50 years ago: Expert’s survey of ENT diseases in Male Island

1. At a Glance

• This is a "From the Archives / 50 Years Ago" item. It reprints a report filed from Madras on October 11, and appeared on page 11 of the Chennai print edition of The Hindu on 12 October 2026. Fifty years back puts the original report in 1976 (inferred from the "50 years ago" format). [1]
• It describes the first ENT (otorhinolaryngology) expert to set foot in Malé, capital island of the Republic of Maldives: Dr. S. Kameswaran of Madras Medical College, who went on a short WHO assignment. [1]
• UPSC relevance: early Indian medical outreach to the Maldives through a multilateral (WHO) channel. It is an example of health diplomacy, links to India's "Neighbourhood First" policy, and shows the island geography–disease link. [1]
• The present-day hook is the Maldives health system, now anchored on Indira Gandhi Memorial Hospital (IGMH), Malé. [2][3]

2. Why in the News

• 2026 marks 50 years since the reported WHO-sponsored ENT survey; The Hindu reprinted the item on 12 October 2026. [1]
• Related current hook: on 13 October 2025 WHO validated the Maldives as the first country in the world to achieve "triple elimination" of mother-to-child transmission of HIV, syphilis and hepatitis B. [4]

3. Background & Evolution

• Origin (≈1976): the WHO gave Dr. S. Kameswaran a short assignment in the Maldives with four tasks: [1]
• conduct a sample survey of ENT diseases
• hold special clinics
• organise a training course for health personnel

• advise and help the Maldivian Government set up ENT units in health centres

• Why it was needed: the population was "extremely prone to upper respiratory tract infections". The report gives three reasons: [1]

• occupational hazards, since fishing, swimming and diving were near-universal
• vitamin-deficient food, with a staple diet of fish and rice

• inclement weather

• What he found: "I have never seen so many cases of chronic tonsillitis, adenoiditis and mastoiditis." (Dr. Kameswaran) [1]

• Health infrastructure then: Malé had a 52-bed modern hospital with an operation theatre. [1]
• Later milestones:
• 2 July 2023: WHO recognised IGMH as a National Influenza Centre (NIC). [2]
• 13 October 2025: WHO validated the Maldives' triple elimination of mother-to-child transmission, with IGMH credited as the national reference hospital and laboratory. [4]

4. Core Static Facts

Item	Fact	Src
Expert	Dr. S. Kameswaran, Director, Institute of Otorhinolaryngology, Madras Medical College	[1]
Sponsoring body	World Health Organization (WHO), short assignment	[1]
Distinction	First ENT expert ever to set foot in Malé	[1]
Maldives population (then)	1,25,000	[1]
Islands in archipelago	~2,000	[1]
Permanently inhabited islands (then)	192	[1]
Total land area	115 sq miles	[1]
Malé population (then)	20,000	[1]
Malé hospital (then)	52 beds, with an operation theatre	[1]
Diseases highlighted	Chronic tonsillitis, adenoiditis, mastoiditis (upper respiratory tract / ENT)	[1]
Main occupation / diet	Fishing; fish and rice	[1]
IGMH today	Largest health facility in the Maldives; publicly funded; serves ~150,000 in Malé; the sole public-sector tertiary care provider	[3]
Regional hospitals	Six atoll hospitals designated as regional hospitals, which depend on the central hospital for referrals	[3]

5. Multi-Dimensional Analysis

Geopolitical / Strategic

• Indian medical expertise reached the Maldives through the WHO, a multilateral route that came before today's bilateral health diplomacy. [1]
• A doctor from Madras being the first ENT specialist in Malé shows how much the Maldives depended on regional specialist manpower. [1]
• Today, IGMH is the single tertiary hub for an island country, which makes it a focal point for health-capacity partnerships. [3]

Social / Health

• The disease burden was shaped by livelihood: daily swimming and diving in fishing communities. This is an occupational-health angle. [1]
• A vitamin-deficient diet of fish and rice points to malnutrition worsening chronic infections. [1]
• Equity gap: complex services (advanced cardiac care, orthopaedic surgery, advanced imaging) are still not available in the atolls. [3]

Geographical

• The population is spread thinly: only 192 of ~2,000 islands were inhabited, on just 115 sq miles of land. This makes services hard to deliver and forces centralisation in Malé. [1]
• Inclement weather is named as one of the drivers of respiratory disease. [1]

Administrative / Governance

• The mission's approach was survey → clinics → training → institution-building (ENT units in health centres). It is a template for technical assistance. [1]
• Referrals still depend heavily on the central hospital, a hub-and-spoke bottleneck. [3]

