May 2011
1 post
Life without bone marrow transplant.
When successful, bone marrow transplant can bring an end to the constant need for blood transfusions and over time, reduce the need for iron chelation therapy. Sadly, bone marrow transplant is not a viable option for many. And for many others [including some known to me personally] it not an option they would even consider.
My mentor, from whom I learnt much about the Thalassaemias, would often...
February 2011
1 post
“If you have a child with Autism please call 7529901 (Zila) and book an...”
– Autism Society of Maldives
November 2010
1 post
Gone Tumblr!
I have migrated by blog to Tumblr after having it managed on GoDaddy’s QuickBlogCast for several years.
The site had been in lock down for a while now but it should be up and running with the same URL from today.
Along with the blog, I am also relaunching the Q&A box, again Tumblr based.
May 2010
1 post
5 tags
Outbreak Alert: Diarrhoeal Disease
Several children (and according to my adult physician colleagues; adults as well) have been seeking medical care for a severe diarrhoeal disease over the past many days. Among the children, several have required hospital admission for management of dehydration associated with the often very watery and high purge rate loose stools associated with this diarrhoeal disease. I have talked to a few of...
March 2010
1 post
4 tags
Outbreak Alert: Hand Foot & Mouth Disease
In the past couple of weeks my colleagues and I have been seeing increased number of cases of Hand Foot and Mouth Disease (HFMD) in Maldives. HFMD is a moderately contagious disease that can easily cause epidemics among infants and young children and from the number of cases my colleagues and I have been seeing, we maybe nearing one now. Here I will quote some general information Q & A about...
February 2010
1 post
H1 N1 Vaccine Information
Here is an information sheet published by CDC on H1N1 vaccine. It is in PDF form.http://bit.ly/3QmCcd
November 2009
1 post
2 tags
Dengue: Follow-up
I have had a long chat with a Minivan News journalist a short while ago. She is planning to write an article about the concerns that I have raised. Finally, some responsible journalism; or did I speak too soon. Anyway, I hope the messages that need to get through does. We have had some very sick Dengue Fever cases in last few weeks. We have had some very close calls in that time. The number of...
October 2009
2 posts
3 tags
We are in to Dengue Season 2009 and the signs of...
Like clock-work, whether the people monitoring such events take notice or not, we have been, year after year, exposed to September-November Dengue peaks for the past many years.
The exact data is held elsewhere and not readily available to the public. Perhaps the numbers this year have not reached that critical level for the monitoring system to ring out alarms. What I am stating is a clear...
4 tags
WHO: Guiding Principles on Complementary Feeding...
Weaning foods (more appropriately called Complementary Feeding) has been the topic on which I have received most questions in recent months (and perhaps always). I would therefore like to share with readers this document that is most useful to understand the basic principles that one must consider in starting and continuing complementary foods.
It is a WHO document: in PDF format. Guiding...
September 2009
1 post
5 tags
Eliminating measles by 2020?
I was one of the members of the Maldivian team that attended the WHO SEAR (South East Asia Region) consultation meeting in New Delhi to discuss whether the region could agree to set a Measles elimination target. Sitting in the same conference hall with highest authorities and experts on Measles from around the world was a huge learning experience for myself. I am sure it was the same for many of...
August 2009
2 posts
2 tags
Corporatisation
Times are uncertain. But the outcome of leaving the biggest state-run hospital in its current state is just about anybody’s guess.
Those who now hold the responsibility of running IGMH seem to be all too happy to let someone else shoulder the burden. Attempting to revive the ailing institution, one could deduce from their eagerness to sell, would, to them, amount to political suicide. To...
3 tags
Proposing changes to the On-Call duty at IGMH.
The current situation:
All clinical and allied departments at IGMH have at least one person on an On-Call duty at all times. The current role of this person is to attend to hospital if called for urgent work that needs his or her expertise. As a Pediatrician, I would therefore be called in - on my On-Call day - to attend to emergencies or urgent situations that the in-house Pediatric Medical...
July 2009
1 post
2 tags
First case of Swine Flu in Maldives
Haveeru Online reports that the Indonesian who was recently screened for Swine Flu has now been confirmed as a case of H1N1. This is the first confirmed case of Swine Flu in the Maldives, although the patient is not a Maldivian. The story so far, one that is very poorly covered by the media in terms of specifics, raise several concerns. I just hope that the authorities would be less secretive and...
