Saturday, October 9, 2010

Doctors in Maldives & their MANAGEMENT

Here is something interesting for aspirants for the post of Medical Officer in Maldives Govt.’s Ministry of Health & Family.
The attitude of management (let me introduce you once again with this term in Maldives and then I can proceed to tell you about other connected events)
[Management consists of those so called 8th or 10th pass community health workers and some even lower grade educated monkeys {called so because these human forms have no imagination of their own. They will try to see what people are doing in the soap operas of the great Indian Hindi Channels and imitate them without knowing the left & right of it. Just like monkeys do in a zoo.} who behave as if they know everything and they should know everything. Whereas the fact is that even if you try to explain something to them, they simply can not understand anything just because of their monkey like brain. 

You can better understand these people if you have seen movies where some fancy jungle tribes are shown doing ‘Zhinga—lala—hu….zhinga—lala—hoooo...’ dressed in some leafy clothe like things. Here everything is the same only dress is a shiny yellow or shiny green half shirt {choice of colors are exactly like any other Islamic territory} and a brown or black pant. That’s it.

BDTHE = Better Dressed Tribal Human Entity. That’s a Maldivian management person to you.

There is one 6th pass family health worker who was till recently a big official in their so called ministry. He got very angry with Indian doctors complaining that he was not given the respect, which he would have loved to command, when he was visiting the Ministry of Health in New Delhi. Now imagine a middle school passed official {not even politicians. Among politicians it is common to be not educated and still becoming a ruler. Just a misfortune of my country, i.e. our dear India} from anywhere coming and visiting the most brilliant and highly placed IAS officers who don the chair of secretary or even assistant secretary in Indian Ministry of Health misunderstanding this family health worker {who is almost a fourth grade employee according to Indian standards} and not giving him respect. We (me and some other consultants were present in the premises where he was telling these gory details of his visit to India) heard it and truthfully it became difficult to stop our laughs. But we did our best and managed to hide our feelings until we were out of the Ministry office. Of course that fellow was complaining very wholeheartedly.
This all is part of the management squad which is bigger than total number of doctors available in that territory. Plus there are few people in budget section (usually 4 to 5) who religiously try to calculate your salary for the whole month and at the end finish up with either miscalculating it in their or your favor. Yes, sometimes they can even overpay you and ask the money back as soon as they find their mistakes although most of the time it is not giving you as much you should get. Each month you have to sit and take your precious 1 or 2 hour and do the calculations for yourself and match with their figures.  Or else you’re gonna be a loser.

So, after your refreshments (in terms of refreshing thoughts about management in Maldivian system) we return back to our original discussion.
The attitude of management towards doctors or nurses or any other staff which has come from outside Maldives is such as with the bondage labor. Perhaps they have been bondage labor in hands of British and other European Colonial Forces for so long that they only now this even in today’s era. But for their kins they become softer than butter. You’ll see a boy of 10 years having an abrasion over hand with small pin point bleeding which is not even active now and his father will acting as if he is witnessing his son die of bleeding. A scene straight out of Hindi soap Opera style moments. People will be running with that boy in a herd as if he is terminally injured. God’s mercy over the attending doctor if it is not over his face or head. Because if so, it will be called ‘Head Injury’ and you have to act as if you have to stop that non-existent bleeding fast and save that boy from an almost sure death. The management will try to tell you that this case is the most important of all and should be attended first. And may be even referred to a higher center if needed.

There is a provision of a break of 1 hour during your 8 hour long duty hour. This is nice as long as it’s being is concerned. What actually happens that as soon as you start your break and start walking towards your residence where you are supposed to take some sort of meal, someone with a small abrasion or a bout of epigastric pain will come and the management will call you in panic (don’t get befooled. They know it is nothing but a minor thing and the patient can wait for hours to see the doctor if the need comes.). But you will be called by the management with words like ‘doctor…emergency patient.’ And then the phone will be disconnected as if all the people are busy managing that emergency case. Now you leave your eating plans and come back to the health center where a stupid situation is awaiting you. No matter how many times you try to explain that you are also a human being and need the usual things like food and rest, they wont listen to you.

