Text posted on 7.31.08
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’ Hospital is planning to hold information sharing activities with mothers with the help of their Mothers’ Support group which was inaugurated earlier this year. Hulhumale’ Hospital is likely to be accredited as a Baby Friendly Hospital some time this year. Activities are also reportedly being planned in those islands with regional hospitals. I will be traveling to Raa Atoll to conduct Breastfeeding Counseling andEssential Newborn Care training after taking part in the activities at IGMH (and hopefully Hulhumale’).
This would have been an opportune time in beginning implementing theMaldives Food and Drug Authority (MFADA) Code on Breast Milk Substitutes. However, a TV announcement is reporting that businesses are being given (an extension to previously announced conformity deadline) until the end of August 2008.
With the new changes at the work place and a continued lack of adequateMaternity Leave in the new Labour Law, protecting, promoting and supporting breastfeeding remains a huge challenge. Many mothers’ are likely to face hurdles in sustaining exclusive breastfeeding for the first 6 months a challenge until and unless legislations protect this basic right of a mother and child. Some improvements are nonetheless noted; with mothers allowed two opportunities to leave work place to nurse their feeding infants. This, I believe is not enough. More changes are needed. Making work places, not just Hospitals, Baby Friendly could be part of the solution. We, in the Maldives, are a long way away from such work place changes.
Exclusive breastfeeding for the first 6 months of life and continued breastfeeding (along with appropriate complementary food) until 2 years and beyond remains the best practice advice for feeding young infants. Infant and young child malnutrition continues to be a major public health problem in the Maldives (as reported by a UNICEF report last year). One practice that would reduce the incidence and magnitude of this problem would be to protect, promote and support breastfeeding. Ensuring a good beginning and assisting parents with appropriate transitioning could, potentially, address infant and young child malnutrition in the Maldives.
Here are a few links to some internet resources on breastfeeding:
Text posted on 7.21.08
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. Improved personal and food hygiene at all times, especially at times like these are an important public health measure to prevent epidemics. Rehydration using ORS and other rehydrating oral fluids is the recommended early home management in affected kids.
Respiratory Tract Infections:
A flu-like illness is being seen in increasing number among children of all ages. Most affected kids have severe cough, runny nose and sometimes fever. A significant proportion of them have altered voice and sore throats. A few of them have been noted to have oral ulcers much like those of Hand Foot and Mouth Disease.
Most affected kids recover with symptomatic treatment while a few, but a significant number, have required hospital care for Lower Respiratory Tract Infections. It is my opinion, based on the investigation reports from cases that I have thus far managed, that the illness is of viral aetiology (possibly an enterovirus being the agent). The few cases that have required more intensive treatment are those that had secondary bacterial infections and the very small infants affected by the viral illness.
Early care seeking behavior, improved hygiene and keeping sick kids away from school until they are well are measures that could help control the illness.
An epidemiological surveillance program is expected to be launched soon to help identify the aetiology.
Dengue Fever:
With the rainy season upon us, we are witnessing a surge in the number of Dengue cases once again. This is likely to increase over the next few weeks to months unless mosquito control measures are initiated on time. Clearing mosquito breeding areas is perhaps one of the single most important measure that could help this endemic disease from once again reaching epidemic proportions.
Responses & Discussions:
Sheela wrote:
I can’t even remember the last time I took my kids out, and feel comfortable that there are no flu or viral fevers going around. I guess it is always comes down to teh basic..”THE PUBLIC” itself, it is just heartbreaking to see that every child I know of every age is down with a cold, cough or fever! As identified by you, public is very unaware of these issues.It was just awhile ago that a friend of mine received a call from her son’s teacher asking why he has not been in school. The teacher was told that the son was down with viral fever. The teacher (asuuming to be friendly) requests that the son be sent to school if at all he could because he was due to participate ina competition. Regardless of thinking how unsafe this child may be to himself and teh other kids at school as well.I don’t understand who’s to be responsible for such ignorance! Then again on what basis can we judge individuals if they are unaware of the seriousness of a situation.
