Intensive care scanty for kids
Fourteen-month-old Afrin was lying on a bed at the neurosurgery ward of Dhaka Medical College Hospital. With a worried face, her mother Jesmin Begum kept staring at her. Sitting on an adjacent bed, Afrin's father Rintu Qazi looked hapless.
Diagnosed with brain tumour three months ago, Afrin was admitted to the ward on January 16. There, doctors said the child must be shifted to an Intensive Care Unit (ICU).
But, the DMCH, the country's largest government hospital, does not have one for children of her age. And Afrin's parents are too poor to take her to a private hospital, which has that particular ICU known as Paediatric ICU (PICU).
So they kept her at the neurosurgery ward of the DMCH.
"I have learnt that private hospitals charge around Tk 20,000 for each day at the PICU. I cannot afford to pay even Tk 2,000 for a day,” Rintu, a human haulier driver, told The Daily Star late last month.
The family from Munshiganj's Sreenagar was still at the hospital yesterday. “Doctors say my child was not yet in a condition to undergo surgery,” said Rintu.
Often, children like Afrin suffer, even die, due to the absence of PICU at government hospitals. Of all the public hospitals in the country, only Chittagong Medical College Hospital (CMCH) has this special facility.
Run by paediatricians, PICU is meant for child patients aged between 28-days and 12 years.
The DMCH has a neonatal intensive care unit that deals with child patients aged up to 28 days old. Operated by neonatal specialists, the NICU is meant only for the newborns and the equipment available there is specially designed for them.
A doctor working at the unit said the weight and the size of a baby usually triple after a year of his or her birth. So the tubes meant for artificial ventilation at the NICU would not fit a one-year-old.
Tofazzel Hossain, an ICU specialist working at the hospital, said children should not be admitted to the ICU meant for adult patients for some obvious reasons.
For instance, he said, the ventilators at the ICU were not designed for children. A child usually inhales 150ml to 200ml of oxygen while breathing against 500ml of oxygen inhaled by an adult on average.
“But, the ventilators at the ICU for adults can't supply oxygen below the 200ml mark. On the other hand, children won't be able to take in the extra oxygen, if given.”
Asked for comments on Afrin, Prof Zillur Rahman, the immediate past head of the neurosurgery department at the hospital, said doctors referred patients to ICU observing his or her condition.
However, many such patients receive treatment at the wards as they cannot afford treatment at the ICU. Some of them do recover with special attention from doctors, he added.
But for patients needing the ICU facilities, even a few minutes can be fatal.
Take the example of Tasfir Alam Rabbi, a one-and-a-half-year-old boy who suffered severe head injuries in a road accident in Narsingdi on February 12.
Hours after the accident, he was rushed to the DMCH around 11:00am. As his condition deteriorated, doctors referred him to PICU, Mohamad Rubel, a friend of the child's father Nur Alam, told The Daily Star that day.
“As we asked the doctors to shift the child to the PICU immediately, they said they don't have one. They told us to take him to a private hospital instead.”
Later in the day, Rabbi died at a private hospital in Mohammadpur.
Talking to this newspaper recently, Rubel said the boy could have been saved had he been given immediate treatment at the government hospital.
“Rabbi was at the hospital for around five hours. Again, much of the crucial time was wasted looking for the PICU outside,” he lamented.
Talking to The Daily Star, another ICU specialist, said, “On several occasions, we found ourselves in helpless situations. It happened when we found out that a child needs to be referred to the PICU at a private hospital and the family is not capable of bearing the medical expenses.”
The Daily Star has talked to the authorities of two city private hospitals, which have the PICU facility. One of the hospitals charges PICU patients Tk 20,000 for a day while the other charges between Tk 30,000 to 40,000.
Contacted, DMCH Deputy Director Khwaja Abdul Gafur said PICU was a very urgent need for the hospital and that they have recently requested the health ministry for it.
“We want to set up a PICU ward beside the adult ICU ward at the hospital,” he said, adding that the hospital currently has a 35-bed neonatal ICU, and a 20-bed ICU for adults, which were not sufficient.
Talking to this newspaper, Brig Md Jalal Uddin, director of CMCH where a 10-bed PICU was set up under a joint initiative of the hospital and PHP Group in 2015, said the facility was inadequate as compared to the number of patients.
Mesbah Uddin Ahmed, a former secretary general of Bangladesh Paediatric Society, said every government hospital must have a PICU.
He also said on several occasions, they had requested the authorities for setting up PICUs at hospitals but the requests “fell on deaf ears”.
Contacted, Abul Kaiser Mahmood Saiedur Rahman, director (hospital and clinics) of Directorate General of Health Services, said they could not open PICU at the hospitals mainly due to lack of trained manpower. “It is very difficult to get skilled manpower.”
About PICU, he said only child specialists were not enough for running those. Doctors need specific post graduation degrees and training, which is a long process.
He also said, “The government has made a decision to establish ICU and NICU at every medical college and district hospital gradually within the next five years. We have plans to open PICUs and SCNUs [special care newborn units] too.”
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