Orientation to Maldives by a doctor who has worked here for more than 5 years.

Welcome to the world of Maldives where the sunny and lazy side of life merge into one.

A brief introduction to those who wish to come here as a medical personnel and gets employed with the Ministry of Family and health. This is being written so that all are aware of some of the facts which are usually kept a secret by the agents.

Contents of this article:

About Maldives- currency, language	How to reach
Stay at Maldives	At the Ministry Office
Health System in Maldives	Contract in brief with pdf copy
Facts to know at Islands	Dependants
Remittance of money

Maldives is an archipelago comprising of atolls, in the shape of a necklace situated in the Indian Ocean, south west of Trivandrum. Each atoll comprises of smaller islands- some inhabited and some uninhabited.

How to reach: There are daily flights plying from Trivandrum (Indian Airlines and Maldivian flights) and Indian Airlines flight operating 5 times a week from Bangalore. The flight timings are usually an hour and ten minutes.

Things to bring from India ---

• Certificates, in original
• At least 100 USD
• Mobile Phone
• Laptop, Pressure Cooker, DVD Player                     
• Any medicines, if needed
• ten passport size photos in white background                   
• Cap, Sunglass, Umbrella

• Mosquito repellant
• Dresses, Ties for gents & Footwear
• e books, MP3’s                
• If you have spectacles, please bring 2 more spare spectacles as islands will not have optical shops.          

The currency here is Rufiyaa. A rufiyaa is approximately 3.25INR. 12.85 Rufiyaa makes a US $. 100 Laari makes a rufiyaa.

Language: English is understood by many and some even speak Hindi. Dhivehi is the local dialect.

The airport is in an island by itself. It is a treat to watch the flight touch down, but makes one wonder if the pilot would make it when you are on board. Experienced flight crew keeps the tensions away.

The arrival at Male` International Airport

You may be received at the airport by a representative from the Ministry who will guide you. Please do confirm this before flying from your country.

There is a cloak room at the airport where you could place the luggage @1US$ per day. They will give a token which should be produced while retrieving the luggage. So it is better to pack a bag separately for the stay in Male`- with some clothes, certificates, mobile phone charger, and other personal items you may need.

If you feel hungry, after completing the check out, turn to the right towards the domestic terminal and you will come across the Aqua restaurant, where you get good food for a reasonable fare. Go into the inside most corner where there will be a self service counter and make the payment.

Buy mineral water as the usual potable water is rain water. 

Please bring at least 100 US $ with you while coming here for employment. There is a ‘Bank of Maldives’ counter at the airport where you could convert it to Rufiyaa. (There is not much of use retaining the dollars).

Travel to the Main land, Male`

There is a jetty in front of the domestic airport where you will board big boats (called ‘dhonis’).

Your luggage will be carried onto the boat by helping crew members. The boats operate every half an hour or earlier.

One has to pay 10Rf for the trip from the Airport to Male`. The ocean can be rough at times, but the crew will take care. Upon reaching Male’ If you are asked to proceed to the hotel (Which they would specify), take a Taxi. The fares are 35rf with luggage and 20 otherwise. These fares are refundable at the workstation.

Within Male’ from any point to any point the taxi fare is 20 Rf flat. Bargaining is not of use.

At the ‘Ministry of health and family’ Office

How to reach

The Ministry is on the road named Ameenee Maagu. Names of the roads usually end in –magu or –galle.  Call a taxi and ask for the Ministry of Health, the fare as mentioned above is 20 Rf.

Enter the building premises, go the extreme corner to see a small board. Climb the first flight of stairs to reach the office.

While at the Office do not surprised to see all would be virtually busy at their desks.

Please do excuse yourself and address your problems. Introduce yourself as a new recruit.

Speak carefully, slowly and clearly in English.

