The state of our health sector
The term ‘health’ does not just mean absence of illness or disease. It also includes physical and mental well—being. However, given the state of our health service delivery system, even physical and mental well—being is adversely affected – if not the patients’, then their family member’s.
Hospitals, doctors and health care
According to statistics, there is one hospital bed available per 2,732 persons and doctor per 3,125 persons according to the Bangladesh Bureau of Statistics. The quality of medicine has gone down and adulterated food, drink and medication has created a negative impact all over the country. For example, in 2008, the disease Kala zar struck 45 districts and it was reported that 7 persons had died after taking the medicine Miltefosin. The medicine was tested in a WHO approved laboratory—and found to be inadequate. Again, in the early 1990’s infants in Bangladesh were falling grievously ill due to adulterated Paracetamol-based medication and on June 5, UNB reported from Faridpur that ‘some 150 children aged between six months and five years reportedly fell sick day before after taking Vitamin A capsules and deforming tablets at Charshalipur village in Charbhadrashan upazila’. On June 9 The New Age reported, ‘Another child reportedly died of complications from Vitamin A plus capsule and antihelminthic or deforming tablet in Munshiganj on Sunday night raising the number of such deaths to two and several thousand children across the country fell sick in the last three days after taking the medicine.
Though there are hundreds of upazila health complexes all over the country, it is hard to find service. Denationalization and privatization campaigns of successive regimes have made the situation worse. Conditions imposed by international financial institutions and multilateral donors have made things more complex. Medical service has become a money minting machine instead of a national service. Poor taxpayers rarely get even standard treatment and their health situation has been compromised with the trends of consumerism and commoditization.
Health services are delivered by specialized personnel. When one thinks of health and well being, one of the first images that come to mind is that of a doctor. However, given the poor state of our health services, it is safe to say that some doctors are involved in contributing to the terrible state of things. The health ministry established a Monitoring and Supervisory Committee on August 31, 2008, in response to the reports of appalling health care conditions published in newspapers. In September that year, it was reported that 104 personnel in several government hospitals were found to be responsible for mismanagement and corruption, and were penalized.109 Between January and October 2007 alone, there were over 76 death cases reported to be caused by medical negligence, according to an investigation of a Dhaka-based NGO, Ain-o-Shalish Kendra.
Again, between January and September 2008, press reports indicate that some 52 persons had allegedly died due to medical negligence. Malpractice cases are numerous, and even affect some of the country’s senior-most and reputed doctors because they treat scores of patients daily, giving each little time or thought, points out Dr Quazi Quamruzzaman of Dhaka Community Hospital. ‘It’s just that the whole system that needs to be fixed.
According to Dr Mohammad Saiful Islam, pediatric surgeon and dean of surgery, BSMMU, one of the biggest flaws in Bangladesh’s medical system is that there is no monitoring mechanism which checks whether doctors are administering wrong treatment resulting deaths. ‘The organization that is to oversee such cases of negligence, the Bangladesh Medical and Dental Council, is now dead. While an alarming number of cases go unreported, the issue of accountability is hardly on the agenda of health care sector in Bangladesh.
Again, our country’s numerous private clinics need close monitoring. Many of such clinics are nothing but money—making ventures, paying little regard to human life. In the last two years many such clinics, especially those outside Dhaka City, have been fined or shut down due to malpractice and fraud. In Dhaka, LabAid and United seem to have gained some notoriety, especially in recent times.
Melamine in milk
At the end of 2008, the world-wide scare of Chinese infants critically ill in hospitals due to melamine poisoning hit Bangladesh and caused major public concern. The government was forced to carry out tests on 8 popular brands of milk, resulting in the ban of three brands on November 3, 2008. What about other food products? Fruits and vegetables are being sprayed/ injected with harmful chemicals to ripen them faster; crops are being sprayed with chemical pesticides and fed chemical fertilizers which may have serious effects on our bodies. Genetically modified seeds are being sown, slowly wiping out the ‘healthier’ indigenous crops and making environment and ecology vulnerable. All these, too, affect our right to health.