I am not in any position to be of much influence as this is not my area. Ofcourse it always comes down to the fact that everything needs to be done in policy maker or admin level. But I admire your work alot,absoutely commendable. I can see alot of people look up to you and many other harworking peadiatricians..I guess everyone is trying to do the best with what they have got..Trying to make teh best out of teh worst situation.
When I was reading yaz’s comment and your response to it, so many things were going through my mind, what quality control? what standards of medications are we subjecting our children to?? ..best practice? standards? For someone like me..this is just mind boggling scary! I have never given much thought to these issues before.
Just wish someone like youirself, would step in.My point is that, we secretly expect someone to mobilise the community to start taking serious action and demanding the care our kids deserve. Some of us are not in any position to start up something, so that we ae heard. But I am positive many of us are a hundred percent on backing up any such propositions.I suppose some other issues are more loudly spoken about in our community these days.
Seems to em that every person has a story tell about how their kid was subjescted to ill treatments in IGMH or by certain doctors.Hearing about fatal incidences related to these endemincs makes me think that tomorrow it might just be my child or someomne I dearly love. Can’t you do anything about it? Possibly silly of me to even ask. But all the readers on this site surely has a lot of faith in you. Can’t we use your blog to form up a body and make sure we are heard?May be too much to ask! But I am simply a very scared parent. (Other reader invited to comment on this post)I am just frankly putting down my thoughts. Thank you so much for doing what you do..Dr. Niyaf.As one of the commentors said My dhu’aa will always be with you and your family for your wellbeing and so forth.
Text posted on 7.13.08
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 research team, the organism responsible for the illness was identified as Rota virus following tests on several patients.
This year, we are again experiencing a house fly invasion. We are perhaps experiencing the early days of the invasion. Unless steps are taken to control this vector, we may have to face another diarrhoeal disease epidemic in Male’.
Food hygiene and clean drinking water are of paramount importance in preventing diarrhoeal diseases from spreading. The many open air restaurants around Male’ would need to work hard to control the fly population in and around their premises. Food handling safety must be ensured at all times but particularly during these times.
I recently sat with a couple of doctors in the Executive section of the canteen at IGMH to discuss a few clinical issues. I do not eat food from the canteen for health concerns and the sight in and around the canteen convinced me that I was right to be concerned. The place was full of house flies. They were everywhere. I assume, not necessarily from having witnessed any evidence of it, that the operators of the canteen must be doing something to control the vector; but clearly they were on the losing side. So would the many hundreds of people eating at the canteen. Just imagine what impact the newly opened “open air ” section would have on food contamination by the flies!
General cleanliness at the household level and at the community level would be required to control the fly population before it causes an inevitable public health crisis. The public on their own and the government authorities too must take necessary steps as soon as possible.
In particular, I would like to urge the general public to take extra precautions in ensuring that drinking water is clean, safe and non-contaminated. Boiling drinking water could be something that could be done at the household level to ensure the safety of drinking water. Perhaps the public water supply company could take public steps to alleviate our concerns too.
Food handling both at home and at public food outlets must be made safer and cleaner. Keeping food protected from flies and other vectors would be of particular benefit during the fly season.
Last, but definitely not the least, improved personal hygiene with particular attention to hand hygiene before handling food or drinks would go a long way in preventing diarrhoeal diseases.
Take care.
Text posted on 5.17.08
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 than wait in the Emergency Room for days.
Yet, I fail to see, or hear of, a public health campaign to help control the spread of the illnesses. I accept that there isn’t a lot that can be done to control the spread of Viral fever, but for Dengue Fever a revival of the vector control program could see much benefit.
Last year, with the general public in Male’ and the different islands running the campaign themselves, clearing mosquito breeding spaces, we saw an expected Dengue epidemic averted. This year need not be different. However, we always see concerned people waiting for fatalities to make headlines before taking any action. The cost of inaction has always been greatest on the most vulnerable of our population, our kids. More than any other segment of our population, children have fallen victim to these sometimes, but unpredictably, deadly disease.
I take this opportunity to call on the concerned authorities at the Health Ministry and the Department of Public Health to revive the vector control program and other public health measures to prevent a disaster. Please, politics aside, increase the capacity of our premier health institution in managing these kinds of surges and epidemics of illnesses.
