Measles: Parents overwhelmed by treatment costs

“My beloved child Falak has fallen asleep. He will never return”—grocery shop owner Md Sakibur Rahman from Kushtia Sadar shared the news of his son’s death from measles in this way on Facebook last Monday.

Falak’s full name was Mohammad Noman Falak. He was only eight months old. He had been admitted to Kushtia Medical College Hospital since 25 March. For two days in between, he was taken to a private hospital in Rajshahi and admitted to the paediatric intensive care unit (PICU). In those two days alone, including travel from Kushtia, the total cost was Tk 50,000. Considering the expenses, his father readmitted him to Kushtia Medical College Hospital.

Falak’s father Sakibur Rahman told Prothom Alo over the phone on Monday that most medicines, saline, and syringes had to be purchased from outside. Including the two days at the private hospital, more than Tk 100,000 was spent on his son’s treatment. He could not even open his shop during the 19 days his son was hospitalised. The borrowed money will have to be repaid.

Like Sakibur Rahman, parents of children suffering from measles are struggling to manage expenses. Costs are lower in government hospitals. However, families incur much higher expenses when they have to move patients between multiple hospitals. Costs are even higher in private hospitals.

Relatives of patients said that in many cases, government hospitals do not have all medicines in supply, so they must be bought from outside. Various diagnostic tests are also required. In some cases, transportation costs are added when moving patients from one hospital to another. Expenses for food and other necessities for attendants also add up. Altogether, these costs are overwhelming for low-income and poor families.

Even then, there would be some consolation if they could return home with their child recovered—but many are returning with their child’s body.

Falak’s father said physicians at Kushtia Medical College Hospital had advised taking him to Rajshahi or Dhaka for treatment, but he could not afford it. With regret, he said, “We are poor people.”

No research could be found on the average cost of measles treatment. However, a 2022 study by Transparency International Bangladesh (TIB) revealed the cost of Covid-19 treatment. According to TIB, a Covid-19 patient had to spend on average more than Tk 450,000 in private hospitals, while the average cost in government hospitals was about Tk 36,000.

According to the latest report from the Directorate General of Health Services (DGHS), as of 8:00 am Wednesday, three more children died in the past 24 hours from measles and measles-like symptoms. Since 15 March, the government has reported 32 deaths from measles and 166 from symptoms.

The DGHS says that in the last 24 hours, as many as 1,032 people across the country showed measles symptoms. During the same period, 666 were admitted to hospitals.

Since 15 March, out of 19,161 people with measles symptoms, 12,318 have been hospitalised. Among them, 2,973 were confirmed with measles. A total of 9,772 have recovered and returned home.

Physician Moinul Ahsan, director (hospitals and clinics) of the DGHS, told Prothom Alo that the country has been facing one disease after another—Covid-19, dengue, and now measles. Currently, there is no difference in measles treatment between district towns and Dhaka hospitals. However, the situation becomes more complicated when intensive care, especially PICU, is required. There is a shortage of PICU facilities for children.

He said there is also a shortage of management capacity, skilled manpower, and equipment.

Moinul Ahsan added that sometimes hospitals may not refer measles patients to Dhaka, but anxious parents move patients from one hospital to another. Instead, if PICU is not required, treatment should be completed at the hospital where the patient is admitted.

Regarding complaints of shortages of syringes, oxygen, and medicines in government hospitals, he said there is no scope for such allegations. However, if any parent has such complaints, they should inform the DGHS.

Four-month-old Redwan is admitted to Bangladesh Shishu Hospital and Institute in the capital with measles symptoms. His father, Sohag Bhuiyan from Gazipur, said that when his son developed pneumonia in February, he was admitted to Shaheed Tajuddin Ahmad Medical College Hospital in Gazipur. After some improvement, they returned home, but the child fell ill again. He had to be admitted three times to that hospital alone.

As his condition did not improve, he was admitted to Kurmitola General Hospital from 8 March. When PICU support was needed, he was taken to the private New Life Hospital and later to Anwar Khan Modern Hospital.

Unable to bear the expenses, Redwan was later admitted to the pediatric hospital. After 16 days of treatment, he returned home, but two days later rashes appeared all over his body. On 5 April, Sohag Bhuiyan readmitted him to the children’s hospital for measles treatment.

Sohag, a driver, said he has spent Tk 600,000 to Tk 700,000 so far on his son’s treatment. He said Tk 350,000 was spent in just seven days in a private hospital PICU. He has not been able to work since his son fell ill and is managing expenses through loans.

“I have become completely destitute. My heart breaks—I can’t even tell anyone. Those who gave money once are unwilling to give again,” he said.

He added that medicines alone cost Tk 2,000–3,000 per day, and food expenses continue. He spends nights under the open sky outside the hospital. “I have no money left, but as a father, I cannot take my sick child home without treatment.”

In recent days, conversations with the parents of 10 measles-infected children at the children’s hospital revealed that they came from Jamalpur, Faridpur, Khilkhet in Dhaka, Manikganj, Kushtia, Gazipur, Lakshmipur, Brahmanbaria, and Bhairab. Their experiences with costs are nearly identical. Families face much higher expenses when the child’s condition worsens.

At the 100-bed Infectious Diseases Hospital in the capital, parents from different parts of the country have come for measles treatment.

Five-month-and-10-day-old Anshi Joydhar is receiving treatment on the hospital floor. Her mother, Seema Gain, said they had to pay Tk 9,000 for an ambulance from Kotalipara in Gopalganj to Dhaka. There is no fan where they are staying, so they had to buy a table fan. They also bought an electric bat to kill mosquitoes. Before coming to this hospital, they had already spent money on blood tests and other examinations. So far, around Tk 30,000 has been spent.

Anshi’s father, Bijoy Joydhar, works in a private company with a low salary. He said his wife is eating the food provided by the hospital, but he and his brother’s wife spend around Tk 300 per day on food.

He added that they would not have been able to afford treatment if the child had to be admitted to a clinic or private hospital.

Habibur Rahman, a farmer who works on others’ land in Chandpur, has admitted his eight-month-old son Omar Faruk to the same hospital. His mother, Firoza Begum, said they do not know how long they will have to stay. The longer the stay, the higher the expenses. Due to costs, they could not bring the child by ambulance from Chandpur and came by bus instead.

Mariam Begum from Noakhali said her daughter’s two children—Jafrin and Zarif, both 10 months old—were admitted to the hospital on 3 April and 8 April. It cost Tk 12,000 just to bring them to Dhaka from Noakhali.

In January 2023, the government’s Health Economics Unit published a report titled “Bangladesh National Health Accounts 1997–2020,” showing rising out-of-pocket healthcare expenditure. It stated that if total health expenditure is Tk 100, the government spends Tk 23, while individuals pay Tk 69. This personal expenditure is increasing every year, pushing many families into financial hardship and even below the poverty line.

Professor Syed Abdul Hamid of the Institute of Health Economics at Dhaka University told Prothom Alo that the cost of measles treatment is becoming unbearable for families regardless of their financial condition. Families are not getting treatment in one hospital and have to run to another. There is no certainty of getting PICU in another hospital. Ambulance fare syndicates are also operating, worsening the situation while the patient’s condition deteriorates.

He advised several measures, including setting up a dedicated emergency cell with a hotline for measles, similar to what was done during Covid-19. The government should maintain updated information on the availability of PICU beds in both public and private hospitals so that referrals can be made accordingly.