experience is not unique. It is a daily event at the only tertiary care government hospital in the country.

After days of searching, we were able to contact the father of a child who received severe injuries to his leg at the time of removal of a cast! The story was reported in Haveeru and other media outlets. We were told of the way Dr Fathmath Ali Didi abused the father for negligence that day. He had walked into the CEOs office carrying the child to show the injuries sustained. Dr Habeeb, an orthopedic doctor was called to show the wounds. What happened then was shocking for everyone who witnessed the proceedings. Taking turn both Dr Fathmath Ali Didi and Dr Habeed abused the father for creating "havoc" in a government office. The fathers' grievances were brushed aside and he was forcibly removed from the office.

Sickening.

The case of Ali Zakwan, the 10 month old boy who died as a result of mismanagement and neglect at IGMH in 2006, gives us evidence of the under-hand tactics used by Dr Fathmath Ali Didi to disregard the parents complaints. MMW has received reports from a source within IGMH, whose identity we promised to protect, that although an internal inquiry into the case found that the institution had failed miserably and that mismanagement and neglect contributed to the sad outcome, Dr Fathmath Ali Didi masterminded a cover-up by hiding the report of the committee and cooking up another more favorable one. The report is shelved at IGMH and has not been made available to the courts or lawyers. Furthermore, Dr George John, who was identified by the report as the person who mismanaged the case was allowed to leave the country while the court case was ongoing!

Dr Fathmath Ali Didi was also responsible for the several internal discord that arose within IGMH, especially involving the now infamous "group of concerned doctors" because of her inability to effectively run the institute.

The recent case of two senior doctors wrongly suspended for voicing concerns about the improper management of admitted cases in the Pediatric ward was also perpetrated by Dr Fathmath Ali Didi. She had acted on self interest, opting to punish two people who had openly questioned her competence and commitment, by cooking up stories about the two. Thanks to the pressure from the general public and "group of concerned doctors" the two good doctors are back to work, angering Dr Fathmath Ali Didi and her masters Dr Firdous and Dr Naila.

IGMH under the leadership of Dr Mohamed Solih has suffered great loss of public support and the institutional commitment of its prime service providers; the doctors. His policies and the evil devil incarnate and incompetent Dr Fathmath Ali Didi have a lot to answer for. But first we demand that they either resign from their posts or be disgracefully discharged from them!

Report filed by Shizmeena Thahir

Presidents medical cover saved from shame by a boy scout

This is not a joke!!
[scroll down to read the update]

Dr Junaid, an ophthalmologist (a doctor specialized in the treatment of the diseases of the eye), is the current medical doctor accompanying the president of the Maldives on all domestic travel. His experiences and ability in managing any medical condition outside of his professional specialty is arguably limited. Accompanying the president of a country as the chief medical officer with the main responsibility of attending to medical emergencies facing the president and his entourage is not a simple task. We, and indeed any reader who comes to know of this, are shocked that this is the kind of medical cover the head of the state is provided and accepted by him and his advisers.

The Maldivian medical community and the presidents' advisers have been saved from utter humiliation by a brave boy scout. Had the president suffered any significant injury, Dr Junaid would have had no experience what-so-ever in ensuring adequate and safe medical care for him.

We contacted medical doctors who have worked with Dr Junaid at IGMH, including physicians who wished to remain anonymous. We asked them their views on the professional capabilities of Dr Junaid in attending to medical emergencies. All three doctors, senior specialists themselves, had no doubt in their minds that he would have been totally incapable of carrying out the required medical treatments.

We tried to get the opinion of the Maldivian Medical Association on the issue of having an eye specialist working as the sole medical doctor as the medical cover for the president. Their hot-line was unattended and we were unable to get their opinion. We have left multiple messages on their answering machine asking for a response by 8pm tonight, before we make the publication. We even contacted some of the Governing body members over the phone; none would continue the conversation from the point the question is raised! One brave soul said that he was sure that we, MMW, would make a good judgment ourselves.

The Maldivian medical community has many local physicians who would, for obvious reasons, be better trained and experienced to be picked as medical cover for our head of state. Dr Ahmed Razee, Dr Abdul Azeez Yoosuf, Dr Ibrahim Yasir, Dr Abdul Hameed, Dr Ali Latheef, Dr Fathmath Nadhiya, Dr Ibrahim Shiham and Dr Ali Nazeem are internal medicine physicians who are trained and experienced in managing emergencies in the adult population. They are all working at IGMH and are actively involved in managing emergencies and adult medical conditions. It is a shame that the presidents' chief medical adviser Dr Firdous has put the presidents life in harms way by selecting the wrong doctor to be his emergency physician.


Update
[22nd Jan 2008]

Some parts of the media have reported on the issues addressed in the above post but have not presented the facts. We would like to provide additional information and updates to ensure clarity.

Dr Junaid had been accompanying the president for the past 1 year or so. This trip was not the first one. Members of the presidential entourage are very much aware of the limitations in Dr Junaids professional capacity to handle potential emergencies. The president himself, was reportedly aware of the fact that Dr Junaid was an eye specialist.

