Accident or negligence?

We have just received news from a family member of a patient admitted in newborn ICU at IGMH about a terrible accident (?) that has befallen their loved one yesterday. This was a baby who was admitted along with his twin sister 4 days earlier because of premature birth. Family source tells us that baby was reportedly doing very well when something terrible happened.

According to the family member, on 27th February at around 9 in the evening the baby's father was called to the ICU because the baby's condition had worsened suddenly. There was a lot of commotion at that time with doctors and nurses giving various medications to the baby and doctors doing cardiac massage.

It was later revealed to the family that for an unexplained reason the child had bled out from an "un-clamped" central IV line! The doctors were unable to clearly say how much blood was lost and for how long the baby had bled. According to the family member, the baby was "white as snow" when the father saw the child and reportedly baby's heart had stopped beating for sometime.

Dr Shafiu had later explained to the family that there was significant blood loss and that baby had to be given urgent blood transfusion. The father is distraught that such a thing had happened because of carelessness in the ICU. The doctors had said that during the time when child had no heart beat, brain damage may have happened.

The family is also worried that their baby is looked after by a different doctor every day and the explanations by each are different. There seems to be no communication between the various doctors involved. No one person seems to be in-charge and no one seems to be particularly willing to give a reasonable explanation of what and how things happened.

Family is expected to make an official complaint to the IGMH office. They have been asked to wait till the office is open after the long weekend.

We at MMW fail to understand how a central line could be left un-clamped! Why was the bleeding not noted earlier and significant blood loss stopped?

Can this be called just an accident? Does this amount to negligence?

Latest updates:

• Baby survived the incident.
• As feared, baby has started to have fits.
• Today doctors have told family that brain injury is the likely reason for fits.
• Family have been warned that baby could be disabled for life with permanent brain damage.

Dhivehi beys: safety and regulations?

Dhivehi beys, the field of medical practice that has been practiced in Maldives as a traditional form of healing, has been acclaimed by many of its practitioners and critics of modern medicine as a "purist" form of medical therapy. We are sure that there would be many people who would support this argument. We are equally sure that there would be people who would question the legitimacy and effectiveness of current "Dhivehi beys verikan".

The roots of Dhivehi beys are lost to history. However the similarities it shares with homeopathic, ayurvedic and herbal therapy suggests that it is a medical practice derived from a combination of these fields of medicine. Our Dhivehi beys practitioners, especially the ones practicing in Male' seem to have also borrowed practices from modern western medicine as well.

As commented by a visitor, modern medicine has heavily borrowed and derived their drugs and medicaments from early herbal and homeopathic practitioners. They have arguably invested heavily into studying the agents and substances for their properties, characters and effect on the living beings to understand the safety and efficacy of its use in clinical settings. This is perhaps the areas where current Dhivehi beys products and medicaments lag in comparison.

Are "Dhivehi beys verin" doctors? Some of them seem to like the title rather much. One practitioner who has a growing business in Male' at his MM clinic likes to be referred to as doctor. He is to our knowledge not registered in Maldives as a doctor. The Maldives Medical Council answered our call and reported that he was not a doctor. Maldives Medical Association office was closed and their opinion was not available on this issue. The use of this title is of concern as many people might be misled by the title itself. While we do note that neither the clinic nor the prescriptions claim the title "Dr" the fact that the Title is used un-corrected by the clinic staff and patients is a serious concern.

(Other people apparently use the title too without having the necessary qualifications: Dental Hygienists in IGMH and in private practice use the title Doctor in public and therefore cause confusion as being equivalent to much higher trained dental surgeons).

The concoctions that are available from MM clinic are famous as being locally produced and "tested". One "veymui sharbat" is claimed to possess healing for almost all illnesses! None of the clinics products have any side effects; claims the "doctor" according to his patients. This is because they are from natural products. His claim: natural products don't have side effects.

There have been some allegations of misuse of modern pharmaceutical agents in medicaments produced by traditional practitioners. One prominent  internal medicine physician from IGMH, who spoke to us on condition of anonymity, alleges that there is concern among his colleagues that a large number of traditional concoctions contain crushed tablets of modern drugs. He specifically mentioned steroids and morphine as being used. He said that he makes these allegation based on observations he has made which included some renal patients showing signs of prolonged steroid use (Cushingoid features) and others showing opiate overdose signs.

These are very serious allegations. It is our wish that authorities look into these allegations as soon as possible.

There are some other very disturbing allegations as well. The doctor quoted his friends in Obstetric practice as having told him about a traditional practitioner in Villingili who carried out per vaginal examination of female patients either by himself or "using the husbands hand" to look for signs of pregnancy or illness! We are unable to verify these claims and therefore have not used the name of the practitioner; we would encourage patients and doctors with information to come forward and confirm the story to our readers, if they are indeed genuine. It is our understanding and belief that the said practitioner has no training in carrying out these delicate examinations and strongly condemn such practices if indeed they are happening.

We have been able to confirm that the traditional practitioner in Villingili is consulted by many young couples struggling to start a family. Some of the patients we spoke to described some treatments that were offered. These included use of herbal and home-made pastes to apply on the genitals, use of different sexual positions and use of disposable syringes to "inject" partners semen into the vagina for "artificial insemination". These techniques have so far, as described by the 2 young couples we spoke to, been unsuccessful in their cases.

We tried to contact Dr Ahmed Razee, who is apparently the chairperson of the "Dhivehi Beys veringe Jamiyyaa" regarding these practices. Unfortunately we have not been able to talk to him to get his reaction or expert opinion. We wonder why HE is the charperson anyway?

