From crowded, chaotic Karachi of 20 million people, Doctor Owais Aziz seemed to have adapted well in the past six months, to life on Thulhaadhoo — a 380 metre-long, 230 metre-wide-island in the Maldives with, well, 2,800 islanders on it and white, grainy sand around it.

The island has a neatly-built school with 22 Indian teachers, a football field, and three general stores that sell Axe deodorants and Kashmir-brand rice from Pakistan, besides a mosque and a hospital. Many homes are made of broken corals.

Aziz has an 18-month contract with the Maldives government and is one of the two doctors on the island. “My colleague,” he says, “is from Jammu and Kashmir.”

Life is lazy, with a dozen patients a day on an average. The money is good, and on his off days, Aziz gets to jump into a motorboat and ride over the calm, transparent blue-green waters of the Indian Ocean to an uninhabited island to fish or to ponder at leisure about his upcoming marriage.

But the sea is not always calm. On days or nights when the waters are choppy and the rain is lashing, Aziz prays that there is no medical emergency on the island. “Rough seas is a big issue. We cannot transport patients to the atoll hospital or to Male, which has the biggest hospital. It is a helpless situation,” he says.

It’s not Thulhaadhoo alone that faces this crisis every now and then. There is one doctor for every 1,400 patients in the Maldives, but the problem arises when patients are stuck on one of the 200 inhabited islands — the Maldives has 1,192 — because of rough weather. Idyllic islands could then become isolated death traps.

For new President Mohamed Nasheed, expanding healthcare equitably across the Maldives is one among many challenges. Compared to many countries in Asia, the Maldives fares better on health indices but referral hospitals in the country are few. For advanced treatment, patients still fly to Singapore or India.

Nasheed, of course, has only just begun. It was October 9, 2008, when multiparty and multi-candidate elections were held in the Maldives for the first time in its 44-year independent history. The face-off was between Nasheed, a former journalist and political prisoner, and incumbent President Maumoon Abdul Gayoom.

The transition from a dictatorial regime to a democratic one was peaceful. But while Nasheed won the political battle, problems were looming.

The Maldives economy, for one, is creaking under a 34 per cent GDP deficit. A tourism-dependent economy, the economic slowdown has hit the country hard. Nasheed expects that a green tax of $3 on every tourist per day will inject some cash into the local economy. The green tax bill will be introduced in the coming session of Parliament. Prices were always high in the Maldives owing to its import-based economy. For example, the rent for a two-bedroom apartment in the capital Male is around $1,000 per month. In many instances, couples not known to each other have to share a two-bedroom apartment to cut costs.

The population of the Maldives is around 3.6 lakh and it has 39,000 civil servants. Nasheed recently told a group of journalists visiting from Colombo that he plans to cut the number of civil servants by 15,000. But first, he says, a “safety net” has to be created and they have to be trained for rehabilitation. “Can’t throw them on the street.”

Then there is the dark, portentous cloud of global warming hanging over the islands. Thulhaadhoo, for one, is facing severe coastal erosion. It is among the 50 islands where the sea is greedily eating into the land; several more could be drowned as sea water slowly rises. At least 16 need immediate intervention.

Nasheed called the Maldives a ‘frontline state’ in the battle against global warming and is pinning hopes on India to stop the ‘you-did-it (global warming)’ and ‘I-did-not’ rhetoric with the West and look for a solution at the December climate summit in Copenhagen.

And even if the ‘doomsday scenario’ was of relocating the entire population when the sea water rises to the neck, the idea, environment minister Mohamed Aslam said, was to stay afloat and fight global warming. Might as well. Not many on the beautiful islands have the option of returning home after 18 months as Owais Aziz from Karachi has.