Tragedies in public hospitals
A 27 year-old woman named Parvin Akther gave birth to a still born baby at the parking lot of the Maternal and Child Health Training Institute's (MCHTI) at Dhaka, after she was refused to give treatment at Dhaka Medical College Hospital (DMCH), reported in all the national dailies. She was asked to pay 15000 taka, if she wanted to have an emergency C-section at MCHTI. So the question is where is the empathy that a doctor supposed to have? Moreover, it is not a random scenario, and few more examples from national dailies will be discussed in the later part of this writing.
Though the medical service is one of the fundamental human rights, in Bangladesh, some public hospitals are the synonyms of sufferings and miseries.
Another incident occurred in Comilla, when one twin was left behind in the womb of the mother, Khadija Akther, during her C-section by the doctor, and then was removed after almost 37 days. How come this sort of severe mistake was conducted by a doctor? What was the rush? Rather it was a result of an utter act of negligence!
Another news of shocking and heinous act came to light, when a dermatologist from Bangabandhu Sheikh Mujib Medical University (BSMMU) was accused of raping his twelve grader patient from Bhola, several times in the name of treating her. A national daily says, "The father of the victim filed a case on this Monday accusing the physician of groping and raping his daughter."
How come a doctor forgets the oath taken to serve their patients and save their lives? These sort of repulsive acts are intolerable and they must be punished. Degradation of societal value, norms, ethics and moral has created these unreliable and insecure doctors among us.
Anik Ahmed, a patient of Dhaka Medical College Hospital, says, "In spite of having sufficient facilities and infrastructure, patients are not getting the treatment due to insufficient doctors and the neglectful mindset of them." He further says that, his appointment was due two days ago, yet he failed to visit the doctor and was told to come the next day.
If you visit any government public hospitals, you will witness a long line of severely sick, injured patients. They are waiting outside of the hospital just to get an appointment. It is the daily scenario of all the public hospitals. One of the patients in front of Dhaka Medical College said that, due to shortage of the trolley, they have to wait in the ambulance for a long period.
The sufferings of patients of public hospitals are beggar description. There is a claim that, from getting the appointment to obtaining the bed in the ward, it is the domination of assistance and hospital clerks. Also there is an objection of corruption and nepotism.
The number of government public hospitals is not sufficient in the country in terms of necessity. According to the ministry of Health, the whole 16crore people of the country have only 124 public hospitals in total for their medical treatment, among them 30 medical college hospitals, 35 specialized hospitals, and 425 upazilla health complexes. There is 4860 union health centres, whereas, only eighteen hospitals are situated in the capital city Dhaka.
Researchers think that, doctors have the required quality, but few may lack the sympathy. Some of the doctors are hardly empathetic towards their patients, and some of them are seen devoting more time to their private practices in private chambers or in private hospital.
Some of them are allegedly accepting fees for their service at the government hospitals. Negligence, avoiding responsibilities, wrong treatment, higher costs, limited facilities, especially at the public hospitals, over prescribing and unnecessary lab tests (for getting handsome kick-backs from the private labs and diagnostic centres) have landed us in crisis at the health service delivery systems. Statistics reflects that, around 60 percent expectant mothers fail to receive pre-natal checkups and 30 percent of dying patients are unable to get treatment from trained physicians.
Another impediment found in existing hospitals is, government is not able to provide the sufficient life saving medicine to the public hospitals. Moreover, often these medicine are sold to the patients in overprice. Then, the shortage of seats or beds in the hospitals, and underdeveloped infrastructure just lengthen the list of problems.
Health is a right rather than a privilege, and it should be delivered with equity. We cannot deny the fact that, health is a requirement for social, economic and national development. However, it is paradoxical that people from low socio-economic background, especially the rural area, do not have the access to the health services. Conditions of upazila health complexes established to take health services to the poor rural people are in a pitiable state. Absence of doctors, inadequate supply of medicines and dressings, unsuitable and rusted medical equipment and unserviceable machines has turned most of them into deserted places.
More people die from lack of treatment than those who had treatment in those rural centres. On the other hand specialized hospitals and institutions with super specialties, both in public and private sectors, are being established exclusively in metropolis, cities and big towns. There are some specialized hospitals in the urban area with great manpower and equipment.
Procedures and treatments in these hospitals are extremely costly and very much out of reach for the low income group of people and the poor rural people such as marginal farmers/cultivators or agricultural or industrial workers, day laborers, construction workers, vendors and petty shop keepers, menials and so much and so forth. They cannot get any help from the public institutions, even they cannot dream of such healthcare.
Kazi Sumaiya, an NGO official and BRAC University graduate, said that, she had to go through an operation due to endomorphic cist in her uterus. Unfortunately, she was not cured and had to visit abroad for another operation. "I was very confused about the treatment; as the doctors did not clearly say anything, and they thought it was a case of miscarriage, which was not," said Sumaiya. She also mentioned that, lack of accountability among the doctors was the case there.
Statistics reflect, only one third of the union health centres are presently manned by an MBBS doctor. The government has created more than 4000 posts for MBBS doctor. Once recruited, these doctors have been posted to the available union health centres. Unfortunately, the healthcare facilities in the rural and upazila area remain very much under-utilized due to absence and negligence of doctors and their private practice (service in the exchange of fee) at the place of their work during and after office hours, absence of ambulance, inadequate supply of medicines or no supply at all and workout instruments and investigation facilities etc.
A good sign always comes after the bad. The government has taken the initiative to establish some more hospitals in the Dhaka city with the help of foreign aid, and these hospitals will be equipped with more advance equipment and medical machineries to reduce the tragidies.
However, much remains to be done. We must put lot of thrust to cut down maternal mortality and child mortality rate. For this we have to put more and more emphasis on reproductive health. If run and managed properly with adequate human and other resources, the community clinics may go a long way in delivery of primary healthcare at the grass root level.