Maldives health and stuff

So here’s what we learned from my new best friend Dr JM Luna, the WHO Country Rep to the
Maldives… The Maldives is definitely not the poorest of the poor, especially when compared to some of the other countries in South East Asia. Basic health levels are fairly good, and there are decent new regional hospitals in 5 of the atolls (groups of islands). However, as with all other government departments here, the system is still fairly centralised around Male’ where 27% of the population live and there are the inevitable geographical transport difficulties in getting patients to medical help from the islands. There’s no malaria here (yay for once no malaria tablets for me to forget to take!), and in fact the epidemiology of disease is moving away from communicable infections to a more a Western pattern of chronic diseases, including cardiovascular problems and even obesity. Up until now AIDS hasn’t been a real issue with only been about 12 or so reported cases, mainly expatriate sailors from India or Sri Lanka. There is however a growing drug problem in Male’; smoked heroin has been the drug of choice but with a move to IV cocaine use, it’s made the government sit up and think about the issue of HIV/AIDS in a way that they hadn’t before.

Despite the fact that there are plenty of islands that have enough land to grow stuff, hardly anything is home-grown; instead almost everything here is imported, even down to tomatoes from Sri Lanka. The only local stuff I’ve seen is masses of fresh fish at the fish market and canned tuna. The mainly fish-based (actually, despite the vast amount of available edible sealife, make that tuna-based) diets in Male’ and especially in the islands means that bizarrely there’s actually a fair amount of malnutrition, not because of a lack of food but because of the type of diet. This was confirmed by some guys from Bangladesh who were in the Care Society office last week – they’re on contract here for a year on an agricultural project to introduce vegetable farming into some of the islands, and are having a really tough time extolling the virtues of veggies, changing attitudes and convincing the locals that veggies are edible… Here’s some extra blurb from the British High Commission on development issues in the Maldives:

“There is a pronounced inward migration trend from the atolls to Male’ as people search for employment and better education. Those living outside Male’ are dependent on fishing, agriculture and other primary industry related activities for their livelihood. Many families depend on money transfers from family members employed in Male or on tourist resorts in the central region. The Maldives has a young population, a shortage of human resources and a serious skills shortfall. A small number of graduates are responsible for managing all major institutions in both private and public sectors. The Government sector is also at a disadvantage to the growing tourism industry which attracts young people away from low paying Government sector jobs. There are concerns about the quality of education children receive, particularly in the atolls. While percentages of enrolment and retention statistics are in the high 90’s, the reality is that 46% of children leave school illiterate having been taught by teachers with no qualifications or training. Administratively, Maldives remains highly Male’ centric, but is endeavouring to decentralize. New hospitals, schools and atoll offices have been established yet all significant political and commercial activities continue to take place in Male with the consequence that the relationship between the islands and Male’ is one of dependency.” OK, you made it through – that’s the end of the lesson for the day There’ll be a test when I get back…