New Governing Body Elected

Maldivian Medical Association held its Annual General Meeting on the evening of 24th April 2009. Annual report of 2007 and 2008 was presented by the Vice President Dr Ibrahim Shiham and the Financial Reports for both the years was presented to the members by the Treasurer Dr Ashraf Ali. All four reports were unanimously accepted by members. The members also decided and voted on different issues relating to the future and functioning of the association. Significantly, it was decided to reduce the term of the governing body from 2years to one year.

At the end of the meeting the results of the Election was announced and all the single candidates got the thumbs up from the members. Below is the newly elected Governing body with the approval percentages in brackets. We congratulate all of them and wish the new governing body all the best.

Newly Elected Governing body, 2009
President Dr. Abdul Azeez Yoosuf (97.14%)
Vice President Dr. Yoosuf Shan (100%)
Executive Secretary Dr. Fathmath Nadhiya (94.44%)
Deputy Secretary Dr. Moosa Hussain (94.44%)
Academic Secretary Dr. Ali Abdulla Latheef (97.22%)
Scientific Secretary Dr. Rizana Abdul Ghafoor (97.22%)
Treasurer Dr. Ibrahim Rasheed (100%)
Spokes Person Dr. Ali Muznee (91.43%)
Health Promotion Coordinator Dr. Jumailath Beygum (97.22%) h

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All set for voting in a new Governing Body!

Time for contesting for elections has closed. Interestingly for each post only one candidate has come forward and thus unless members take serious exception the next Governing Body members will be these very capable individuals. We wish all the candidates the very best.

Candidates for the Governing Body - 2009 of Maldivian Medical Association are as follows.
President Dr. Abdul Azeez Yoosuf
Vice President Dr. Yoosuf Shan
Executive Secretary Dr. Fathmath Nadhiya
Deputy Secretary Dr. Moosa Hussain
Academic Secretary Dr. Ali Abdulla Latheef
Scientific Secretary Dr. Rizana Abdul Ghafoor
Treasurer Dr. Ibrahim Rasheed
Spokes Person Dr. Ali Muznee
Health Promotion Coordinator Dr. Jumailath Beygum

Voting for the above mentioned posts will be held from 1900 to 2200 on Friday, 24th April 2009.

Results will be announced at 2230 on Friday, 24th April 2009.

Should you have any queries or concerns regarding the elections, please feel free to contact us.We encourage all members to actively participate and wish all the candidates the best of luck.

Annual General Meeting 2009

Annual General Meeting (AGM) of Maldivian Medical Association is scheduled for 24th April 2009. Election for the new Governing body (of next 2years) will take place during the AGM. The deadline for submission of application forms to contest the election is 12 pm (noon) on 23rd April 2009. The application forms are available from the Election Commission, Governing body members and can also be downloaded from our website.
All members are requested to attend the AGM and be there for the voting. We wish all the prospective candidates best of luck. With the current trends and challenges we as a profession are facing it is of immense importance that those of us who can contribute come forward. Thus we urge all members to contest the elections and enthusiastically take part in the AGM.
Venue: Lecture Hall, IGMH
Date: 24th April 2009, Friday
Time: 7pm (Voting starts at 7.30pm)

We look forward to your presence.

Happy Doctors' Day
18TH APRIL
Maldivian Doctors’ Day was celebrated by the Maldivian Medical Association on Saturday, 18th April 2009. The celebrations culminated in a highly entertaining performance by the Doctors on the stage of Dharumavantha School in the evening of 18th April in a special function held to commemorate the day. The special guests of the evening, it was announced, were all the doctors and the day was dedicated to those hardworking professionals working selflessly for the betterment of the individual patients and the sector itself, despite myopic disruptive campaigns by many in places of immense responsibility. We feel that the difficult circumstances in which health care is being provided has been wittingly or unwittingly created by some shortsighted but influential persons whose efforts to gain some short term advantage for themselves, demoralize and harm the medical profession and health sector itself. But averted from our cause we are not! we seemed to be saying by showing our high spirits and togetherness that we will face any challenge put forward by those with vested interests. Thus we salute those courageous doctors who are boldly and firmly standing up for the rights of the patients and in the interest of the health services at a time when many seem to have forgotten the basic fundamentals of health care provision.

