Maldivian way of Interpretation of working Conditions for Doctors in Maldives.

Folks, think what….there is an interesting story to tell about. Although in my blog I may look like having endless complains about the working pattern of Doctors in Maldives, I am not meaning to say that it is the same everywhere. There are places where the small group of local managers take good care of the staff of Health Centers and which in turn affect you as well. 

 

Like, I at my place have persuaded the entire staff in collecting little bit of fund (equal contribution of MRF 100/- from every staff) and we have made a small breakfast space and now a days we take early morning tea and coffee with some Maldivian locally made short-eats (kinda fast foods, mostly fried little things with fish stuffing in almost everyone of them) together. This is in fact creating a better harmonious atmosphere here. By God’s mercy.

But here is an interesting story which is coming from southern part of Maldives where one of my friend’s friend is posted as a Medical Officer in an atoll hospital. In hospitals there are roster duties dividing the day in three parts of eight hours each. There are virtually only two medical officers there and due to the shortage in number of MOs, the anesthetist (there is not much of work in atoll hospitals for an anesthetist anyway) also is working as a makeshift MO treating children and all. So that fellow was on duty from08:00 AM to 04:00 PM on duty, had to come on duty again at 12 o’clock midnight, the same day when at 4 PM he had left the duty, to 08:00 AM in the morning and had to come back on duty at 04:00 PM for duty again and had to continue till 12 midnight again. This is called no overtime duty. As per our contract we have to work for 8 hours in a day and then be ready for on call duty anytime. So what the management has done is that the 12 midnight to 8 AM duty they’ll call ‘ON CALL’  duty just for the sake of calling it like that and wash their hands from it. This way they say that they are not breaking the contract. Understand it whichever way you want. You can not, in no case, convince them that these kind of routines are impossible. You have to comply.

Now comes the interesting part of the story. After this all 8 hours of scheduled working, followed by 8 hours of rest, then again 8 hours of working which has to be called ‘ON CALL’ duty so as not to break any official rule in their eyes and then 8 hours of  resting period after which again you have to do 8 hours of now scheduled duty, of course you are beat… want to take a nap if possible. Leave the matter of cooking and washing and taking bath etc. Because again after this resting period of 8 hours they will put you on duty and may be call in ‘ON CALL’ again or maybe they’ll use some other flimsy word to cover this bastardness up. They shake up with the roster all the time just to make you uncomfortable. Actually we firmly believe that it is simply due to one cause. They don’t know how to be happy in any other way than creating trouble for outsiders. It’s simply that. You will fail to describe it in any other way. Because as soon as you will bring any sort of complain in front of anyone (even in front of some other than management people, like your translator or reception guy or anybody), they will start laughing hilariously as if they have got what actually they wanted to achieve. It makes you so depressed sometimes that you actually think about committing suicide (it is anyway better than reacting to their deeds).

So, where were we………ya, this fellow had completed two slots of this 8hours duty-8 hours of rest-8 hours of duty slots and then was taking nap to get ready for another 8 hours of duty slot.  One call came from the office at around 11:30 AM (consider the fact that the guy has gone to sleep at 08:30 AM and has to get up at around 02:30  PM get ready for 04:00 PM duty again) to ask for his passport  details. They had to send this information to the Ministry of Health for enrollment of that guy in some pension scheme or things like that (as if that guy is going to stay here for more than this contract period, with this kind of behavior going on, to receive any sort of pension. Oh my Gosh…even the thought of it rattles me. Having goose bumps already typing it.).

The call was made. That guy was woken up and anyway that information could not be fetched from him as he was too delirious due to lack of rest to yield any information. He again tried to go to sleep. Somehow came to duty again at 03:45 PM (here people have to reach a few minutes earlier on duty to sign in the attendance register. That’s the way they like it.). When confronted with the office guy that what was the urgent need of disturbing his so much needed sleep for a not so urgent cause at all…..have you any idea what the reply was?????

(I am re-constructing the conversation. There may be some alterations [although there are none as I have confirmed it already] in the actual wordings than the actual incident)

Management: “You are supposed to be ‘ON CALL’ 24 hours every day without any leave. For the entire contract period.”

 Doctor: “But as a human I need to sleep. I have continuous duties. How will I take rest if you will wake me up in between my much needed sleep? And anyway I was going to come to the office in a few hours. You could have told me this personally when I would be here.”

Management: “There is no mention in your contract that you have not to be disturbed in your sleep. We will call you whenever we need to talk to you.”

