Coronavirus treatment inadequate outside of Dhaka

With the spread of coronavirus, the number of COVID-19 patients outside of the capital city Dhaka is on a rise.

Treatment outside of Dhaka is inadequate, and totally non-existent in some areas. However, the treatment of coronavirus is mostly Dhaka-centric.

Experts say that there is less focus on coronavirus treatment outside of the capital city.

According to the Directorate General Health Services (DGHS), outside of Dhaka city, there are no dialysis facilities for kidney patients afflicted with coronavirus. In the four districts of Mymensingh division, there are only 7 intensive care (ICU) unit beds. In Dhaka city and other districts of Dhaka division, there are 205 ICU beds. There are an inadequate number of general beds too for coronavirus patients in other districts.

Till Monday, 115,786 coronavirus cases have been confirmed in the country, of whom 45,755 have recovered and 1,502 have died. A total of 67,529 patients are undergoing treatment at various hospitals and at home. There are no accurate figures, however, as to how many are being treated in hospital and how many at home.

There are also complaints that some coronavirus patients have been unable to get admitted into hospital. At the same time, there are also reports of beds remaining vacant. Experts say, it would be possible to assuage people’s sufferings if coordination and surveillance was stepped up.

Speaking to Prothom Alo, the prime minister’s personal physician ABM Abdullah said, there are bed problems at the hospitals. Along with patients, the number of deaths is also increasing. He said it was essential to take all steps to reduce the number of deaths. Due to past trends, everything is Dhaka-centric and this is becoming more obvious during the pandemic.

Director (hospitals) of DGHS, Aminul Islam, said that for the time being there is no plan to increase the number of hospitals or beds for coronavirus patients. He said, while speaking to Prothom Alo, “Treatment for COVID and non-COVID patients in all government and non-government hospitals is being given priority. Hopefully this will resolve the problems outside of Dhaka.”

110 hospitals

A total of 110 government and private hospitals all over the country have been specified for the treatment of coronavirus cases. Of these, 26 are in Dhaka. The least number of these hospitals are in Sylhet division, where there are only 6.

Among the selected hospitals, there are large ones like Dhaka Medical College Hospital and also some with just 50 beds. Several institutes are being used as hospitals. There are also reports of coronavirus patients being treated in under-construction buildings.

There are 13 hospitals specified for coronavirus treatment in the capital city. Four of these are private hospitals. The private hospitals are providing treatment with assistance from the government. However, official and unofficial sources have confirmed that there are several other private hospitals that are treating COVID-19 patients.

The DGHS director Aminul Islam said that preparations have almost been finalised at the 1,500 bed isolation centre at the DNCC Market in Mohakhali. And the problems will further be abated, he said, when the 2000 bed isolation unit at Basundhara is fully utilised.

Number of beds

There are 12,034 beds in the hospitals for coronavirus treatment. Of these, 6,696 are in the capital city and other places of Dhaka division. That means 56 per cent of the beds are in and around Dhaka. The least number of beds, 413, is in Barishal.

Experts say that in almost all districts, the number of beds for coronavirus patients is inadequate. About a month and a half ago, the public health advisory committee of the health directorate had said that Barishal division would need at least 898 beds. They proposed 6,612 beds in all for districts of Barishal, Khulna, Mymensingh, Rajshahi, Rangpur and Sylhet divisions. They even specified how many beds there should be in specific hospitals of the districts and the upazilas. The health directorate has made arrangements for 4,200 beds in these 6 divisions, that is, 2,412 beds less than recommended.

There is discrepancy between the information of the health directorate and the divisional health offices. The directorate maintains that there are 13 hospitals selected for coronavirus treatment in Rajshahi and Khulna divisions. The number of beds in these two divisions is, respectively, 924 and 713. The concerned divisional health offices informed Prothom Alo that there are 10 hospitals in Rajshahi with 1,620 beds. In Khulna, there are 12 hospitals and 743 beds.

A member of the public health advisory committee, on condition of anonymity, told Prothom Alo, no serious mistakes had been made so far in the arrangements for the treatment of patients. Perhaps the number of beds could have been increased in the districts and arrangements for oxygen supply could have been improved. Attention now must be given to ensuring the treatment of all patients.

ICU crisis

According to the World Health Organization (WHO), 40 per cent of the coronavirus cases have mild symptoms. And 40 per cent have medium symptoms. In 15 per cent of the cases, the patients have acute symptoms. And 5 per cent of the patients develop complications. On the whole, 5 per cent of the patients need ICU treatment.

Neither the health directorate, nor the Institute of Epidemiology, Disease Control and Research (IEDCR), is making public the number of patients being treated in ICU or how many patients require ICU treatment.

According to DGHS sources, there are 339 ICU beds in 110 hospitals. The advisory committee had said that at least 720 ICU beds are required (outside of Chattogram division).

Mymensingh division has the least number of ICUs. In Mymensingh sadar, there is one hospital with 7 beds for coronavirus patients. There are no ICU beds in the other three districts of the division. According to the health directorate, there are no ICU beds for coronavirus patients in 49 districts. These facilities are basically restricted to the divisional towns.

There are 158 ICU beds in the capital city Dhaka and 49 in the 6 districts of Dhaka division. That means 60 per cent of the ICU beds are for Dhaka patients. And 40 per cent are for the patients in the rest of the districts of the country.

Dialysis only in Dhaka

Medical specialists have said that when the patients, who require regular dialysis, are infected with coronavirus, their condition deteriorates. They require special treatment. A patient needs to be attached to the dialysis machine for 3 and a half to four hours. And this treatment must be administered regularly. But outside of Dhaka there are no dialysis facilities for coronavirus patients.

There are 101 dialysis machines in 4 government hospitals of the capital city. Of these, 5 are in the Kuwait-Bangladesh Friendship Hospital, 2 at the Sheikh Russel Gastroliver Institute, 30 at Dhaka Medical College Hospital, 32 at Mugda General Hospital and 32 at Kurmitola General Hospital. The non-government Sajeda Foundation Hospital has one dialysis machine.

Unless sincere efforts are made, these problems will not be resolved, said public health expert and former director of the health directorate’s disease control unit, Be-Nazir Ahmed. He said, “A people-friendly public health structure has not been created in the country. There is no health planning with marginalised communities in mind. Something new could have been done, given the coronavirus situation, but nothing new has been taken up. However, there is still time.”

Correspondents of Rangpur, Mymensingh, Barishal, Sylhet, Khulna, Rajshahi, Narayanganj, Gazipur and Manikganj helped in preparing this report. The report has been rewritten in English by Ayesha Kabir.