Public hospitals run shorthanded, private ones pitilessly exacting

Hospitals, diagnostic centres and medical colleges have found a rapid growth in the country but people are still being deprived of quality healthcare services. A double fix is diagnosed as the main cause of deprivation.   
Insufficient doctors, nurses and beds in public hospitals and skyrocketing costs and irregularities in private ones have limited the scope of healthcare for them, a spot survey reveals. Such a double bind is causing immense sufferings to patients and their relatives in cases of serious diseases.
Above 80 per cent of the people are deprived of quality healthcare for deficit in government facilities and lack of proper law guiding private healthcare, experts said.
Md Kamrul Islam, a farmer from Gheor in Manikganj, came to Dhaka Medical College and Hospital (DMCH) on March 7 with his father who suffered critical injury in tendon of his leg. Manikganj Sadar Hospital referred his father, Moksedul Islam, to DMCH for better treatment.
"It was a horrible experience for me when I saw the emergency of DMCH full with patients and another twenty waiting for immediate operation," he said.
The limited-income farmer had no way to get his father admitted to any of the private hospitals in Dhaka city as he heard it could take 80,000 to 100,000 for such treatment. It is impossible for him to bear.
At 02.00 am, Kamrul got response from a doctor, fortunately, but on a term that his father would get no cabin after the surgery.
As a high blood sugar and diabetic patient, Mr Moksedul needed ICU (intensive care unit), but there was no room in the premier government hospital to spare for him.
Visiting the state-run National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR) for consecutive three days the FE correspondents found three to four times more patients than the capacity of the hospital to host.
They came across a syndicate of unscrupulous staffers that works for private medical facilities and forces many patients to leave the public hospitals.
Many of other brokers also were found cashing in on patients' critical state. They take Tk 100 to Tk 500 in exchange for getting them quick surgeries and test results.
However, many of the hapless patients got no help despite offering extras to brokers for scarcity of capacity.
Md Abdur Rahim Chandan, a broker at the hospital and also a tea-stall owner, pointed out a justification for such brokerage service in medical emergencies. He told the FE that if people with badly fractured legs need an operation, it would take Tk 60,000 to Tk 100,000 at a private medical facility like trauma centre. But they tried to manage scope at NITOR for patients for Tk 300-Tk 400.
"Sometimes we fail due to existing limited capacity," said Chandan while he was refusing a relative of a patient who had a backbone injury in fall from a tree. 
Director of NITOR Prof Dr. Md. Iqbal Qavi said each day around 120 to 180 patients rush in the NITOR emergency unit. The 500-bed hospital has only 30 beds for emergencies and those remain occupied most of the time.
"There are around 237 second-, third- and fourth-class staff members, 292 nurses and 156 doctors here with whom we can treat highest 600 people," he said.
But the number of patients exceeds 1,000 everyday.
Md Mubarak Ali from Koddarmor in Sirajganj district had a massive chest pain on March 12. He was waiting for a bypass surgery at the National Heart Foundation (NHF), a privately-run medical fiduciary in the capital city.
Talking to the FE, his son Md Ariful Islam said after his father had complained a pain, they brought him to the government National Institute of Cardiovascular Diseases (NICVD) where doctors said he needed an angiogram as they fear blockage in his coronary arteries.
"But there was no schedule in the institute before the third week of April for angiogram and we moved to private hospital Labaid," he said.
Angiogram was done here and doctors felt the necessity of a bypass surgery which could cost above Tk 0.45 million (excluding ICU and some other charges) at Labaid.
"I have brought him to NHF for having considerably lower cost for bypass (Tk 0.27 million)," he said about the tribulations in case of medical emergencies.
Although the amount is lesser than that in some posh hospitals, but Ariful had to manage the amount by selling half of their farmlands.
Prof Dr Abdullah Al Shafi Mazumder, director of the NICVD, said the 431-bed hospital was now giving treatment to 700-800 people.  
The director said the situation had gone beyond the hospital's capacity, and serious patients had to be kept on the floor, as bed could not be provided.
He said people from across the country rush in here for cardiac surgery and vascular surgery in view of low expenditure and quality service in the institute.
"Emergency vascular OT (operation theatre) is functioning for last few years. Recently a separate vascular-surgery department has been established and the institute has developed the first paediatric cardiology department of the country," the physician said.
He expressed his optimism that the hospital would be able to manage more patients after the inauguration of the 200-bed annex.
Prof Dr. Mozaffer Hossain at Dhaka Medical College and Hospital told the FE that the medical has the capacity of about 2,650 beds whereas at least 5,000 patients take treatment regularly.
The medical hospital has only 45 seats at ICU (including burn unit) for all kinds of patients when demand always hovers around 450 to 500.
Researches by icddr,b and Brac show Bangladesh has only 5.4 doctors and 2.1 nurses for every 10,000 people, which should be at least 25 each.
According to the global healthcare index, Bangladesh has been marked as a critical case among 58 countries in respect of availability of healthcare providers.
An official at the Directorate General of Health Services (DGHS) said there are 483 primary healthcare centres run by the directorate at upazila level with some 20,500 beds. There are 126 hospitals with 29,000 beds under the DGHS at the district level and above.
"But the number of regular patients is three to four times the numbers of beds in these hospitals," he said.
According to the Ministry of Health and Family Welfare, the country has registered doctors numbering 55,000 and 11,000 of them have gone abroad.
Of the total number of doctors, only 38 per cent are working in government-run healthcare and 62 per cent in private hospitals.
The number of diploma nurses is above 29,500 of which only 16,000 are working while the rest have ether gone abroad or are unemployed, the ministry sources said.
The sources said the deficit in recruitment of doctors and nurses by the government is now 22 to 26 per cent.
However, according to Bangladesh Private Clinic Diagnostic Owners Association (BPCDOA) data, there are 1,033 diagnostic centres and 610 clinics in Dhaka while the rest of the country got 3674 diagnostic centres and 2151 clinics with a 10 per cent growth year-on-year basis for last one decade.
Dr Ali Hasan Md Mowla, a healthcare expert, told the FE that capacity of public hospitals has increased in last one decade but not apace with the increasing number of patients.
Parallel to it, he pointed out, private healthcare service increased significantly but costs went beyond the reach of limited-income and even middle-class people. Lack of regulation is to blame.
He said apart from doctors, nurses are very important for quality treatment. But there is also lacking here.
The privately-run hospitals have yet to come under any regulation, which is prompting many hospitals to do as they wish.
Consumers Association of Bangladesh Secretary Humayun Kabir Bhuiyan said 80 per cent of the people who are suffering from serious diseases like cancer, cardiovascular criticalities, kidney failure, neuronal complexities, liver etc are derived of quality treatment amid scarcity in public healthcare and sky-rocking cost in private ones.
He noted that ensuring healthcare for the people has been ratified in the Constitution as a fundamental right, which is being violated.
"The inflation in the country rises 6 per cent despite lower prices of food and many other products as higher healthcare costs contribute a lot," he said.
Prof Dr Zafrullah Chowdhury, a noted public healthcare specialist, said the proposed 'private healthcare act', which has been floating table to table for two and a half years, should be enacted forthwith.
He suggested conducting audit in private hospitals regarding prescriptions provided by the doctors, for the sake of better transparency.
"Government-run hospitals' capacity and medical colleges' seats should be increased significantly by raising health budget which has been declining annually compared to the overall budgetary allocation," he said.
The physician, who is known for innovating alternative medicine for the masses, also prescribed that the government should ensure safe food and people should be aware of food habit, which could help minimise diseases significantly., [Read More]

Source: The Financial Express


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