Sunday, September 26, 2010

Working Environment for Doctors in Maldives.

First of all I’ll request you to go through the 1st  page of this blog to get an overall idea about the subject.
I could not get enough time to sleep since last few days and hence had not enough time to write anything.  But now the article is presentable so I am publishing it over this blog.
The environment which you’ll get as a doctor, if you come to work in Maldives will be as such:

1.      Working hours are usually eight hours per day for 5 days in a week which means a total of 40 hours in a week is required to complete normal working schedule. You become even 10 seconds late and someone may react on this leniency. Usually reporting time is 5 – 15 minutes before actual start of duty. No matter it’s raining or whatever or that you were called from mid of your sleep at 04:00 AM after which you could not fall asleep for another one hour and hence may have got up late today. You have to report at 08:00 AM then you have to reach before it. I have actually sometimes left brushing my teeth or freshening up in the morning to catch this reporting time. Of course felt bad the whole day about it….but who cares about that!!!

2.      The administration (of course comprising of those so called community health workers who are now called community health officers or community health supervisors in accordance with their capacity to command the management and anyway whatever they call themselves, they don’t do anything anyway except holding meetings about how to eat up all the funds) can one sided declare that your working hours now will be not 40 but 48 hours a week. You cannot do much about it. As I explained earlier in my 1st page here, all the conditions in the contract they give us here are able to be revoked by their side without our opinion on it.

3.      Other than these 40 or 48 (or maybe someday they’ll declare that  70 hours are needed as minimum in a week) hours as the case may be, all the time you are on call. Being on call means you can be called from anywhere and you are supposed to run to their health centre to see that particular emergency (as they call everything from a hair-fall to itching). You will be entering the total time you took in giving consultation to that patient in a book which will be 20 to 30 minutes and for this you will be entitled for Over Time (OT) which will be calculated as [basic salary /total hours of work scheduled in a month] – [15% of it] X [time you spent in hours]. When you try to calculate this all you’ll find that it is almost not worth waking up and disturbing your whatever activity you were indulging into at the time of this call to get OT for half hour or so. But since your contract says you have to attend all calls immediately and that too in proper dress code including formal wear and a shoe (yes, these stupids have mentioned even this in the contract) preferably within 10-15 minutes, you have to do all this. They must be believing that by wearing formal clothes and shoe doctors become wiser or else I personally fail to find any worthwhile logic.  It is believed that the locals don’t think of you as a doctor if you are not well dressed in formal.
[P.S. - When you’ll come to Maldives and will get a chance to visit their offices and all, a strange sort of formal wear is on display here.  You close your eyes after reading the entire combo and then imagine, you’ll find it interesting. Half Shirt in some glazing color or dark brown, a tie which is not tied daily but which comes all made and attached to an elastic string to wear around neck just as school children in our country use sometimes, pant worn above ankle joint as preferred in Islam, a shoe of any kind, green betel leaf in mouth or some deodorant sprayed around.  This was for men. Women mostly in veil. But by their clothes every corner of their body is exposed, every contour accentuated as clothes are skin tight from top to bottom.  This is the official look of men & women. They looked real funny creatures to me earlier but now I have developed a resistance. ]

4.      You are not supposed to leave your station. Translation: Going inside the Ocean water to see corals is also called  leaving station for which you are not allowed officially.  So, you may be seeing the ocean everyday but going inside is so complicated [some health worker has to be requested. Then your In-charge has to be requested. He may even call his/her higher officials after which you cannot always succeed in getting permission to go inside water.] that you may actually hate the idea of touching the beaches.

5.      In case you fall ill and you are the only doctor over that island, as is the case in 90 percent postings, then you need to try to treat yourself  first. Suppose you consulted a specialist over phone on the matter and you are suggested to visit a higher center for investigation etc, you first apply on paper to the In-charge about it. You may get an answer about your permission to go to the higher center  after a day or may be even two days. Up to this time you need to work as usual. You’ll tell ‘I m having pain lower abdomen’, they’ll say ‘ok. Take rest doctor.’. Then again some so called cough & cold kinda emergency will come and again you need to repeat that you are actually sick. And they’ll listen to it and say that come for 5 minutes and see the patient after which you can take rest. This thing will go on like this for the entire day. You may better decide to sit in your chamber to minimize your torture eventually because all the time going to your residence and coming back will kill you even before you would like it to happen. So, by the time you get the permission to at last visit that higher center and your travel arrangements are made, you may be either better already or your disease may have been aggravated to another level by now. One of my doctor friends here got Dengue and by the time they allowed him and arranged for him  to go to Indira Gandhi Memorial Hospital in Male’ which is the only tertiary care hospital here in the country, he was already in convalescence. God’s mercy upon him that the serotype was not a lethal one. Or else a anything could have happened. No need to say that after completing his contract, he has not gone back to continue.

6.      But suppose the condition when one of the Maldivian is sick…..then? Then irrespective of the sickness [cough, cold, body ache, weakness, fever….or likes] that fellow is brought to the emergency room. You do something and send him/her home. Apparently tomorrow again the same patient will visit you in visibly better condition. Then….the patient will come to you after 5 days to ask for sick leave for 7-9 days including two days when he/she could not come to you to show + the day you saw him/her in so called ER + the recovery time of 2-3 days + 2-3 more days when the patient didn’t think of going to class or duty due to laziness. And you can turn as red as you would like but you have to issue this medical Certificate and curse yourself for signing such a thing. If by any chance you deny to give it [management will always tell you to decide on your own about all things although never is this case], he/she may become aggressive and shout. You have to live there unharmed I think? Right? So, you better give it without resistance.

7.      The most demanding of all is: You are a doctor so you have to treat all [medicine, surgery, ortho, ENT, eye, Gyne, Obs, Pediatry], everybody [Child, women, child, men, child] and every known disease on earth….and this all with total accuracy of doses and all. Imagine getting a small sick child on your first day of arrival with seizures and you have no bloody idea of how much Diazepam per kg body weight has to be given and how. They all will stand around you and start conversing between themselves in such loud voices that it becomes difficult to concentrate or even talk to a specialist.

8.      Most of the time, even after knowing that the doctor can in no case understand their language or reply them,  One of the relatives will stand in front of you [with smelling foul breath] and start telling you in louder than loudspeaker voice about his anger on your incompetence or dissatisfaction about the treatment or even about some local event. You are astonished, frightened and in shock…that what to do in such case?  And the locals will smile on your misery. Forget that the local staff or translator will come to your help. They love spectacles.  Like this they deal with any foreign staff. Be it doctors or laborers. There is actually not a big difference in a Maldivian mind between both.

      In all, the gist of the matter lies in; This is a tough condition tackling even the littlest of things here. All the local staff and people, no matter how friendly they seem when you talk with them, will support the locals. Mostly because due to the incestual tendency in marriages here everybody over an island is a close relative. They breed within their family [The interpretation of Family as we see in non-Islamic world with no offence intended because it’s not in every religion or community that step siblings can marry between themselves] and hence the support for each other and hence the absence of secrecy over an island. Everybody knows everything about everyone here. All elders pairs contains 50 percent of pairs which are married twice or thrice in their life. So, children are of different category. One may be from one father, another may be from another and third one may be from the same father but different mother altogether and all living in the same house doing whatever they want between themselves.

Anyway, their system of marriage is none of our concern. Although all this little somethings have an impact over the environment we get here to work in.

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