Doctor: “But I need to sleep. Is it so difficult to understand?”

Management: “ There is no mention of your sleeping hours in your contract. You will be ‘ON CALL’ all the time and we will call you again if need comes. We can’t keep track of who is on duty and when. If you have complains, you should have thought about it before signing the contract.”

Doctor: “But this kind of things are never written anywhere. It is common sense that any person needs his share of rest & sleep in a day.”

Management: “You can complain about this with the Ministry (supposedly the Ministry of Health & Family which comprise of only a few very talented [???] people).”

This is the situation when there are only 2 people (1 MO & 1 Anesthetist) doing all the MO duties and naturally they are always on alternate duties, no matter what you call these duties, ‘ON CALL’ or scheduled ones, you have to be alert for the call after all even if you are sitting at home and waiting to be called, sometimes 6 to 8 times within a period of 8 hours for anything between Rhinitis or Dermatitis to Abrasions/CLW or  CVA (every possible medical condition even by a distance is an emergency). Consultants are in their OPDs only between 08:00 AM to 04:00 PM after which they are also always ‘ON CALL’ as it is said.

So there you are. If planning to come here or already landed up in this hell and are going to sign the contract, which they insist you sign immediately and in a hurry due to apparent reasons, just try to talk about these things and get them included in it if possible. Best of luck to Doctors who are coming here from outside Maldives. Because for the Maldivian doctors none of these rules apply. Not exaggerating, I have tried to call Indira Gandhi Memorial Hospital in Male’ for some consultations and whenever it is some Maldivian Consultant who is on call duty, he/she doesn’t even bother to pick up the call most of the times (my ratio is: only 2 out of 10 attempts were successful. Rest 8 times they did not pick the phone).

Maldivian Ministry of Health & Family (MOHF, Maldives) wants to model itself on middle east countries.

Folks, there is news for all who have somehow got interested in Maldives as a destination for getting jobs in health sector.

Not only doctors but Nurses also keep landing up here (and all of them are sometimes paying up to $ 4000/- to get the Working Visa in MOHF Maldives. Specially Nurses who mostly belong from South India are really paying this much to get this job.) and now a days these Maldivians are asking them to clear IELTS with a minimum score in the band of 5.5.

Imagine, these fellows who have not much of knowledge of English (they study it in school where they almost don’t study at all. Only a few of them are interested in studies or else others are more busy in having sex here and there or sniffing drugs.) asking others to clear IELTS to get a job here!

Actually when anyone of you come here (Let God save you from it at the first place!!!) you will find out that even the young generation is not able to make a workable conversation with you in English. Only a few people who have gone through specialized training to work in resorts etc have a knowledge of English and that’s it. In Male’ you may be getting taxi drivers who can at least understand your English, but on inhabited islands as soon as you try to start a conversation in English, they’ll run away.  They are not shy. They are hooligans actually (2 days back I came to know by one of the nurses who are employed here that someone tried to cut the net cover over her room’s ventilators to take a look inside at night when she was sleeping there. Now you can imagine what would have she felt like. She quickly switched the night lamp off as she was not properly dressed in her bed and till date she is still waiting for some kinda MMS or picture of hers to appear in local public showing all her beauty to all. It is pathetic. Don’t even think about why the hell she didn’t shout and all. Who will come to help? No one. And they will even tell that she must have invited the youth herself to have sex and all. These fellows are like that only. Any two or even 3 or 4 male and females are sitting together talking and for them they are secretly having sex. That’s the way their mind works. ). But they will not be able to talk to you.

Anyway, we are deviating from the topic. MOHF here is going to give administration of 7 – 9 zones, which they have made in Maldives, to their zonal headquarters and they are gonna call it corporations (??? Why corporation in particular and not anything else, you please don’t ask me. These duffers somehow come to know about a few fancy words and start using it to it’s fullest). Now these corporations are supposed to be trying to minimize the cost of providing health services, making it payable for all (until recently it was free for all locals and only payable to foreigners to get medical help) and make the health system smoother (they are using this word. In which sense it’s still not exactly clear). In the regimen of this bloody corporation thing, working hours are going to increase and overtime payment is going to get a kick (kicked out). Plus this demand of IELTS from Nurses. Tomorrow they can say this very thing to the doctors also. Or even better, they may ask them to learn their strange language (in which they pronounce every word so harshly that you may want to die after talking with one patient).