I also urge the concerned general public to pressure the authorities to take.
Text posted on 5.15.08
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 affect children.
At a time like this it is important to take necessary preventive measures to help control the spread of the illnesses.
- Mosquito control measures and mosquito bite prevention measures are recommended to prevent the spreading of Dengue Fever.
- Vaccination against the vaccine preventable diseases like Measles Mumps and Chicken pox is recommended to reduce disease burden and prevent it from spreading.
- Case diagnosis, institution of appropriate treatment and isolation from non-affected children (and adults) is one of the most important measures to prevent the spread of most viral contagious illnesses.
- Improvement in personal hygiene; especially in the care of sick and unwell children would also help contain the illnesses.
Text posted on 5.12.08
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 to work anunspecified but reasonable length of time in the islands once we return after completing our training. Unfortunately in recent years, several Maldivian medical graduates were allowed exemption from this already agreed obligation while others were virtually forced to adhere to it. This had created a sense of inequality among the graduates and prompted some to refuse to carry out their obligations unless equality is restored.
There is no denying that our countrymen, women and children need our graduates to serve them in earnest. We are indeed duty bound on moral and ethical grounds to serve them. Many of the graduates have done that, in perhaps the harshest clinical settings they themselves have ever had to practice under. It is therefore deeply concerning and highly unfortunate that Maldivian doctors as a whole have been accused of being insensitive to the peoples needs.
I do understand and share the feelings of those who have served in the islands when they hear of their colleagues’ refusal to do the same. It is even moredisgusting when rules are bent and broken in favour of allowing certain members of the medical fraternity to be made exempt from such rules. If rules are to be applied, they have to be applied across the board. No exceptions and no exemptions. We must create such a situation of equality.
Indeed, if one would be so diligent to look into the matter, one would find instances where a number of the graduates were never asked to serve in the islands. Surprisingly some were held back from doing so even upon request. In this kind of situation, the accusations are misleading and demeaning.
The current practice of sending graduates fresh from medical colleges to workunsupervised, on their own, in a poor resource setting is alsoquestionable. Most of these doctors, although full and complete graduates from medical schools, have little or no experience in handling cases entirely on their own, especially in high pressure and resource constrained settings as those found at most health centers in the country. It is perhaps better to allow them to be nurtured and groomed under proper supervision for a reasonable length of time at a tertiary hospital or regional hospital before being posted to practice medicine on their own.
It is, in my personal opinion, paramount that we revise and review the current practices of posting Maldivian doctors to the Health Centers and Regional Hospital, if we are to realistically tackle the medical staff shortage situation in the islands. The current system is flawed and outdated. The exceptions and exemptions of days gone by have made it an inequitable system that is frowned upon by Maldivian medical graduates.
I support and am in favour of posting Maldivian doctors to the islands to serve our people. For this to work, we must make the system fair for everyone. For the doctors posted in the islands to deliver reasonable quality of services they must be nurtured and groomed well prior to their postings. The places they are posted to must also be resourced-sufficiently to allow for the doctor to serve to his abilities.
Responses & Discussions:
Text posted on 5.02.08
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 information session for the mothers group where the group members were given information on various aspects of counseling and mutual support of breastfeeding practices in a community. Today we laid the ground work for future Breastfeeding Counseling Training Courses for the group members and staff of Hulhumale’ Hospital. The training program is tentatively scheduled for late May to early June this year.
These first steps would definitely go a long way in making Hulhumale’ Hospital and the island a Baby-friendly place.
Text posted on 4.26.08
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 age selected and also lists warning signs for developmental disability for that age.
Check list
Select the age of the child from the drop-down box and click “go”. The new page gives a check list of activities or milestones appropriate for that age. Tick the boxes that are applicable.
Text posted on 4.18.08
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 workers like myself. I am in no doubt that this concern is shared by many others. We all know how deadly an illness Dengue can be in its severe form.
I was at work (at IGMH) the other day when I couldn’t help but complain about the number of times I was bitten by mosquitoes while seeing patients in OPD. I get terrible reactions to mosquito bites; with very rapid appearance of a severe Urticarial rash. A dozen or so mosquitoes were in a feeding frenzy within that single room. I along with the patients who had come to see me were at the mercy of these air-borne pests.
