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Maternal Health Services in Hills

Clinics are there, docs rarely seen

Star Report
Hanpa Mro lost two sons for a lack of medical attention at Bulu Para in Bandarban's Thanchi upazila. Both of them died of high fever before reaching the age of two.
The nearest healthcare centre to her house is about 40 kilometres away at Remakri Bazar which is around six hour's trip by boat. The family's poor financial condition never allowed her to take her sons to the district headquarters for better treatment.
The community clinic for around 14,000 indigenous people in Remakri union remains closed most of the time. Doctors come in once or twice a month, and they are not aware of their schedules, said residents.
"Doctors and health service providers rarely come to these remote areas," said Remakri Union Parishad Chairman Mui ShweThoai Marma.
The situation is the same for families in the neighbouring hilly districts Khagrachhari and Rangamati.
Bandarban has union health and family welfare centres in 22 out of its 33 unions, said deputy director of Bandarban family planning department, AungTha Loo. "However, we have skilled manpower only at 10 centres."
The maternal mortality rate in Bandarban is about 247 per lakh live births, Aung said. The figure is much higher than the nationwide maternal mortality rate of 196 per lakh live births, as estimated in Bangladesh Maternal Mortality Survey 2016.
"People in the district's remote hilly areas are still deprived of maternal healthcare as the centres have a shortage of manpower and are ill-equipped to handle emergencies," said Civil Surgeon Dr AungSwi Prue Marma.
As per government plans, there should be a union health and family planning centre in every union, but the reality is different. Most union health sub-centres remain inactive for a lack of doctors, added the civil surgeon.
Doctors posted in these unions either take transfer to the district headquarters or join there only to have the monthly paycheque showingup two-three times a month. They prefer to work privately in nearby towns for better pay and access to amenities, said the civil surgeon.
He said he could not manage the situation.
In Khagrachhari, emergency maternal healthcare is only available at the district headquarters as most upazila
health complexes do not have any gynecologist or anesthetist.
According to the Khagrachhari Civil Surgeon Office, 62 doctors are working in the district against 128 posts. Four upazilas have no gynecologist on call.
Bidarshi Chakma, resident medical officer at Panchari LIpazila Health Complex, said there was no gynecologist at the hospital for a long time.
"Now there is one for regular maternal checkups. However, for more complicated cases that require cesarean deliveries, patients are referred to Khagrachhari District Sadar Hospital as there is no anesthetist or necessary medical equipment."
Patients get preliminary maternal health services in all upazilas, but emergency services are only available at the district headquarters, said Khagrachhari Deputy Civil Surgeon Md Shahjahan.
"High quality maternal healthcare requires teamwork.” At least two doctors - a gynecologist and an anesthetist - should be there to provide such services, he added.
Nelson Chakma, chairman of Sajek Union Parishad in Rangamati, said the government has recommended only two community clinics in the union that has a population of nearly 55,000 in 186 villages.
"One of the clinics has not started operations yet, aggravating the situation further. Pregnant mothers suffer the most during their deliveries," he added.
Shahid Talukder, civil surgeon of Rangamati, said, "We are working in the remote areas that are lagging behind. Many local NGOs are working with us to provide better healthcare during childbirth."
There has to be a shift in mindset to improve the situation; even after significant improvements in road communications, healthcare providers are reluctant to move away from their urban abodes, he added.
Our correspondents Sanjay Barua in Bandarban, Saikat Dew an in Khagrachhari and Anvil Chakma in Rangamati contributed to this report.