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.

What will the new year bring?

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

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

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

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

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

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

Corruption within the recruitment process

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

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

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

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

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

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

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

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

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

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

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

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.

Foreign spouse and Thalassaemia

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

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

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

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

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

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

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

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

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

And Yes: being un-contactable is a fashion!