This year, Malta’s medical environment witnessed quite a few dramatic events. The country was rocked by demonstrations against Bill 28 (which spelt out in which circumstances a woman would be allowed to terminate her pregnancy). The bill was later amended and subsequently ratified in June after parliament unanimously agreed to it.
This was followed up with a scandal involving falsified medical certificates, which prompted the authorities to review how medical certificates are being assessed by disability boards.
The other major scandal involved the hospitals deal, which seems to have reversed itself, and which impacted heavily on the provision of the planned psychiatric and obstetric centres and the northern community hub. The trickle-down effects on government spending to compensate for missed opportunities and unnecessary patient suffering are incalculable.
Malta’s medical education did not fare for the better this year, either. Earlier last month, the European Digital University (EDU) disappointingly closed its doors to students just five years after being inaugurated by then education minister Evarist Bartolo. And the University of Malta’s Medical School global ranking fell down a tier in The Times (UK) higher education world rankings, suggesting increased competition from other campuses.
On a more positive note, COVID-19 has gained less attention this year and, for the first time, the authorities and the public have finally let go and continued with their daily routines.
People with diabetes can now access more medications via the pharmacy of their choice. Four oral preparations are available to improve diabetic control when previously two preparations were provided prior to adding on insulin.
People with diabetes can now access more medications via the pharmacy of their choice
In the private sector, the novel GLP-agonists are becoming ever more prominent but are still out of financial reach for some groups. The latter has been FDA-approved for diabetes control and weight loss in the UK and the US.
Health systems are facing new ethnographic needs. Doctors encounter more foreigners in their daily practice and are becoming more familiar with presentations of illnesses that vary from domestic cohorts.
Maltese patients are becoming older and more socially vulnerable after an epidemic, price hikes, overburdened medical services and fewer youngsters to care for them. Wealth will likely become concentrated in fewer individuals via inheritance as subsequent generations dwindle due to Malta’s meagre fertility rate. Unfortunately, this does not guarantee that people will escape poverty.
The next challenge for health professionals will likely be sociocultural, with an increase in the number of elderly patients requiring care for chronic illnesses, assistance in daily care, long-term care, dementia and pensioners working one or two jobs to keep up.
The number of young people providing services will decline unless foreign nationals participate. Health systems must start investing in keeping persons cared for at home and as independent as possible. This also means that community resources must be bolstered to avoid overloading specialised care.
The increase in demand will mean that salaries must increase if professionals are to remain employed, lest they go for independent setups working fewer hours, permitting the same income.
In the UK, the House of Commons has just decided to start implementing changes to rules for migrant families and work visas but has spared health professionals most changes, especially when over two-thirds of doctors covering foundation doctors (basic medical practitioners) are now migrants.
Similar changes are likely expected in Malta after it was reported by the media that the government has embarked on a series of measures to try to limit the number of non-EU nationals living in Malta. It is as if the populace woke up from a dream where migrants came in during COVID-19 to help sustain the economy.
My concern is that such measures tend to have unexpected effects on small economies. We are, after all, talking about human beings who kept the economy and healthcare systems on the island afloat and assisted when COVID-19 was thrashing Europe. It is also a concern that when economies get a taste of the boost provided by temporary workers, it becomes difficult to wean off.
Going back to the UK, changes include limits to the number of relatives of a migrant the country is willing to host, an increase in the baseline minimum salary that allows skilled workers to hold a visa (a jump of £12,000 to £38,700), a drop in the number of titles of jobs on the shortage occupation list, which provides benefits to migrant workers, and a review of educational visas.
What I hope for is a bit more common sense in prioritising doable social interventions that respect human dignity and intelligence, rather than sensationalist dreams.
Ian Baldacchino is a specialist in family medicine.