We believe that Dhivehi beys has a role to play in our medical system. We do not doubt that it has helped many patients find cures and alleviated of suffering, even in cases where modern medicine has failed to find cures. None the less, we would like to see this branch of medical practice to be more refined. We would like to see the the safety of the "medicaments" and concoctions established through proper scientific studies (and not just by anecdotal evidence).

We cannot afford to be duped by a wayward, unregulated and unsafe traditional medical practices. It is our wish that authorities look into the serious allegations that have been made and make an attempt to regulate this branch of medicine that so many Maldivian are turning to.

Child sexual abuse victims: abused and neglected [edited]

It was several years ago. I was waiting outside the door to our house waiting for my young daughter to be ready for school. I was considering the route to school that we'd have to take to keep my feet dry as I push my bicycle through the mud-puddled streets when a friend tapped my shoulder and began to tell me about the hot topic of the day. A couple of Maldivian teachers had been caught sexually abusing young girls in their private tuition sessions. To my horror one of them was my daughters teacher; Naseem sir! I was so horrified that I told my wife that our daughter was not going to school for a few days till we could be sure that our daughter was not a victim herself.

There was no help offered either by the school or any organisation to kids like my daughter, to see if they had suffered themselves. No assessment of counseling to help them get over the trauma of listening to stories of their best-friends having been made to do disgusting things by their teachers!

I took my daughter to Central Hospital to get help for her. I thought she needed more than the support we could offer ourselves. I had real fear that my daughter might have been a victim. She had been behaving very differently lately. She easily cried about things that happened at home, she stayed unusually quiet for her usual self, she ate much too little for her mothers liking and she had stopped socialising with her friends. But most frightening of all she had started to make a fuss about having to go to school. All that just a few weeks before the news of Naseem sir and his accomplice's sickening stories became public.

At the hospital there really wasn't anyone to help us. Dr Mohamed Ahmed's name was mentioned to us. We took our daughter to his clinic which used to be house at his residence just across the street from the hospital. He wasn't particularly helpful. He asked us to give our daughter a couple of pills, something to relieve the "transient depressive mood". It probably didn't help, but we followed his instructions carefully. It was years later with our daughter preparing for her O'L exams when she confided in her mother that she was "touched" by her teacher! To our horror, by then the scum-bag was back in Male' and nearly freely going about his life; Our daughters life destroyed by an experience that would almost certainly scar her for life.

It is worrying that the number of reported cases of child sexual abuse in Maldives has been in the rise in recent years. The past few years have seen horrific tales of sexual assault on children of either gender; especially at the hands of those people who are entrusted with their welfare.

I will not be discussing the different cases, why it is on the rise or why the punishment for such terrible crimes is so meager. That needs to be discussed and is one important area of social protection of child welfare that is neglected in Maldives. What I will be touching on, and hoping to open a discussion, is the lack of proper assessment and support mechanisms within our medical services to help those who have been victims of these grave crimes.

The situation has indeed improved since the times of my daughter. A child welfare service is now established at the ministerial level at Gender ministry, child protection services are being decentralised to the atolls, IGMH has established a Family Protection Unit to help improve identification, reporting and early case management and an improvement in the publics  understanding of the need to report and seek help.

All that said, our children are still not receiving adequate care and treatment to get over the effects of these atrocities committed against them. Many of these kids are never counseled at all. Their families are not taught about the danger signs that need to be looked for and certainly little if any is done to help kids get back to "being kids" again!

My daughters friend who were subjected to the most severe abuse lost their way in school, were unable to integrate into society and became social outcasts themselves. At least one of them has significant criminal records; especially linked to sexual criminal conduct.

I would be the first to agree that even with the best treatment and care a few children may never return to "normal" childhood, but with little or nothing done the chances are that our unfortunate kids are further "abused" by a system reluctant to invest in proper care for kids under going such traumatic and forever scarring experience.

The carers currently working in the field are too young themselves, having little more than a year of work experience (within our severely inadequate system) with no professional medical or psychological or psychiatric assistance or supervision. Fair enough, a psychologist has recently started clinical work at IGMH and a couple of Psychiatrists do lend their support to the management, but their involvement is insufficient. More than that, their skills and training don't necessarily give them the required skills to actually work in this very sensitive area. There isn't a single child psychiatrist in the country!

There are many areas of need in our health system. Building and expanding ICUs, improving health care provision in the atolls etc...are all important and perhaps even high on the priority list. But with the current trend of increasing child abuse and other forms of domestic violence isn't it time that we get better help available for our kids who do fall prey to Pedophiles in regaining their childhood innocence and providing them a way back to a life that is not scarred?

Report submitted by Mubeen Jaleel.

Child sexual abuse victims: abused and neglected.

It was several years ago. I was waiting outside the door to our house waiting for my young daughter to be ready for school. I was considering the route to school that we'd have to take to keep my feet dry as I push my bicycle through the mud-puddled streets when a friend tapped my shoulder and began to tell me about the hot topic of the day. A couple of Maldivian teachers had been caught sexually abusing young girls in their private tuition sessions. To my horror one of them was my daughters teacher; Naseem sir! I was so horrified that I told my wife that our daughter was not going to school for a few days till we could be sure that our daughter was not a victim herself.

There was no help offered either by the school or any organisation to kids like my daughter, to see if they had suffered themselves. No assessment of counseling to help them get over the trauma of listening to stories of their best-friends having been made to do disgusting things by their teachers!