March 2009
1 post
Accepting the strike but not the method?
Lessons not learned?
Maldives has seen 4 major industrial strikes in recent years. The Taxi drivers strike, teachers strike, the tourism workers strike and now a “strike” by doctors at IGMH. All four have, in my personal opinion, not gone down well with the majority of the public. At the very least, that is the impression one gets from the publics’ response. The fact that the...
February 2009
2 posts
Running into the Maldivian Health Minister at a...
Yesterday was a half day at work for us, WHO Fellows at AIIMS, and we took the opportunity of an afternoon off to go to Delhi’s favourite hangout: Select City Mall at Sarket. It is a nice place with a young Delhi crowd hanging around and having fun. After checking out the few electronic shops (my favourite part of any Mall) I ended up at the food court.
I was just near the end of my...
Why I believe the new appointment system at IGMH...
This is my personal opinion and it is independent of any official IGMH position. And for the record: the system has since changed back to the old system.
I read a news article on Haveeru Online. It presented an interview with an official from IGMH regarding a change to the OPD appointment system starting from 1st February 2009. The change, apparently made after discussions with relevant...
November 2008
4 posts
Bronchiolitis
What is bronchiolitis?
This is a viral illness of the respiratory tract that usually afflicts children of less than 2 years of age. It is characterized by an increased effort of breathing and wheezing following an uppers respiratory tract infection.
What are the symptoms and signs of Bronchiolitis?
Affected children would have a prodromal illness with runny nose and cough for a few days. The...
Diarrhea Again!
I have observed a sudden increase in the number of children presenting with an acute Diarrheal disease over the past couple of weeks. I am also aware of an increase in the number of children with Diarrhea requiring hospitalized care during the same period. It may be too early to say if this is the beginning of another Diarrheal epidemic in Male’, however, I would like to take this...
Children visiting the sick at the hospitals
During the visiting hours at IGMH, we see several kids going in and coming out of hospital wards, visiting members of their family and friends who are admitted for treatment. Their numbers are not small. I presume, based on personal observations that the numbers are high enough to be very concerned about potential pubic health implications of the practice.
Hospitals harbor a multitude of...
Another emerging Enteroviral illness in Male?
Since returning to work last Thursday, I have seen a few kids with what appears to be an Enteroviral illness. Enteroviral infections have the potential to cause epidemics. Epidemiological surveillance is therefore important in keeping tract of further cases to see if this illness could lead to an outbreak. I have reported the cases that I have seen for the benefit of surveillance and I urge...
September 2008
3 posts
Milk Scare
The news of young infants dying as a result of illnesses cause by consumption of Melamine tainted-milk in China has been making the international news headlines for the past week or so. Two infants have reportedly died so far and reports suggest that more that 13000 infants in China, have been affected. The true extent and implications of this crisis may not be clear for many months to come....
Blood culture tests temporarily discontinued at...
Both IGMH laboratory and ADK laboratory has had to stop doing blood culture tests for out-patients for the past one week! Three of my own patients, for whom I had requested Blood Culture tests (among other tests) were refused service at both the laboratories during the past 3 days. Blood Culture is an essential investigation in the work-up of patients suspected of having infectious diseases of...
Antibiotics out of stock in Male'!
Pharmacies around Male’ have run out of three commonly used injectible antibiotics! Ampiclox (a combination of Ampicillin and Cloxacillin) has not been available for a few days and today caretakers are struggling to find both Augmentin and Cefuroxime for their loved ones at pharmacies in Male’. This is not the first time this has happened. This time around, however, the number of...
August 2008
1 post
Another Health Insurance Scheme to be launched...
It is probably a bit too early to start celebrating the proposed launching of another health insurance scheme in the Maldives. The last time this happened, the scheme did not survive long enough. Nevertheless, in these times of desperation, as the proverbial saying goes, we are indeed willing to make an effort to clutch at even a straw.
Some information on the new NSPA (National Social...
July 2008
3 posts
World Breastfeeding Week 2008: Mother Support -...
The first week of August every year is celebrated the world over as WABA (World Alliance for Breastfeeding Action) World Breastfeeding Week. This years theme is Mother Support - Going for the Gold! Activities are planned in Male’ and some of the islands. In Male’ IGMH andDPH are organizing a mothers’ group forum for the 6th of August to be held at IGMH. Hulhumale’...
