This is not fear mongering! I am just disappointed, with the way the media is reporting this story. The media, as always acts as a mouth piece which simply relays the information dished out by the authorities. There is hardly any analysis. I just hope it changes, as soon.

The story so far has me wondering about many things:

I believe we have had Influenza spreading among Maldivians for quite sometime now. I do not mean Swine Flu, please don't confuse all Flu to be Swine Flu. I suspect the reason why we have not previously detected Influenza A in Maldives is because we have only been screening a minority; only those with symptoms who had recently traveled. Patients who are diagnosed as Flu Like Illness who have not traveled (or have had direct contact with travelers) have not been screened. The screening kits have, I have been explicitly told, reserved for cases identified for screening by Port Health, not by Clinicians in the Hospitals. Had the screening net been wider, we could have found Influenza A much earlier; but perhaps used up all our screening test kids in the process.

We do have a National Pandemic Preparedness Plan that is to be used in handling this very kind of situation. If a case is suspected, then the case and its close contacts must be segregated to prevent further spread of infection. This is important because, should the suspected case become confirmed, both the case and contacts could be responsible for further dissemination of the infection if left in the community.

For lack of information, I wonder if this was the way we acted. It sure would be very satisfying to know that it indeed was.

I wonder how the case was indeed transfered! Was it by flight? If it was by flight; were there other common passengers on the same flight? If there were; were they informed that their fellow passenger was a suspected Influenza A case? And, if there were other passengers; how are they being managed after sharing the same atmosphere for the duration of the flight?

They are contacts, aren't they?

If indeed the worst of our fears is true; about the contacts that is, the other fear is already realized, then does the handling raise legal issues about endangerment of lives?

There are so many unanswered question that without actually knowing about the way the case was actually handled we wouldn't be able to take the story in further. I just hope the media would play its role in making the information available and making the situation clear. The media could ensure that the authorities do their jobs effectively in protecting the health of the nation.

I wonder why clinicians in Maldives are still not adequately sensitized about the National Pandemic Preparedness Plan and their role in the entire process. I recall being called to just one meeting; I attended too. I quite clearly remember requesting the chair of the meeting to educate the clinicians as to what the plan was all about and to identify what the role of each of us was. That, to my knowledge, has not happened so far. And here we are talking about the arrival of Swine Flu to our shores.

Having a plan is of no use if the people who are to execute it are not made aware of the plan itself and the role each has to play! 

I just hope this post creates some awareness among journalists in Maldives to ask the necessary questions.

We are hoping to be able to certify the participants as counselors before commencement of activities for this years World Breastfeeding Week - 1st to 7th August. The week is marked every year to re-focus attention on the importance of protecting, promoting and safeguarding breastfeeding. The challenges are many and the way forward is to educate more and more people; especially women of child-bearing age into the benefits of breastfeeding. I hope this year we would, in addition hold discussions with school children too. More on the activities for the week coming later.

I have had the opportunity to travel to Noonu Atoll in June and Shaviyani Atoll in July to conduct WHO training on Essential Newborn Care for healthcare service providers working in the two atolls. The two programs went very well. I am, in particular happy that we have been able to train more trainers during these programs.

This is another long term project that I have had the satisfaction of working on. There is still a lot of work to be done, but we are slowly getting the protocols completed one by one.

Please visit my Facebook and Twitter to see what I have recently written about. I have also spent a bit of time learning about digital photography and am developing a keen interest in photography. Please visit my main page at niyaf.com for an aggregation of all my online content.

It is my understanding and belief, that calling for and going on strike is not the problem. It is the method of the strike and the way the strikers and the media "sell" the cause and effect of the strike. Most strikes that disrupt services, no matter how small the impact, would face resistance and hence has the potential to be disliked by the public. Perhaps, this was one of the reasons for the apparent poor acceptance of the doctors Sick-Leave-Strike!

I wrote earlier, at another forum, on how I'd prefer to "strike", at least during the initial phase. Industrial action is within our rights too. I think in Maldives, at this stage of realization of our rights, we'd do better, in terms of results, with a more visual strike than industrial action. That is my opinion. I had discussed using the "lunch break" for demonstrating. It shouldn't halt services at IGMH because people taking part would be on their official break! The striking staff could stand along the sea wall just to the west of IGMH with banners and posters. These could display reasons for demonstrating and their demands. Perhaps slogans could be used too. Media could be invited to cover the daily Lunch-Break Strikes. The protest for the day must be wrapped-up before the lunch break ends to allow staff to return to work. A form of visual demonstration could be continued beyond the lunch-break using arm bands or badges. If these strike fail to achieve results or at least a constructive dialog then further steps could be considered. Then, for the greater good of the profession and ultimately that of the health of the people too, an industrial action would be necessary.

