No ICU service at government facilities in 22 districts

Md Shahin who sustained head injuries was in need of treatment at the Intensive Care Unit (ICU). The injury was too critical to continue treatment keeping him in the general ward of a hospital. He could not be treated at the hospitals in his hometown Feni. No ICU bed was available at the government hospitals in neighbouring district Chattogram. He was brought to Dhaka. Upon returning to Feni, Shahin breathed his last on Wednesday as he did not get medical treatment here too.

This crisis faced in getting an ICU bed for Shahin is not an isolated incident. Prothom Alo correspondents on Thursday learned from the civil surgeons of their respective districts that there is no ICU service at the government hospitals in at least 22 districts.

ICU beds are required for patients who are critically ill or and at the risk of death. A patient is kept under observation at the ICUs for 24 hours and the patient needs special care. Special equipment is required for treating a patient at the ICU. Alongside the physicians, the nurses are given special training to work at the ICU. This specialised service is relatively cheaper at the government hospitals in the country. That’s why people want to avail the service at the government hospitals.

Shahin was an electrician and his family could not afford private hospital treatment. He had been injured critically in a motorcycle accident. He was brought to the National Institute of Neuroscience and Hospital, Dhaka from Chattogram on Tuesday. The NINH is well-known for providing better care to patients with head injuries.

But the hospital that day said it did not have any vacant ICU bed. His relatives then took him to Dhaka Medical College Hospital (DMCH) but the result was same, no vacant ICU bed. Shahin’s relatives did not have the capacity to bear his medical treatment costs at any private hospital. Finding no other alternatives, the relatives took him back to Feni.

The death of Shahin once again revealed the decrepit state of the healthcare sector in the country. The number of accidents is on the rise, the number of people suffering from complex diseases is also increasing, along with this the necessity of ICU service. But people are not getting this service and at the same time there are many allegations in this connection too.

Speaking to Prothom Alo, Bangladesh Medical Association (BMA) secretary general Ehteshamul Huq Chowdhury said, “The head of the government during the beginning of coronavirus breakout three years ago directed that ICU facilities be opened in all the districts. But this could not be opened in all the districts due to the ministry’s negligence and indifference of the health directorate. This is extremely unfortunate.”

There is no ICU bed at the government hospitals in Rangamati, Bandarban, Khagrachhari, Barguna, Lalmonirhat, Gaibandha, Chapainawabganj, Panchagarh, Natore, Magura, Jhenaidah, Bhola, Nilphamari, Thakurgaon, Kurigram, Jamalpur, Jhalakathi, Pirojpur, Shariatpur, Netrokona, Chuadanga and Sunamganj. Besides, though there are ICU facilities in Bagerhat and Madaripur hospitals, these are not functional.

Responding to a question on what do they do if an ICU bed is required, Lalmonirhat civil surgeon told Prothom Alo, “We send emergency patients to Rangpur.”

Several large government hospitals in the capital city also do not have ICU beds. National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) is a 1000-bed hospital where many critical patients take admission every day. But it was found out on Thursday that this hospital does not have any ICU bed. National Institute of Ear, Nose and Throat (ENT) also does not have any ICU facility.

As per the health directorate’s Management Information System (MIS), until 2021, the number of ICU beds at specialised government hospital in country was 548. Such beds at the district level was 348. That means the ICU beds in the country were 896 as of 2021.

Some more ICU beds have been added in the government hospital in the last two years. The health directorate’s deputy director Md Moinul Ahsan told Prothom Alo that 10-bed ICUs have been opened at 10 government medical colleges each. At the same time, 10 ICU beds each have been opened at 13 district hospitals.

Currently the number of ICU beds in the government hospitals in the country is 1126. Though there is no specific information, the number of ICU beds at private hospitals is nearly 1000.

Health directorate’s acting director (hospital & clinics) Sheikh Daud Adnan told Prothom Alo, “Our goal was to open ICU beds in all the districts. We opened ICUs in all the districts during the coronavirus pandemic and trained 400 people on it. There is no problem of using those ICUs now.”

The health directorate has several directives regarding opening 10-bed ICUs. It said the service has to be kept open for 24 hours a week. There will be nine compulsory and four selective services there.

There will be 13 full-time physicians, seven different physicians and 16 full-time nurses for a 10-bed ICU. Besides, there will be 16 more health workers there. Sixty three types of equipment and 49 types of drugs will be required to run the unit.

People wait in queues at every government hospital with ICU facilities. Those who cannot manage an ICU bed at government hospital go to private hospitals.

Health directorate officials said owners of many private hospitals and clinics use a section of the hospital as an ICU. There are few owners who provide the ICU service after taking due permission.

Owner of a hospital in Mohakhali in Dhaka said the daily charge is Tk 15,000 for an ICU bed. This does not include physician fees, medicine expenses and cost of tests. In response to a question on overall cost a day, the owner said, “Around Tk 30,000- Tk 35,000.”

The larger the hospital the costlier the ICU service. Many people cannot avail the service while many people stop treatment midway.

When the relatives of Shahin could not manage any ICU bed at the Dhaka Medical College Hospital on Tuesday, they took him to a private hospital in Dhanmondi thinking it would cost them Tk 10,000-12,000 to admit him there. But they could not do so. It was said from the hospital that the cost would be Tk 50,000-60,000.

The relatives could not manage the money and took him back to Feni that night. Later he breathed his last on the next day, Wednesday.

* The report was originally published in the print edition of Prothom Alo and has been rewritten for English edition by Shameem Reza