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.

Life saving surgery?

This report is based on an unpublished article written by a Maldivian doctor stationed overseas reporting on an incidence that happened at IGMH.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

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

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

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

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

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

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

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

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

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

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

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

Presidents medical cover saved from shame by a boy scout

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

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

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

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

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

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


Update
[22nd Jan 2008]

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

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

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

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

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