& çâÌæÚUæð´ ·¤è ¥ôÚU Îð¹Ùæ ÁæÚUè ÚU¹ð´ ¥ÍæüÌ ¥ÂÙð ÜÿØ ÂÚU ŠØæÙ ÚU¹ð´Ð ãæÚU Ù ×æÙð´, €UØô´ç·¤ ·¤æ× ·¤ÚUÙð âð ¥æÂ·¤ô ©gðàØ ·¤è Âýæç# ãôÌè ãñ ¥õÚU ÁèßÙ ·¤æ ¹æÜèÂÙ ÎêÚU ãôÌæ ãñÐ ÖÜð ãè ÁèßÙ ×ð´ ç·¤ÌÙè Öè ·¤çÆÙæ§ü €UØô´ Ù ¥æ°, çÁ™ææâæ ¥õÚU ©ˆâæã ÕÙæ° ÚU¹ð´Ð ŠØæÙ ÚU¹ð´, ÜÿØ ã×ðàææ ¥æÂ·Ô¤ Âæâ ãôÌð ãñ´ çÁ‹ãð´ ÂæÙð ·Ô¤ çÜ° ÂýØæâ ¥æÂ ·¤Öè Öè àæéM¤ ·¤ÚU â·¤Ìð ãñ´Ð

ON THE RECORD

Private Sector Can Play a Role in Upgrading Health Facilities in Bangladesh

Something must be terribly wrong with the way we are managing our affair* including the medical care th-cflitiea. It does not seem to bother our policy-makers but our doctors should be the first ones to ponder over this phenomenon because their patients are voting their lack of confidence tn them by the thousand