Historical

• Comparing a 52-bed hospital for 20,000 people (1976) with IGMH serving ~150,000 today shows how fast Malé has urbanised. [1][3]

6. Recent Developments (last 12–18 months)

• 13 Oct 2025: the Maldives became the first country to achieve triple elimination of mother-to-child transmission of HIV, syphilis and hepatitis B, validated by WHO, with IGMH as the national reference hospital and laboratory. [4]
• 12 Oct 2026: The Hindu reprinted the 50-year-old report on the ENT survey. [1]
• Earlier context: WHO recognised IGMH as a National Influenza Centre on 2 July 2023. [2]

7. Prelims Hooks

• Dr. S. Kameswaran was the first ENT expert to visit Malé, the Maldives capital, on a WHO assignment (≈1976). [1]
• He was then Director of the Institute of Otorhinolaryngology, Madras Medical College. [1]
• In the 1970s report, the Maldives had ~2,000 islands, of which 192 were permanently inhabited. [1]
• Total land area of the Maldives in that report: 115 sq miles. [1]
• Maldives population in that report: 1,25,000; Malé: 20,000. [1]
• Malé then had a 52-bed modern hospital with an operation theatre. [1]
• Diseases reported as unusually common: chronic tonsillitis, adenoiditis, mastoiditis. [1]
• Main occupation: fishing; staple food: fish and rice. [1]
• IGMH, Malé is the largest health facility in the Maldives and the sole public-sector tertiary care provider. [3]
• The Maldives has six atoll hospitals designated as regional hospitals. [3]
• WHO recognised IGMH as a National Influenza Centre in July 2023. [2]
• The Maldives is the world's first country to achieve triple elimination of mother-to-child transmission (HIV + syphilis + hepatitis B), in October 2025. [4]

8. Why One Hospital in Malé Still Carries the Whole Country

• The 1976 problem has not gone away. It has only grown bigger
• In 1976, all specialist care meant one 52-bed hospital in Malé [1]. Today, IGMH is still the only public-sector tertiary hospital (the top level of care, for complex cases) [3].
• The six regional hospitals depend on it for referrals. Complex services like advanced cardiac care and advanced imaging are still not available in the atolls [3].

• So the country has grown, but the system is still built around a single centre.

• Weak primary care fills up the big hospital

• Primary health care (PHC) is the first, local level of care: a clinic on your own island.
• WHO's Regional Director said that low spending on PHC in the Maldives has directly raised the cost of tertiary care and made the big hospital more crowded [8].

• The diseases Dr. Kameswaran saw were chronic: tonsillitis, adenoiditis, mastoiditis [1]. Treated early at an island clinic, such infections need not reach a surgeon in Malé. Left untreated, they do.

• The sea is the ambulance route, and it is slow

• There are no roads between islands. Emergency care means crossing open ocean by boat or air.
• WHO names "the geographical remoteness of many islands" and the difficulty of "traversing vast oceanic distances" as the core problem for emergency care [6].
• So every gap in island-level care becomes a costly, risky transfer to Malé.

9. Training Local Staff Is Harder Than Sending an Expert

• The 1976 mission saw the real need: training, not just treatment
• Only one of Dr. Kameswaran's four tasks was holding clinics. The others were a survey, a training course for health staff, and setting up ENT units [1].

• A visiting expert leaves after a few weeks. Only trained local staff and working units stay behind.

• Fifty years later, the Maldives still relies on foreign doctors

• A WHO mental health system report found that a large share of doctors in the Maldives are expatriates (foreign workers), and that turnover is high [7].
• Doctors leave the atoll clinics most often. Remote postings offer little career growth, and life on small islands is hard [7].

• So a clinic may have a doctor this year and none the next. That undoes the 'ENT units in health centres' idea from 1976.

• The lesson for any donor, India included

• Measure success by how many local staff are trained and kept in service, not by how many expert visits take place.
• An expert's visit or a new building makes news. A Maldivian doctor who stays on an outer atoll for ten years is what changes outcomes.

10. From WHO Visitor to Bilateral Donor: How India's Role Changed

• In 1976 India's help came under a WHO flag. Today it carries India's own name
• Dr. Kameswaran went on a WHO assignment, not as a Government of India envoy [1].
• Today, India funds health projects directly. A major renovation of IGMH, paid for by the Government of India, was completed in June 2017 at a cost of ₹52 crore. External Affairs Minister Sushma Swaraj dedicated it to the people of the Maldives in March 2019 [5].

