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.

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

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

No oxygen in health centers and hospitals

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

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

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

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

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

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

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

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

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