17th April 2009.
The ‘Every Life Matters’ campaign that the association has taken upon itself for the second year in running got underway on 17th April in Maafannu Madhrasa. Not only was basic life support demonstrated and taught by those doctors handling it on a day to day basis, but the event went a step further offering the expertise and experience of seasoned clinicians where anyone could just walk in and asks our panel any health related questions. It was a great success with many members of public walking in and availing of the offered opportunity.

16th April 2009
The final! Third year in succession one of the main draws to the doctors’ day celebrations remain the 6-a-side football tournament. The final day was highly and in some cases tragically eventful. The kick-off of the match between the ADK team and FC Stamina, both of whom had already advanced to the finals, was in no way lacking in competitiveness. The first half saw FC Stamina exerting itself well and by half time they were leading 2-1. Then just as the 2nd half was about to commence tragedy struck. Dr Shaurav who came on as the substitute goal keeper for FC Stamina in his warm up exercises fell down square on his back and had to be ‘rushed’ to the hospital after an agonizing wait for transport. The match was abandoned since time was running out and the 2nd match of the day FC Adrenaline playing against Arrest team was almost a non-starter with the FC Adrenaline having to ‘borrow’ many a player from other teams to play the match. Predictably it was the Arrest team that won the match earning them the 3rd spot.
The final between FC Stamina and ADK team was slow to start but the referee (Dr Faisham) managed to heighten the tempo by awarding a very controversial goal to the ADK team. After a fierce battle the match ended in a draw 1-1, and extra time commenced. It was in the 2nd half of the extra time that the victorious ADK team scored a decisive goal and the match ended 2-1 crowning the ADK team as the champions.

Maldivian Doctors' Day
16 Apr 2009

18th April, celebrated every year for past 3 years. This is 4th year we are celebrating it. It denotes the day Maldivians started getting services of the first Maldivian Doctor. (Dr. ND Abdulla)

Activities planned:
18th April: Official Dinner and entertainment , 8pm in Dharumavantha School Hall
15th n 16th:
Futsal tournament
Four teams participate. Venue: Futsal grounds. 4.30pm onwards on 15th and 16th April.
Dodgeball tournament
Venue: Thaajuddeen compound from 8pm on 15th and 16th April. Many female doctors have been complaining there is no game they can really participate so now here it is. It has 8 teams participating

Open day “Every life matters -2”. This is the second of its kind by MMA. This time the venue is Maafannu Madarsa Hall, got after our team spent many hours talking to almost every school sun had risen to on this island. Last year was held in Kalafanu.  MMA doctors will teach public how to handle emergencies like CPR, Drowning etc … as well as provide a forum to ask and get advice from specialists from different medical fields.
Future and Challenges to Health Care System. Initiative taken again by MMA to discuss the various issues plaguing the health care services and conveniently overlooked by many. Live radio discussion is to be on 19th morning on Sun FM from 10am and we are working on a TV program to discuss the same issues in a bigger panel. Details still are being worked out.

UPDATE:
FUTSAL TOURNAMENT
The Madivian Doctors’ Day celebrations went underway on 15th April at the futsal grounds with the roll of the football.
The first match was between FC Stamina (FC Fatigue of last year) and Arrest Team (Emergency dept of IGMH). After an entertaining match which saw a hat-trick by Dr Nazeem, who had to be carried away from the field at the end of the match, FC Stamina came away with 3 points and 3 goals to its credit.
The next match between Arrest team and ADK team was initially dominated by high flying ADK players but soon Arrest team started to look like they had had enough warm up (second half of their second match!). The match was won by ADK team 3 goals to 1.
Last match of the day was between FC Stamina and FC Adrenaline (Clinical Assistants of IGMH). In this match FC Stamina true to their name showed their stamina is cheering so the players kept insisting to getting off the field for rest and cheerleading. On the field players were seen in different stages of lying down while the FC Adrenaline team showed where the real adrenaline was – with the girls cheering their team from sidelines. So an exciting match, closely contested on the field with Stamina and adrenaline displayed more off the field the FC Stamina came victorious with a score line 3-1.
16TH APRIL will see 3 more matches of the tournament including the final match, insha Allah.