I took my daughter to Central Hospital to get help for her. I thought she needed more than the support we could offer ourselves. I had real fear that my daughet might have been a victim. She had been behaving very differently lately. She easily cried about things that happened at home, she stayed unusually quiet for her usual self, she ate much too little for her mothers liking and she had stopped socialising with her friends. But most frightening of all she had started to make a fuss about having to go to school. All that just a few weeks before the news of Naseem sir and his accomplice's sickening stories became public.

At the hospital there really wasn't anyone to help us. Dr Mohamed Ahmed's name was mentioned to us. We took our daughter to his clinic which used to be house at his residence just across the street from the hospital. He wasn't particularly helpful. He asked us to give our daughter a coupleof pills, something to relieve the "transient depressive mood". It probably didn't help, but we followed his instructions carefully. It was years later with our daughter preparing for her O'L exams when she confided in her mother that she was "touched" by her teacher! To our horror, by then the scum-bag was backin Male' and nearly freely going about his life; Our daughters life destroyed by an experience that would almost certainly scar her for life.

It is worrying that the number of reported cases of child sexual abuse in Maldives has been in the rise in recent years. The past few years have seen horrific tales of sexual assault on children of either gender; especially at the hands of those people who are entrusted with their welfare.

I will not be discussing the different cases, why it is on the rise or why the punishment for such terrible crimes is so meager. That needs to be discussed and is one important area of social protection of child welfare that is neglected in Maldives. What I will be touching on, and hoping to open a discussion, is the lack of proper assessment and support mechanisms within our medical services to help those who have been victims of these grave crimes.

The situation has indeed improved since the times of my daughter. A child welfare service is now established at the ministerial level at Gender ministry, child protection services are being decentralised to the atolls, IGMH has established a Family Protection Unit to help improve identification, reporting and early case management and an improvement in the public's  understanding of the need to report and seek help.

All that said, our children are still not recieving adequate care and treatment to get over the effects of these atrocities committed against them. Many of these kids are never counselled at all. Their families are not taught about the danger signs that need to be looked for and certainly little if any is done to help kids get back to "being kids" again!

My daughters friend who were subjected to the most severe abuse lost their way in school, were unable to integrate into society and became social outcasts themselves. Atleast one of them has significant criminal records; especially linked to sexual criminal conduct.

I would be the first to agree that even with the best treatment and care a few children may never return to "normal" childhood, but with little or nothing done the chances are that our unfortunate kids are further "abused" by a system reluctant to invest in proper care for kids under going such traumatic and forever scarring experience.

The carers currently working in the field are too young themselves, having little more than a year of work experience (within our severely inadequate system) with no professional medical or pscychological or psychiatric assistance or supervision. Fair enough, a psychologist has recently started clinical work at IGMH and a couple of Psychiatrists do lend their support to the management, but their involvement is insufficient. More than that, their skills and training don't necessarily give them the required skills to acually work in this very sensitive area. There isn't a single child psychiatrist in the country!

There are many areas of need in our health system. Building and expanding ICUs, improving health care provision in the atolls etc...are all improtant and perhaps even high on the priority list. But with the current trend of increasing child abuse and other forms of domestic violence isn;t it time that we get better help available for our kids who do fall prey to Paedophiles in regaining their childhood innocense and providing them a way back to a life that is not scarred?

Announcement

We at MMW have received several emails requesting that we moderate the comments made in response to our posts. We have noted with disgust that few people who have used severely abusive words in commenting. While we do not condone these acts, we would like to allow free expression of opinions.

We understand that people on both sides of a discussion have much to say. Sometimes emotions run high and language is allowed to deteriorate. We have made a decision that we will be allowing a free hand at commenting at present. We reserve the right to change our stand on this issue at a later time.

It is our request that all individuals who comment on the blog refrain from using foul words. We would appreciate it very much if comments could be made in relation to the post. Kindly self moderate your comments.

Non-affordable health care and a welfare system in ruins? The socially vulnerable left to fend for themselves.

Thousands of Maldivians apply for welfare assistance in financing essential treatment each year. The exact number and the total expenses have never been revealed by the concerned ministry in all the time it has been providing this social security assistance. Yesterday, 13th of February 2008, we visited IGMH during visiting hours to talk to patients and their relatives about welfare assistance.

Welfare assistance for the poor and needy

More than half of all in patients in the general wards at IGMH are on one or other form of welfare assistance. We counted 7 in ENT ward, 10 in Pediatric ward, 15 in Medical ward and 12 in Surgical ward as being on welfare assistance to pay for health care costs. A large majority of them are truly deserving and needy, while a few of them were individuals from well-to-do families with reasonable ties to powerful figures within the welfare system including the presidential palace, Theemuge.

We asked around and found out that no patient is refused a welfare assistance letter by treating doctors if one is requested by the family. Apparently some doctors, judging the financial capacity of families, even offer to give such a letter if they deem it necessary. Except for a rare few, none of these families are refused welfare assistance by the Ministry of Gender and Social Security either. They are each reportedly entitled to a weeks welfare assistance to cover the cost of hospital bed charges, investigations and medications that are available from STO pharmacy. (Some medications not available at STO have to be purchased by families on their own, at their own expense). This assistance obviously means a lot for the very needy, who still have to spend out of pocket for food and accommodation of patients attenders. The cost for that is terribly high as well.

Only a small minority of the really sick cases get to complete the treatment and leave the hospital during the period when welfare assistance IS available.The majority of them need further assistance and extension of welfare assistance to continue treatment. Ministry of Gender and Social Security is not so willing to continue assistance beyond the initial welfare assistance period. Some patients do get a final 7 days of assistance with the warning that further assistance would not be possible and that applications should not be send after this current period expires.