Diarrheal Disease, Respiratory Tract Infection and...
Diarrheal Disease: As predicted, my colleagues and I have noticed a significant increase in number of kids being brought for treatment of diarrheal diseases in the past few weeks. While the majority of them have been demonstrated to be of viral origin by stool tests, some of them have been found to be of bacterial aetiology. Both forms of diarrhea are spread via contaminated food and drinks....
House fly invasion 2008: is a diarrhoeal epidemic...
Last year, around June, I issued a public health warning on a house fly invasion in Male’ via this blog. That time, as was expected, a surge in diarrhoeal disease incidence was noted. Several children were affected by the illness with many requiring hospital care for severe disease. Food and drinking water contamination was thought to be the mechanism of spread. Thanks to a visiting Thai...
May 2008
4 posts
Time for Department of Public Health to act!
I am sure that those responsible for monitoring emerging epidemics in the country must have realized by now that there is a significant increase in the number of cases of Dengue and Viral Fever in the past few months. The biggest hospital in Male’ is overflowing with admission, with some families making decisions to have their loved ones flown to neighboring Srilanka for admission rather...
A number of viral illnesses reaching concerning...
Several viral infectious diseases are currently causing minor epidemics in Male’ and possibly in nearby islands. The illnesses that have recently increased in number include;
Dengue Fever and Dengue Hemorrhagic Fever
A non-specific Viral Fever
A non-specific Flu-like illness
Sporadic cases of Measles
Sporadic cases of Mumps
Sporadic cases of Chicken pox
These illness predominantly...
Maldivian doctors refusing to work in the islands?
Today I heard some of my colleagues talk about the recent criticism and accusations made against Maldivian doctors that they refuse to work in the field in the islands. I believe it is only fair to put these accusations and criticism in proper perspective. As per an agreement, signed by most Maldivian medical students at the time we receive scholarships for medical studies abroad, we are required...
Hulhumale' Hospital launches a Mothers' Group to...
Today, Hulhumale’ Hospital has officially launched a Mothers’ Group to support and promote breastfeeding. This is, to my knowledge, the first of its kind in the country. As a Breastfeeding Counseling and Lactation Management Trainer I was delighted to be a part of this effort from the administration and management of Hulhumale’ Hospital. I am just returning from the inaugural...
April 2008
3 posts
Interactive guide to childhood development
These are links to interactive guides to early childhood development that could be used to assess and identify developmental disabilities in children. I find this tool especially useful because of the lack of technical jargon and its easy usability by non-medical people. Milestones Select the age of the child and click “go”. The new page gives milestones that are appropriate for the...
Mosquitoes everywhere.
This is probably the topic that I have written most often about in recent times. Yet again, I am compelled to write about mosquitoes and their potential to cause ill health in this country. After the recent rainfall, as expected, there is a definite increase in the number of mosquitoes buzzing around and biting us to spread illnesses such as Dengue Fever. This is a huge concern for health care...
Birth trauma: Collar bone fracture
A very brief and short summary available on niyaf.com Click here.
March 2008
2 posts
Toxoplasmosis: general information
Some of my friends and patients relatives have asked me to write some general information on Toxoplasmosis. Some people close to myself have recently had to go through difficult times because of this illness.
What is Toxoplasmosis? Toxoplasmosis is an infection caused by a bug called Toxoplasma Gondi. It can cause severe illness and blindness in those who have poor immunity and adversely...
My position on the Elken dispute.
I have on previous occasions answered questions on Elken products from patients and close friends. I am happy and extremely proud of the two Maldivian NGOs, Maldivian Medical Association and Diabetes and Cancer Society of Maldives, for taking a stand and making their positions very clear on the medicinal use of Elken products in the Maldives. As a clinician I have been witness to patients who have...
February 2008
5 posts
Donate blood, please.
A new drive to get voluntary blood donors to come forward and donate blood was launched recently in Male’. This new campaign has been launched to coincide with the establishment of a new central blood bank in the country. A large number of Maldivian children and adolescents require blood transfusions every months for managing beta Thalassaemia major; a blood disorder that requires life long,...
Hand Foot and Mouth Disease on the rise!
My colleagues and I have in recent weeks seen a significant number of cases of Hand Foot and Mouth Disease in Male’. Viral illnesses like HFMD easily spread and have the potential to cause epidemics. I will therefore present some general information which could help people understand the disease better and take preventive measures. What is Hand Foot and Mouth Disease? It is a viral illness...