I realize that the whole of Male’, and probably the rest of the country, is experiencing a resurgence of the mosquito menace. But, for the mosquitoes to be present in such large numbers in the one place where they could readily feed on people with mosquito borne illnesses (such as Dengue) is a serious concern. These hospital premises are fast becoming the prime location where Aedes mosquitoes are spreading the Dengue virus.
Where the mosquitoes are coming from, I am not so sure. But the fact that they are indeed there is as certain as these really itchy wheals on my arms. It is a very likely possibility that some of these mosquitoes are coming from outside of IGMH, probably from the several construction sites around the hospital. However, I suspect that a significant number of them are born and bred within the hospital premises!
There are so many water logged areas within the hospital premises, not least the roofing and the roof drainage system. The terraces are also water-logged for several days after the rain ceases. It probably is my ignorance, but I really don’t see anyone putting in an effort to clear up the potential breeding areas within the hospital.
It is quite probable that any such effort restricted to the hospital alone would be, on its own, of no significant impact to the mosquito population. Nonetheless, I believe that such an effort is needed as soon as possible. IGMH could begin the work and urge the community and other responsible bodies to revive the mosquito control program.
I don’t see any logic in waiting for the mosquito menace to cause an epidemic, as happens every year, before we launch a preventive health campaign. If we wait even a bit longer, the epidemic may soon begin. Or has it already!
Text posted on 4.11.08
A very brief and short summary available on niyaf.com
Click here.
Text posted on 3.26.08
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 affect an unborn child if a pregnant woman gets infected.
How do we get it?
The most common mode of infection is through consumption of food and drinks contaminated with the bug. In the Maldivian context, cats are probably the main animal host. Infected cats excrete Toxoplasma bug in their feces. Certain birds may also get infected and pass the bug in their fecal droppings.
- Rain water collected from roof tops contaminated with cat feces and bird dropping maybe one of the most common sources of infection in the Maldives. Especially in the Islands, rain water remains the main source of drinking water. Rain water itself is clean, however, the way we collect rain water is far from clean.
- In household where cats are kept as pets, poor personal hygiene after handling the pet and after cleaning its litter may result in contamination of food and ingestion of the disease causing bug. The surfaces of fruits and vegetables maybe contaminated with cat feces and other animal droppings; washing them well before consumption is important.
- Consumption of raw milk is another route of transmission; however, with raw milk unavailable in Maldives, this may not be a problem for us.
- Another very important mode of transmission occur when an infected pregnant woman passes the infection through the placenta to the unborn child. If infected, the unborn child may develop severe illness including significant congenital anomalies and brain damage.Toxoplasma gondi infection during pregnancy is not uncommon in the Maldives.
What happens if infected?
In most cases, with the exception of those with poor immunity, the infection itself is asymptomatic and goes unnoticed. Sometime it may result in a mild flu-like illness.
In the very small children and in those with poor immunity, infection can cause significant illness with fever, enlarged lymph glands, altered liver functions and generalised un-wellness. If ocular infection occurs and left untreated scars appear in the retina that could result in reduced vision and blindness.
If an unborn child is infected in the womb, significant congenital anomalies including brain damage, may occur.
Is there any treatment?
In most adults with an intact immunity no treatment is necessary.
If a pregnant woman is infected certain medications are prescribed to minimize the risk of transmission to the unborn child. However, the treatment is not always successful and transmission and infection of the unborn child may occur despite treatment. It is therefore advised to test for status before pregnancy in those at increased risk of infection.
In infected newborn babies multi-drug therapy is used to halt the infection and minimize the impact of the illness. The treatment is unlikely to reverse any damage that has already occurred.
What can we do to prevent infection?
A much better news, I believe, is the relative ease with which we in the Maldives could prevent this infection.
The collection surface for rain water in the Maldives are the house-hold roof tops which are frequented by cats. They are also exposed to bird droppings. While many never care to bother, others do attempt to clean the roof before collecting rain water. The concern however is that none of the cleaning mechanisms involved is even near effective enough to effectively remove theToxoplasma gondi (the bug causing this infection).