Some of the very needy patients are therefore left to beg, borrow or steal to continue medical care. Fortunately most people beg or borrow. Private businessmen frequently, but not  always, offer a few days of assistance or a lump-sum assistance of a US $ 100 to 200. Whatever they could get is accepted by many, as there really isn't much of a choice for them.

The not-so-needy getting assistance

The heavy expenses of medical care at IGMH and the cost of staying in Male' to assist the patient is much too high for most people to shoulder themselves. With the current welfare system a large number of the not-so-needy people get the assistance that could be best provided for the very needy, who have no other way of supporting the finances of medical care, especially when the course of the illness is long and treatment lengthy.

The families of senior level government officials and well-connected middle level civil servants get welfare assistance on an open budget, mostly thanks to the Theemuge welfare assistance. Surprisingly, these people are often flown out of the country for medical treatment that is available and competently delivered at the local institutions.

The Theemuge welfare budget came under great scrutiny during the recent budget proposal, but sadly our elected (and the unelected) members of the parliament refused to go the distance to merge welfare funds under one body to give better assistance. We do understand that a bigger budget does not necessarily mean better management, that is something that needs to be addressed separately as well.

Medical insurance cover

We have been taken for a ride recently by the authorities with stories of a government medical insurance scheme being in place within a few months. The very public arguments between powerful figures within the government establishment saw the collapse of the process and we are left to fend for ourselves and no closer to a medical cover that possibly would inherently be more fair for the needy.

Again, bickering among political rivals has destroyed an opportunity for the needy to find a way to get medical care in a dignified manner. But the medical insurance scheme would not mean an end to welfare assistance. The social security net would still be important, to ensure that the unemployed, self employed and people with special needs don't fall through the holes in the net.

Identifying the truly needy and assisting them

Who wouldn't want to get something free? Many financially able families currently opt for welfare assistance because it is possible to get that assistance regardless of their own financial capabilities. Everyone gets that assistance, why not them? It is the governments money, kind of their own!

Doing the right things does not seem to be a top priority. Social justice is a challenge.

In this situation a near fool-proof system of identifying the needy is essential. We understand that none of the systems in use in the different developed countries is effective in ensuring 100% uniformity, but the UK and US social security system could be studied to find out what would be a reasonable system for our situation. Professional bodies and organizations that have made a name providing such consultancy maybe sought through the assistance of international donor agencies and a "method" identified for Maldives. That is something that needs more thought and discussion; we have no simple solution. The solution will not be simple we are sure. However,  there will be a solution should we try hard enough to find one!

Medical care abroad

With the cost of medical care sky high in Male', many Maldivians including the poor find traveling to neighboring India a financially better option. The cost of traveling to Male' from an island, supporting family members to stay in rented apartments in Male', the cost of food and other personal expenses are all considered to be way to high. The small amount of money, often a life saving, could be wasted in Male' with not that much of a return in terms of improvement of the patients health!

For this reason, even the not-so-well-off families make the decision to travel to India for treatment by much senior doctors, with better medical diagnostic facilities, at a cheaper cost and with less expenses for the caretaker and other family members. This prospect has taken many Maldivians away from IGMH and other medical institutions in Maldives. Most of them probably fare well in India and return, at least in their own opinion, in better health.

Sadly, we must highlight the increasing number of cases where unnecessary treatments, investigations and other expenses have eaten into the limited finances available to family that they return home financially broke, terribly shaken and in worse health than they left in the first place. Illnesses close to spontaneous remission may do so despite the sometimes unnecessary treatment offered; the credit being given to the foreign stationed doctors medical acuity and skill.

Medical care abroad on welfare aid

The welfare assistance for treatment abroad is another area where social justice is at its poorest. The system in place is heavily misused by those entrusted with running it, monitoring it and executing its decision making.

Some very needy patients are refused welfare assistance to go abroad by medical professionals; because they feel that the treatment is possible in Maldives. This even when, reportedly curable and manageable conditions go uncured or uncontrolled for ages. When complication after the other diminishes the doctors and the family's confidence of ever being able to get over the illness.

Some chronic illnesses cannot be properly managed in Maldives (like cancers) and the only rational option is to travel abroad; even when it is for hope alone. Such cases are also refused assistance at various levels of the selection process. Sometimes it is the medical board at IGMH, while at other times even at their insistence the fund issuing agency refuses for no obvious reasons.

Even when the assistance is obtained, the assistance usually does not match the amount of expenses the treatment for which the patient is referred abroad. Regardless of the disease or medical condition, the government assistance is "return ticket for 2 people including patient and US $ 300". A patient going for cardiac surgery, renal transplant, chemotherapy or many other treatment need finances much bigger than this. This would amount to little help in such cases.

In the name of being fair, the Ministry of Gender and Social Security refuses to offer additional funds to special cases, unless of course there is an interest from a high ranking government official, minister or MP. Many patients have had to travel repeatedly, getting treatment in parts and portions because of this. Some have had to cut-short essential treatment and return to wither away and die.

Way forward? or continue direction-less as we do now?

We don't intend to say that we have a solution to all these issues. But we are not ready to give up by saying there is no way to do things properly. There must be a way. A more fair and equitable distribution of welfare assistance for the needy needs to be established.

If we do not see a solution that we can quickly employ, it is paramount that we look for one. An open discussion could throw more light on to how things could be done differently to get better results.

