New recruiting policy could lead to doctor shortage: Minivan News

New recruiting policy could lead to doctor shortage:


The health ministry has asked Indhira Ghandhi Memorial Hospital (IGMH) to recruit doctors without offering them a migration allowance.

The migration allowance is a very important factor in attracting foreign doctors to the Maldives.

Miadhu reported that Dr. Mohamed Razi, senior medical officer at IGMH, said he was concerned that low salaries for doctors combined with the cancellation of the migration allowance would make it very difficult to employ doctors.

IGMH and other hospitals were struggling due to the shortage of doctors, he said.

Razi said he believed IGMH would be able to increase salaries and benefits to doctors once it was privatised.

Source: Minivan News 30th December 2009

Migration allowance cut and Civil service Commission: The drama

Read this two various article written in january 2009 and december 2009. You will understand the drama staged by Civil Service Commission, Maldives which managed to create its own hatred on Doctors.

Latest news on 30th december 2009 from Miadhu"

Doctors worry the elimination of migration allowance

Wednesday, December 30th, 2009

Dr. Mohamed Raazee of the IGMH has expressed concern that the Health Ministry had asked the IGMH to recruit the doctors without promising a migration allowance, which encourages the much needed expatriate and local medical doctors to work in the Maldives. Dr. Raazee also said he believed that the decision was made by the Civil Service Commission, and said that when the salaries were revised this year, migration allowances were not paid for the new doctors. He also said that if that allowance is not paid for the new expatriate doctors that would not be paid for the new local doctors as well. He also said that he is concerned about the low salaries being paid for the doctors as well.

Dr. Raazee also said that the because of the unattractiveness of the package, they are finding it very difficult to recruit doctors and IGMH and other hospitals are barely surviving because of the shortage of doctors.

But he said that once the IGMH is privatized it would bring independence from the civil service and IGMH can then increase salaries and other benefits for doctors and other employees. He also said that already an “Article of Association” is drafted and he believed that the change would come next year.

Once the change is made IGMH would be managed under a public-private partnership and of the 5 parties which expressed interest to manage the IGMH, one party is being evaluated for possible management handover.

A flashback news from March 2009 from Muthuim's blog:

Thursday, 26 March 2009

Maldivian Doctors Vs Civil Service Commission - A clash which might jeopardize the medical profession!

It’s saddening to witness a scenario of tug-of-war between Maldivian Medical Association and Civil Service Commission of Maldives (CSC). The situation initially heated up when the CSC revised the pay structure which resulted 13-42% deduction in doctors salary. The pay structure was revised with the main objective of pay increment to civil servants following the government decision to allocate further 1 billion rufiyaa to the purpose. But the expected happy news from the government turned out to be a nightmare for doctors by the unfair means it was delivered by CSC.

CSC is repeatedly opposing the fact there is any reduction in the pay, which is an act simply to fool/confuse public on the issue and spread hatred against Maldivian doctors. They even have publicized grossly inflated and erroneous figures to show doctors are being paid excessively. In fact in a meeting with Nurses Association the President of the CSC has apparently remarked that "even though doctors may be angry with us, now (we have made sure) public is against them”. BUT all this while it is their actions and silly application of 'rules' that has vastly reduced the services being rendered to patients, in terms of OPD patient numbers and ease of follow up.

Post	Pay till 31st Jan 2009 (Total in Rf)	Pay from 1st Feb 2009 (Total in Rf)	Deducted Amount (Rf)	Deducted %
Medical officer	13077	11375	1702	13%
Senior Medical Officer	14786	12335	2451	16.6%
Senior Registrar	22441	14565	7876	35%
Consultant	26517	17390	9127	34.4%
Senior Consultant	37481	20920	16561	44.2%

(The simplest rule one can see in this is the higher the qualification and the level the higher amount of salary is deducted as the reward)

After doctors enquired this controversial- revised- pay- structure a ‘migration allowance’ has been included to fill up the deducted amount. BUT the CSC circular number (188-B/2009/8) clearly states the various allowances which can be listed under the ‘other allowance’ kind. It hasn’t revised since then which could give them authority to include whatever they wish. The regulations clearly indicate ‘migration allowance’ is not a permanent solution rather it’s a temporary trick CSC attempted to calm the heated situation. Therefore doctors who will get recruited after March 1^st will not be entitled with this ‘unknown-fill-up” Migration allowance. Also this allowance might get investigated by anti-corruption board (cases such happened in past where CSC allowed allowances later were made to re-pay from servants own pockets)

The result of the pay deduction is not just a problem of medical professionals getting less salary; more importantly it might risk the future of the whole health sector. In this globalize world opportunities are open for qualified professionals as they are always in-need everywhere like here in Maldives. We have several vacancies and doctor shortage are all over the country, and public is desperate to have competent, qualified doctors in all health centres and hospitals. BUT as some of the doctors stated on this issue “If we pay peanuts we will only get monkeys”.

