Lives of children with measles fading while searching for ICU beds

The home of Sohag Kumar and Bandana Rani in Natore was filled with joy just six months ago with the birth of their first child. Little Gouri, whose cries, smiles, and movements had brought life to the entire household, has now left that home in silence. While waiting to get into the intensive care unit (ICU) at Rajshahi Medical College Hospital, Gouri’s breathing eventually stopped. The child died in the hospital’s measles isolation ward.

After Gouri’s death, her father Sohag Kumar told Prothom Alo over the phone on 20 April, “By the time we got a serial for ICU admission, my Gouri was no more. I tried, the physicians also tried; but all the patients already admitted in the ICU were in critical condition. The serial cannot be broken. If the government can, it should increase ICU beds.”

Private service holder Al Amin, from the capital’s Mirpur, also lost his four-year-three-month-old daughter Akira Haidar Arshi on 2 April while she was on life support at the Paediatric Intensive Care Unit (PICU) of MR Khan Children’s Hospital in Mirpur.

Al Amin told Prothom Alo that Akira had been admitted to that hospital twice. In addition, the child had been under treatment for a total of 27 days at Delta Hospital, Global Specialised Hospital, and several other hospitals with pneumonia and measles. Her fight for survival began on 8 March—ultimately ending in the PICU.

A report published in Prothom Alo on 28 March titled “Measles spreads, three of four children waiting for ICU die” described the overall situation at Rajshahi Medical College Hospital.

It mentioned that the hospital has only 12 ICU beds for children with measles, while 30 to 50 children remain on the waiting list. In March alone, 12 children died while under treatment there; even after being taken to the ICU, nine could not be saved.

Mahfuzur Rahman and Neela Akter from Sirajganj had an 11-month-old daughter named Maliha. Before her first birthday, her condition became critical due to measles symptoms and pneumonia.

Mahfuzur ran for 20 days in search of an ICU—from Ullapara in Pabna to Ashulia in Dhaka, and then from one hospital to another in the capital. Their final refuge was the PICU of the Bangladesh Shishu Hospital & Institute in Dhaka.

Mahfuzur Rahman works as an electrician in a garment factory in Ashulia, Savar. On 19 April, he told Prothom Alo over the phone that after moving across Ullapara, Ashulia, MR Khan Children’s Hospital, and Bangladesh Children’s Hospital and Institute (commonly known as Children’s Hospital) in search of a PICU, his daughter Maliha died on 12 April.

Mahfuzur Rahman said that at the Children’s Hospital, his daughter was first kept in the measles ward, then in the ICU for measles patients, and later in the PICU. More than Tk 250,000 was spent on her treatment. To arrange the money, he sold his wife’s 10-ana gold jewelry, borrowed money, and took help from relatives.

Overwhelmed by the pressure of his daughter’s death, hospitals, and expenses, Mahfuzur said, “Along with tests, almost all medicines had to be bought from outside during ICU-PICU admission. Later, physicians called and said, ‘Come see your child.’ By then, Maliha had died.”

Ten-month-old Soha Moni from Madaripur died on 10 April in the Respiratory Care Unit (RCU) of the Children’s Hospital after being infected with measles and pneumonia. Before that, she had to be taken to four hospitals, including the Infectious Diseases Hospital.

Soha Moni’s uncle, Rashedul Islam, said she had been admitted to the Infectious Diseases Hospital in Mohakhali from 30 March to 4 April. At one point, an ICU bed was available there; however, as her condition worsened, she was referred to another hospital. This was because the ICU at that hospital does not have ventilators for children under six years of age.

Junior Consultant (Medicine) of the Infectious Diseases Hospital, physician Sribas Paul, who is in charge of the ICU, told Prothom Alo that measles patients are currently being treated in limited ICU and HDU (High Dependency Unit) beds at the hospital.

This hospital has seven ICU beds (for adults) and five beds in the HDU. Currently, children with measles are being treated there on a priority basis.

There are also cases where, even after getting an ICU bed, children could not be kept there due to financial constraints, resulting in death. One such case is eight-month-old Md Noman Falak. He died on 13 April at Kushtia Medical College Hospital. He had been admitted there on 25 March. When his condition worsened, he was taken to a private hospital in Rajshahi for two days in the PICU. However, after spending Tk 50,000 in just two days, including travel, his father Md Sakibur Rahman, a grocer, brought him back to Kushtia.

