Just See these things before heading for Maldives and wanting to work as a doctor there.

Doctors in Maldives

Another Nail in The Coffin

There is something new in the air folks. Doctors wanting to come to Maldives don’t know that most of them will not get posting in Male’ and they will be sent to islands where there will not be any banks or other ways to either keep their money (which you’re going to receive in Maldivian Rufiyaa only, as your salary) or send it to their respective countries. If you keep the money with you, there is no guarantee that you will not be robbed of it. Mainly due to three reasons; 1.- Everyone over the island knows about the exact amount of your salary and when you got it, 2.- All the windows and doors at the place you live look fancy but they are of no use, 3- there is no system of policing here, so in recent times(last 1 year) quite a few mishaps of Doctors and Managers being robbed have happened.

PONDER….PONDER:

1.      The Gynecologist of our hospital(who gets a salary of almost $2500 per month) was robbed after he got his salary 3 months back. Only the next day, someone opened the house by a key as there is no sign of break in, and cut open the suite case where he has kept his money.

2.      Day before yesterday one of our doctors accidentally locked his room and forgot to take keys. Locks are Chinese which can be locked without keys but have to be opened with keys only. Now that he forgot the key inside, he went to the land lords to tell that let them give him the spare duplicate key so that he could retrieve his own key back. The land lord came downstairs with a plastic scale, did something near the lock and it opened up. Only with the help of that scale. Our Mr. Doctor is so shocked by the incidence that now he carries all his valuables with himself on work and doesn’t come outside his room in the free time. He wants to get another lock mounted in that door but since that kind of lock is not available over the island and it will be found in Male’ only, we all are waiting for him to get relaxed. Imagine, everyday morning he comes to duty with a small cabin luggage kind of bag and his laptop. Keeps it in his chamber and goes back with both the things after finishing up his duty hours.

Of course there are some islands which are called Atoll capitals, where there is a hospital. If you get your posting there then there is a branch of the Bank of Maldives over there. A small branch, but it is there. Usually the case was that at least where these Bank branches were located (apart from Male’), you could open an account and take international Visa Debit Card and give this card to your kins in your own country. They could always withdraw money there and all he transaction commissions etc were deducted from your account automatically. It was not difficult or complex. Not for anyone.

Now, from this month (October’2010) onwards all the Visa Debit Cards for foreigner clients are blocked for international use. Banks (not only Maldives Bank, but HSBC or Western Union or Moneygram; whichever was sending money from Maldives to other countries earlier) have denied taking Rufiyaa for sending to other countries. They are asking to give them Dollars only if you want to send money out of Maldives. And Dollars you can’t buy because no bank is selling. They are buying Dollars and other currencies…yes… but selling….’No’.

So, now no one has any idea about how to send money to their country without visiting Male’.  And what’s even more interesting, we are getting news from Male’ that even there the trouble is hanging over them. The Bank counters which used to send money to other countries (in State Bank of India, Habib Bank of Pakistan, Western Union & Moneygram) have started working slower than before, leaving a many in the end who can’t succeed in sending their money that day. This all means that some sort of trouble is ahead. Only time will tell which kind. I fortunately have an account in State Bank of India in Male’ and I am hoping that they will transact money to India at least when I will be finally leaving for India after finishing my 1 year of contract period. Reverse Counting has started. For me 267 more days to go. That’s all. After that I am a free man once again.

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 8^th or 10^th 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 6^th 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 11^th 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.

Working Environment for Doctors in Maldives.

First of all I’ll request you to go through the 1^st  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 1^st 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.

Another Clipping from a News Channel.

Doctors quit over intimidation

The resignation of three doctors from the largest private hospital in the Maldives has brought its gynaecology department to a grinding halt, according to a hospital official.

Ahmed Afaal, the managing director of ADK hospital, said all of the doctors in the department quit over the past two weeks, claiming their work environment is not safe due to threats and pressure from members of the public.

“Doctors face a lot of pressure and persecution from patients,” he said. “Most of the time, doctors are treated very inhumanely, and this makes them lost interest in their work.”

Due to the rise in the number of threats against doctors in the Maldives, the ministry of health issued a press release in early June. “Qualified specialists are refusing to work in the Maldives, saying they don’t want to work in such a terrifying place,” the statement read.

Doctors in the Maldives are predominantly recruited from India.

According to Afaal, over 60 patients visit the hospital everyday for labour and emergency services as well as caesarean facilities.

Hospital records show that more that ten per cent of patients visit the hospital for gynaecological services.

“We are working to begin the services once again,” said Afaal explaining the three resignations had led to fewer patients. “But it’s hard to recruit professional doctors.”