FAQ: Hib vaccine for children
Among the common childhood vaccines that are recommended, Hib vaccine is one that is not currently covered by the Maldivian national vaccination program. I have written about this vaccine before in response to a question. However, I have recently received more questions about Hib that I decided to write a full post on it. What is Hib vaccine and what does it protect against? Hib is the short form...
Health messages and clinic ads on TVM
I have been watching a bit of TVM lately. I was pleasantly surprised over a few “health awareness clips” that I saw on the telly and would like to applaud TVMfor the efforts. There was one clip that shows Dr Ismail Shafeeu, a fellow Paediatrician talking about rational treatment of common cold in children. I think the message was very clear. Most common cold need no treatment. They are...
Dengue fever: the struggle continues
The fact that we eradicated Malaria from the Maldives a few decades ago gives us an indication of what we are capable of achieving should we really put our best foot forward and give a 100% to achieve something. One would expect, and the vector control program workers claim, that with the necessary commitment and community support, we should be able to achieve similar results in the fight...
January 2008
3 posts
Q and A: Ferritin and Desferal in Thalassemia
Your Questions:
What is, in your opinion, a safe Ferritin level for a patient with beta Thalassemia major and what is the best way to inject Desferal?
My Answers:
Safe Ferritin levels:
Ferritin levels are the most commonly measured body iron storage measurements. While it may not be the most ideal measure of iron level in the body, it has continued to be a very useful tool because of the...
Chickenpox cases on the rise!
After a much needed and lengthy leave, I returned to work at IGMH today to find an increased number of children being brought to the Paediatric clinics with chickenpox. I have myself seen 5 cases of chickenpox within the past 24 hours both at the hospital and privately. With schools scheduled to open on the 13th of this month, affected children are almost certainly going to miss the start of...
Q & A: Breast milk drops for the eye!
When babies scratch their eyes or when the eyes go red , it has been a practice in the Maldives to put breast milk in the eyes of the baby. So, I was wondering whether this practice is right? What makes it right? Does breast milk really reduce the itching and if so why is it?
That is a common practice in many parts of the world. What is common practice, however, does not necessarily make it a...
November 2007
2 posts
Jaundice in the newborn baby
General information, facts and myths! What is Jaundice? Jaundice is the appearance of yellowish discolouration on the hands, feet, eyes and other body surfaces because of accumulation of the yellow pigment bilirubin. The degree of yellowness depends on the amount of bilirubin that has been accumulated. Why do newborn babies become jaundiced? There are many reasons why a baby may become...
Drug Abuse of a different kind
I have spoken on this issue a few times with my professional friends and colleagues. It is something that causes concern to me and some of my colleagues. The issue is Drug Abuse! Not the type that we most commonly hear about. This is different but nonetheless deeply worrying and potentially dangerous and in extreme cases potentially life threatening. I am referring to abuse of non-narcotic...
October 2007
2 posts
Constipation in children
Constipation is the passage of stools with a frequency much less than usual or passage of hard and difficult to pass stools. Different children may have different “normal” frequency of passing stools and may range from soft stools passed every 3-5 days to passage of soft formed stools a couple of times a day. Is constipation an illness? Constipation is not an illness per-se. It is rather a...
Breath holding spells in children
What is a Breath holding spell? A breath holding spell is a frightening experience for parents and on-lookers. During the episode the child becomes still, as if lifeless, with no breathing or movement. Traditionally breath holding spells have been divided into 2 main groups. One which is associated with cyanosis (bluish discolouration of the lips, tongue, face…..or even the whole body)....
January 2007
1 post
Testing times again!!
To say that we are going through a rough patch would be an under statement. There was no smooth patch before…..and there is no sight of any of it in the near future either. It seems that in recent months all we did was manage one crisis after another. One major illness on top of another has increased our patient population to an extent that is clearly well beyond the current capacity of...
November 2006
1 post
Chikungunya: another mosquito borne illness
It may not be here yet but Chikungunya, another Mosquito borne illness, is knocking our doors. With our recent track record in controlling mosquito borne illnesses, we are likely to struggle a lot more if this illness makes its way to Maldives. We have now conceded that Dengue is probably endemic to the Maldives. Cases keep trickling in daily to Hospitals across the country. The cases have never...