Dr. Freex replies on the recent Doctor protest August 21, 2007

Me:

It has to be a two way security to be fair for all parties involved.Only then these incidents can be prevented.

Dr. Freex:

The 8month old child weighed less than the expected birth wt of a NEWBORN(btw 2.5-3.5Kg)!!!!…that falls btwn the ‘Extremely low birth wt’ & ‘Very low BW’ category..this is proof that that the parents neglected the welfare of the child!…At that age the child should have atleast twice the birth wt!!

Prognosis for even the most trivial illness in such a child will be poor esp. if not treated in a Specialized Paedatric Center!.. Which IGMH is NOT!!

We seem to think that all our wishes will come true if we resort to violence and intimidation!…We are the only country in the world whr doctors are subject to such harrasement by a population hu seems to think they hav becom masters of the world coz they had a few street protests in the name of ‘democracy’!

Me:

An 8 month baby could weight 2.5 - 3.5 kg due to many things as you are also aware of as a claiming doctor. It could be due to the negligence of the child, it could be that the baby was having a co morbidity illness which was undiagnosed. Why are you jumping in to conclusions here?

What is wrong here is that no one has issued an explanatory statement to the public or the family involved. No postmortem has been done. No one knows for sure who is and to whom should the blame be thrown at.

It has become a common practice and a day to day practice now to say that IGMH is not fully equipped and specialised to treat the sick. Is that acceptable to the people who seek help from these “professionals”?

It could be that the child was so medically compromised that the doctors were unable to comfirm a diagnosis or a diagnosis was missed. It could be that the childs parents did their best but were helpless in the deteriorating condition of their loved child. It could happen. Right?

On the part of negligence i have this to say.

Access to information, education and means to do it is a fundamental right every human being should have when it comes to their health.

If these things are not provided, or easily accessible, there remains a responsibility on part of the health professionals and the authoritis as well. The public blame game has and needs to end if we all are to minimise these incidents and start working on real issues at hand and working towards protecting the public and children and safeguarding the rights of its citizens. This includes the people who are delivering the service as they too are receivers of the system.

You are so wrong in saying that we are the only country. Infact, if something like this happens in most developed countries people can sue the doctors ( a legal mean of acquiring their rights) which does not appear to be present in Maldives. So obviously people will resort to other means.

Dr. Freex:

You wrote” An 8 month baby could weight 2.5 - 3.5 kg due to many things “

It is not normal for an 8-month-old child to weigh the same as a NEWBORN, for whatever reason it may be!!! I don’t think many of you realise how grossly abnormal that is.

The fact that the child’s health was allowed to deteriorate to the point where the child weighed less than 50% of the expected 50th percentile (NORMAL BEING ABOVE 85%) points to negligence; because the child should have been brought to the attention of a health professional much much earlier!

That aside, I accept (as I have repeatedly on previous occasions) that there needs to be greater transparency on the part of the medical team. However it seems that our patients do not want to hear anything except that ‘total and complete cure is without a doubt possible; whatever disease may be affecting them & whatever maybe the state they are brought in, & whatever maybe the resources available at hand’.

And in this case the gravity of the situation was made clear to the parents; they were told that given the state of the child he/she would require treatment in a Paediatric Specialist Centre (this implies more than the availability of a paediatrician and Intensive Care facilities).
That being not available, & fully made aware of the precarious prognosis, they were offered whatever care IGMH could provide. The child succumbed, and this is hardly surprising considering the Weight of the child alone!

There are basic protocols that a doctor will follow in managing any case & even the most, dare I say, stupid of doctors would have been exposed to such scenarios throughout their MD years. Gross mistakes, as are being implied by the public whenever and every time a patient dies, are in fact less likely than the possibility that the life saving measures that were & can be taken, were exhausted.

Even with the best medical care available, trying to salvage a child weighing so less and in a centre where there are no intensivists or advanced life support systems is at best a shot at luck, unfortunately.

Regarding the issue of harassment, I stand by what I said. No country except in ours is there such a tradition (quite recent I would say) of intimidation & violence directed against doctors, WITHOUT so much as looking into the matter.
There is a system as of late to sue doctors, is there not? We have Hon.Husnu Suood don’t we?
In developed countries there is a system, which balances & recognises the rights of the doctors as much as that of the patients! The administration has utterly failed to protect its medical staff against a public who have grown comfortable with its attitude of malice towards doctors. The latest being this particular incident where the attending female paediatrician was physically assaulted & violated by the members of the grieving family, because the child succumbed to hi/her illness! TOTALLY UNACCEPTABLE!