Anyway, these changes are saying one thing, these poor tribal people are trying to model themselves on the middle east countries in terms of demands from us is concerned. From their own people they can not take any kinda work anyway. Local staff works less. In wards local nurses are only sitting and they provide information to the management which nurse could put IV Cannula in one attempt and which one could not. Or which doctor is treating people with respect and which one does not. Things like that. They are basically spies only. Work you ask and then you see their attitude. They will instantly start calling the foreigner nurses to come and do this or that.

Usual story of local staff is: they will come to the Medical Officer for a Medical Certificate of this many days (usually 3 – 4) saying that sir, I did not attend my duties since last few days and now I need this M C to cover the attendance. You don’t even think of scolding or not giving this MC. You have to give. Yes if you or another foreign staff is even if having fever, that means they have to take only one day’s rest. That’s quite enough for them to recover.  You can try to get 2 day’s rest but in that case get ready to attend their calls because your contract says you are always on call. There is no mention of no calling in sickness times. For you their patience is lost in may be 6 hours. Only Maldivians are so feeble that they need rest of 3 days for cough. For loose motions they will not attend duties for a week.

Earlier they were providing us with a rented accommodation which was being rented buy them and for us was free. But now they have started giving a paltry kind of living allowance to us which is not even half of what we need to hire a room somewhere. Mostly because they don’t want to give us rooms for a reasonable amount of money. Their logic: You are earning quite much here, give it back to us in form of rent or other  things. If someone is growing banana in his house, he will not eat it. Rather he will come to us and try to sell it for as much money as he can. Even if we pay $ 5 for 10 banana, which if considered in Maldivian market can be called cheap, they will tell this story to their people that how he trick fully deprived me of my $ 5 and got it back. This is the generalized feeling of a common Maldivian.

Now a days, the management  people (those very 8^th or 10^th pass duffers about whom I have described in earlier blogs) are coming to me, saying that “I will go for a trenning porogaramm for masters in public helth so that I could become a manager here”. Now think people……who has heard getting a masters degree without having a bachelor’s one?? But here they can call whichever certificate a master’s program or may be even PhD in a few days.

VISUALIZING…………DR. So & So, a Maldivian with actual education of up to 8^th grade after which he could not clear Maths, English and general science (considering they have only 4 normal subjects in their school  namely maths, English, general sciences and life sciences. The other 4 subjects are Dhivehi, Islam, Fishery Science etc) is now the Director General of Health or some other Services after getting his double PhD in Human Resources and may be in Fish catching techniques etc etc.

This is the Maldivian punch which will be available for everyone very soon. Maybe in December 2010 itself. So, get ready. Want to come here? Start gathering up qualifications. Because this country of uneducated is becoming a very demanding one.

The General Behavior of Public & Patients towards Doctors or any outsider professional in Maldives.

If I say that the general public of Maldives is retched or bad behaving then it will not be total truth. Apart from a few of them 99% are very bad behaving. Not only doctors, there are quite a few teachers also coming from outside Maldives and they also have to bear with all the things these people do to us all.

Some Glimpses of patient behavior:

1.     A healthy girl of 18 years of age comes to the consultation room with C/O   1 episode of vomiting with pain epigastrium and the fact that she has not eaten anything since last 8 hours(by the way these stupids are so funny when it comes to address the issue of food. They know only fish and red chilly and coconut in this world and naturally when they get gastritis out of this combo them they simply stop eating as long as possible and hence every person here is having gastritis). Now see what she is saying (speaking loudly and with greater authority than you, not requesting) for “ I have vomited and I want IV fluid”…that’s it. If you don’t give even NS or DNS, then they can shout and cry so much that the Health Ministry (Consisting of people like her only) may consider you incompetent and try to change your place of working

Want proof??? Here is it coming; A friend of mine, posted in an Atoll Hospital in some southern part of Maldives, was harassed by the management just because someone brought a child of 4 years of age with so called history of vomiting & loose motions (they tell like he has vomited 15 times and passed 8 watery motions) although the child is not looking dehydrated or inactive. He was still playing happily inside the consultation room. But hence it was already 10 PM and the parents of the child didn’t want any hassles they barged inside the consultation room with an order “ADMIT….”. Now the doctor evaluated the child’s condition, advised anti-emetics, ORS etc and gave the prescription to the father of the child. That man took this prescription and threw it over the table, beating the table with his clenched fist and started shouting “ADMIT…” “ADMIT….”. The translator is not saying even a single word to him to stop behaving like this. That man now threatened to tear everything apart if his child was not admitted. The doctor took respite in ordering admission, feeling terrified, with IV Fluid Isolyte P 40 ml/hr. Now the man is shouting that where is the medicine written in order? He knows that IV fluids are IV fluids..now some medicines must be added too. Ultimately this matter was raised with the Management (??) the next day and within 2 weeks the doctor was sent to some empty island where they don’t have electricity for more than 8 hours in a day. This was supposed to be the punishment for him for not being competent enough. He ultimately finished his remaining term of contract (4.5 months) somehow and went back to India to never return back to these animal’s land.