The medical service providers, including those of us at IGMH, have had unnecessary and unacceptable stress and inconveniences added to the frustrations of a grossly inadequate and under-resourced medical care provision system for years and years. Any time something good happens and the expectations and hopes for a better health care system gives us hope for the future, someone comes along to kill those dreams. The frustrations build and finally the last straw breaks the camels back!

I can understand, one may say because I am an "insider", why the doctors at IGMH went on the Sick-Leave-Strike. There are several reasons for a strike or a show of disapproval and displeasure. Salary is an issue, an important one too, but it is certainly not the sole one, as some politicians and Commissions would like the public to believe. That was just bad politics adding insult to injury.

Pay is an issue because, in addition to our work being one which is in itself  humanitarian, it is work and a means of earning a living too. There will be people who disagree with me, and that is perfectly fine with me, but it is not wrong to ask for a pay increment when your official work hour has increased by 2 hours per day too! Fine, we are faced with financial and fiscal challenges and one may need to revise pay scales to suit the financial capacity of the government. But then, why would the authorities call the changes to pay; a "pay increment"? Just for the technical truth in it? How is it that they then justify  the political elite being allowed to continue to draw salaries that truly burden the national budget even during this same financial hardship? How dare the MPs attempt to discredit us on national TV when they have voted for themselves a pay rise? Then again, is there any reason why we should expect anything less from them?

A doctors work should be professional, capable, caring and humane. Drawing a salary or getting paid for providing a service does not make it any less humane! I'd be happy if doctors participate in Free-Medical care. Many of us do that too in our own capacity. Go on, make health care free for the people. We'd be happy too. It is disgusting and hurting to think that people look at us as money hungry and inhumane. That is so far from the truth. 

Perhaps ensuring alternative striking methods wouldn't have caused these false accusations. Again, I wonder if it is fair to expect anything different from those opportunistic politicians either way. Nonetheless, industrial action that results in service disruptions could have allowed for bad politics taking advantage of the situation.

Just for the record, I have been told, that my take-home pay has not decreased during this pay scale revision. It is exactly the same Rufiyaa for Rufiyaa as it was before. All my allowances were canceled, according to my employers, but my basic salary was increased to adjust for that. So despite the significant increase in official work hours (lets not even talk about the actual time some of us spend at the hospital) we would have to be content that our salary is not going to be reduced. To think that it could have been worse, I am just about content.

Unfortunately though, I am told, some of my colleagues didn't fare as well. They will actually be taking home a significantly less salary than earlier. Some of them having to be "thankful" for a reduction of only a few thousand! That too when the purchasing power of the Rufiyaa is falling due to various reasons. It would put a different perspective to the situation if one accepts that the changes in economic condition would affect everyone, doctors included, and not just the government.

I'd like to add here that it is not only doctors or nurses who are affected by these pay changes. There are probably others in other fields of work too. My thoughts are with them as well. It is not fair for them either. I'd encourage them to make their voices heard too.

During the recent presidential election campaign, while campaigning for DRP, we heard the then Health minister, Ilyas Ibrahim, say that it was a failure of the administration at IGMH that was the primary cause for the institutions failures. Many of us had literally gone blue in the face saying the same thing, repeatedly, to the authorities without them heeding a word of it. The only action they were ready to take was to try to silence the very people who tried to convey the truth. 

Members of the current ruling party, MDP, both before and after the election continue to say that the administration at IGMH is a failure. Is it then not surprising that the very elements that they have so openly labeled as utter failures are now either in the same posts (may I mention with a better pay) or at similar or higher posts within the ministry. All that, when the public continue to suffer the inadequacies and failures of the health system and its institutions. 

We anxiously wait to see what the 3 month deadline for an A-Z change at IGMH would actually bring about! I wonder too, what is the rationale for allowing the decay to continue for another 3 months while we wait for that all-fixing change?

Truth be told, the attitude and lack of professionalism among the service providers including doctors has not helped either. There is no smoke without fire and there must be reasons why the public mistrust health care workers! We hear again and again of few doctors speaking rudely to patients, doctors who fail to see patients under their care (even when patient is in ICU), doctors failing to provide reasonable explanations and information to their patients, etc. These are some of the reasons for the mistrust but there will be many other that one could list, should one attempt to make an all inclusive record. Having said that, it is also true that there are several doctors who are truly professional, caring and capable in their work. The few bad apples certainly are spoiling the whole basket. It would take much effort to bring out the kind, caring and professional face of this profession to the forefront. That is a challenge we must meet. 