This issue should have been resolved peacefully at first place. Instead various sources within government and CSC hurried in blaming doctors negatively in public which lead the profession in risk.

• The decreased pay to medical doctors means the availability of qualified expatriates will decrease.

• The decreased pay and most crucially the negative image (hatred) public has for the profession might change the minds of our youths who previously admired to pursue carrier in medicine.

• Already graduated doctors might seek jobs abroad and their migration together with the above reasons will decrease the country’s medical professionals.

CSC claims they have revised it having dialogue with concerned people and did it with points given to technical, professional (skill and knowledge), and interaction with the public together with the leadership ability. Which is always pleasant to say but the truth is Maldivian doctor were never communicated or consulted with this issue (to whom its mainly related) and with the ‘fair’ pointing system, presently a doctor who has to handle life-risk situation in ICCU is offered a lower salary than a laboratory technician or a radiographer. (How on earth a medical doctor can be equaled in any professional way with someone taking a simple X-ray?) Please before comparing different professionals reflect on how much sacrifices, how much time and money one spend/use to become a doctor. By ignoring the qualified professionals with technical skills and knowledge there is great fear, the country might face the condition of ‘brain drain’ which will be very costly for the betterment of the nation.

I call CSC to respect the rules and regulations and refrain from spreading false information on this issue and end the defamation campaign it’s carrying out against the doctors. We have given you high-profiled post and giant salary in order to serve us with justice and honesty. There is nothing positive we can achieve by blaming each other instead it will only harm the people of this country.

Expat doctors deserting Maldives

A article published in minivan news gives more introspective view on current scenario of salary cut and doctors mentality to stay on..

Source : Minivan News

"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."

Invitation to 350 Postcards Exhibition

Atlast the 350 postcards are ready be shown at exhibition. Here is the venue they have invited us,

Postcards from the Frontline: The Exhibition

Venue: Raalhugandu Kuda Park

Time: 4:30 pm

Date: 24 October 2009 (exhibition continues on 25 October 2009)

15 percent Salary Cut for doctors-Going back to 2006

The 15 per cent salary cut is unfair to doctors. There were no hike in doctors salary by new regime in feb 2009. Rather the new government has no idea in increasing or decreasing the salary as they went on over board by many fold increasing the salary to all sectors by giving them the satisfaction of around 1000 USD for everyone.

For eg. the basic pay of a medical officer's salary since January 2007 is MRF 7175. With government change has brought the new basic pay into 7875 in February 2009 but some how maintaining the same total from the past government without altering the total but basic salary. Now 15 % reduction as brought this basic pay around MRF 6694. Its has brought back the salary lower than what the previous regime offered in January 2007. In retrospective perspective, the salary has taken travel to 2006.

A civil servant has to obey the government and growing together is called democracy. A government should have long term views in making changes. Its not money that matters, its growth what it matters. The scenario in 2006 or 2007 is different. But the cost of living is increasing each year. What manner they raised the salary in February is still a miscalculation. What manner they cut the salary should not be another miscalculation. The increase or decrease in salary to civil servants should be appropriate to all levels with some basics principles and also should be transparent to the public.

Note: I'm neither medical officer nor against government.

Climate change bigger challenge than terrorism: Nasheed

“Climate change is going to affect a large number of people through flash floods, diseases and massive human displacement due to sea (level) rise, besides creating food scarcity,” president nasheed said at a talk on ‘Environment and Conflict Resolution’ in India.

Source: The Hindu.

A sinking feeling

Source:
A sinking feeling - A frontline spotlight article
TEXT: B. MURALIDHAR REDDY AND PHOTOGRAPHS: KANCHAN
The Maldives faces an existential threat from rising sea levels owing to climate change.

President Mohamed Nasheed. “[The countries] that embrace the Green New Deal will be the winners of the 21st century,” he said in his address to the United Nations climate summit.

“THE Maldives was largely terra incognita for tourists until the early seventies. Strewn across the equator in the Indian Ocean, the Maldives archipelago possesses an exceptionally unique geography as a small island country.

“The Maldives has always been a unique nation. Apart from a period of Portuguese domination in the Sixteenth century and carrying the status of a British protectorate from 1887 to 1965, the archipelago has been an independent archipelago for at least twenty-five centuries.