The Government obtained three different results from three testing labs. The Dhaka University Chemistry Department, in its tests, found that melamine had been spotted in all eight brands. However, the Bangladesh Standard and Testing Institute (BSTI) and the private testing lab Plasma Plus found melamine in only one brand (Yashlee-1). The Government, with the aid of World Food and Agricultural Organization, again sent samples of eight brands for testing to a research lab in Bangkok and to the Bangladesh Council of Scientific and Industrial Research (BCSIR). However, given its inaction the High Court, on hearing a public interest petition by HRPB, filed on 23 October 2008, stayed the sale and display of the eight brands of powered milk in consideration of public health until the publication of the test result and issued a Rule Nisi upon the Government to show cause within four weeks why their failure to stop the sale should not be declaredillegal.23On 3 November, after receiving three reports, and results obtained by the Bangkok Research Institute, the Government banned three brands, Yashlee-1, Yashlee-2 and Sweet Baby-1. These are the glorious examples of the conditions of our health sector which shows us whether it is in a position of bad or good.
6.1.3: Chart: health condition of Bangladesh at a glance
Government Hospital 589
Registered Private Hospital 2271
No. of Bed in Government Hospital 38171
No. of Bed in Private Hospital 36244
Registered Doctor 49994
Registered Nurse 23729
Doctors in Government Services 12382
Nurses in Government Services 14377
Trained Midwives 5000
Total Population 143.9 million.
Masses of people in Bangladesh face a perilous situation due to hazardous health conditions in the country, according to reports from health workers and the World Bank. The main source of these conditions is the poverty and backwardness maintained and deepened by capitalist rule. According to the survey of the government in April 2009, the total numbers of registered doctors are 49,994 & nurses 23,729. According to the health department of Bangladesh government, there are estimated one doctor for every 2860 people and one nurse for every 5720 people. According to the public health specialists, one doctor required 3 nurses and 5 assistants. The proportion is 1:3:5. But in Bangladesh the proportion is l: .54: .27. According to the WHO the estimation of doctor and nurse for every 10,000 people in South Asian countries are as follows:
Country Doctor Nurse
Bangladesh 3 3
India 6 13
Srilanka 6 17
Pakistan 8 5121
This summary states that our work force in health sector is very poor. According to the health department, 12,382 doctors and 14,377 nurses are working in government health sectors. They are serving in 589 government establishments including Thana Health Complex, District Hospital, Medical College Hospital, Specialized Hospital and Research Institute. The most pathetic information is that maximum portions of these 12,382 are serving in cities, metropolitan towns or areas alongside the towns. Therefore, the sceneries of rural areas are more formidable. In some areas there, only one doctor runs a total health complex or hospitals. He has to manage about 300-400 patients everyday. A report in Prothom Alo states that there is only one doctor in Sadullapur health complex of Gaibandha. There total posts for doctor are 20. But government appointed only five. Among them two went to deputation, one went to abroad for higher studies and the remaining one is busy with government duties. So there is only one doctor to look after the whole health complex.
According to health department, 6861 posts of doctor and 16707 posts of nurse & medical assistants are still empty. The reason behind this is most of the doctors are interested to practice privately. On the other hand, every year thousands of ill Bangladeshis go abroad in the hope of getting better; in spite of huge costs of travel, hospital care & surgery. This large-scale exodus of patients reflects the dismal condition of health care in Bangladesh. Wrong diagnosis & medical negligence are rampant even in the most prestigious hospitals. This has led to a deterioration of public trust in medical professionals. Many patients complain that doctors refuse to talk to them properly or explain what their ailment is or how they will be treated. Those who can afford it & those who manage to scrape up their savings or use whatever source of funding they have opt for going thousands of miles away where they believe they will get the proper treatment.
At a glance these are the conditions of our health sectors. The government should take appropriate measures for removing these problems of our Health Sector.
The conditions of the Hospitals of Bangladesh
The environment of the Hospitals of Bangladesh is not patient intensive. The maximum hospitals are ruled by corruption and by mismanagement. Particularly the condition of the public hospitals are very much bed. In the public hospitals are also corrupted by dirty politics. Their different types of labor organizations which are governed under the shadow of different types of political party. These organizations of doctors or nurses or the stuffs without any cause call strike for obtaining private gain. For such activities of these organizations the patients becoming deceived from their service. In an interview Advocate Nizam Ul Huq Nasim told that the doctors or the nurses have no right to call such strike at the hospitals. The conditions of the private hospitals are better than the public hospitals. But against these hospitals there are some allegations that they take high fees. In this stage, I tried to make some reports on the public and private hospitals of Bangladesh by going to the premises of the hospitals of Bangladesh.