But meeting that challenge is increasingly being made impossible both by the actions of the politicians and Commissions who continue to attempt to undermine the profession and the health sector as a whole. Inciting the public, to further mistrust the service providers, on state media is likely to make the gaps even wider. Their short-sightedness may make them popular for a while, but it threatens to suffocate the health sector even further. Why would they care? They could easily afford, especially with the benefit of their healthier pay, to travel abroad for medical care. We suffer. Our patients suffer!

It is no secret that quality medical services require certain infrastructure, including human infrastructure. Medical equipment at IGMH and many other health institutions are at best; basic and historically poorly maintained. Once in a while the media highlights non-functioning of certain essential equipment and brings it to the publics notice. CT scans, ultrasound scan machines, Xray machines  and ECHO machines: out of order, blood culture services discontinued for months and ventilators waiting for spares happens far too frequently. The lack of back-up systems has on several occasions compromised the institutions ability to provide even essential care! Quality of care is an even bigger challenge in this situation. The brunt of all this is usually borne by the clinical workers. Add to that the lack of several important drugs despite repeated requests at various forums. Even with those that are supposed to be available, supply is a major concern. We have had instances when Male' ran out of Paracetamol, Augmentin, Penicillin and ceftazidime, just to name a few!

Personnel development and training opportunities has over the years been on the decline. Seats for MBBS and specialization supported by government funds (or donor aid) has decreased. Cheaper opportunities are invariably preferred over quality. It is an expensive field, we accept. A bit of investment to quality is nonetheless essential. Private funding has tried to fill that gap in past few years. Thankfully such arrangements have helped and we are very thankful to the parties who have sponsored many of us. It is not only about training doctors though. Providing health care requires a team: doctors, nurses, lab technicians and several others. Training opportunities for the support services too, is far from adequate. For instance, medical equipment need maintenance to keep them in proper working order. The lack of appropriately trained Biotechnicians at IGMH is one reason for the poor maintenance of vital medical equipment. Add to that the lack of support and spare parts and the system could literally grind to a halt.

So there are reasons for unhappiness. That list isn't an all inclusive list either. Perhaps some of us should sit together and make that all inclusive list soon.

I'd like to hope that there will be no need for a next time. It is not something we'd hope to see in a democracy that functions along the lines of fairness, equity and transparency. We are happier working than staying away from it. Whether one believes or not, we take great pride in the work we do, at the same time being humble in accepting our human limitations. 

Strikes don't always work. They sometimes make things even worse than they were before. Perhaps, if forced with the necessity,  a re-think of the method, a more thought-out, better planned and less disruptive strike could be more effective and acceptable with the public. Or would any strike be acceptable? Ever? Certainly not for the party in power. The public, though, maybe more receptive if they could be engaged and better informed.

Here is wishing that there'd be no need for any of it.

I was just near the end of my Shredded Lamb Sizzler when out of the corner of my eyes I noticed, to my surprise, familiar faces at the table just next to mine. There sitting and having Kebab were Minister Aminath Jameel and her team from the health ministry of Maldives. A small world, huh? I went over, and over pleasantries found out that they were in Delhi to meet the Indian health minister. I impulsively asked Dr Yasir, a member of that team, if it was regarding IGMH. What I gathered from the conversation was that IGMH-foreign-management wasn't a done deal yet and that their visit was related to a number of issues. 

It was good to hear that they were trying to improve the health sector in the Maldives. They were trying to do what they believed was the right thing to do. I do not agree that giving IGMH to foreign management is the only solution though. But right now, I'd be willing to consider that option as an alternative to the utter mismanagement at IGMH! It is too painful to see our people suffering the effects of an inadequate and grossly mismanaged health care institutions. Certainly, a well performing health institution is far better than one that doesn't. It hurts to think that by bringing in a foreign management we are proclaiming our incapacity to manage such institutions ourselves. I would like to think that we do have people who could truly manage an institution of this size and importance among our own people! Then again; the handful of individuals who, over the years, were given the opportunity and responsibility of managing IGMH did not do anything worth much praise. Perhaps, one would argue, there are others who are more capable.

One way or the other, IGMH, and possibly other health institutions in Maldives, must change to meet the medical care needs of our people. Years of neglect and failure must now be addressed. It most certainly won't be easy. Difficult decisions may need to me made. I, as a practicing clinician and a Maldivian citizen hope that the changes happen quickly and more importantly deliver results that meet our peoples needs.