“The Maldives is a member of the United Nations, the Commonwealth and the Non-Aligned Movement. The Maldives maintains a very cordial relationship with the international community and the Maldivians themselves take pride in their hospitality and friendliness!”

These lines are from the introductory note titled “Maldives – The sunny side of life” on the country’s Ministry of Tourism website.

The Republic of Maldives comprises around 1,200 islets, the average height of which is 1.5 metres. Only 196 of them are inhabited.

Contrast these with the doomsday scenario outlined by none other than the Executive President of the Republic of Maldives, Mohamed Nasheed, in an article in The New York Times dated December 23, 2008, exactly a month after he took over the reins of the country after emerging victorious in the first multiparty, multi-candidate elections in the country’s 44-year-old independent history.

The first three paragraphs of the article, titled “Losing paradise”, read:

“Like any other nation state, at any point in history, the Maldives must protect itself from the menace of foreign invasion, terrorism and espionage. Still, to be honest, I really don’t see anyone wanting to invade or attack us.

“For the first time in the country’s history, however, the Maldives face a new threat. This new danger is of apocalyptic, existential proportions, and it looms silently, invisibly and menacingly over our azure horizon. I am talking about climate change and rising sea levels.

“The average height of our islands is just 1.5 metres above sea level. The Intergovernmental Panel on Climate Change warns that sea levels could rise over half a metre by the end of the 21st century, unless urgent steps are taken to halt greenhouse gas emissions. Low-lying island states such as the Maldives are living on borrowed time.”

The two statements, read together, project elements of the Maldives’ past, present and future. The Maldives may be the smallest Asian country in terms of both population and area and the smallest predominantly Muslim nation in the world, but it has plenty to offer to the wealthy tourist and the angry environmentalist agitated over the issue of climate change.

Nasheed and his team have grabbed the opportunity presented by the climate change conflict between the developed and developing countries to showcase the Maldives as a textbook case in the search for answers to some of the complex questions on global warming and the threat of an environmental catastrophe.

The Maldives islands, officially the Republic of Maldives, is a group of atolls in the Indian Ocean stretching south of India’s Lakshadweep Islands between Minicoy Island and the Chagos Archipelago, and about 700 kilometres (435 miles) south-west of Sri Lanka in the Laccadive Sea. It is also the country with the lowest highest point in the world, at 2.3 metres. The population of the Maldives is currently a little more than a quarter of a million.

Officials of Maldivian Tourism pointed out to a group of visiting foreign journalists that in jest they dare nature-loving adventure tourists to come to the Maldives and count the number of islands in it. They say that counting the islands, including the sand spits, is like trying to count the number of stars in the sky. The commonly agreed upon figure of 1,190 is but an approximation.

Boats are the primary mode of transport in the country.

These islands, of pure white coral sand, are grouped into natural atolls that are protected by surrounding reefs. The Maldives actually straddles the Equator. The climate is tropical with no major seasonal differences. Though the southwest monsoon brings most of the rain, mostly around June and July, tropical rain showers can occur any time.

As for the economy, statistics for the past two decades indicate an average of 10 per cent growth. Tourism is the main industry and contributes almost 20 per cent to the gross domestic product (GDP). The Maldives boasts South Asia’s highest GDP per capita, but the figure is inflated by the country’s significant tourism revenues, which do not trickle down to everyone. Some 40 per cent of the population still earns less than $2 a day. Until the beginning of 2009 the Maldives did not have a university.

In an interaction with the visiting journalists on September 7 at his presidential office, Nasheed said his biggest worry was the economy. “We are running on 34 per cent deficit. Conventional economic wisdom says hit the panic button once the deficit crosses 14 per cent. In the last four years this country has spent a lot of money, but we didn’t have it all. We have accumulated lots of debt. The global recession and fewer tourists have added to our economic woes.”

The capital, Male, spread over a geographical area of 2.5 square kilometres, is a classic case of overcrowding, with people and motorised vehicles competing for space amid the concrete work that, according to the local people, never seems to end. More than a third of the country’s population lives in such a small space. Statistics for motorised vehicles are not readily available, but the government believes that every household in Male has more than one vehicle.

The waiting area at Hulhumale islet, where the government, in association with local and international organisations, is implementing projects to minimise the impact of climate change.

There are no fixed-line telephones in the country, and people depend entirely on mobile communication. With the fervour of Ramadan at its peak on September 7 and 8, Male wore a deserted look throughout the day only to come alive at sundown when people broke their fast and drove around on the congested roads in the swankiest of cars and motorcycles.