• India has also carried out MEDVACs (medical evacuations by air or sea) and search-and-rescue operations since 2019. A team of Indian medical specialists has served at the Maldives National Defence Force's Senahiya Hospital in Malé [5].

• The trade-off between the two routes

• Multilateral route (through WHO): it is seen as neutral. The help is not tied to one country's image, but the donor gets little visible credit.
• Bilateral route (country to country): India gets visible goodwill. A hospital named after Indira Gandhi is a daily reminder.

• The cost is that bilateral help can get pulled into domestic politics in the receiving country. Help that the Maldives itself owns, like trained staff and its own guidelines, lasts longer than help it borrows.

• The Maldives is now building its own systems with several partners

• In 2025 the Ministry of Health launched Emergency Medical Services (EMS) Guidelines and Mass Casualty Management Guidelines with WHO and the Asian Development Bank (ADB) [6].
• So India is one partner among several. Its health diplomacy works best when it supports plans the Maldives itself owns.

11. Anchors for Answers

• Data: ₹52 crore — the cost of the Government of India-funded renovation of IGMH, Malé, completed in June 2017 [5]
• Data: 1 public-sector tertiary hospital (IGMH) and 6 regional hospitals for the whole country, a hub-and-spoke model [3]
• Report/Committee: Maldives EMS Guidelines and Mass Casualty Management Guidelines (2025, Ministry of Health with WHO and ADB) [6]
• Report/Committee: WHO-AIMS Report on the Mental Health System in the Maldives — high share of expatriate doctors and high turnover [7]
• Comparison: 1976 WHO technical mission (survey, training, ENT units) versus today's bilateral Indian help (hospital renovation, MEDVACs, specialist teams) [1][5]

12. Mains Relevance

• GS-II: India and its neighbourhood (relations); important international institutions (WHO); issues relating to health.
• GS-I: Geography, specifically physical features of the Indian Ocean island region and how they affect settlement.
• GS-III (minor): Science and technology, specifically health infrastructure.
• Possible question stems: 1. Health diplomacy has been an enduring pillar of India's relations with small island neighbours. Examine with reference to the Maldives. 2. Geographical dispersion poses unique challenges to healthcare delivery in archipelagic states. Discuss, citing the Maldives' hub-and-spoke health system. 3. Evaluate the role of WHO technical assistance in building health-system capacity in developing countries of South Asia.

13. Related Topics to Study Next

• India–Maldives relations: the bilateral context for health, infrastructure and security cooperation.
• Neighbourhood First and SAGAR doctrine: the policy frame for India's outreach to Indian Ocean island states.
• WHO South-East Asia Region (SEARO): the Maldives and India are both in this region. [3]
• Triple elimination of mother-to-child transmission (EMTCT): the Maldives is a global first, and India is still working towards it. [4]
• Global Influenza Surveillance and Response System / National Influenza Centres: the network IGMH joined in 2023. [2]
• Small Island Developing States (SIDS): vulnerabilities in climate, health and connectivity.
• Lakshadweep and Minicoy: an Indian archipelago with similar geography, next to the Maldives.

14. NCERT Concepts to Revise

• Maldives (Geography): The whole article is about health conditions and medical outreach in the Maldives, India's island neighbour.
• Atoll (Geography): Maldives is made of coral atolls; thin, scattered island settlement explains why health services are hard to deliver.
• Sample survey (Economy): The expert's task was a sample survey of ENT diseases, observing a few people to judge the whole population.
• Malnutrition (Economy): A vitamin-deficient diet of fish and rice worsened chronic infections among islanders.
• Infrastructure (Economy): Hospitals, ENT units and the hub-and-spoke referral system are health infrastructure that the mission aimed to build.
• Lakshadweep Islands (Geography): India's own coral archipelago just north of the Maldives, with similar geography and health-delivery challenges.

15. Common Errors / Trap Areas

• The year: the article ran in 2026, but the event is from ~1976. Do not attribute the survey to 2026. [1]
• The sponsor: the mission was a WHO assignment, not a bilateral Government of India programme. [1]
• Island counts: "~2,000 islands" and "192 inhabited" are 1970s figures from the article. Current counts and population differ, so do not use them as current data. [1]
• Population figures: the "~150,000" served by IGMH is for Malé city only, not the national population. [3]
• "Triple elimination": the three diseases are HIV, syphilis and hepatitis B. It is not HIV/TB/malaria. [4]