Our representatives in parliament, rather than using sickness in people in their constituency as a tool to "buy" votes, should look at the greater good of the people and work to address the unfairness of the current system, inadequacies in the current system and the lack of auditing, transparency and monitoring of procedures and processes.

I am sure readers have their own opinions on this issue. Have your say. Throw in your ideas.

The essential drug list and health service outlets

We understand that with the assistance of WHO, senior level health service providers in the Maldives drew up and occasionally update a list of medications and consumables under the broad heading of Essential Drug List. Its been several years since the list was first created and the list has not been updated for a few years now.

The Essential Drug List names medications and consumables that are to be made available, as a prime responsibility of the Ministry of Health, at all health service outlets across the country at all times. These are basic requirements that need to be in place at all centers regardless of the geographical location within the archipelago. Recently we read about several hospitals and health centers running out of medical oxygen. When we were investigating the story we found out that many of the health posts and health centers that we were able to contact, also had some of the essential drugs missing.

Haa Dhaal Maavaidhoo has a health post but no doctor and no medications. The community health worker is unable to manage anything, even under the advice of properly trained doctors who he reaches by phone for assistance. Maavaidhoo health post is left decapitated because of lack of proper health service personnel. The island recently made the news in Maldives when few of its residents protested against the health conditions on the island.

Haa Alif Ihavandhoo has a health center and 2 small pharmacies managed by local businessmen. Recently, patients had to be transfered to Haa Dhaal Kulhudhufushi and Haa Alif Dhihdhoo because the doctor in the island said that he was unable to treat the cases because he had nothing more than Penicillin injections and some over the counter pain medications available for use. One case of epilepsy was transfered because they ran out of Diazepam. No routine anticonvulsant therapy was available.

We can also confirm that in moth Raa Alifushi and Rasgatheemu the health posts were until recently running on very little amount of medications. An asthmatic in Alifushi was referred to Ungoofaaru regional hospital because there was no ventolin in the island. The elderly patient had been keeping a stock of his own medications but ran out just at the time when his asthma had worsened. He survived the attack and has brought back a good stock of ventolin with him to Alifushi. Ventolin is listed on the Essential Drug List.

One young doctors from Alif Alif Rasdhoo atoll hospital reported to us that he and his colleagues receive calls from nearby islands when they are requested to take charge of cases because the doctors in the health centers don't have simple antibiotics to manage infections. The doctor fears that even mentioning his gender endangers him being identified as there are only four doctors working there including a gynecologist.

In Thaa Atoll Burunee the recently upgraded health center also reported a dire lack of medications and IV fluids. Sporadic cases of Dengue fever are seen in the island, especially among the Tsunami refugees. Not having IV fluids of the type needed in Dengue, the station doctor was unable to manage cases as best as possible.

These are some cases where we were able to identify issues of availability of even the essential drugs for basic health services. We wonder how many other islands and health centers would have similar problems. Even maintaining a supply of medications that MoH itself has declared as basic necessities for health service provision is not guaranteed.

We are also concerned about the lack of health service providers in a large number of islands. We do understand that MoH has made a renewed commitment to ensure that doctors are placed in many of these previously neglected island. This is promising, however, it comes to us as no surprise that many of the doctors currently working in the islands are mere novices who graduated from basic medical training less than 6 months before joining the Maldivian health sector! Their ability to work exclusively on their own in the very demanding conditions is highly questionable. This compounded with lack of medications and investigative capabilities leaves them and the public exposed to sad outcomes that we often hear about.

We ask the public to pressure the authorities to ensure that a basic health service guideline be established and minimal standard of health services to be provided to the islands be established. The Essential Drug List needs to be updated and provisions kept in place to ensure that all health facilities including the very basic ones have a ready supply of these medications.

Young girl spends 3 years at IGMH ICU......and counting

This was a case that we stumbled upon when Shizu was investigating Sharaf's story about little Mishka.

A 20 year old young Maldivian girl will soon be marking 3 years of stay at IGMH ICU. This is in contrast to the many cases that reach ICU for their last rites. We at MMW find this young girls story a unique one that we feel must be shared. We will call her Aish, not her real name.

Aisha was reportedly admitted to IGMH about 3 years ago with a medical condition that caused progressive paralysis of her muscles that led to an inability to breathe on her own. Since admission to ICU she has remained on artificial mechanical respirators to breathe and stay alive. Her doctors and family realize that her condition is probably beyond medical cure and that she will need the same kind of care for the rest of her life. It is hard for any person with an able body to comprehend what it would be like to be unable to move a single muscle in their body. For Aisha, who was a very able and active young girl in her hay days, this must be terribly difficult. When most medical and allied health services have given up on her making a miraculous recovery, Aisha fights on. She has been able to do that with a lot of help along the way, but nonetheless she has done that, and is doing that as you read this.

Unlike most of our reports this story has a very strong positive side to it. One that we decided we will not ignore. The survival of this young girl is a true tribute to the dedication and commitment of her care givers. That will be the IGMH ICU nurses and the doctors of the Internal Medicine department who take pride in looking after her. It goes without saying, someone who has been on artificial mechanical respirator would have had several complications along the way. Aisha has had her fair share of them. She has however been strong enough, and the help she received from her carers good enough to see her through them. We have decided not to dwell on the negatives surrounding her medical condition, that would be something we would leave for some other time, perhaps on a different case. However, if you believe this story is all good, we would caution you on making that assumption far too easily.