DODGE BALL TOURNAMENT
8 teams competing both on and off the dodging arena, displaying their skill at dodging, throwing and catching saw health care persons from all departments (medicine, ortho, surgery, dental, gynaecology, dermatology, laboratory of IGMH,ADK …) enjoying themselves to the fullest. Each team donning their colors, expressing themselves with high pitch decibels, showed a team spirit worthy of any competitive sports in any place. War cries abounded (especially from the blue team and yellow team – ADK and CATs) terrifying the daylights out of some. At the end the finalists were the CATs team (yellow), name of which is kept secret from its members for unknown reasons, and DT Side effect (mixed bag of players but mostly medical dept and laboratory). This clash which saw many players biting the dust literally ended with the crowning of the DT Side-effect as the champions of this first ever Dodge ball tournament organized by Maldivian Medical Association.

Dodge Ball Tournament-TEAM LIST
Foot Ball tournament-TEAM LIST

MMA News Release
18 Mar 2009

News Release cum Open Letter published today in Haveeru Daily by the Maldivian Medical Association in response to the mis-information and defamation campaign the Civil Service Commission is carrying out against the doctors.This release is to set the record right. And as information for those interested. Kindly read the document and make a personal effort to make the public understand the dire problem that awaits the whole health sector should the CSC be allowed to wreck havoc.
News Release PDF

MMA reaffirms its position on EECP

Maldivian Medical Association is greatly disappointed by the behavior and lack of any social responsibility shown by certain business enterprises involved in the health sector. From 28 March 2008 our web site has carried concerns regarding the clearly false and misleading statements contained in the leaflets distributed by the newly sanctioned clinic IMDC. Though the group chose to ignore these concerns, once the same concerns were raised in a public forum on 3rd April 2008 the representatives of the clinic chose to hastily attempt to demonize and discredit the medical community rather than recant the false claims. Though profits are expected to be high on priorities of any business enterprise the response seen is totally unbecoming of any group even remotely involved in matters dealing with health.

Representatives of IMDC have not only chosen to show utter disregard to the context and spirit of the statements made by MMA but also to the content. While we maintain that we are not an association conducting medical research our statements and findings reflect the current scientific knowledge base attaining consensus rather than conclusions of isolated studies. Hence we standby our observation that certain statements published and distributed by IMDC in their effort to promote EECP is both misleading and false. Here we present only some evidence for it but would like to invite all concerned to read our position statement number 02/08 dated 27 March 2008 before approaching us for more details.

IMDC Leaflet: Page 1, last sentence (in reference to EECP):
“The most advance and FDA approved treatment for heart patients”

1. American Heart Association/ American College of Cardiology: (ACC/AHA/SCAI) Practice guidelines, Circulation, 2006;113;e166-e286, February 21, 2006 states:
In patients with refractory angina who have no vessels suited for revascularization, a number of new therapies are being tested. Enhanced external counterpulsation (EECP) appears to decrease symptoms.

2. ACC/AHA guidelines for the management of patients with unstable angina and non–ST-segment elevation myocardial infarction
Other less extensively studied techniques for the relief of ischemia, such as spinal cord stimulation and prolonged external counterpulsation, are under evaluation.