You will have to:-

a)      Surrender the Passport and departure card which has been given to you at the Immigration desk while you entered the Male’ airport.

b)      Please check the name, passport number and designation (besides checking your photo) on the ID card and work visa card provided. [Once you leave for the island, it will be a big headache to get it corrected].

c)       Register with the Maldivian Medical council by paying a fees of 150 Rf. It is a temporary registration valid for 3 years.

d)      Your certificates will be checked and returned. You may have to surrender your Xerox copies of the same.

e)      After getting your certificates back, send them back to your home by regd post. It is better than to have them stolen or lost while at the island. Usually the certificates are not needed after being shown at the ministry. Some islands may not have a post office.

The onward journey and postings will be informed as soon as your medical checkup is done at the Indira Gandhi Memorial Hospital (IGMH). This is the largest hospital in the country and has been gifted by the Govt of India.

The Health Care System:

Tertiary care	IGMH	Male`	Basic & superspecialties	Lab,x-Ray,OT,Physiothaerpy
Secondary care	Regional Hospitals	Atolls	All basic specialties	X-Ray,lab,OT,Physiotherapy
Primary referral	Atoll Hospitals	Atolls	OBG,Med,Anesth,Pedia Medical Officers	Lab,OT and X-ray SOS
Health Center		Small islands	Medical Officers	No auxillary facilities

               

The IGMH is the largest Hospital in the country with around 150 beds. It is the tertiary referral center and houses all basic specialties, super specialists in the field of cardiology, gastroenterology and neurosurgery. There are different units for each department, but the internal politics is quite disturbing and it is very common to be confronted by a member of the governing body to get things done their way. There will be plenty of Maldivian doctors at this hospital and they may even head the departments, though under qualified.

This is not a Medical College. It is just another hospital. All doctors will be looking after their own admissions. There is hardly any team work.

There will be accommodation provided in the campus, if available, or else alternate accommodation out of the campus will be provided for a fee. Those staying in Male` will have to buy drinking water (or can accept 20 liters of rain water per day),will get 100 Rf for electricity and will have to pay for the television cable connection charges.

Things to be kept with you

·         A photocopy of the Air ticket to Male’ for refund purpose, if it is not done while you were in Male’. The Ministry will refund the fare, but, it may even take as much as 3 months to realize the fare after umpteen calls, faxes and even threats!!! One can always approach the workstation management with a copy of the ticket and tell them of the refund. They normally would clarify if the ticket had been refunded from Male`, but the procedure can be painfully slow!

·         ID card and work visa card given from the MOH

·         Contract copy

·         At least 3 passport copies attested by the Ministry. (For opening a bank account etc)

·         Flight tickets and bill of stay at hotel while in Male` to the work station

·         Xerox copies of your certificates.

While at Male`, after getting the Passport copies attested by the Ministry

·         Open an account with the State Bank of India, Male`. You can opt for internet banking and ATM card ( not of use in the islands).

·         Purchase either a Dhiraagu or Wataniya SIM card with connection

·         Any purchases, if any

·         Call someone at the proposed workstation. This is helpful in deciding the purchases

One will be assigned a posting in either a Health center, Atoll Hospital or a Regional Hospital. It depends on the whims and fancies of the ministry clerks (10^th grade pass outs or school drop outs). The agent who recruited you may have given some sweet talk about assuring you a job at a good place. This is not to be believed!

The decision as to where one is to be posted rests with the Ministry.

A couple may not be posted at the same hospital as well. Usually they make provisions for both, but sometimes, it`s just not possible.

The working time is usually from 7:30 am to 3:30pm (8 hours) , 3:30pm to 11:30 pm and 11:30pm to 7:30 am the next day by turns. Fridays and Saturdays are holidays to the office.

Salient features of the contract are as follows:

·         Look for a clause that states about payment of fees incurred out of court proceedings in event of a mishap at the workstation. It used to be there and most people do not even read it while signing.

·         The contract is usually for a year.

·         Annual paid leave on completion of 12 months ( tickets will be provided)

·         Emergency leave is for ten days- which will be granted for death of father, mother, spouse or children. Please note brother, sister, uncle or aunty doesn’t qualify as family!! Marriage is not a reason for emergency leave!!! Emergency can be availed once in a year`s contract. It used to be deducted from the annual leave as well. You will be expected to deposit a sum inclusive of a month`s basic pay and allowance, migration allowance which will be refunded on arrival back in time.

