The largest coronavirus treatment center in the Maldives Islands has around 300 beds and a constant supply of oxygen. But last month, when the country reported some of the highest per capita case rates of the disease, Covid patient services needed another resource: workers.
“At the worst possible time, we had a nurse to see 20 patients in general services,” said Mariya Saeed, director of the Hulhumalé medical center in the capital, Male. “We needed human resources to provide adequate care for many elderly hospital patients, but the nurses were exhausted. “
The pandemic has resulted in a shortage of health workers around the world, forcing governments to act urgently. Spain, for example, has launched an emergency plan to recruit medical students and retired doctors. And in India, Prime Minister Narendra Modi last month urged local authorities to start recruiting senior medics.
But the Maldives archipelago, with its some 1,200 islands in the Indian Ocean, faces unique challenges.
The government cannot easily recruit large numbers of students because it only has one university with a faculty of medicine. And he cannot rely solely on the citizens of the country, as his healthcare system relies heavily on foreign workers. Many doctors and nurses come from India, a country facing a huge epidemic.
One consequence is that the Maldives, which approach the pandemic with meticulous attention to detail, is unsure of how they will equip their hospitals for the next crisis. “We are discussing with countries like Bangladesh and India” the recruitment of doctors and nurses, said President Ibrahim Mohamed Solih. “But they are unable to provide assistance due to their own Covid situation.”
The Maldives, a predominantly Muslim country with a population of around 540,000, have created a pandemic response model for small countries. Using strong contact tracing and relying on distance between islands to stem the rate of outbreaks, the government has kept the rate of Covid transmission low enough to suspend containment measures and re-engage tourists in its luxury resorts, a pillar of the economy.
In April, he authorized Ramadan holidays and the normal holding of local elections across the country.
“You never know what’s going to happen tomorrow,” Thoyyib Mohamed, director of the country’s public relations agency, told the New York Times in February. “But for now, I have to say it’s a good case study for the whole world, especially tropical destinations.”
While 59% of the population has received at least one dose of the Covid-19 vaccine, the recent epidemic has taken a heavy toll. Almost half of the 200 deaths from the disease in the country during the entire pandemic were recorded in May. Many people in Malé today have relatives who have died from Covid, said Marjan Montazemi, UNICEF representative in the Maldives. “Since the numbers are not as high as in other countries, they do not attract much attention,” she said. “But for us it was very difficult.”
Authorities have not confirmed the number of variants present in the latest outbreak, but local doctors say the delta mutation, first detected in neighboring India, likely played a role.
As cases rose to more than 1,500 a day last month, hundreds of Covid patients were arriving at Hulhumalé medical center. Despite being built last year for the purpose of treating Covid patients, the facility – with 16 doctors and 89 nurses – was unprepared. “We are always ready for a possible epidemic, but such a sudden and massive wave was not expected,” said Nazla Musthafa, the government health adviser.
To alleviate the shortage of doctors and nurses, the Faculty of Medicine of the National University of Maldives, opened in 2019 and with a total of 115 students, sent dozens of students to help work in the Covid services in Male. The government has also brought in retired nurses and recruited volunteers with no medical experience. The bottleneck highlights dependence on foreign health workers, which the government knew was a problem even before the pandemic.
In 2018, foreigners made up a fifth of the nearly 900 doctors in the Maldives and more than half of the archipelago’s nearly 3,000 nurses, causing high turnover that affects the quality of health care, according to a government report.
Other countries, such as Ireland, Israel and New Zealand, also rely heavily on expatriates for health work. But unlike them, the Maldives are not rich. This means they can’t compete to attract foreign doctors and nurses, especially during a pandemic that has left almost every country with a shortage of these professionals.
S. Irudaya Rajan, president of the International Institute for Migration and Development, an organization based in southern India, said he hoped countries that export large numbers of health professionals, such as India and the Philippines would change their policies to prevent workers from leaving. .
The Maldives needs a better strategy to ensure a more stable supply of foreign doctors and nurses, Rajan said. One option, he says, would be to sponsor medical students in India and make them work in the Maldives for a few years after graduation.
“One lesson every country should learn from Covid-19 is: don’t exploit poor countries like India and the Philippines,” Rajan said. “Invest in them and their people, and they can be beneficial. It is currently difficult to employ professionals from India, Bangladesh and Sri Lanka. Especially from Sri Lanka it is almost impossible. for several days. “