3. Ontario Health Technology Advisory Committee, OHTAC, Literature Review of Enhanced External Counterpulsation
Completed February 2003
Updated March 2006
Very recently, investigation began into EECP as an adjunctive treatment for patients with HF. Anecdotal reports suggested that EECP may benefit patients with coronary disease and left ventricular dysfunction. The safety and effectiveness of EECP in patients with symptomatic heart failure and coronary disease and its role in patients with nonischemic heart failure secondary to LV dysfunction is unclear. Furthermore, the safety and effectiveness of EECP in the different stages of HF and whether it is only for patients who are refractive to pharmacotherapy is unknown.

4. 2005 ACC/AHA guideline update for the diagnosis and management of chronic heart failure
Until more data are available, routine use of this therapy cannot be recommended for the management of patients with symptomatic reduced LVEF.

Maldivian Medical Association observes: These statements by independent authorities in cardiology clearly shows the actual standing of EECP in the scientific community. It is indeed very different from the assertion that this was the most advanced therapy for cardiac patients. The role of EECP in cardiac care is currently just being evaluated and tested according to American College of Cardiology (ACC) and American Heart Association (AHA) and many other non profit professional organizations, and in such a situation it is definitely unethical and misleading to promote it to the public in this manner.

IMDC Leaflet: Page 4, Line 18 (in reference to EECP):
“EECP has numerous distinct advantages over surgery.”

1. Technology Evaluation Center (TEC), USA, External Counterpulsation for Treatment of Chronic Stable Angina Pectoris and Chronic Heart Failure, Assessment Program, Volume 20, No. 12, January 2006
The available evidence does not permit conclusions regarding the effect of ECP therapy on health outcomes or compared with alternatives. … It has not yet been demonstrated whether ECP therapy improves health outcomes in the investigational setting. Therefore, it cannot be demonstrated whether improvement is attainable outside the investigational settings.

2. Heart. 2003 August; 89(8): 830–833
At present, EECP use should be limited to patients with debilitating (functional class III and IV) refractory angina pectoris who are not candidates for revascularisation, are symptomatic despite being on maximal antianginal pharmacotherapy, and have no contraindications to EECP use.

Maldivian Medical Association observes: Here the Technical Evaluation Center, USA after much review of literature clearly states that the there is not enough evidence to compare EECP to other modalities whereas the IMD clinic has not only compared EECP to bypass surgery but are boasting of advantages over surgery thus unduly promoting it. As the authoritative academic journal “Heart” asserts, EECP should only be considered when bypass surgery (one form of revascularization) cannot be done. Thus to compare this second choice option to the primary therapy is misleading and has no evidence behind it.

IMDC Leaflet: Page 4, Line 24 (in reference to EECP):
“No side effects.”

1. Journal of the American College of Cardiology
Volume 33, Issue 7, June 1999, Pages 1833-1840, The multicenter study of enhanced external counterpulsation (MUST-EECP)
Exercise duration data were available for 57 subjects in the active-CP and 58 in the inactive-CP group. Fourteen subjects in active CP were not evaluable for exercise duration: four had protocol violations, seven (ie. 12.3%!) withdrew because of adverse experiences and three dropped out for personal reasons

2. Heart. 2003 August; 89(8): 830–833
The rate of adverse experiences was 4%. The placebo effect of the device can not be ruled out, as this report is from a cohort study.

3. Journal of the American College of Cardiology
Volume 33, Issue 7, June 1999, Pages 1833-1840, The multicenter study of enhanced external counterpulsation (MUST-EECP)
More patients in the active-CP group reported adverse events than in the inactive-CP group: 39 (55%) versus 17 (26%), p < 0.001. Ten of the 25 events reported by the 17 patients in the inactive-CP group were considered device-related, involving either the skin, lower legs or back.

4. Heart. 2003 August; 89(8): 830–833
Compared with patients without heart failure, significantly fewer patients with a history of heart failure completed the course of EECP and exacerbation of heart failure was more frequent in them.