·         Service contract for specialists entail one to work for 48 Hrs a week. Friday will be the only off.

·         Accommodation will not be provided free. However, they will give a housing allowance and will assist getting a suitable place to live. One is expected to pay for the gas cylinder (230 Rf for a cylinder), water charges if applicable, and for electricity. A unit of electricity is roughly 8.0 Rf.

·         The salary will be inclusive of this allowance. So ones take home pay will be much lesser than one thinks.

·         There is no extra salary given based on the seniority. There is no gratuity or PF.

·         A copy of the contract will be displayed for all to see and read. The ministry is well known to suddenly come with a brain wave and implement some changes, which are usually not to our favor. All one can do while you are working is to complain to the Hospital administration. God help you if you get any clarifications!

For most of the things to be done at Administrative level, one has to get the help from the Ministry. Thankfully (!!!!) they never pick up the phones and if it is your lucky day, they pick up and tell you that they are either busy or at a meeting. These people start a week with meetings to decide what the modus operandi would be, half way through the week have a reassessment and on weekend, decide what to plan for the next week. Looks like a good strategy, but nothing concrete materializes out of these so called meetings.

Facts to know at the islands

You would normally reach your workstation either by a boat, sea plane or a domestic flight.

Please do take ‘Stugeron’ for motion sickness, if you are prone for the same.

A typical workstation in an island which would be nowhere near what you dreamt of. Rugged roads, people, if any, sitting or talking doing nothing and a few cars or motor bikes plying the roads. However, some islands do have well laid out roads. But, those are just a handful, anyway. Most of the islands are small not more than 1 sq Km diameter. Some are large. The hospitals would always be painted in white with green roof tops. There are usually 2 water taps at homes- one is for well water, which can stink, and the other rain water. It is safe to boil and cool the rain water as the roof can be dirty. The stink of the well water can be reduced considerably by storing it in a big bucket overnight. Use this for washing and cleaning only.

A Health worker or Manager would be there to greet you.

Depending on where one is posted, things would vary.

Facilities at a health center:

One will rarely get overtime. Killing the time is an art! Some islands have only the local channel on TV. So, one will have to resort to DVDs, Videos to pass away the time.

Do get your Laptop serviced before you leave your home as it would be next to impossible to get it repaired here, unless by sending it to Male`.

Bring your own pressure cooker, urud dal etc.

Learn swimming; befriend the teachers, who are mostly from either from India or Lanka.

Working hours are usually from morning 7:30am to 3:30 pm. One will get an hour’s break in between for lunch.

One may get food from a common mess with the staff nurses or one would have to cook on their own. So, if you know to cook, it would be an asset. If one is a vegetarian, your choice of food would be limited. Fish, eggs and chicken are the non vegetarian raw products available. Atta (wheat flour) is available, though, maida or the refined flour, called ‘fishi’, is preferred by the locals. Please check the expiry dates of the things while you purchase. It will help if you could befriend a boat captain as he could help you get things by boat while he visits the major islands or even Male`.

You could always be in touch with the specialists available 24 x7 at the Atoll Hospitals or Regional Hospitals. There will be a provision for keeping a patient for observation, but only during duty hours.

One will be expected to learn the local dialect, though there may be interpreters to help.

One will be expected to conduct and supervise deliveries, run antenatal checkups, be well versed in ECG interpretation. However, you also have to facility to fax the ECG to the Physician and get his opinion. Referring a patient to the next higher center will involve calling the concerned specialist, and transferring the patient with or without a medical escort by boat through the calm or rough sea.

All islands may not have internet or banking facilities. However, an account can be opened in the nearest Island where such facilities are available and the money would be deposited there. One can send money to their home country only through the State Bank of India.

It would not be easy to leave the islands in between for recreational purposes. However, if nearby resorts are operational, there would be tie up with the management. Beware of transfers at the drop of a hat to another island for no apparent reason.