Aisha's room in the ICU is very different from the rest of the rooms at IGMH ICU. She has ornaments hanging from the ceiling, has cable TV well placed for her to see, even if she can't move her head. Her personal, private ICU room is indeed very cozy. She clearly deserve all this and perhaps more. We are all for it.

IGMH ICU is a small ICU. It has 8 beds in 6 cubicles. We hear of several patients being moved in too late to ICU because time had taken to get the bed vacant. We also hear of patients being moved out of ICU far too quickly than the treating doctor would prefer. These are all constraints from having to manage an increasing patient number in a limited bed capacity ICU.

We at MMW believe that an ICU expansion and extension at IGMH has been over due for at least 15 years. We were dumbstruck when about a year ago IGMH built a waiting area just adjacent to the ICU without using that space for extension of the overcrowded ICU. We are sure that most clinicians at IGMH would have felt the same. The delay in initiating an extension has probably cost the Maldivian people many lives that could potentially have been saved had an ICU bed been available. Sharaf may not have had to endure the agony of loosing little Mishka.

Aisha does deserve the best care available. Could IGMH provide that care outside of the crowded ICU? They probably could. Aisha needs to be able to interact with her loved ones and experience more than the ICU environment, a place that is traditionally crawling with bacteria of all sorts. Real nasty ones too. In the ICU she gets mechanical artificial respirators to give her breaths, this could be given in a special private room if the power supply and gas supply connections are available. She would need close nursing care; this could be provided by having a shift nurse in the room. Most of her nursing care currently revolves around keeping her clean, giving her medications, moving her position to prevent bed sores and giving her feeds. We believe that this could be delivered even in a private room like those they have in the executive private ward. So why not? Why not free up ONE ICU bed? Why not remove Aisha from a location that harbors disease causing bacteria that could arrest her chances of a miracle recovery? Why not allow her to be in a place where her family could spend time with her at their will?

Will freeing ONE bed from ICU mean anything? It probably could mean a lot. It would mean an increase in available bed capacity of over 10%!

Will such a move be resisted by her family? Well the safety of being cared for by the same people who have kept her alive for this long maybe something the parents would fear of losing.

How about the cost of keeping Aisha in ICU? We know that government chips in at times to pay her hospital bills, but the true cost of keeping her in ICU would be a lot more than that. Would perhaps the cost be less in a modified room?

We propose that IGMH admin considers moving Aisha, to a dedicated room outside of ICU where she could be guaranteed the same level of care that she currently needs, she really does not need intensive care right now.

Increasing bed capacity by 1 bed would be too little to make a realistic impact. We believe that MoH and IGMH should consider expanding the ICU to at least double its current capacity and also provide for a place to care for cases like Aisha and those who are being down-graded from intensive care.

We wish Aisha a miraculous recovery. We wish her family all the best and hope that their prayers would be answered.

Update: Both mother and baby in the latest reported case improve and come off life support.

Both baby and mother who were in critical conditions in intensive care at IGMH have improved and come off life support.

The baby's condition is reported as "stable with no evidence of asphyxia or brain injury" and although still being managed in the newborn ICU is reported to be making a full recovery. This comes as a relief for both parents and doctors. We can confirm that the baby was on artificial respirator for about 24 hours when 2 days ago baby was "weaned" off the machine. The initial communication that parents received from the doctor who was in charge of the case at that stage, Dr Vikas Bopache, was that baby has severe asphyxia (a condition in which the brain suffers damage from lack of oxygen) and that there was a strong likelihood of baby developing fits. This fear has now been removed by the new team of doctors looking after the baby; who say that there are no signs to suggest such a possibility.

The father was visibly relieved when our source saw him in the Obstetric ward. He was telling the people around him that he was happy at the progress and very publicly praised the doctors for their efforts.

In more good news for the father, the child's mother has also improved in leaps and bounds since her admission to ICU after delivery. Apparently, doctors from the internal medicine department got involved in the case on the request of a family doctor, Dr Zumra. It is believed that, with their experience in handling cases corrupted by other departments, they were able to get the patient to safe territory. The last update we got was that the mother had come off mechanical respirator, was shifted out of ICU, did not require to have the uterus removed (bleeding did get controlled finally) and was in a special private room at the expense of the hospital.

The case was reportedly reviewed by the hospital administration and some statement is expected in the coming few day. We believe that IGMH will not make a public statement but expect the family to be briefed about their findings.

Blood transfusion stand-off:

Rumors have been circulated around the hospital that the father had refused transfusion of any blood other that his own to his wife when she was in a critical condition. This rumor is false. We can confirm that the issue of blood transfusion arose well before the patient was taken for C section. Apparently the hospital has a new donor policy (that is reportedly in accordance with international red cross's own donor policy) that blood will be collected from donors and then cross-match done. The father was asked to get a donor while the patient was in the ward for "monitoring". He had himself volunteered. At the blood bank he was asked to donate the blood first and told that cross-matching would be done after the full blood pint was collected. This father did not want to have a pint of blood removed from him IF it was not going to be used for his wife. This was where the misunderstanding started.

Because of his religious beliefs, he is a devout muslim, "who takes pride in looking like a true muslim", he didn't want blood of someone whose character and health was unknown to himself to become the donor. He was counselled on this issue by doctors and his views on the issue changed. MMW supports non-renumerated blood donation and wold take this opportunity to call on the blood bank to inform the public on the benefits of this system of donation.

The father had not refused transfusion as a life saving treatment for his wife.

We wish the family a speedy recovery. We hope that the father and family is given support in overcoming this intensely traumatic experience.