2.     Patient will come with complains like “I think I am having appendicitis”. Now you explain him/her that even if we suppose he may be actually having the appendicitis, he must have some symptoms supporting this diagnosis. But no, he had one episode of pain in Right Inguinal Region two days back and hence he thinks he is having appendicitis so you have to treat him. God forbid if you tell him that he has no appendicitis….this statement may have consequences.

3.     Patient says he feels there is something inside his thigh, means you have to cut the said place and explore for an imaginary foreign body and then suture it. All this because the patient actually wants some leave or something (even the desire to get sympathy from her wife or for instance he has done some crime and wants to seek forgiveness from his family members so better to get something of this sort done and divert their mind from his current crime) and he decided to get that like this.

     

Now, as far as general public is concerned, they don’t like outsiders here. And we Doctors are also outsiders here.

What they actually do is they try to behave rudely with us, try to frighten us with their deeds and behavior, shout in their language and say bad words to you in public and all will start laughing over the occurrence just to demoralize you. Things like that. And I firmly believe that they will be quite happy if we leave from here. Their government is forcibly (applying force on them to accept us on their islands) keeping us here.

For instance;

1.     Take my example: Someone (??) throws some solid object (supposedly a dry coconut or stone)  over the roof of that room where I reside in between 02:00 AM to 03:30 AM almost every night. It makes such a horrible sound when that thing falls over the tinned roof that it can freeze your blood if you are sleeping and are awakened with this sound. Sounds terrifying, right?? It actually is terrible. I get palpitations whenever I get up with that horrible sound. There is no policing available here. So, always I worry about my life. This guy can come inside sometime also. Two three times someone knocked over the door of my room (Here every place is a room only. They construct rooms which opens on road. That’s it. There is no concept of a closed house here at most of the places.) at 03:00 AM. Knocks come on the glass window as well. When I don’t open up then this shade of a person moves away from that window. I have seen the shade a few times, wandering here and there. If by that sound no one is coming to help me, who will help me if he barges inside my room per force some day? No one. I think I have not slept peacefully since last 1 month. I wait for this thing to happen before I can go to sleep. It does not happen if my lights are on. I have already experimented with it. Only when my lights are out, he or she will throw this thing over the roof. So, I switch off my lights at around 01:30 AM and wait for it, then again after it has happened, I need 15 – 30 minutes to calm down and after it only I lay down or try to fall asleep.

2.     One of the nurses we are having here has multiple times observed that some particular group of youth is always waiting for her near the health center and it simply follows her to her room making some sort of comments in their own language. Once she tried to remember the exact wordings and asked the meaning from a local Maldivian staff. Guess what…it was one of the ugliest thing which we could have listened in life. Such vulgar parallels are not available in Hindi (my mother tongue). Since so many days they were doing this to her. Now she stays put in health center or takes another route with some other staff after her duty finishes up.$ But even after that no one has tried to talk with those hooligans to stop this kind of routine.  

3.     There are so many drug addicts here. They are always prowling over roads (if you can call those lanes filled with sand & mud a road) after evening with un-kept look and long hair and cigarette in hand. One of my friends told me that over his island almost every home is having one or two known addicts. People stop him over the road and nicely ask for money. He can not do anything else. No one comes to help. So, he every now and then ends up paying them 2 – 5 dollars and saving his life. He has to go to shop in evening when less public can see him on road. In last 5 months since when he has been sent over that island he has saved himself by paying up 6 times by now. God only knows what will happen if someday they catch him without money. There is no policeman to be called to help. Their most of the islands are not covered by policemen. Only 15 – 20 bigger ones among almost 300 inhabited islands is having 5 – 7 policemen’s team and a police station and a court but anyway there is no defined law in this country. These fellows beat the policemen up if they try to stop them from doing anything so even police is a bit helpless here even if it is present.

