Current Practice
There is one government tertiary referral hospital in the capital with approximately 350 beds and a 15 bedded ICU with ventilators. There are a total of 7 operation theaters divided over two buildings. 3 of these theaters is dedicated to obstetrics and gynaecology surgeries. The other 4 theaters provide service to orthopedics (spine, joint replacement, trauma and paediatric), general surgery, ENT, maxillofacial, urology, ophthalmology, bronchoscopy. In addition, anaesthesia is provided for CT scan, MRI and interventional cardiology. Six days a week we run a pre anaesthetic walk in clinic. End of 2018 it is expected that an additional 4 operation theaters will come into service along with endoscopy services requiring provision of anaesthesia. Approximately 4000-5000 cases are done per year.
There were 3 private hospitals in the capital area providing anaesthesia services with about 5 operating theaters at beginning of 2018 with one facility providing Neurosurgery services. In 2018 cardiothoracic surgery facilities has been started at one of these hospitals and additional 3 operating theaters have been introduced. In March 2018, a new private 188 bedded tertiary multidiscipline hospital with facilities for cardiothoracic surgery has been opened. Some neonatal surgeries are performed at these private hospitals and the government hospital.
In the remaining regional and atoll hospitals under the ministry of health, one or two anaesthetists per hospital provide anaesthesia for obstetric services and limited general surgical / orthopedics surgeries.
Key Challenges
We do not have adequate number of local anaesthetists and as such have to depend on foreign anaesthesiologists. The government sector finds recruiting anaesthesiologists challenging as the salaries in countries from where we had been hiring has improved while salary in government sector in Maldives did not improve. As such we have difficulty filling vacancies in the public sector. In addition, there has been a steady movement of the limited trained anaesthesiologists to the private sector further compounding the problem. Majority of Maldivians are dependent on the government hospitals as they are free of charge.
We need to find more training opportunities and ways to attract more doctors for anaesthesia training.
Due to the geography of Maldives, there is a huge challenge in providing anaesthesia for all at the level provided in the capital region. Most people still travel to the capital for most surgeries. facilities at regional levels has to expand and the public’s perception of these facilities needs to be improved.