by Shah AMS Kibria
ONE of the most beneficial fruit* of modern science and technology la the phenomenal advance made by medical science. The development of surgery, for example, has been almost explosive.
I was both surprised and impressed when I found that one of the candidates who fought for the democratic nomination in American election was former Senator Paul E Tsongas of Masaachusett*. In fact he fought hard and waa ahead of Clinton in the New Hampshire Primary. The American voter* knew that Sen. Taonga* had major aurgery In the stomach for cancer and yet many of them voted for him as a candidate of their choice for the highest . and also the most demanding a office in the country. He lost the race for the nomination to Clinton but the fact that a cancer patient could be considered healthy enough to contest for presidency in undoubtedly * tribute to American medical profession. I have cited this remarkable case to make the point that the progress of medical science 1* Indeed a matter of pride for humanity. Some of the most dreadful diseases such as small pox, polio, tuberculosis, malaria etc. have been either eradicated or brought under control. Spectacular success have been achieved in organ transplant and brain surgery. The clear evidence of success can be seen in the significant Increase In longevity of human life. Infant mortality has decreased and thanks to the growth of medical science, people are enjoying healthier and longer life. Unfortunately however In Bangladesh we are way behind the rest of the world. Indeed we have been left behind even by most of the countries of Asia.
Life expectancy at birth In Bangladesh today stands at 51.8 years. In Japan, it is 78.6 years. In Sweden and Switzerland the average is 77.4 years. In the United States It is 75.9 and in the UK it Is 75.7
years These are the richest and most advanced countries and It is only natural that the quality of health care In these countries will be far superior to ours. But what about Aslan countries will similar social ■nd economic background? Life expectancy at birth In the Republic of Korea and Malaysia is 70.1 year — a twenty year gap with Bangladesh Even In a tow-income country like China the average is 70.1 years. Srl Lanka, a country so similar to ours.wlth relatively low per capita income ha* been able to achieve an average life span of 70.9 years. India and Pakistan have also left us behind India has increased the average life span to 59.1 and Pakistan to 57.7 years.
Nothing could be more disappointing than the statistics quoted above. After all, with India and Pakistan we started the Journey together, after the British left in 1947. Granted that our per capita Income Is tow but It has been seen that life expectancy st birth can be raised even with relatively low income level. While 1t would be easier for a rich society to have better health care. 1t is not impossible to bvercome this handicap. The case of Sri Lanka and China prove the point. These are low-income countries but the average life span In them is higher than many richer countries. In Bangladesh we have 8 medical colleges from which, I am told, as many a* 1200 doctors grad uate every year. Despite the brain drain the number of doctors with post-graduate degree and diploma Is also pretty large. Yet the most disheartening experience for me. during my years in Bangkok, was the large and regular flow of patients from Bangladesh to Thailand. A good proportion of the passengers arriving from Dhaka, one would find out with dismay, had travelled for medical treatment. In fact, busi-
ness activities being at a stand still. It is this category of air travellers who seem to have made the flights between Dhaka and Bangkok profitable for the airlines.
Why is it like thio? How come we prefer medical treatment In Bangkok over Dhaka? The history of medical education tn Thailand is not much older than Bangladesh I •m told that not too long ago Thai students used to come to Dhaka to study medicine Yet today our medical profession is held In such tow esteem by our own people that for those who
Those who go to these places are mostly affluent people who can afford the best that Bangladesh can offer by way of medical facilities but they go abroad due to lack of faith In our doctors and our hospitals This, I am sure, is the crux of the matter
The usual explanation I am given for this unhappy situation is that our doctors are good but the support facilities are poor Why are they poor? Can we not do something about it? Another complain I hear most often is that our doctors
can afford it is vastly preferable to gel medical care in Bangkok than in our own country. (US officials and diplomats are routinely evacuated to Bangkok when they have any serious medical problem). I can understand If people prefer London or New York to Dhaka for the treatment of complicated cases. These are the world centres of modern medical science and the quality of hospital facilities are superior to any thing that we possess in Bangladesh. But we should sit back and reflect when we fall behind even neighbouring countries like India or Thailand. Something must be terribly wrong with the way we are managing our affairs Including the medical care facilities. It does not seem to bother our policy-makers but our doctors should- be the first onep to ponder over this phenomenon because their patients are voting their lack of confidence tn them by the thousand. Singapore and Calcutta are the other cities which are reportedly attracting patients from Bangladesh.
are so over worked that they •re not able to give personal attention to the patients. This, I am afraid, Is an explanation which I Just cannot accept. Good doctors and experienced surgeons are very busy people every where in the world. Yet this is never advanced as an argument for lack of attention to a patient. In face patients go to a famous doctor or surgeon, even though he may be the busiest person In the profession. simply because he is likely to get the best medical care from him. We have today hundreds of little clinics spread all over Dhaka. The facilities in them are Inadequate and often of a quality which is nowhere near what one gets in private hospital in Thailand or Singapore. Some of them are good but generally there is lack of confidence in them. In my view, the situation calls for fresh thinking and initiative by people in the profession. 1 have no doubt In my mind that our physicians and surgeons are as good or even better than those In the neighbouring countries but it is essentially a
question of proper organize t»on and management. If. for example, the owners of a few private clinic* pool their resources end jointly set up a re ally large private hospital with
as high as those In Thailand ex Calcutta or Singapore Why should they always wait for the government to take the tnftto tlve? The fine Institution built by Dr Mohammad Ibrahim to an example of what can be achieved by private initiative provided. or course, there Is dedication and commitment The Diabetic centre and hospi tai ought to have been an inspiration for our doctors Dr Ibrahim did get the support of the government but he the driving force behind the insti tute. The standard of maintenance of hospitals Is another matter which has a tremendous impact on the morale of the patients and their re la Uvea Not being a doctor I can voice the feeling* of an average layman In these matters. A private hospital in Bangkok or Singapore Is as clean as that tn New York or London. Naturally this Inspires confidence in them and the patients arc prepared to pay much higher fees and hospital charges mainly due to this confidence factor. The reliability of pathological tests is another are* In which we are lagging behind Yet this I* one field In which Improvement 1n standard and reliability to not tab difficult to achieve
I was talking to a friend of mine — an actuary who is a leader in the insurance industry. He had no satisfactory explanation for not having private health Insurance in Bangladesh. The possibility of misuse of the facilities by the patients as well as the doctors was cited as the main reason for the failure of the Industry to move into this vital field. An I then to understand that our
moral standards are so tow to have faetkUes which paapte in other countries have by now taken for granted'*
Introduction of health Insurance tn the pubitt sector. I can well imagine, will mast probably lead to the usual mto uw and corruption and indeed tt may become another peren ntol claimant for substoy from the state treasury But this need not be the ease tn the private sector A system of checks and Incentives can be Introduced to ensure that peo pie are not given the opportu nity to stoop to theft 1 am no expert In this field but I feel that health care to not a matter only for experts Every Individ ual In the society has a stake tn the system We must speak up when It Is necessary to do so
What I have said above to. of course of Interest to a small minority of people — the upper classes living mostly In urban centres The bigger question of public health Is much more complex and I do not have the
My experience In Bangkok led me to share some of my thoughts on the subject.
Needless to say. tn my view, public health, together with more literacy and public education. ought to be a major Issue for the political parties In the recent elections In America, the health care issue was a significant factor In Clinton’s victory. After al), this Is one question which affects the welfare and happiness of al) of us. Irrespective of wealth or class or profession. Why should it not enjoy the priority that Is enjoys elsewhere? The UN system is working towards the goal of Health For AH by the Year 2000 but in Bangladesh It to no more than a slogan. Even the affluent class has failed to organize a health care system for Itself within the countiy. The plight of the common men and women seem to have little chance of any appreciable improvement unless health care becomes a priority issue for the whote nation