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BITTER TRUTH

Health sector: Victim of anarchy and mismanagement

Md. Asadullah Khan
THE photograph of a seriously sick patient being treated by a lady doctor and a nurse on the corridor of the Dhaka Medical College and Hospital (DMCH) published in the Daily Star on September 16 last reveals the pathetic state of the government-run hospitals primarily meant for the treatment of the poor throughout the country. Lamentably, DMCH with a capacity of 1700 beds is now providing treatment to about 2500 indoor patients daily with just one third of the manpower it needs. With 246 doctors and 653 nurses working under 24 departments round the clock, experts say, it's not possible to provide effective services to the increasing number of patients that continue to crowd into this hospital every day with incidents of increasing violence and accidents in the adjoining areas of the city and the capital city itself.
With the derelict public healthcare system collapsing, there has been a mushrooming of private hospitals to attend to the
rising graph of patients. No doubt, many of these hospitals are efficiently run and offer state-of-the-art diagnostic and clinical facilities, of course at a considerable price, but there has also been a profusion of commercialized clinics and hospitals with hardly any accountability. It has led to a worrying increase in cases of negligence and malpractice. The recent incidence of death of a person scheduled to travel to Malaysia on job due to a wrong operation done in a shabby clinic at Fakirapool in the city by a quack passing for a doctor is a glaring instance of malpractice committed with impunity.
No issue facing the Bangladeshi citizens these days strikes harder and none demands more attention than healthcare. With the advancement of diagnostic devices, costs for treatment are exploding and this proves to be unusually burdensome in the context of a situation when the country is bordering on impoverishment and people, even the urban dwellers, lack any insur-
ance coverage for meeting the enormous expenses of health care.
Unhappily, DMCH, the premier treatment centre for the poor and middle income groups who cannot afford it at the city's private hospitals, unfolds a bleak picture. Though the number of beds has increased to 1700 in 2003, providing only medical and surgical requirements, there has been no increase in the manpower, infrastructure or other ancillary facilities in the hospital negating the very purpose of increasing the beds. And, shockingly, one third of the patients admitted at DMCH are not able to get beds and forced to seek treatment from floor beddings all the year round. More pathetically, visitors walking past these patients expose them to dust, dirt and increasing risk of infection which the stalwarts in the health sector did hardly take into account. A visit to any of the government medical college hospitals and facilities rooms like the operation theatre, professor's chamber and postoperative care unit reveals these
mess and dirt. Helpless patients are streaming in and many of them from far flung areas of the country where facilities for modern treatment or any type of treatment are totally non - existent
Not surprisingly, financial capacity of the people stricken with diseases in the whole country is distressingly disappointing. They can't meet the increasing cost of diagnostic facilities deemed to be sophisticated and modern. On the other hand, medical facilities available in the country are actually dwindling. It is learnt authoritatively that the country has one hospital bed for every 4100 people and one doctor for every 5000 people. Hopefully, because of the sustained efforts by the UNICEF and other NGOs working in the country in the health sector most vigorously since 1988, child mortality rate figures stood at 78 in recent years in place of94 per thousand in 1990.
The country's 61 per cent urban population and more than 75 percent of the rural population are
beyond the reach of basic health care system. On the other hand, hospitals like the DMCH and the Mitford, two prominent hospitals in the city for common disease treatment for the not-too-rich in the country are in a pitiable condition. In all these government-run hospitals throughout the country, plasters are falling off, walls are crumbling and floors are stinking with wastes and last of all food and medicine shelf by the side of the patient's bed appears to be safe abode for cockroaches and ants, let alone the quality of food served for the patients. .The toilets in the general wards, most often, are overflowing with sewage and strewn with used cotton and bandages suggesting lack of management. Not even the very sick patients would like to use the toilet and wash basin unless forced by emergency call.
More than that, these hospitals are plagued with drastic shortages of staff, equipment and supplies. Medicines supplied by the government drug store for indoor
patients seldom reach them because these supplies are allegedly smuggled out by a racket of lower class employees.
The country's medical system is too ill- equipped to cope with the masses' illnesses. It is borne out by the fact that even in hospitals in the district towns, doctors are fewer in numbers than the actual need, and they are lacking in expertise and experience to handle complicated cases besides the fact that the facilities they have at their disposal in these hospitals are pathetically meagre. Hence the rush to the capital city for 'clean diagnosis and effective treatment.'
The crisis has long been in the making. Throughout the last two decades, substantial amount of funds allocated for hospital devel-opment and infrastructure improvement allegedly went into the pockets of some corrupt health sector officials, some greedy doctors and high ups in the hospital complexes. It is only now that a big racket in the purchase of hospital equipment in BSMMUH has been unearthed.
On the other hand, a collapsing public healthcare system has seen a profusion of private hospitals and diagnostic clinics, largely unregulated, and having little accountability. By all appearances, it seems that the government is rapidly relinquishing its role of providing efficient healthcare. Today, government hospitals account for 20 per cent of all healthcare in the country.
Look at it through the prism of a Bangladeshi patient. He is stuck in a dangerous dilemma. The choice is between a slew of overburdened, understaffed and under-funded governmerit hospitals where queues stretch longer than your sight meets, where bodies are pressed together like sheep, where infection levels are high and diagnostic facilities crumbling. .How can a doctor, say, at DMCH examine 200 patients in six hours beginning from 8-30 A.M to 2-30 PM ? And if he continues his work without any break, he can at best devote 1.8 minute to each patient for examination and writing prescription! And that's the real story of the out door departments at DMCH, where patients wait for six hours and still many of them have to go back without even seeing the doctor.
Patients have no option but to seek treatment from the private clinics that have proliferated in the nook and comer of the country. The private sector hospitals vary in range from glitzy five-star standard charging, say Tk.10,000.00 a night to seedy kitchen clinics that advertise in loud neon and where also the price of service is still very high but the quality very poor. People sarcastically feet that it would be better for the health sector to invoke a statutory warning : “Beware, we can be injurious to your health." Some diagnostic clinics are doing a totally unethical job punishable by law. They receive the blood, urine and stool samples, get it tested by some
technicians either hired or on their pay roll and prepare a very dazzling computer-print report allegedly signed by a well known chemist or microbiologist There has reportedly been a surge of such-diagnostic centres and private clinics with no registration and accountability in the country.
Believably, many of our political leaders were aware of the people's suffering because of disease and poverty, but they did simply nothing to redress their problems. But this time the political government that would be coming to power through a credible election in December next must, in the light of the lessons learnt, consider very seriously setting up of at least three 1000-bed modem but affordable hospitals in the outskirt of the city for the poorer sections in the country — one in between Savar and Mirpur, second one in between Narayanganj and Jatrabari and the third one in between Gazipur and Uttara.. People in the country still remember the inspiring assurance of the Chief of Staff of the Army, General Moeen U Ahmed who told that wealth or money either laundered outside the country or acquired through corruption by politicians, officials and businessmen would be confiscated and utilized for building modem hospitals with the state- of-the-art facilities for the poorest section of the people.
Md AsaduBah Khan is a former teacher of physics and Controller of Examinations, 8UET
***Believably, many of our political leaders were aware of the people's suffering because of disease and poverty, but they did simply nothing to redress their problems. But this time the political government that would be coming to power through a credible election in December next must, in the light of the lessons learnt, consider very seriously setting up of at least three 1000-bed modern but affordable hospitals in the outskirt of the city forthe poorer sections in the country.***