Since Kushtia Medical College Hospital does not have a PICU, Falak was treated using a locally made ‘headbox’—a plastic box with oxygen supply pipes. Physicians describe this locally innovated headbox system as a “better than nothing” solution. Similar headboxes are also being used at Sher-e-Bangla Medical College Hospital in Barishal to cope with ICU shortages.

During the COVID pandemic, the ICU shortage became a major issue in the country. At that time, in response to a High Court order, the government stated that there were 733 ICU beds in government hospitals. Under pressure, initiatives were taken to increase ICU capacity. In November 2022, the Directorate General of Health Services reported that there were a total of 1,169 ICUs in both public and private hospitals.

When asked about the current number of ICUs, officials of the Directorate General of Health Services said there are now 1,372 ICU beds across 74 medical colleges, district, specialised, and general hospitals in the country. However, no complete separate list of PICUs for children is available.

At Bangladesh Children’s Hospital and Institute, there are 44 beds in the specialised measles ward. Within this ward, there is a 16-bed ICU. In addition, children are being admitted to single cabins and isolation wards.

According to updated data from the Directorate General of Health Services, from 15 March to yesterday, 34,662 measles-symptom patients have been identified in the country, of whom 23,348 were hospitalised. Measles infection has been confirmed in 4,856 patients. Among the infected, 47 have died, while 226 deaths occurred with symptoms.

In the last 24 hours, 1,276 new measles-symptom cases have been identified, and 163 cases have been confirmed. This shows that the number of daily measles patients alone is only slightly higher than the number of ICU beds.

According to the Expanded Programme on Immunization (EPI), measles has spread to 61 districts of the country. Among those infected, 83 per cent are children under five years of age.

Professor Md Mozibur Rahman, Director of the Institute of Child and Mother Health in Matuail and consultant at Bangladesh Neonatal Hospital, told Prothom Alo that the neonatal hospital has a 38-bed ICU for measles patients and a 5-bed free PICU for street children. So far, three children have died there. On the other hand, 190 patients with measles symptoms have been admitted to the Child and Mother Health Hospital, which has an 8-bed measles ward and a 3-bed PICU.

Professor Mozibur Rahman said there is a shortage of PICUs, skilled human resources, and equipment in hospitals across the country. It is urgently necessary to ensure oxygen services, training, and essential medical equipment.

The Directorate General of Health Services estimates that the measles outbreak may continue for another one to one and a half months. As children are the most affected, physicians see a greater need for pediatric ICUs (PICUs).

However, shortages of PICUs across hospitals have been highlighted in Prothom Alo’s series of reports. A report published on 2 April titled “Measles-symptom patients rising, no ICU-ventilators for children” noted the absence of a PICU at Shaheed Ziaur Rahman Medical College Hospital in Bogura. PICUs are also not available at Mymensingh Medical College Hospital and Cumilla Medical College Hospital.

Physician Md Mushfiqur Rahman, in charge of the NICU at Queens Hospital Private Limited in Jashore and serving as a medical officer in the PICU of Al-Manar Specialised Hospital in the capital, told Prothom Alo that it is essential to have PICUs in all 64 districts under government initiative. While treatment through private initiatives is expensive, it is feasible at the state level.

Parents Mohammad Harun Al Rashid and Kamrun Nahar had been fighting with hope to return home with their 7-month-20-day-old twin sons Jabiyan and Jahiyan after recovery. That wait has finally ended. After prolonged treatment and multiple hospital stages, they returned home with their two sons on 22 April.

Harun Al Rashid, a call center employee of Dutch-Bangla Bank, told Prothom Alo that on 2 March, the twins were first admitted to Bangladesh Neonatal Hospital in Narayanganj with pneumonia. After some recovery, they returned home. Later, on 23 March, they were admitted again to the Child and Mother Health Institute and Hospital in Matuail. During this period, Jahiyan was infected with measles twice and Jabiyan once. Jahiyan was in the ICU from 12 to 19 April, after which both were treated in a cabin.

At Bangladesh Neonatal Hospital, Harun Al Rashid spent Tk 130,000 for seven days of PICU care for his two sons. Later, combining both hospitals, the total cost has exceeded Tk 300,000.

Harun Al Rashid said, “Moving between wards and PICUs again and again, we became exhausted. Finally, we have been able to return home with our sons.”