An ailing healthcare system
Zaid is 43 years old, working at a reputed multinational company in the city and the proud father of a 25 day old son. Parenthood came like a blessing in the Rahman household, but it came at a high cost – financially as well as emotionally.
“Zaffar, my son, was born premature and had a weak lung and a delicate kidney. In the later stages of pregnancy, my wife suffered from severe hypertension and the doctors decided not to take any unwarranted risks and my baby was born through a C-section,” said Zaid. Zaffar probably has to stay another two weeks in the NICU; it all depends on his health.
For an educated family like Zaid's, and a family with means, the cost of the neonatal intensive care unit may not pose as a serious concern. “I had received a lot of bad reviews of the hospital my son was born in, but frankly speaking I am convinced of their sincerity and the quality of the health care provided. You cannot put a price on the health of a dear one,” Zaid said with conviction.
However, this is just one side of the story. The other side narrates tales of horror, mismanagement and gross negligence even from the most reputed and posh institutes in the country.
According to The Daily Star, in 2006 the World Health Report put Bangladesh among 57 countries with a serious shortage of medical professionals. With 4719 patients per doctor, and one of the poorest nurse-doctor ratios in the world, the existing flaws of the healthcare system seem more apparent. There has been no significant improvement of the situation in the last eight years.
According to Bangladesh Medical & Dental Council (BM&DC), there are 15 public medical colleges and 39 private institutions imparting medical education. Despite the outpour of thousands of medical graduates every year, their contribution to society upon entering professional life is viewed with skepticism and sometimes, utter dismay.
“When we look at the healthcare sector, our vision is very constrained. We try to analyse the whole industry based on our personal experiences,” said 33 years old Zaema, a student of economics at a public university. “If the middle class feels betrayed of a good healthcare framework, what does an average Joe feel when he is denied even the most basic of healthcare facilities?” she said. “It is no wonder that whoever has a little extra cash in hand opt for foreign sources of medical care.”
A health system consists of all organisations, people and actions whose primary intent is to promote, restore or maintain health. It is the infrastructure through which services required by the target population is delivered.
There is no denying that the level of healthcare in Bangladesh is poor. However alarming is the high cost of the care provided and the lack of maintaining even the basic of standards of the care. “We hear stories of lack of sincerity, mismanagement and even negligence in diagnostic procedure from some of the most reputed names in the industry. And that is totally unacceptable” said Zaid.
Even a decade ago, some of the most advanced forms of surgery and certain medical procedures requiring specialised skills were simply not available in the country. “Medical tourism in those days was a matter of urgency and need and not a choice. But there is no denying that the country lacks research on medicine, even now” said Dr Abdur Rahman, a physician working at a leading diagnostic centre of the country.
“A big chunk of the patients who go abroad in neighbouring countries, mostly India, Thailand and to some extent, Singapore are basically the middle class. In most cases they prefer to go abroad 'hoping' for better treatment and care. They are not certain about the standard of the medical care abroad but look for a better 'last resort' Dr Rahman added.
The standard of medical care in nearby countries is well within the limit of the emerging bourgeois but is it any cheaper? Exploring the reason for this outflow of patients we find that in most cases, they are indeed, cheaper options because of the infrastructural backup that they receive from the government.
The added cost of transportation and accommodation however makes the overall cost higher than it is in Bangladesh. Yet, no one wants to compromise on health and the money required for foreign treatment is somehow managed.
Another point that needs to be registered is that for Thailand, India and Singapore, medical tourism is a booming business. The medical set up in these countries are not only motivated towards serving people but also to earn foreign currency.
People reiterate their grievances when it comes to the PR skills of doctors in Bangladesh vis-à-vis doctors in India, Thailand or Malaysia. Dr Rahman expressed his dismay at this. “Even the specialist doctors in their respective fields need to build their social skills. A patient needs to feel cared for, and attended – something we find rarely in the Bangladeshi context.
“Doctors prescribe drugs, ask for diagnostic procedures but rarely explain the need for this. Every patient has the right to know about his/her health problems. A well informed person will learn to appreciate the service provided by the doctor” he added.
We can stop this huge outflow of patients and foreign currency, only through meeting the growing demands of our ailing healthcare facility. We must promote research, reevaluate our policy for building public and private medical colleges, make medical education a people oriented sector and above all we must learn to put service as our outmost priority. Only then can we have a healthy nation.
By Mannan Mashhur Zarif
Names of some of the interviewees have been changed to hide their identity.
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