For those posted at the Atoll or Regional Hospitals:

The islands will be bigger in comparison to those where the health centers are situated.

But, likewise, the drug peddlers and addicts would be more.

Thefts are common, but can be reduced with a little commonsense from ones part.

Some islanders are pretty hostile and can even physically harm you like even pelting stones and even attempting physical harm. The police are there, but are, most of the time, silent spectators.

Usually a Post office, bank of Maldives, Internet cafes, good well-stocked shops and hotels would be there in the island. The general mode of transport would either be walking or by a bicycle provided. However in times of rain or at night for an emergency call, the hospital may provide ambulance to pick up  and drop you back.

There will be three shifts. An afternoon shift starts from 3:30pm to 11:30pm and the last starts from 11:30pm to 7:30pm the next day. For the specialists, they are required to work from 8am to 4 pm all days except Fridays.

There are times when the Medical officers may be in scarcity or may have fallen sick. In such situations the specialists will have to take the afternoon or night duties to make up the deficit. Those specialists working in the Atoll Hospitals will be expected to see general cases as well. The anesthetist will have to see OPD cases and even take over as physician, in the absence of the Physician. This usually is not divulged by either the agent or the Ministry.

The gynecologist and surgeon are expected to know how to perform ultra sonograms. There is no qualified radiologist at any island. There are times when the gynecologist will have to perform ultra sonograms for clinching a diagnosis of acute abdomen. Be prepared to have the management breathing down your neck when needed. One can be called at odd times to see non emergency cases as well. After developing a good rapport with the management, this could be smoothened out.

The theater may not be well appointed and the staff may not be well trained as well.

Some of the medications, which you are more familiar with, may not be available. The medicines are usually routed through a central store in Male`.

There may not be much of a workload at all, as when compared to India, Pakistan or Lanka. Some management policies insist the physical presence of those on duty, while some allow one to rest at home and come when called for.

Surgeons, Gynecologists, Orthopedists, ENT surgeons and Ophthalmologists may lose their operating skills here due to the scarcity of work. The people here can be rude and arrogant, mainly due to their ignorance. Many have not seen the world outside of their islands. Surgeons, anesthetists and gynecologists could be transferred from hospital to hospital as and when the vacancies arise.

All that glitters is not gold

Your offer letter may quote a figure for which you may be willing to work for. But, when the day comes to collect your salary you will be shocked to find a 15% reduction in the total amount – Adverse effect of the Global melt down!  You may call it cheating, uninformed reduction etc; etc; but, the fact is that you will go home with a less figure than what is quoted in the contract.

Although Ministry sets the guide lines for implementation of the contract each hospital follows its own rule. Due to this you may end up getting less overtime when compared to your colleagues working in some other Islands. This will further reduce your salary.

Dependants

Those who come with family would find getting a servant quite a horrendous task. The agents usually tell it is very easy. A Maldivian will generally be very lazy and so could not be relied upon when the time comes. The first 90 days are considered free tourist visa, but the airfares to the islands could set you back by almost 1000Rf. Take a sponsorship letter from the Ministry to avail the dependant fares. If planning to retain your dependants for a period longer than 90 days, make sure you complete the dependant formalities before you take off to the islands.

Those who come with their dependants will be expected to pay 250Rf per month as dependant fees. Please pay for either 6 months or 9 months if you are sure they would be with you for that period.

Photos have to be sent periodically and laminated cards will be issued by the Immigration and emigration department at Male`.

Those whose children are enrolled into the schools here will have to pay 100Rf in lieu of 250Rf monthly. Please bring along the birth certificates in English. Usually the Maldivian children are 7 years old while enrolled into the 1^st grade.

The medium of instruction is English and the syllabus followed is IGCSE. The school curriculum is usually from January to November. There will be a 2 week break in June and the annual vacation is from mid November to first week of January.

There is usually no school fees levied. If one decides to get their dependants here while working here, process the request for the same well in advance. Things move at a snail’s pace which is the norm.

Give an application to the respective Hospital administrator showing your passport copy, your work permit copy and also whom you plan to bring with their passport details, their flight details, their return dates and date of birth for children less than 12 years of age.