Residents of Male, among whom are middle-rung diplomats and an estimated 80,000 foreign employees and another 35,000 illegal immigrants, complain about the high cost of living. Rents sometimes match those of Hong Kong or New York. The foreign employees and illegal immigrants consist mainly of people from India, Sri Lanka, Bangladesh and Nepal.

The largest island in the chain is not more than 8 sq km. The sheer logistics of providing transportation links to the inhabited islands and basic infrastructure for education, health care and other necessities is a nightmare for the government.

The Maldives has no room for the middle-class tourist; it has created for itself a niche as a destination for high-budget tourists. No prior visa is required to enter the country. Entry permits are granted to visitors on arrival at designated ports of entry on the basis of immigration requirements.

Beach scene at a private resort outside Male.

Maldivian Air Taxi and Trans Maldivian Airways operate special air transfer trips to most of the resorts but the costs are beyond the imagination of ordinary mortals. A one-way trip by a seaplane to an island 30 minutes away from Male is $175.

Maldivians are generally not race conscious, perhaps because the country has been inhabited for centuries, and visitors from as far apart as China, Africa, Arabia and Persia have been assimilated into its society.

As a country that is threatened most by the rise in sea level, the Maldives has the status of a front-line state in the debate on climate change.

In his address to the United Nations climate summit in New York on September 22, Nasheed called upon world leaders to seize the historic opportunity at the Copenhagen climate summit to be held in December. He asked world leaders to “discard [the] habits that have led to 20 years of complacency and broken promises on climate change”.

Trans Maldivian Airways seaplanes line up for take-off to resorts in islets around Male. The Maldives has created for itself a niche as a destination for high-budget tourists. A one-way trip by seaplane, run by Maldivian Air Taxi or Trans Maldivian Airways, to an island 30 minutes away from Male costs $175.

He said: “For the past 20 years we have stood here warning you of the threat of climate change. But we have not told you what the solution is, we have not clearly explained that it is in your interest – not just ours – to pursue that solution, and we have not been willing to prove that such a solution is achievable and mutually beneficial by pursuing it ourselves – by leading by example.”

He said the solution to climate change lay in three major areas:

• Developed countries accepting ambitious and binding emission reduction targets consistent with an average temperature increase of below 1.5{+0} Celsius compared with pre-industrial levels;

A Villa on the beach at one of the private resorts.

• The developing world being ready to jump, by accepting binding emission reduction targets under the principle of common but differentiated responsibility;

• The developed world providing new, additional and predictable adaptation financing.

The lounge and reception area of a private resort in one of the islets.

He blamed, among other things, the belief that tackling climate change would reduce growth and production, the mistrust among world leaders and the focus on a negative list of actions as the main reasons for the lack of progress in the climate-change crisis.

On the perception that climate change is a killer of production and growth, the President said: “[The countries] that embrace the Green New Deal will be the winners of the 21st century. Oil is running out and will become increasingly expensive, while clean technologies and renewable energy are becoming ever more efficient and affordable.”

The summit, which was held at the U.N. General Assembly hall, was attended by over a hundred world leaders. Alas, a few hours later, the U.N. News Centre reported that at the end of the summit there was no agreement between major powers on carbon emissions.

Prawns and fish being dried at one of the islets. Some 40 per cent of the population earns less than $2 a day. The Maldives boasts South Asia's highest GDP per capita, but the figure is inflated by the significant tourism revenues, which do not trickle down to everyone.

On the Copenhagen climate summit, Nasheed told the foreign mediapersons on September 7: “We can’t even go there. We don’t have the money. If you look at the fiscal balance and the monetary system it is very important for me to forgo an important event, for others to understand the importance of balancing the budget.”

At the same time he was emphatic that there was hope and optimistic that the situation could be reversed. His logic, on the face of it, is simple. There is no point in blaming the past and also trying to justify inactions and destructive actions. “Whatever the Europeans have done in the past is done. If India and China continue to do that, it’s not necessarily correct. Two wrongs do not produce a right. We wouldn’t want people to go on and on,” he said.

On the Kyoto Protocol, he is of the view that it proved to be a damp squib as it came after nuclear disarmament agreements. “The whole framework was based on disarmament treaty obligations. I think conducting these negations through similar jargons produced similar results. People should have thought outside the box, about adaptable solutions.”

Urban waste disposed of callously along the coast in Male.

The Maldivian President is scheduled to visit India in October at the invitation of Prime Minister Manmohan Singh and intends to enlist New Delhi’s cooperation in the global quest for a common understanding on climate change.