Bangabandhu Sheikh Mujib Medical University Hospital
The ground floor of the Bangabandhu Sheikh Mujib Medical University Hospital is Houses by 20 general wards, morgue, ticket counter, X-ray room, administrative office and OCR. On the first floor, there are 16 more wards, blood transfusion centre and eye bank. The operation theatres, intensive care and coronary care units are on the second floor. The third floor has the gateway to the rooftop, which is locked. Through an opening on the third floor I spot another building where some patients lay outside the wards on the corridor.
I find the pathway to the building, which is accessible from the emergency ward. I climb up the stares and run into Mukul Islam, a salesperson of a pharmaceutical company. Mukul is from Kushtia and has problem hearing with his left ear. His first visit to the doctor at the Dhaka Medical College Hospital cost him only Tk 5. The doctor advised him to see him at his private clinic. He was charged Tk 500 for a session with the same doctor at his private clinic. He tells me that ‘The doctor told me that I needed an operation and it will be done better at his clinic’. ‘The operation would have cost me Tk 20,000. As I said I could not afford that much money, he referred me back to the Dhaka Medical College Hospital where he will perform the surgery.
At about 7.45 pm I buy a lemon drink from the canteen, located right next to the burnt unit. Most of the people having evening snacks there are brokers. They were gossiping about their income throughout the day.
Dipali Karmakar, 62, finally lost the battle after a 24-hour struggle for life. The duty doctors met her yesterday evening when she was admitted but that was as if a courtesy visit to prescribe the prerequisite medicines. Dipali, mother of three sons and a daughter, suffered brain hemorrhage after she was hit by a motorcycle in front of her house on the Dhaka-Khulna highway. The nearby Faridpur Sadar Hospital did not have any expertise for brain injuries and the doctors referred her to Dhaka Medical College Hospital, telling her family that time was of the essence.
‘We came all this way, only for my mother to die like this? The doctors ruined all the possibilities of her survival despite our efforts,’ says her son Swapan Karmakar. Other members of the family complain that none of the doctors has examined her since her admission to hospital. Swapan says that she was unconscious but still breathing and could have been saved if the doctors had taken care of her. Moreover, she was not even given a bed and put on the floor of a room, which is the doorway to upper floors. Dipali was among 20-30 other patients also lying on the floor of the hospital waiting for care, a common scene in the hospital.
The nurses and doctors who had been busy all this while finally found the time to come and declare her dead. ‘We had no idea that the hospital is so terribly crowded and patients have to wait for days to find treatment, if any at all,’ says Swapan. While the wards are packed with patients at any time of the day, the condition is worse for patients waiting outside the wards and lying on the floor for days unattended by doctors.
The entire day has passed by watching how brokers and syndicates made money out of patients. I am now walking through the second floor of the hospital’s emergency unit. The constant scream of a woman from one of the 16 wards in the floor makes me curious. I walk down the floor to the first ward at the farthest end. Only two doctors are there for the 16 wards that accommodate more than 500 patients. A nurse is sleeping in one of the wards. A high official of the hospital was bragging the other day about the presence of doctors and nurses in each ward round the clock. ‘Patients cannot be left alone at any period of time as long as they are in hospital,’ he had said. The hospital packed with more than 2,000 patients against its capacity of 1,441 was bursting at the seams.
Except for saline which is sealed with DMCH logo, all medicines are sold outside. Even though as per the regulations patients are supposed to get medicines free, the doctors advise the patients to buy medicines from pharmacies near the hospital. Most medicines are unavailable at the hospital pharmacy, as the syndicate sells them to neighboring pharmacies. The neighboring pharmacies on the other hand are involved in a number of unethical business practices that include selling spurious medicines and charging high price for those, knowing fully well that most buyers will pay them in desperation or ignorance.
I also found that before at the back side of the emergency department there was some dust particularly the used bandage, syringes of the patients. This is also one kind of negligence of the hospital authority.
Lab Aid Hospital
Labaid Hospital is situated in Dhanmondi residential area. It has two separate building. One building is for specialized treatment and another is for Cardiac treatment. Labaid Hospital is well known for good treatment. It takes high fees to treat at Lab Aid Hospital. But it is also not free from negligence. The patients often allege that the conduct of the doctors before and after surgery is not same to the patients. They also allege that the doctors are not interested to talk with them without fees after their operation/surgery. But the concerned doctors refused the allegation. Dr. Col. Harun told that there arises no question for taking extra fees from the patients. Another allegation against Lab Aid Hospital is that though the patients need not keep at CCU or ICU unit but only for capital gain they send the patients at those units. For example, kamal who came at Lab Aid Hospital with his son Pavel for the treatment of his heart disease. He told me that though his pain of heart is normal but the hospital authorities only for profit are not sending him at cabin.
