No ICUs in 52pc of govt corona hospitals

Seventy-eight-year old Lalni Kanti from Collegepara area of Naogaon’s Badalgasi upazila was diagnosed with Covid-19 at Naogaon sadar hospital.

As his condition deteriorated, physicians advised taking him to intensive care unit (ICU). Since there was no ICU facility at the Sadar hospital, Lalni was sent to Rajshahi Medical College Hospital (RMCH) and he died on the way in the evening of 1 July.

The in-charge physician of Nagaon sadar hospital’s Covid-19 unit, Shapla Khatun told Prothom Alo many patients were being brought to the hospital at the last moment. In most cases, there is nothing to do as the hospital has no ICU facility. And risk of deaths is increasing, she added.

More than 100 people have been dying daily for the last seven days. Last week, 77.5 per cent of the deaths, according to Directorate General of Health Services (DGHS), were reported from seven divisions with little ICU facilities and 22.5 per cent of deaths from Dhaka division.

Fifty two out of 100 government hospitals designated for treatment of Covid-19 patients don’t have the ICU facility. Thirty five of these hospitals are the district Sadar hospitals. Seventy five per cent of the ICU facilities are in Dhaka division and the remaining 25 per cent are in other seven divisions. Had the Sadar hospitals had the ICU facilities, more fatalities would have been prevented, officials and physicians at the districts’ health departments observed.

On 2 June last year, prime minister Sheikh Hasina at a meeting of the Executive Committee of National Economic Council (ECNEC) ordered to set up ICU unit at all district hospitals. She also directed to install ventilator and increase supply of oxygen at each hospital and purchased the necessary machineries. Public experts blame DGHS’ negligence and lack of plan for not setting up the ICU unit at district level in 13 months.

DGHS’s spokesperson and director (disease control) Nazmul Islam Prothom Alo shortage of manpower is a big barrier to installing ICU. If infrastructure is developed without manpower, people won’t get any benefit. An initiative has been to recruit necessary manpower including junior consultants. Instalment of ICU is underway though slowly, he added.

A Covid-19 patient with critical condition requires emergency invasive mechanical ventilation and IUC facility. According to World Health Organization, 15 per cent of Covid-19 patients show acute symptom and 5 per cent becomes critical. Almost all patients showing acute symptom to critical condition and many patients with mild symptom requires hospitalisation and almost all critical patients require ICU service and ventilation.

Critical Covid-19 patients are not getting admission to the hospital due to shortage of ICU facility. If condition of any admitted patient deteriorates or any patient requires an ICU, the patient is then being shifted to the other district’s hospital. Many patients die on the way to the hospital.

Trader Billal Sarkar from Peyarpur area of Madaripur’s sadar upazila died of Covid-19. As he suffered from acute respiratory problem, Billal Sarkar was being taken to Dhaka Medical College Hospital. He died on the way. Sagar Sardar, elder son of Billal Sarkar, said, “My father was sent to Dhaka at the last moment. Had there been an ICU facility at the sadar hospital, my father would have survived.”

Madaripur’s civil surgeon Md Shafiqul islam told Prothom Alo opening ICU isn’t possible without necessary manpower. A demand letter on various matters including manpower has been sent to the DGHS, he added.

There are 16 hospitals designated for Covid-19 treatment in Dhaka city. Three of them - Infectious Diseases Hospital, National Institute of Kidney Diseases and Urology and National Institute of Neurosciences and Hospital – have no ICU facility.

There are 14 hospitals designated for Covid-19 treatment in various districts of Dhaka division. Six of these hospitals – Zinzira 20-bed Hospital, Sadar hospitals of Madaripur, Narsingdi, Munshiganj and Shariatpur districts and Bhairab trauma center of Kishoreganj - have no ICU facility.

In Chattogram city, one out of four hospitals designated for Covid-19 treatment -- Chattogram Railway General Hospital -- has no ICU facility. In Chattogram division, there is no ICU service in Mongolkandi 20-bed Hospital of Feni’s Sonagazi, corona centre set up at Noakhali’s Shaheed Bhulu Stadium, Cumilla General Hospital and sadar hospitals of Bandarban, Khagrachhari, Rangamati, Chandpur and Brahmanbaria districts.