Dr Junaid was reportedly selected for this post by Dr Mohamed Firdous, the presidents Chief Medical Advisor. All senior level health official were aware of the potential for disaster this appointment had created. Dr Firdous himself is the Chief Medical Cover for presidents' overseas travel.

We can confirm that Dr Junaid has now been removed from Presidential medical protocol. We have also been informed by IGMH and MoH insiders that the issue has been discussed in at least two high level meetings one each at the ministry and IGMH.

Members of the IGMH "special function medical cover team" who usually provide medical cover for government functions such as the July 26th and November 11th official receptions have been asked by IGMH to be available for future trips that the president is expected to undertake. The team includes a Physician, two medical officers and a senior nurse.

Chinese medical centers: unregulated and dangerous

An investigative report

"The child had developed acute renal failure secondary to heavy metal poisoning following treatment at a Chinese medical center in Male'." Sharaf reports to Medical Investigators Team as he had heard a Maldivian doctor telling his colleagues.

We went to a Chinese Medical Center in Male', on an under-cover investigation, to see for ourselves what goes in these unregulated clinics. We have collected a bit of information on the Chinese Medical clinics in Male'.

We found out that the different Chinese Medical Centers registered in Male' have the names of senior Ministry of Health officials listed as their directors and beneficiaries. This was not surprising. Neither is it unique. Most medical clinics in Male' and the islands are registered under similar officials and high ranking administrators.

These medical centers are being allowed to flaunt the regulations governing clinics and medical centers in the country. Simple regulations are broken on a daily basis. Advertisements of hospitals and clinics do not appear on newspapers or broadcast media because of regulations. You wouldn't be able to see ADK hospital running a visual ad campaign. However, ads from Chinese medical centers are seen on most mass media, surprisingly with unbelievable medical claims. A TV ad is on these days on TVM too.

It was easy for our under-cover team of two to get a walk-in appointment at the clinic on Sosun Magu. A "doctor" who apparently is a specialist of "everything under the sun" took us into his office. He took a short history from the patient with the help of a translator. Then after a quick surface examination, even using a stethoscope, came to a conclusion that the patient needs the treatment that he was going to prescribe. He scribbled on a letter head and asked us to show to the nurse. The "nurse" asked us to purchase the medications from them. There were 4 injections and 4 "tablets". We paid Rf856 for the medicines. The nurse then took a disposable syringe and loaded 2 of the injections into the same syringe. We weren't going to get the injections, so we made a scene of the patient being scared of injections and after much convincing got ourselves out of the clinic saying that we'll be back in about an hour.

Import and sale of medications is regulated by the Ministry of Health by a Pharmaceutical Board. The board currently places restrictions on import of certain vital medications into the country for reasons even they would not be able to explain to the public. However, the Chinese Medical Centers can import, use and sell unlabeled and inappropriately labeled medications including injections. Even those that are labeled, are exclusively labeled in Chinese. We got someone to read the labels; his understanding of the "labels" was that "they were just names" and a few of them had names of "herbs". These medications were sold at the clinics by their staff in unlabeled bottles or paper packets, keeping the "secrets" of Chinese medicine secured!?

Our under-cover operation confirmed the way the medications were packed and sold. The contents of the tablets remained a secret until we were able to trace the "patient" the doctor had referred to in the over-heard conversation.

The said patient was a 9 year old girl from an island, we are withholding her identity, who had gone to the Chinese Medical Center with complaints of frequent headaches. She was given injections at the clinic and given 3 different coloured tablets to take regularly. Injections were given twice a day for 3 days and the tablets given for 2 weeks. Halfway through the treatment, she developed blood-stained urine, swelling of the face and legs and severe hic-ups. She was admitted at IGMH and found to have renal failure. She required dialysis and was transfered to India. Luckily, they took the medications with them. These were analyzed and found to have among other things high levels of Lead, Morphine and Lithium (all pharmacological agents of allopathic medicine). The injection was found to be Methylprednisolone (a pharmaceutical agent, a steroid). The doctors in India had diagnosed "Acute Renal failure secondary to Heavy metal poisoning". She did get better and returned to Maldives. Her case was discussed with the doctors at IGMH, who are now monitoring her kidney functions as per advice of the specialists in India.

We called Department of Public Health to inquire about the Chinese Medical Centers. We were told that those centers were not under their regulations; they were apparently registered as businesses at the Trade Ministry.

We also called Ministry of Health and spoke to a "Pharmacist" who said that the "Pharmacy board doe not regulate the Chinese medicines", they were apparently imported as health supplements for which no approval is required!

We understand that none of the medical clinics are properly regulated in the Maldives, but the operation of these Chinese Medical Centers as purely businesses with no regard to public health consequences is beyond our logic.

We are sure that there are other stories of similar nature. We would like to encourage those with personal experiences of similar , or even good experiences to write to us.