At the moment only one gynaecologist is employed at the hospital and he has been suspended following an investigation into the death of a mother and her baby, said Afaal.

The mother and baby died following a caesarean section which led to protests outside the hospital.

His passport was confiscated under a court warrant issued by criminal court.

A 26-year-old mother who gave birth recently at ADK hospital expressed concern over the temporary termination of gynecology services, saying “many women will have to suffer”.

In the Maldives, only two hospitals in the capital city Male’ offer basic facilities. The largest hospital Indira Gandhi Memorial hospital recently experienced a shortage of equipment such as x-ray machines and CT scan machines.

Dr Rajshekar Kalgudir, ADK hospital medical superintendent, said pressure from the public was a recent phenomenon, and at times, either the patient or their family openly threatens doctors. 

“Sometimes they might ask for 100 percent guarantee in the cases,” he said.

Kalgudir said this kind of behaviour had only been exhibited by Maldivians. “If this continues…many more doctors will quit,” he said.

“Patients and their family should have faith in doctors,” he said. “We’re trained to care, not to harm.”

Some old News Clipping of some Maldivian News Channel

http://minivannews.com/society/expat-doctors-deserting-maldives-5021

Expat doctors deserting Maldives

By JJ Robinson | November 23rd, 2009 | Category: Society | No Comments » 

 

Expatriate doctors are deserting the Maldives because of poor facilities and uncertainty over their pay, according to a doctor working at Indira Gandhi Memorial Hospital (IGMH).

“We’ve lost five expat doctors in the internal medicine department in the last four months,” said Dr Ibrahim Shiham. “Only one has been replaced, and from an island so not a new recruit.”

Foreign medical staff are vital to the country’s health services and comprise 85 per cent of the country’s doctors, according to Shiham, most of whom come from India with some from Nepal and Pakistan.

Many are showing reluctance to renew their contracts, Shiham claimed, because the latest round of cuts to government salaries have added to the uncertainty that followed the efforts to standardise civil servant renumeration in January.
“What actually happened was a lot of pay scales were streamlined, and doctors’ basic salary, including allowances, was ultimately down 30 to 40 per cent. So what [the government] did was invent another allowance to take it to the original break-even level. But the extra allowance has no legal standing, and in theory doctor’s salaries got a major decrease.”

With their salaries “propped up and not in the rulebook”, many expatriate doctors “started talking about leaving and looking for other opportunities,” according to Shiham.

“People who’ve been working [in IGMH] for 14-15 years have begun leaving in the last four months,” he added, when their contracts come up for renewal – something he says was rare in the past. “They realised that once they sign the contract there’s not much they can do [if the allowance is withdrawn].”

Deputy Director of the Health Ministry, Abdul Samad Abdul Rahman, said three specialists and six medical officers had left the Maldives in the last two months, and that replacements were declining offers because of the lower wages. CEO of IGMH, Zubair Mohamed, meanwhile told daily newspapers Haveeru that departures from the hospital were a “normal occurrence” and that “doctors are always leaving because their contract has expired.”

Because of its reliance on expatriates staff, particularly from India, the Maldives is also competing with the burgeoning Indian medical sector to attract staff.

“Even in Indian government hospitals, which have to compete with the private sector, a medical officer in Delhi undergoing training would get 52,000 Indian rupees, around 16,000 -17,000 Rf,” Shiham said.

Moreover, Male in particular was proving an unattractive destination for foreign staff because of high living costs and the need to leave families behind. The lack of facilities was also professionally unsatisfying, a particular issue for attracting senior staff, he explained.

“Here [at IGMH] I am only able to do 30-40 per cent of what I am trained to do because of a lack of facilities – out on an island, maybe five percent. Even equipment for kidney biopsies or needle for taking bone marrow samples. Doctors’ skills are underutilised and referrals overseas are common practice.”

Impact

The loss of medical staff is placing pressure on those who remain and affecting the amount of time doctors have to see patients, Shiham said.

The rule is we see four patients an hour, 15 minutes for each,” he said. “If we start seeing a patient every 5-6 minutes, then the patient is not being seen properly, even if he might be happy he’s seen a doctor. The level of documentation will also go down, and that will later attract a lot of litigation. The patient loses, the doctor loses and the system loses.”

Appointments were starting to being made through contacts, a situation Shiham describes as “embarrassing.” The pressure to thin the growing queues of patients was also leading to staff being recalled from other critical roles.

“I cannot stomach it when a medical officer is pulled off ICU (intensive care) to see a few more flu patients just because people are starting to shout outside. We don’t have a doctor on duty 24/7 in our critical care unit,” he said.