The solution is not complicated. Do clean the roof as much as possible before collecting water from its surface. And most importantly BOIL all water before consumption. Boiling kills these bugs. I would advice boiling rain water, water supply water and any water for that matter.
Fruits and vegetable, if eaten raw, need to be washed well to remove any bacteria or other disease causing organisms from its surface. In the home “vegetable and fruit garden” they may have been contaminated with cat feces and other animal droppings.
With respect to transmission of this infection to the unborn child: If it wasn’t so expensive, and time consuming, testing for Toxoplasma infection before conception could be one other strategy to help minimize the effect of this infection on our community. If pregnancy is planned, those at an increased risk of infection (women who use rain water for drinking, those who have pets at home or those who were previously infected) should be tested before becoming pregnant.
If infected, women may be treated to minimize the risk of transmission to the unborn child.
ASK your DOCTOR for more information.
A reasonable array of blood tests to detect Toxoplasmosis is available at most Labs in Male’. Discuss with your doctor whether you need to have the tests done.
Responses & Discussions:
Text posted on 3.12.08
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 had their clinically proven treatment discontinued purportedly due to aggressive and unethical marketing of the Elken products by their Maldivian marketers and promotional materials. Patients with chronic and long-term illnesses are the most vulnerable. It is my personal experience that these patients, having discontinued their rational and proven therapies, suffer complications of the illness for not receiving the necessary treatment. This is particularly true for patients with Juvenile Diabetes Mellitus on Insulin therapy.
We as clinicians are at least partly responsible for our patients testing and trying the different alternative therapies. This is not to say that aggressive and unethical marketing has not played with the emotions and fears of the vulnerable patient population, but we clinicians need to improve our communication with the patients to minimise the risk of similar situations in the future. A significant amount of time need to be spend on educating our patients and their families on the illnesses and treatment strategies. Working at public hospitals, where the administration hopes to increase quantity rather than quality and where communication and health education is labeled as “sweet-talk”, we are increasingly exposed us to various avoidable problems. We must challenge and improve the situation if we are to realise our dreams and aspirations of quality health care in the Maldives.
I would like to also touch on one of the claims used by product marketers; the use of Elken products in feeding young infants. The promotional material being distributed in Maldives show the use of the product as a breast milk substitute and claims it to be equivalent to breast milk in some way. A video shows the product being mixed in milk and being given to an infant as an improved milk feed. This is a very dangerous and misleading promotional tactic. I strongly recommend against use of any product, whether from Elken or any other company, in this way.
The Elken products may possibly have nutritional supplement value. They are, nevertheless, not to be used as a replacement or alternative to treatment of proven benefit. The benefit and adverse effects of modern medical products are rigorously tested and their research peer-reviewed to gain the trust of clinicians and patients. The same is not true for some of the many nutritional supplements that have been wrongly marketed as alternative therapies based on poorly conceived and executed studies. These studies fail to generate even reasonable level of clinical evidence necessary for recommending them as alternative treatments. Until properly planned and executed trials and research show clinical evidence of benefit in specific clinical conditions there is no place for them in modern medicine.
It is encouraging that senior figures within Elken have held talks with MMA in recent days. They have reportedly distanced themselves from the misleading marketing strategies and claims made by some local promoters. I believe that the situation also requires the company reining in rogue marketers using such inappropriate strategies and re-evaluating the promotional material being circulated. I hope that the concerned authorities and responsible figures within Elken would look into the matter and address the the situation appropriately.
I hear that a good number of med students are currently abroad. Probably more than 200? IF they come and serve in the islands, for sure, the services are going to be better for us poor folks living in the islands. Each one of them can be sent to an island. Each island will have a new doc. BUT.. like u say .. b4 placing them in the islands, 1 year grooming is a good idea.
Lets say it takes 7 years to finish MBBS. That means by 2015 a doc should have been trained for each single island.
Bodaa haakaane kameh nei. Aharumen fageerunah hidhumai koh dheyn thi kudhin fonuvanee kiyavan.