5. Heart. 2003 August; 89(8): 830–833
At six months, (after EECP) patients with history of heart failure, although maintaining their reduction in angina, were significantly more likely to have experienced a major adverse cardiac event.

6. European Society of Cardiology, E-journal of Cardiology, Volume 3, 2004
EECP has not been associated with life-threatening complications; however, some bothering side effects may occur during treatment, including leg or back pain, skin abrasion or edema, headache, dizziness, epistaxis and respiratory discomfort.

Maldivian Medical Association observes: These evidence clearly shows that the claim to ‘no side effects’ is entirely false and baseless. It is also inconceivable that the clinic while preparing the promotional leaflet was not aware of this fact as we have quoted from major American, European authorities as well as from the only randomized major study (MUST EECP) done on EECP.

IMDC Leaflet: Page 4, Line 22 (in reference to EECP under “Advantages over surgery”):
“No additional medication.”
Maldivian Medical Association comments: Since after surgery it’s only the current medication that is continued (it is expected that all concerned are aware of this medical fact) this statement can only be in reference to the same medication. And as it alludes to a difference between surgery patients and patients undergoing EECP the only logical conclusion is a difference in medication between a post surgical patient and post EECP patient. Hence despite a sentence within the same document to the contrary (highlighted by the group in public) this is an untenable misleading claim still existing in the promotional leaflet.

It is hoped that this time rather than taking issue with professional bodies including the AHA and ACCP (which it is hoped even the clinic’s representatives recognize as leading professional authorities in Cardiology) the clinic named IMDC will exert efforts to promptly discontinue the use of misleading and false medical statements in their promotional material.

However the initial response by the clinic and its representatives of not correcting its misleading claims but rather targeting those who brought the subject to public notice is evidence to the fact that the claims were not an oversight but a deliberate attempt to dupe the public. This testified intention to continue aggressively in this path with no regard to other considerations is a greatly disturbing attitude which is intolerable in health sector whatever is the background of the involved party/parties. While this association does not consider it its job to question the integrity, whether professional or not, of such groups we do openly question the intentions of the said group.

The fact that many a cardiac patient not only gets referred for EECP wrongfully but indeed gets the procedure done while being prime candidates for bypass surgery is a sad truth we unfortunately have to see very frequently in Maldivian patients. And it gives us no pleasure to note that some of these patients have subsequently suffered repeat infarctions (heart attacks) which we can safely presume a prior CABG could have helped prevent. Thus when the same procedure, which in reality is a medical fall back option, is launched here with promotional claims which are not fully truthful we are justified in bringing to the public the fact that people do wrongfully get referred for EECP. The association cannot be held responsible for losses in profits incurred due to a sensitized and informed public.

While, as we noted in our press conference, some standard research and service institutions do offer EECP in accordance with current guidelines, as a last resort when nothing else is possible, these hospitals do not advertise it as the most advanced care for cardiac patients or claim it has nil side effects. Thus rather than comparing the Maldivian clinic to these reputed centers where the standard options are also readily available, it is strongly advised that IMDC take steps to ensure it does not become just another center where Maldivian cardiac patients are exploited. This association has no material benefit or loss linked to business of clinics and thus whatever statements we issue is done in the interest of the general public only. And we do not give any weight to arguments such as ‘this many people/clinics agree with us’ when giving an opinion which should be based on study of hard medical evidence.

We would also like to categorically state here that despite the wishes of some investors this association will not act as an advisor to business ventures in health sector, and thus will not approach any investors with advice regarding how to conduct themselves. But it is expected that certain standards will be adhered to by such enterprises and in case there is disregard to these and it comes to the notice of this association we will not hesitate to bring it to the notice of the responsible authorities and ultimately to the public.

We reiterate that despite all efforts to thwart us, the Maldivian Medical Association will continue to take up such issues and where the rights of patients are trampled upon, consideration will not be given to the profits of any investing party. Thus all are advised to stick to good practice and ethical standards while advertising/promoting as well as while practicing.