The ministry will be notified, who in turn would notify the Immigration and emigration department. Rarely, you may be allowed to fly to Male’ to escort them back. Staying at Male’ can be quite expensive (ranging from 40 $ to as much as 250$ per day). Arrange for the onward travel to the workstation as well.

Remittance of money

Normally the salary is deposited either in the local ‘Bank of Maldives’ or the SBI at Male`. One has to give the relevant details of the same to the Local Hospital Office while joining. Some islands have even the ATM facility and a VISA card will be provided linked to your account. One can transfer the money to SBI Male` (5 Rf commission for every 1000 Rf sent) It takes 3 working days for it to be credited into your SBI account at Male’. One has to send a fax to the SBI to instruct them to send the money to ones account in India. One can opt for Telex transfer, swift transfer, online transfer or even a Demand Draft. However, one has to collect the draft personally and then post it. Now-a-days they allow a maximum of 3000$ to be transferred per person a month with an interval of at least a week between the remittances.

Alternatively, one could also send money through the Western Union Money transfer from Male` or even through designated Post offices through the Money gram facility [provided you pay in US Dollars!]

Some even send the VISA cards back home where the money is withdrawn from any ATM machine after punching the secret number code. However, a sum not more than equivalent of 200$ can be drawn per day per card. Dollars are hard to get these days and the inflation has struck here as well. The latest rates vary to as much as 18 Rf against a Dollar in the black market.

Concluding remarks

It is indeed a welcome break for those who want a quiet life, relaxation and time to sort things out. Enjoy the morning walks, the non polluted crisp air, the pristine beaches, the turquoise waters, the cooking, the independent life, bask in the equatorial sunlight, abstinence from alcohol ( it is prohibited, unless at a resort) and idle away doing practically nothing and collecting a reasonably good purse. It all depends on ones priorities. There is enough time to read and prepare for a competitive exam for those inclined to do so. There have been many in the past who could even continue here for decades earning a name for themselves as sons or daughters of the soil. Some have even married from here. Of course, the threat of a tsunami always looms large. But, well the wrath of Mother Nature cannot be prevented. Always look into the fine prints before embarking here on a job. The image of Maldives as depicted in the web pages is not where one normally works. Those holding the work permit cards are entitled to a discounted stay at most of the resorts. There is even a submarine trip at Male’ which takes you down to the sea bed to see the amazing world there.

As of February 2010, the salary given will be after deduction of 15% , which will not be refunded. It is still a tax free country.

Accommodation is to be looked after by oneself at the islands. The respective hospital staff will assist in procuring the housing and bargaining of the rents. A sum of 1500 Mrf will be given towards the accommodation. It has been proposed to have a slab of 5000 Mrf to be given for the utility charges for GP`s and 7000 Mrf for the specialists.( this includes the housing, electricity gas cylinder refills and cable connection charges for the TV and telephone charges). It has been implemented from April, 2010 for those signing the new service contract. The specialists have been asked to sign the service contract. The medical officers are to follow another contract till as of now.  The specialists signing the service contract will get 37500 Rf as salary which includes the allowances and overtime will be extra.

Be prepared to have problems getting your salary in time while working in smaller islands. Make sure you get the dues in time and keep receipts of the same if any clarification is needed later.

Staff nurses have to clear the IELTS exam with an overall score of 5.5. They will be denied the registration with the respective Council. It may be a matter of time before the Doctors may have to follow suit. This has not been mentioned in the contract as of yet.

The site will be periodically updated.

Some useful links :

www.health.gov.mv

www.minivannews.com

http://www.haveeru.com.mv/english/

http://www.miadhu.com.mv/

These details and photos have been submitted by a doctor who has worked in Maldives for more than 5 years. Please bear in mind that since then, the recruitment process has changed. Refer to my previous blog. Also note that the level of the Maldivians thinking has fallen even lower!

Thanks Sir ji, for all your valuable insight which will give our readers a good understanding of various aspects of Maldives.

regards, 

mosquito