I agree that doctors should go the islands and severve as they are obligated to do. But we really need to ask y doctors are refusing or reluctant to go and serve?
last time i cheked there were lots of issues. hoping to hear those voices who had experiences…
Can you elaborate on the reasons why these doctors are refusing to serve in islands, other than the administrative discrimination of letting some exempt, specially the ones related to the ruling class. Is that a valid reason for the rest to sideline the islands?
A lot of doctors I know serve happily in islands. Some even are serving longer than they were asked to. While others are refusing to even stay and help the islands a single day. Is this how the doctors are taught to serve? Doctor while staying in an air-conditioned room?
Sadly due to these refusals we loose the trust we have for doctors in general. We do not believe that doctors really intend to cure anyone, but rather we tend to think that they are just looking for capitalists benefits and want to be treated as people superior in status than the rest. Niyaf, you can write something addressed to these doctors, you are not among these doctors!
I totally agree with what Niyaf has said.
When we were medical officers I never met a single doctor who was not willing to serve in the islands (it maybe different now).
When the system of posting doctors in islands collapsed some time back, we had meetings with the Ministry and forwarded a report highlighting the problems and possible solutions. This was never taken seriously.
As far as I know there were even some who requested to be posted in the islands but the ministry had refused to do so.
Inspite of all this a former health minister went on record in parliament stating that Maldivian doctors were refusing to serve in the islands. A very horrific attempt to cover-up their inadequancies!
oi, most Maldivian doctors DON’T refuse to work in the islands. What they are asking the authorities to do is to be fair. Being fair should apply to everyone. The patients, the doctors….everyone. The only way to make the system work is to revamp the current system to make all doctors equal.
Even the doctors, the few of them, who apparently refuse to serve in the islands are asking the authorities to treat themselves and their colleagues fairly without discrimination.
Aishath Shaleela, there are several reasons. I am not attemting to make an exhaustive list here, let me high-light a few issues though: the level of clinical experience a junior doctor gets from working in the islands is very little compared to that which he will get by working in a tertiary center (important because for post graduate training opportunities a certain amount of experience is required), the facilities in the island health centers are bare minimal (not enough for the doctor to serve to the best of his abilities; even when he strive hard to do so), the duration of service in the islands is variable (6 months, 1 year…..not fixed), doctors are posted to the islands in an ill-organised way (you maybe asked to serve in the islands when several others who joined just before you were made exempt for undisclosed reasons), ……….these are just reasons specific to the field of medicine…..there are others that are universal to all fields (having to leave family and kids, living conditions, schooling for kids, …..etc).
But like you said; we are a profession that should be dedicated to serving the people. We must serve in the islands too. BUT the current situation needs to be improved!
I think many people unnecessarily glamorize a doctors professions. It is hard work. Thankless at times. Distressing too. We don’t just sit in AC rooms. It is a glamor job for some, but for the dedicated people it is serious and hard work.
Ziyan has spoken from experience and points out few vital points.
It is so easy to criticise……but it serves us all better if we could get the system improved to make it work. We have to make it work. And we have to get the system off the sick-bed to make it work!
So why don’t you go on and make the system fair and just for all. Whats keeping you from doing that? Get rid of the barriers if needed.
After all it is the health of a nation and its people we are talking about here.
Hi dj, I will try. It will help if others, who too believe the same, participate in the effort as well.
Ya if all work together may be we can over come the obstacles from the administrative side.
Insha Allah
Niyaf, I totally agree on your article. What you highlighted in your article are true, but sadly there are a FEW doctors who refuse to go to islands simply because their parents are influential people in the society and they know they can use that influence to refuse.
I propose that the Maldivian Medical Association (of which you are president, I think) to propose the following to the Medical Council. That regardless of their or their parent’s or family’s status in the society.
• All non specialist doctors serve the islands for a period of no less than 1 year (btw, now it is ONLY 6 months)
• All Specialists serve the islands for a period of 6 months
• All doctors who have done specialty without serving the islands give a service of 1 year to the islands.
• All those who refuse should get their licenses to practice medicine in Maldives revoked.
If we want the public to respect maldivians doctors and truly believe that maldivian doctors are not only in the profession for materialistic benefits extreme measures are needed.
I salute you, I am proud that there are Maldivian doctors like you. Keep up the good work!
Insha allah, if everybody works together you will succeed.