Note: MMW does write on issues and events that are happening outside of IGMH. Check our archives for them. We will however not wander away from an event like this where interest of the patient were given secondary importance. If any reader feels that we have presented a false case, feel free to have your say! We are witness to many sad stories that have happened in our health system and would like to make it very clear that we will report these kinds of events; not to destroy IGMH or the health system but to let them know that these events will not go unheard. We too want to see a reliable and trustworthy health system and hospitals, but we have remained calm and waited for the administrative bodies to do the right thing for far too long. We shall not stay quiet as we did before. We shall pressure the authorities to bring good change. For all our sake!

Another baby and mother in critical condition at IGMH

For the second time in a week, a baby and mother are in critical condition at IGMH. This comes to us as no surprise because the IGMH administration has successfully swept all cases of neglect and maltreatment under the carpet ever since its inception. The perpetrators of these criminal dealings are high and mighty, well protected by the senior administrator.

On 5th of February a mother with 4 previous kids was admitted to IGMH because of premature contractions and signs of early labor. It was still a couple of weeks till the declared expected date of delivery. She was kept in hospital with apparently no monitoring or treatment other than a few routine jabs and pokes by doctors and nurses on "rounds".

On the night of the 6th of February 2008, she started to have severe bleeding from her birth canal. After several attempts at getting the attention of the nursing staff in the ward, finally after nearly an hour of waiting the on duty junior doctor came, saw the patient and advised her to be transfered to delivery room. A scan was done which reportedly showed that the placenta was low lying. After the unusually long delay of about 3 hour, the mother was shifted to the operation theater for emergency C section. Our source confirms that the baby's heart rate had dropped to dangerously low levels during this time.

The obstetrician struggled at C section in getting the baby out of the unusually small incision that was given. After much struggling and wasting precious few minutes for the baby, the incision was extended and baby forced out. The attending pediatric doctor was able to revive the baby after about 15 minutes of resuscitation but baby had trouble breathing well by itself. Baby was transfered to the newborn ICU and connected to an artificial breathing apparatus (ventilator). The baby reportedly is in a critical condition, still requiring assistance with breathing, but the pediatric doctors are apparently confident that the baby would recover enough to come off respiratory support in a few days time. The family was however warned that baby could have significant brain damage caused by lack of oxygen during labor and because of the delay in extracting the baby at C section. It was informed to family that baby was likely to have fits too.

The C section was more eventful than described above. After the baby was forced out of the womb, due to an unreported reason (most probably an injury concealed by doctors) the mother started bleeding heavily from the uterus. The obstetric surgeon struggled to stop the bleeding. Over on hour passed with the mother bleeding heavily on the operating table. Finally after a back-up obstetrician arrived to assist with the surgery, the bleeding was stopped. By then the mothers condition had severely deteriorated. Mother continues to fight for her life in the ICU on artificial breathing by a ventilator.

A huge commotion was reported at IGMH overnight apparently relating to some minor detail in arranging blood for the mother, who obviously needed urgent transfusion.

The damage-control and cover-up apparatus at IGMH headed by Dr Fathmath Ali Didi is reportedly in hyper-drive coming up with stories to hide the details of the negligent acts committed in this case.

With this second obstetric bungle the publics confidence in IGMH in effectively managing safe birthing is lost. The authorities are still doing everything they can to hide facts rather than review the processes to make health care safer.

Dr Solih, your staff are killing and maiming our people. Act to save us.

The cover up has begun.

This is nothing new. We all expected that this would indeed happen. Our sources at IGMH have reported that a secret closed-door meeting was held today at 8am at IGMH headed by the corrupt Dr Fathmath Ali Didi to plan a cover up story for the events in the labour room that led to the newborn baby dying.

This was reportedly a meeting that involved the chief nursing staff from labor room, obstetric doctors and a couple of lady pediatricians. Our source reports that the meeting went on for nearly 2 hour. This meeting was apparently in preparation for a meeting that was to be held with the family of the deceased baby.

It is our belief, and that of our analysts, that a certain official "the way that things actually happened" would have been created to ensure that parents are misled into believing that normal procedures were followed in the delivery process and the delivery itself wasn't the cause of death. They were expected to inform the parents that there were congenital abnormalities in the baby that caused the death and that it was unpreventable. That would be an IGMH-styled review of mortality and morbidity.

We were able to confirm that the meeting with the parents was going to happen today. Although we can't confirm that the meeting actually took place; it was expected at around 12 noon today.

We spoke to one private practitioner in Male'. He tell us that he expects the review process to yield nothing less than a total denial of responsibility in this case. This, he said was what IGMH have done after reviewing all previous cases.

We have been unable to speak with the family directly to get their views, but have read their views on some of the daily newspapers. The 35 yr old mother is reportedly in a stable condition in the general ward and according to doctors is expected to make a full recovery from her injuries.

Mother and baby in critical condition following "assisted delivery" at IGMH

Following a special "assisted delivery" at IGMH labour room in the early hours of sunday (3rd Feb 08) morning a mother and her baby are in a critical condition at IGMH. The mother, reported to us as a 35 year old first time mother who was past the due date for delivery, was admitted to IGMH for induction of labour.