It seems to me that the environment of the hospital is patients intensive. The hospital authority regularly keeps clean the hospital. But the relatives of the patients alleged that the stuffs including ward boy and nurse want extra money from them for taking extra care of their patients. Nasima Banu who came with her husband Mustafa AH (who is taking treatment for his kidney disease at the hospital), told me that as her husband is now at ICU unit, so whenever she wants to see her husband she has to give extra money to the ward boy.
In this stage I am referring another fact which is collected from internet. Negligence of the hospital authorities led to the death of 47-day-old baby Afia at Labaid Specialized Hospital on December 27. The baby Afia was admitted to Labaid hospital on December 24 and underwent a successful cardiac operation the next day.
Father of the baby Shafiqul said that on December 27, the hospital authorities suddenly informed him at 11:00am that the oxygen supply to the ICU was interrupted and he would have to shift his daughter to another hospital. The problem, however, started at 4:00am. Mr. Shafiqul says that “I made all arrangements for her shifting, but the hospital authorities kept my ill baby hostage for about half an hour until I paid all the dues worth Tk 7,740. When I took my daughter to another hospital the doctors there declared her already dead”.
But the Coordinator of Labaid Specialised Hospital Mahbubul Hoque told that the child had congenital cardiac problem and was in a critical condition with lung infection.
He also added that “The baby underwent septrostomy, an invasive procedure, on December 25 and was kept in the ICU. As her condition was deteriorating gradually, we informed her parents of it and they agreed to shift the baby”.
He denied that the hospital authorities told the girl’s father about an interrupted oxygen supply and said there was no trouble in the supply. Even an alternative system was ready and the moment the parents wanted to shift the baby, the hospital authorities initiated the emergency procedure to transfer the baby by an ambulance.
Another example of medical negligence in Labaid Hospital is given bellow.
On October 29, 2007, when Bangladeshi software engineer Masum P. Mohammad, flew back to Bangladesh to see his ill father struggling for life at the Central Care Unit (CCU) of Lab Aid Cardiac Hospital, he was in shock.
Masum alleges that when he saw his father lying on a bed, full of blood. Then he asked the nurse to show him where he was operated, and he was speechless to see the unhygienic condition where his father was put in. He stood there for the longest moment, not knowing what to say.
Masum’s father Late A.K.M Fazlum Haq was admitted at LabAid on October 25 under the treatment of Dr Prof. Baren Chakraborty, after he was struck by a sudden chest pain. After Haq had a massive heart attack on October 26, he was given injection and later a ring was put around his heart on October 27. Later that week, Haq’s chest x-ray revealed dark areas over the lung, after which Prof. AH Hossain was involved for the lung treatment. ‘On November 2 that day, Hossain told to Masum that, food was stuck in the patient’s lung and he wants a Bronchoscope immediately.
After the Bronchoscope Prof. Hossain provided cough samples for the Tuberculosis (TB) test in two different diagnostic centres-one in LabAid, and another in Monowara Diagnostic, at Panthopath, Dhaka. Three days later the result was completely different in the two hospitals. Masum alleges that the LabAid results showed that his father has not have TB, and the Monowara Diagnostic test result showed that the report was actually positive!
Masum explains that later they also learnt that his father had suffered from massive brain injury right after being admitted to the hospital, which was not detected by any of the doctors. ‘When he had a heart attack earlier, blood was stuck in his brain. So, he was not being treated for his brain injury during all these days.
Masum says that his father’s TB test was sent on November 3, 2007. He asked that why did it take so long to send the TB test for diagnostic, and why did it take so long to detect this TB? Masum also alleged that even the TB diagnosis result was wrong.
Masum also told when his father was given a medication; his father could not recognize them anymore. At that time they requested Prof. Chakraborty to call a neurologist to check his father’s brain, but again he did not bother to listen to him. Two days later, on November 11, his father was announced dead.
‘Masum’s story is nothing exceptional, says Dr Quamruzzaman who heads the Dhaka Community Hospital in Malibagh and has himself been a victim of medical negligence through which he lost a perfectly-functioning kidney. ‘We have countless other cases of medical negligence and ignorance. But, it is important to realize that one of the biggest flaws of our health care system is that we have no accountability what so ever.