In Rangpur division, there is no ICU facility in sadar hospital of Dinajpur, Panchagarh, Nilphamari, Kurigram, Thakurgaon, Lalmonirhat and Gaibandha districts, Tajhat Chest Disease Hospital and Haragach 31-bed Hospital of Rangpur, Lailmonirhat Government College (isolation centre) and Lalmonirhat Railway Hospital.

Since there is no ICU service in Thakurgaon, four to five critical Coivd-19 patients are shifted to Dinajpur’s M Abdur Rahim Medical College daily. Many of them died on the way to the hospital. Former finance secretary of Awami League’s Dinajpur district unit Rowshan Ali died of Covid-19 recently while he was being shifted to Rangpur.

Superintendent of Thakurgaon sadar Hospital Nadirul Aziz said the DGHS has decided to set up an ICU unit at the hospital. The DGHS sent letter to the Public Works Department to construct a separate building for ICU facility. And it will take time, he added.

There are 25 ICU beds in Barishal division including 22 ones in Sher-E-Bangla Medical College Hospital of Barishal and three in Bhola Sadar Hospital. There is no ICU facility for Covid-19 patients in Jhalakathi, Barguna, Pirojpur and Patuakhali districts.

More deaths have been reported from Khulna and Rajshahi divisions for several days since there is no ICU facility in 10 out of 18 districts in these two divisions. There is no ICU facility in Chapainawabganj, Naogaon, Natore, Pabna, Sirajganj and Joypurhat districts of Rajshahi division.

The DGHS approved setting up of an ICU unit at 25-bed Naogaon General Hospital in August last year. Necessary equipment to set up two ICU beds arrived at the hospital two month ago but it hasn’t been installed as yet.

The acting superintendent of the hospital and civil surgeon of Naogaon, AMB Abu Hanif told Prothom Alo the ICU facility wasn’t set up as monitor, ventilator and high flow nasal cannula haven’t arrived as yet.

Critical patients aren’t receiving treatment due to lack of ICU facility in Natore sadar hospital. Hospital’s assistant director Poritosh Kumar Roy said they have been getting in touch with the DGHS for the ICU. But the DGHS replied saying they have no ICU equipment right now. Besides, no central oxygen supply system has been installed at Natore sadar hospital as yet and an ICU can’t function without it, the official added.

There is no ICU bed in the Sadar hospital of Chuadanga, Jhenaidah, Narail and Magura districts of Khulna division.

Mymensingh and Sylhet divisions have the lowest number of ICU beds. There are 13 ICU beds in Mymensingh district and two ICU beds in Jamalpur Sadar Hospital and no ICU bed in Netrokona sadar and Sherpur sadar hospitals.

There are 21 ICU beds in Sylhet division including 16 ones in Sylhet district and five in Moulvibazar. There is no ICU facility in sadar hospital of Habiganj and Sunamganj districts, health complex of Dakshin Surma and Rajnagor upazilas and Khadimpara 31-bed Hospital.

There were 278 patients at 250-bed Kushtia general hospital as of 4 July. According the DGHS, the hospital has four ICU beds. But sources at the hospital said there is no necessary machineries at the ICU unit.

Regarding this, Kushtia’s civil surgeon HM Anwarul Islam told Prothom Alo, “It’s not a complete ICU unit since it lacks some equipment. Ventilator hasn’t been available as yet. The DGHS in Dhaka has been informed but no supply has been made as yet.”

The member of Covid-19 national technical advisory committee, professor Nazrul Islam thinks that not having ICU at all district is a gross negligence of the DGHS.

Nazrul Islam, who is a former vice chancellor of Bangabandhu Sheikh Mujib Medical University (BSMMU), told Prothom Alo what the health ministry has done in a year so far. There was no shortage of money and even prime ministers’ order wasn’t being followed. The health ministry didn’t pay heed to the treatment of Covid-19 patients at all, he added.

Pothom Alo’s Correspondents and Staff Correspondents contributed to the report from the respective districts.

*This report appeared in the print and online edition of Prothom Alo and has been rewritten in English by Hasanul Banna