We are able to confirm that both mother and baby are in intensive care following the use of a technique of delivery that is banned in modern obstetric practice. Apparently the maneuver is commonly employed at IGMH labour room by senior obstetricians, to bring about delivery of the babies where mothers have poor effort in pushing the baby out by herself. What is surprising is that a good number of nurses are also taught to use the technique at the labour room by the senior obstetricians. The maneuver includes applying excessive force on the upper part of the abdominal wall, over the fundus of the uterus, thus virtually squeezing the uterus between the mothers spine and the hands (and sometimes the arm and elbow) of the person applying the maneuver. This is apparently called "fundal pressure" a maneuver that is known to cause uterine injury, fetal cervical injuries, fetal cerebral hemorrhages, and significant other birth injuries such as Erb's palsy, fractured clavicle and major trauma to internal organs of both mother and baby.

In this case, a vacum machine was used to pull the baby out of the birth canal by attaching a suction cup to the baby's head and pulling on a cord attached to the cup. This is also a potentially harmful procedure, but one that is an accepted obstetric maneuver to effect delivery when the labour is prolonged and baby's condition deteriorating. In addition to the vacum application, nursing staff and obstetric doctors alternated in exhausting their stamina and strength in giving fundal pressure. The mother was subjected to this physical torture when the case could, and probably should, have been taken for a cesarean section delivery.

As would be expected from this extremely dangerous and traumatic process, the baby was born in a terrible condition. Even the senior pediatric doctor who was at the site could not revive the baby to a normal state. After a long attempt the almost dead baby was transfered to the new Newborn ICU for life support. The baby was in a critical condition when we got our last update; having found to have severe cerebral edema, intracranial bleed, seizures, pneumothorax and just barely hanging onto life. We were told that the baby could pass away any minute and that there wasn't much the doctors could do to avert such an end.

To add insult to injury, the family had to endure a grave turn of events for the mother as well. Apparently due to the excessive force used by the obstetrician and nursing staff in applying fundal pressure, the mother sustained injuries to her uterus and internal blood vesels. She had bleeding into her abdominal cavity and had to be taken up for emergency surgery to patch-up the injuries sustained in the traumatic birthing process. She remains in a critical condition in the adult ICU at IGMH, also fighting for her life.

The family is outraged at the horrific treatment they have recieved at the hospital with some members of the family unable to comprehend the gravity of the situation.

MMW understand that this "fundal pressure" maneuver has been a routine practice at IGMH since the department was taken over by the current head of department Dr Rabo Chako. We have also been told that a huge argument had broken up between the pediatric doctors and the obstetric doctors over the way this case was handled. We recieved reports that some angry pediatric doctors have demanded to have the case revieved, the "fundal pressure"  maneuver banned and some accountability established for these cases.

MMW learnt today that some of the nurses who were at the delivery were so traumatised themselves at the sight of a grown person virtually jumping up and down on the mothers pregnant abdomen that they left the delivery room in  protest.

These kinds of inhumane, unethical and potentially traumatic practices must be stopped and internationally acceptable practices established at IGMH. We call on the Maldives Medical Council, IGMH, MoH and other concerned authorities to investigate this case and bring those responsible to account. Dr Solih must take steps to get his house in order or leave the job to someone who can manage to acieve that.

The Maldivian Medical Association in a crisis

The bi-election held on 2nd February 2008 to fill the post of President of the association, left vacant following the shock resignation of Dr Abdulla Niyaf in October 2007, has failed to elect anyone for the post. The results of the election are on display in the lift lobby of IGMH and shows Dr Didi (Dental Didi) failing to get the required number of votes to get elected. Dr Didi reportedly got less than 40% of the vote. Incidentally, Dr Niyaf was elected to the post by a 100% of the electorate.

We are made to understand that Dr Niyaf had handed in his resignation in October 2007, during his now infamous suspension from IGMH (along with his close friend and colleague Dr Ismail Shafeeu) for standing up for the rights of the patients and expressing concerns regarding the way Dr A C Bhagwat was treating pediatric in-patients at IGMH. A close friend of Dr Niyaf, who himself has refused to discuss the issue any further, told us that in his resignation letter Dr Niyaf had expressed that he no longer wished to continue to represent certain elements within the association who were working to harm him, his career and his family's well-being. This is believed to be a reference to Dr Mohamed Solih, Dr Fathmath Ali Didi and Dr Mohamed Firdous, who in addition to being members of the association are senior administrator of IGMH. It is believed by many that the suspension was a means of silencing Dr Niyaf and harming his reputation as a leader. Unfortunately, his resignation seemingly has achieved the target set by the administrative elements.

Many of the senior members of the association claim that the association was left in this state because Dr Niyaf had been too hasty in handing in his resignation. Many of his colleagues and the public blame internal hospital politics and dirty tactics by IGMH admin in the suspension of Dr Niyaf that had led to him abandoning the association.

Following Dr Niyaf's resignation, many of the projects of MMA have been left abandoned. Their website remains un-updated and their publications "beys-sitee" and "Prescription" have failed to get further editions to print either.

Dental Didi's failure at the elections is being viewed by many members of the association as a huge blow to the credibility of the association. The association has lost it voice in recent months, failing to carry out any activity or projects in that time. The influence it has on the health sector seems to be at an all-time low. Even the "group of concerned doctors" the unofficial pressure group of the association has apparently disbanded.

The Maldivian Medical Association is an important NGO and a fellow watch-dog that needs to regroup to ensure that medical profession is free from undue influences, doctors return to professionally sound ethics in their practice and that the rights of the patients and doctors are protected. We look forward to a resurrected MMA that gains back the trust of the public and the professionals who are its members.

We urge the elected members of the governing body of the association to revive the vital body, get its members united and return to working on changing the system that is sick to the bone and on its death bed.

NB: We would like to congratulate Dr Ashraf (Urologist) for securing enough votes to win the seat of treasurer.