Rafiq, a salaryman in his late forties living in Bhola, suddenly became unconscious while at work. His coworkers immediately took him to Bhola District Hospital, where the doctors suspected he had a stroke.
Bhola District Hospital has no Intensive Care Unit (ICU), so the doctors there referred Rafiq to Barishal Sher-e-Bangladesh Medical College Hospital for proper treatment. The three-hour delay in emergency healthcare left Rafiq’s left side of the body permanently paralysed.
Rafiq was diagnosed with hemorrhagic stroke, and though he survived the ordeal, his mobility may have been saved if he had quick access to an Intensive Care Unit (ICU), his son Jamal told The Business Post.
This is not an isolated story. Finding a hospital with an ICU has always been an uphill battle for patients needing emergency medical care, especially outside the capital city of Dhaka. Even if a critical patient is able to find a hospital with ICU, there is no guarantee that a bed is available.
Discussing the dire situation, Bhola Civil Surgeon Dr KM Shafiquzzaman said, “At least 17 lakh people live in Bhola. Many come to the Bhola District Hospital seeking emergency medical care, but we refer them to Barishal and Dhaka, as we do not have ICU facilities here.
“We need at least 15-20 ICU beds to be available every day. Our patients are suffering deeply due to a lack of ICUs in the district. We hope to get an ICU unit with 10 beds soon.”
A grim reality
The ICU shortage is a grim reality in nearly every district in Bangladesh.
According to the Directorate General of Health Services (DGHS) Health Bulletin 2018, there are 52,807 beds in government hospitals across the country, so there needs to be more than 5,000 ICU beds available, or at least 2,112.
But the actual number is only 211, which is less than 1 per cent of the total number of beds.
After Covid‑19 cases began surging in Bangladesh, Prime Minister Sheikh Hasina issued a directive on June 2, 2020 to set up ICUs in every district hospital on an emergency basis to protect the countrymen from the pandemic.
There were only 14 ICU beds in two district hospitals in 2019.
Following the prime minister’s directive, the DGHS installed 202 ICU beds in 27 district hospitals with revenue budget and local contributions. But 18 out of 27 ICU units are now non-functional due to a lack of skilled manpower.
About Tk 2.5 crore to Tk 3 crore were spent on every 10-bed ICU facility, and total expenditure was at around Tk 70 crore, including the purchase of equipment, DGHS sources said.
Dr Kazi Mizanur Rahman, superintendent of Bogura 250 bed Mohammad Ali District Hospital, said, “The ICU beds set up during the Covid-19 pandemic crisis are now non-functional. We cannot offer these beds to patients due to a lack of specialised personnel.
“The government or the Health and Family Welfare Ministry should take immediate measures to set up modern ICU facilities.”
Echoing the same, Civil Surgeon of Bogura Dr Mohammad Shafiul Azam said, “The district is facing a severe ICU crisis. I hope the ministry will resolve the shortage soon.”
Personnel shortage
According to Bangladesh Society of Critical Care Medicine, at least six consultants of different levels, two coordinators/registrars, 12 senior and junior medical officers and nurses, four ward boys and eight cleaners are a must to run a 10-bed ICU unit for 24 hours.
The country’s ICU units are facing a shortage of skilled manpower. Even the district hospitals, that have functional ICUs, have been suffering from a lack of dedicated doctors and nurses.
The 10-bed ICU at Tangail District Hospital is operational, but it has no specialist doctors. Doctors from the medicine department run the ICU, and there is no dedicated nurse for the unit.
Khondoker Sadikur Rahman, assistant director of the hospital, said, “We need adequate manpower at our ICU facility. I am urging the ministry to take the necessary initiative in this regard.”
According to Bangladesh Society of Critical Care Medicine, there are 82 critical care medicine specialists in the country, and 50 per cent among them work in private hospitals.
As many as 1,800 doctors, nurses and staffers from 43 districts and 27 medical college hospitals across the country were trained for ICU management at the district level by the Bangladesh Society of Anaesthesiologists, funded by Save the Children and USAID.
‘Did not see any fruitful initiative’
Prof Dr Nazrul Islam, noted virologist and former vice-chancellor of Bangabandhu Sheikh Mujib Medical University (BSMMU), said, “We are worried about ICU operation in the country. Medical education is going through a bad state.
“There are no adequate teachers at medical colleges. We have also been asking the government to create skilled manpower for running the ICUs. But we did not see any fruitful initiative.”
He added, “Many government and private hospitals were established with no ICUs and still lack the experts needed to run it. Regrettably, the patients are suffering every day. The ministry should take immediate action to improve ICU facilities.”
M Iqbal Arslan, former dean of the Faculty of Basic Science and Para Clinical Science at BSMMU, said, “The government will not be able to reach the target for universal health coverage without setting up and running the ICUs properly.
“Healthcare does not mean much if patients in critical condition lack quick access to ICUs. The ministry should think more on how to resolve this matter.”-
Threat of Covid-19 resurgence
Authorities in 227 countries and territories have reported about 676.6 million Covid‑19 cases and 6.9 million deaths since China reported its first cases to the World Health Organization (WHO) in December 2019.
The DGHS is planning to restart the Covid-19 vaccination programme as infection of Covid sub-variant JN1 has started to increase in various countries, including India.
Dr Mohammed Nizam Uddin, director of the Expanded Program on Immunization (EPI) at the DGHS, said they are ready to face another surge of Covid-19. “We will provide vaccinations again if the National Advisory Committee advises the move,” he said.
Prof Dr Nazrul Islam pointed out that the government should keep the ICU beds ready to tackle emergencies and save people’s lives.
A little hope for ICU
Funded by the World Bank, the DGHS took up a project titled “Covid-19 Emergency Response and Pandemic Preparedness (ERPP)” in April 2020 to build ICUs in 53 districts and 10 medical college hospitals.
The project had a Tk 7,000 crore budget, but this amount has decreased due to the USD price hike, insiders say.
“We spent TK 42 crore to buy vaccine doses, built central oxygen systems at 30 hospitals and artificial labs at 29 medical colleges. We also launched one stop emergency services under this project,” former Project Director Dr Shah Golam Nabi Tuhin told The Business Post.
Dr Kham Mohammad Arif, the incumbent project director, told The Business Post, “We have started 10-bed ICUs at 13 district hospitals, 18 are under construction and work on 17 more is going on.
“We are trying to complete all the work by this year. It is true that we have a personnel crisis, but I hope we can operate the ICUs smoothly.”
He however mentioned that the project’s completion has been delayed due to a number of reasons, such as changes in the project director position, increase in USD prices, and issues regarding equipment purchases.