Such is the level of enlightenment we Maldivians have reached! The recent news of an expatriate worker being castrated and murdered, and the immigrant community being subject to gang style terror, and the violence against doctors and children and women, all are the hallmarks of a society that has long abandoned all its moral values and it’s humanity.
And what do we have to show for it? Expensive bikes-phones, designer clothes & an arrogant conviction that we are as advanced as the west; and since we are acting like it, we deserve no less.

Speaking as a doctor, what I seek (as I have said on previous occasions as well) is reconciliation, mutual respect for each other’s rights & a collective ethos and a hand-in-hand effort (patient-doctor) in the war on disease & infirmity; because doctor needs the patient ‘s help as much as the patient needs ours, in order to fight disease. Please meet us halfway through!
And reject violence as the answer to everything and come to terms with the realities of health care in the Maldives – yes we are ill equipped! The Maldives is one of the poorest countries in the world and the logistical nightmare of catering to a minuscule population spread so far and wide is without parallel, in any part of the world. So far we have managed to build tertiary level hospital in Maale & in regional areas; and the post-tsunami influx of patients from the islands isn’t making matters any easier.

Let us therefore stop blaming doctors for the shortcomings of politicians & circumstance.

I say again, violence is not the answer. The assault on the female doctor is unacceptable.

Me:

I understand the frustrations of doctors these days. No. It is not acceptable to resort to violence. It is not acceptable by any means.

The point i am making here is this.

+The weight of the child was not normal.
+We have become spiritual beasts who no longer consider reason and facts as acceptable.
+I do not know if the family came from a far away island, in which case we can imagine the services provided and available.
+We do not know the financial status of the family
+ we do not know the education and how much they understand what the doctors are saying
+we need to approach each and every case with empathy and understanding
+ we need to provide and understand and listen to their stories as well.
+ If doctors do not have time to do that, they should fight to get that time needed to be with their patients.
+My conscience does not agree that if the parents were well informed , in an understanding and empathetic manner, they would have resorted to violence.
+For gods sake it is their child.They will be going through so much.
+We do not know why the child was not brought to a doctor b4.
+ we do not know the situation of the parents
+ we do not know whether they knew that the weight was below normal levels even b4 they brought the child.
+We should not rule out negligence
+We should not say that it is due to negligence without a thorough assessment which includes the family
+These things will happen if you neglect the parents and concentrate your efforts only on the child. No social workers for the family to talk to.. No support services but only wondering speculation and assuming left for the family is available while the doctors are working on the child..

I totally agree with you that politicians need to play a more passive (active ) role in the delivery of health care.

Who are there to pressure them?

As advocates of the public ,i feel that a huge responsibility lies on the shoulders of doctors and other health professionals.

Yes, i agree that we need to join hands. Divide and rule has been the motto so far. We , all as health professionals need to make it a point to the politicians that we need a safe environment to work, we need a safe environment for the patients who we treat, we need legislature which clearly defines what is illegal and negligence. What the responsibilities are. What a doctor cannot do.

To make that point we health professionals are the major driving force and we become politicians in the process. Dont you agree? There is no way that politics can be sidelined and just say that it is not our job to bring about changes. We cannot say that it is the job of the politicians alone, if you would like to phrase it like that. Health professionals are politicians. And we as a collective force need to push for changes to happen and then only will change happen.

Recent strike is a good start and i would like to see many more. I am really happy that the doctors decided to strike on a mini scale. But, i reiterate again, but.. we need a strike on a bigger scale to even get the message out there.

No one cares about the health professionals at the moment. The message need to be delivered to the public about the lack of legislature, infrastructure, support and etc..

If not many more of these incidents are going to repeat. It is inevitable. And foolish to think otherwise.

We just cant say NO TO VIOLENCE and expect a growing number of population who are also frustrated and helpless in the way medical care is provided and expect nothing to happen. We are all humans after all. A child is a child and a parent is a parent. A sister is a sister and it is not easy to see your loved one die.