12:02 AM, April 09, 2014 / LAST MODIFIED: 01:53 AM, March 08, 2015

Treatment shrouded in questions

Treatment shrouded in questions

Emran Hossain with Aminul Islam, from Mymensingh
Saad Ibne Momtaz
Saad Ibne Momtaz

Misdiagnosis and scant medical attention at Mymensingh Medical College Hospital hammered the final nail in the coffin of Bangladesh Agriculture University student Saad Ibne Momtaz, a victim of the country's violent politics.
His life could have been saved with timely diagnosis and proper treatment, a number of experienced doctors in Dhaka and Mymensingh have said upon studying Saad's postmortem report.  
The first doctor who examined him was university physician Abul Kalam Azad and he found the patient's condition grave, given he could not sit on his own and could move only his right hand.
According to Azad, Saad had already vomited once and marks of clotted bloods had covered his body from the savage beating by fellow Chhatra League men on the campus.  
“It took me no more than five minutes to refer him to Mymensingh Medical College,” Azad told The Daily Star.
Nine BAU students then took him to the MMCH around 9:30pm on March 31. One of the doctors, who turned out to be an intern, seeing Saad at the hospital's surgery ward assured the students that his injuries were not a matter of concern.   
All the nine students were Chhatra League activists, and one of them was Mizanur Rahman.
“The doctor's words failed to assure me as I could guess Saad's condition was not good,” Mizanur, who claimed to have boarded the ambulance carrying Saad from the university midway as he was not present at the dormitory during the beating.

The BCL activists, all being allegedly involved in torturing Saad with iron rods, cricket stumps and hockey sticks over a dispute centring on a class tutorial, left the hospital around 11:00pm.       
Mizanur said doctors confirmed them that Saad did not have any injury in the head.
The Daily Star spoke to the surgery ward chief Prof Ashraf Uddin, who said a few doses of painkillers and an antibiotic injection were all that had been administered on Saad.  
Referring to the postmortem report, the MMCH Director Brig Gen Fashiur Rahman tried to misguide these correspondents by insisting that Saad had blunt injuries all over the body from the neck down, but not in the head.
“Since it was not an emergency case, we decided to examine his whole body the next day,” said Fashiur.
The Daily Star obtained a copy of the postmortem report that reads: “Extensive bruise of different size and shape found throughout the whole body. One haematoma [clot of blood] 1.5*1.5 inches size over occipital region of scalp.
“Extradural and subdural [two of the five layers that protect the brain] haemorrhage found in occipital region. Haemorrhage found in occipital lobe of brain.”
Still, Saad was conscious. And weary about his treatment, he stayed at the hospital that night.  
He had called his brother Muaz Ibne Momtaz around 1:30am on April 1 by borrowing a patient's cell phone.
“What I'm receiving cannot be called treatment,” Muaz recalled Saad telling him.
This newspaper consulted doctors in Mymensingh and Dhaka about the postmortem report. They spoke on condition of anonymity as the case was under investigation.
“The head injury was severe and obviously life threatening. It had affected scalp layers finally reaching to the brain at the back of the head,” said one of the physicians.  
According to the postmortem report, Saad's liver was ruptured and abdominal cavity was full of clotted blood.  
The report concludes: “The cause of death was due to hemorrhagic and neurogenic shock resulting from the above mentioned injuries."
Neurogenic is a complex medical condition born out of fear. It is not necessarily related to injuries: even people's fear of ghosts can cause it and it alone can cause deaths, doctors said.  
According to them, Saad's injuries, that included a "dislocated left wrist," were enough to produce a neurogenic shock, which presumably aggravated every minute due to lax medical care.
Explaining further, doctors cited instances of cases of road accidents as bad as this or even worse.   
“Many lives can be saved through timely diagnosis, surgery and proper care of the injuries," said a doctor at Birdem hospital in the capital.
According to a physician at Bangabandhu Sheikh Mujib Medical University, "He [Saad] was misdiagnosed and an immediate surgery could have saved his life.”
Saad made his last call to his elder brother Muaz around 9:40am on April 1, after he was taken from MMCH to a nearby private clinic, Trauma Centre. He breathed his last on the floor at the centre's reception half an hour later.
“Saad sounded happier being convinced that he was receiving better treatment at Trauma Centre,” said Muaz.
The Daily Star investigation reveals Saad did not receive any treatment except for an intravenous saline at Trauma Centre either.
The private clinic does not treat risky patients, said Alamgir Hossain, receptionist at the centre.
 An unidentified youth took Saad in his care from MMCH around 6:00am on April 1 for having some tests, including a CT scan and X-rays, done on him. All these tests, prescribed by the on-duty doctor almost nine hours earlier, are available at the government hospital.
Ward Boy Rofiz while pushing the stretcher heard Saad having a conversation with the youth, who apparently decided to get Saad out of MMCH for better treatment.
Saad was taken out of the government's health facility without any authorisation from the doctor, who simply listed the case as "absconding" at 9:00pm that day as the patient did not return by then.
The hospital director, Fashiur, finds no problem in patients getting out of the hospital without any authorisation. According to hospital documents, 73 patients "absconded" in the first five days of this month alone.
The director is rather interested to add buttonhole CCTV cameras to the list of the already existing 64 cameras on the hospital premises for heightening the security.
He claimed to have handed over to police the footage containing Saad's admittance and departure. “Relatives can decide where it is better to treat their patients.”
Many patients at the MMCH thought that Saad would get special treatments since he was a university student.
But now we know he is just one of the 73 "absconders" who ended up losing his life as help came too late for him. His death put the government health service management under scanner, with private medical facilities sprouting in their hundreds all over the country, particularly in the old district town of Mymensingh, either owned or patronised by doctors of government hospitals.  


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