Suppose you have admitted a patient or kept him/her under observation and after finishing your duty have come home leaving that patient in perfect peace and tranquil in the ward.  You have in mind that you will take some rest and by the time that IV fluid will finish you’ll go there and discharge the patient as the case is settled. No sir…never. That case is not at all settled. People will call you again and again about how that patient wants to go to pass urine now…or may be he or she is crying and missing his or her boyfriend or girlfriend (as the case may be)…or that the paper in school, due to which the patient landed up in the health center at the first place so as to avoid it, is finished so that so called bastard wants to be discharged. You have to go and obey the wishes.

Here admission or discharge of patients is not as per doctor’s wish. Patients come to say we want admission…or no we want discharge…or I want medical certificate for 7 days, from 2 days back to 4 days in advance as I am having cough since last 2 days and not only I have not attended work since last 2 days, I don’t want to work for 4 more days. And the management will be standing on back of it.

And now you suppose (may God be with you and your sickness) you got sick. I actually did get sick with right hypochondrial colicy pain. Naturally it was difficult to sit and I requested to be on sick leave that day to which the Management  readily agreed. Only they started calling me for each and every patient and I had to attend calls even in that condition. I was having difficulty in walking. I told them so. But they kept calling again and again for every  case of dandruff to abrasion and after 11th call my ability to tolerate pain was finished and I had to give up the idea of rest and I sat down in the consultation room itself for the remaining 3 hours of my so called duty hours.
I talked with surgeon on call about it as anti-spasmodics were not helping. We agreed on some treatment which I started then and there. 2 days of treatment didn’t given even a 4 – 5 hours relief and upon re-consultation it was agreed that I should visit a nearby hospital (which happens to be the Indira Gandhi Memorial Hospital, Male’) for USG and follow up.
Now comes the management’s part. They decided all by themselves that I should wait for another 2 days before going to Male’. I queried the health worker (the supposed In-charge guy) that how could you all decide about my condition when the surgeon is asking to come for a USG Scan? They remained silent but didn’t say anything positive. I got angry. Bought the ticket of speed launch myself and told them that let them complain in the ministry about my un-authorized leave, but I was going to IGMH for USG scan. Then in he morning when I was almost reaching Male’ information came that I should visit ministry (in the same condition with colicy pain going on) to get the papers for my supposed free treatment in IGMH. I simply went to IGMH without going to ministry, paid my own bills, got some more help in medicines after surgeon’s consultation as it was actually a case of Acute Cholecystitis, and returned back to my island all by myself.

So, here is the place for you. Almost our enemies dictating your every move. Beware folks. The guarantee of being and remaining sound (health wise) will be the first need from your side before you submit to a contract from where there’s no way out for 1 year. There is way out after 6 months but it is so costly that you would agree for 6 more months to finish the contract and run away from here forever. Agreed that not everybody’s experience will be like this.
But mine was. Is. And one of my doctor friend’s was as well, who was left without a companion…being referred from hospital to hospital (first to their Atoll hospital then to their regional hospital) only on the name of protocol, suffering from Dengue and ultimately landed up at IGMH after 2 flights. All alone and  bleeding with a canula in one hand, rashes all over, severe gastritis due to internal bleedings with every possible chance to collapse with a  platelet count of 16 thousand. You can imagine his shock and desire to live and helplessness. I was praying to God for his life all the time when he was sitting at different airports without any medical (or other) escort. His luck was good. He left Maldives alive within a few weeks and never returned back. You mention the name of Maldives and his wife becomes silent with wet eyes (she was in India when this all was happening. Actually there was a moment when she and his father were wanting to come here but I stopped them because by that time my doctor friend was actually only 2 hours away from Male’ where in IGMH he could get proper attention at last along with platelet transfusion and all). It is something you ought to feel. You can never understand until you live these moments even as a spectator.

MANAGEMENT in Ministry of Health, Maldives  didn’t even apologize for the irrational behavior they showed towards us, neither to him, nor to me. And to think that for a Maldivian even ureteric colics get referred immediately without any fuss to wherever is possible. And we are the people who do it with all the efficiency.

Nice Stories to ponder over.


  1. Hi,
    do you want to know more?
    Read this wonderful blog. Written by a specialist who has worked here for more than three years.


  2. heheheheh brother dont explain the health management of any country. just 1st look at the management of our own country.i can show you more worse pictures of indian health management then maldives. what are the condition in our gov hospitals. what are the hygienic conditions. plz visit the wards of TB, oncology etc. how drs working how patients surviving God know. and you are talking about mosquitoes. brother you are frustrated and need psycho therapy.