4.     An additional story to read; there was one instance when two teachers of Indian origin were sitting near the jetty over an island (in south Maldives) when 4 hooligans tried to push them in ocean and take their watches and wallet. One of the teachers showed courage and started fighting with them and eventually these hooligans ran away. Like every muslim contingent, the cowardness and treachery with ruthlessness is prevalent here also. If you raise a hand you can really frighten them up. Now, after this episode they both waited there on the jetty for a while and then decided that they should register their complain of the incident to the Island Office (obviously there is no police station over the island). But guess what, the bastard lads had reached there before them and ultimately the matter reached the ministry of labor & education. One of the teachers (who had resisted the robbery actually)was terminated sighting the reason that he is not a good teacher. The second one was transferred to another school sighting the reason that he used to have bad eyes for female students and the island people didn’t want him to be teaching in that school. 

5.     Another horrible story; Here people from Bangladesh are considered as servants. Usually each household is having one servant and 99% of them are Bangladeshis. Here men & women are having sexual relationships with almost entire possible contingent available locally. Not only before marriage, but even after marriage they continue their rendezvous with all of them, past & present lovers and spouses. They simply have to taste everyone. They lure foreign nationals also with all sort of provocation (The translator here, who is 21 years old and twice married already has tried to show her breasts quite a few times to me and she keeps staring over my eyes in case my gaze eventually falls on her.) be it a male or a female.

Now….one woman got one Bangladeshi in her bed somehow. Maybe he was at fault or maybe she. But one day her husband came to know about this and you can not imagine what happened next.

They took the boy, dragged him in an open field, started beating him up and pelting stones over his head until he was dead and then by kitchen knives 5 – 6 people cut his body parts (nose, ears, intestine, his testicles etc) in small pieces and all the males available there took one small part by one in their hands, all red with his blood and started shouting victory sounds. One fellow who has seen the incident told that the most horrible thing he saw from them was that someone took the cheeks out with lips and all intact and was trying to tear it apart by his own hands and was blowing wind through that piece of flesh over people around him so that they could bathe in the small blood droplets which were oozing out from this piece of meat. Then they went to ocean for fishing together in front of the entire island’s watch, using his small body parts as bait for fish. This entire thing was duly filmed and made converted into a CD (remember the throat slitting CD of that American journalist in Afganistan region which those talibanis had uploaded over internet for people to watch their bravery???) and was circulated in Maldives. This happened almost 2.5 years ago. People still remember it here and they site this example to terrify us that if anything we do which will not be of their liking then we can end up like this. Specially Medical personnel. Anybody can die anytime anywhere by anybody’s or even nobody’s fault by the way. I don’t know how much this story should be considered related to us but if that form of cruelty is readily available and can be evoked then better to beware.

6.     My sisters were telling one day that whenever someone comes here for IV Canula fixation, they will say it pains or it is not fixed properly if it has been done by a non- muslim nurse. When a muslim nurse, even if of foreign origin, is doing the same thing, the canula is ok. There is similar attitude with doctors also. If they have a few doctors among which there is a muslim, they will flock there for treatment. It happens all the time in atoll hospitals here. Everywhere. Even if you come to work and reach ministry, they will keep all the muslims near Male’ or in northern part of Maldives (North & Central Maldives is supposed to be more educated and better behaving than it’s southern areas) whereas hindu doctors will be either thrown to small deprived (nothing to eat except yellow rice & potato, no milk or bread and may be even no natural ‘Atta’ or Pulses available) islands or far southern Maldives where there are non-humans dwelling. Especially South Maldives is very notorious. Non human is the accurate term; there are no other words to describe their behavior.

THIS  IS  THE  REAL  MALDIVES  DEAR  PEOPLE.  NO  ONE  WRITES  OR  SAYS   ANYTHING  ABOUT  THEM  JUST  BECAUSE  WE  DON’T  UNDERSTAND  THAT  ONLY  BY  TELLING   THESE  STORIES   TO  OTHERS  CAN  WE  HELP  OTHERS  FROM   SUFFERING  THE  SAME  FATES  AS  DESCRIBED  ABOVE.  REST  IS  UPON  US  TO  DECIDE. AND  BY  NO  MEANS  I MEAN  HERE  THAT  EACH  AND  EVERY  MALDIVIAN  IS  SAME AND BAD.  THERE  ARE  BOUND  TO  BE  GOOD  ONES  TOO. WE  SIMPLY  FAIL  TO  NOTICE  THEM OR  BITTER  THINGS  ARE AFFECTING  OUR  THOUGHTS  MORE  THAN   THE  GOOD  ONES.