Indeed, Masum’s case is not an isolated one. According to an investigation of a Dhaka-based NGO, Ain-o-Shalish Kendra, between January to October 2007 alone, there were over 76 death cases reported to be caused by medical negligence.
BIRDEM Hospital is the teaching hospital of the college. It is a 600 bedded multidisciplinary Hospital Complex at Shahbag, yet another prestigious institution of the Diabetic Association of Bangladesh. It has already earned national and international reputation as center of excellence for medical services and research.
The hospital is housed in two magnificent buildings one is 5 storied & other is 15 storied twin-towers. The 15 storied twin-towers accommodates the hospital, while the 5 storied building houses the outpatient services, intensive care unit and a modern sophisticated cardiac center Ibrahim Cardiac Hospital & Research Institute (ICHRI).
Over 3000 patients are attending outpatient departments daily. The in-patient departments have a total of 600 beds of which over 100 (number is flexible) are free. Internal Medicine & sub-specialties have a total of 220 beds. General Surgery & sub-specialties have a total of 165 beds, while gynecology and obstetrics have 60 beds. Emergency Units have a total of 30 beds, which include emergency (10), Intensive care unit (10) and Coronary care unit (10). Besides it has 120 cabins.
It is also mentionable here that I’ve tried to make a consultation with Dr. Al Mamun who is a surgeon of BIRDEM Hospital, Dhaka. But I failed as he didn’t have enough time. Though, the BIRDEM Hospital has a reputation for better treatment of the disease of diabetics, but it has failed to provide good services to its patients. There also exists medical negligence. An observation at Birdem Hospital is given bellow:
I went at BIRDEM Hospital on 05/11/2010 for the purpose of my Research. The day was Friday and as it was a public holiday so it was overcrowded. I saw some persons were waiting for their doctors. I told with Mrs. Naima Begum who was a patient of Dr. Tareq M. Bhuiyan who was a medicine specialist. She came from Barisal and she obtained the doctors serial by his youngest son Rana Sarkar who lived in Indira Road, Dhaka. She told me that she is waiting for doctor for 2 hours. The visiting hour of the doctor is 5.00 pm but the doctor came in hospital at 6.30 pm.
The outer environment of the hospital was satisfactory. Because there was overcrowded environment in the hospital even the ICU was also overcrowded. But we know that the ICU should keep crowding free. The relatives of the patients were coming and going at ICU. Though there is a time for visiting hour to visit the patients but it was not obeyed. The duty servant of the hospital took money from the relatives of the patients for visiting. I also observed that the doctors were not available in the hospital even at their visiting hours.
The Hospital is a twelve floor high rise building which is situated in nearest to Muhammadpur thana. Basically it is an NGO based institution. It is 140 beaded Hospital. In last 07/11/20101 visited at that Hospital. As it is an NGO based hospital, so it was well decorated. The management system of the hospital is also good. But the conduct of the hospitals stuffs is not good.
For instance, Tajnin who is a baby of one and half years old. Her parents admitted her at that hospital for a surgery in her mouth as she is a patient of talukata. On 07/11/2010 her parents admitted her at that hospital for the purpose of operation. During time of admission, as whole environment of the hospital was unknown to her, the baby start to crying. At that time the stuffs of the hospital made a rough conduct with her even with her parents. They also threatened the innocent baby. It is also mentionable here that the hospital free treat the babies who are the patients of talukata and all kinds of medical surgery is retreated freely. But the baby’s parents paid 60,000 tk. for her operation. In spite of paying tk. they did not get redeem from their rough conduct. In ICU unit which is situated in 3rd level of the hospital there I’ve also observed some corruption. Though in the door of the hospital, it was written that no money transfer is allowed except money receipt. But this rule was not followed properly. Rahima khatun who came from Narail district with her grand son, told that last night she gave some money in the hands of duty servant, that’s why he did not make any obstruction to visit her patient. She also told that today she will also do that for stopping the mouth of the duty servant.
These are in a nutshell the conditions of Hospitals of Bangladesh. Finally it can say that the quality of care at government hospitals isn’t satisfactory because the care providers are not interested to do the job. In the private clinics, they take higher fee but do not provide the appropriate care because they are not accountable for their action. Many happy families are shattered due to medical negligence. So we should take a measure to prevent medical negligence in the hospitals of Bangladesh.