Covid-19 ICU in Sylhet Division: Unaffordable, inaccessible

Heart patient Syed Shofiqul Alam, 75, from Habiganj's Nabiganj upazila, was admitted at the general ward of Sylhet's North East Medical College Hospital on June 11 with fever.

A day later, he was shifted to the private hospital's intensive care unit (ICU) which is for coronavirus patients. There he passed away on June 14. Tests showed Shofiqul was Covid-19 positive.

His grandson Fakhrul Alam said it cost them over Tk 1 lakh, which includes that for two-days' ICU support and medicine bought from pharmacies outside.

While Shofiqul's family could bear the cost, such expenses are unaffordable to many in Sylhet division.

Dr Naseem Ahmed, the president of Private Hospital and Diagnostic Centre Owners Association, at a press conference on June 8 encouraged Covid-19 patients to look for treatment at government hospitals, where the cost is almost zero while private medical care is expensive.

But the reality is 32 out of the 46 ICU beds for Covid-19 treatment in Sylhet division are at private hospitals -- 20 at NEMCH and 12 at Mount Adora Hospital. All of the 46 are in Sylhet city.

The only public hospital with ICU facility for coronavirus patients in the division is Sylhet Saheed Shamsuddin Ahmed Hospital, managed under MAG Osmani Medical College Hospital (SOMCH).

All of its 14 ICU beds have been dedicated for Covid-19 treatment.

INACCESSIBILITY ISSUES

For patients with illnesses other than coronavirus, SOMCH has 15 and private hospitals have about 40 ICU beds in Sylhet division, consisting of four districts. 

Since all of these facilities are located in Sylhet city, it is difficult for people from other districts of the division to quickly access ICU support.

A 70-year-old heart and kidney disease patient from Moulvibazar's Sreemangal lost her life on May 31, while her family searched for ICU facilities.

"As she developed stroke-like symptoms and severe breathing difficulties, we took her to Sreemangal Health Complex, then to Moulvibazar District Hospital, where doctors recommended ICU support and told us to rush to Sylhet," said her relative Mazharul Islam.

Reaching the city, they first went to several private hospitals, some of which did not have empty ICU beds, while others denied admittance without a coronavirus negative certificate.

By the time they reached SOMCH, doctors declared her dead.    

Noting that Sreemangal to Sylhet is about 2.5 hours by road, Mazharul said an ICU facility at Moulvibazar would have saved the woman's life.

Dr Anisur Rahman, assistant director of Sylhet Divisional Health Office, said, "Due to the crisis of anaesthesiologists and other trained medical staff for ICU, there is no scope to increase the number of ICU beds for Covid-19 patients in the division."

He added, "Two new government isolation facilities -- Shahporan Health Complex and Dakshin Surma Health Complex -- with 31 beds each will be dedicated for Covid-19 patients. But these two facilities have no ICU beds."

ICU BEDS FILLING UP FAST

Prof AFM Nazmul Islam, former head of Sylhet MAG Osmani Medical College's medicine department, said, "Around five percent of all Covid-19 positive cases turn critical and at least two percent of positive cases may require ICU support."

As of yesterday, 3,631 people in the division tested coronavirus positive in Sylhet division. Of them, 814 already recovered, 60 patients died and 2,757 are still recovering.

Based on these numbers, at least 55 Covid-19 patients may require ICU support in the division any time.

Furthermore, as of yesterday, 118 doctors, 79 nurses and 161 other health staff were infected with Covid-19 while two doctors and a nurse died, according to Sylhet Divisional Health Office.

Authorities of different hospitals yesterday said 32 out of the 46 ICU beds for Covid-19 patients are currently occupied -- seven at Mount Adora and 13 at NEMCH and 12 at Shamsuddin.

Besides, said Dr Anisur, not all the ICU beds in private hospitals have ventilators.

Only six out of the 12 ICU beds for Covid-19 patients in Mount Adora have ventilators, according to hospital authorities.

Moreover, the ICU at Sylhet Saheed Shamsuddin Ahmed Hospital is running on oxygen cylinders in the absence of a central oxygen supply system. Even the stock of oxygen cylinders is low compared to the daily demand, as reported earlier this month.

Abdul Karim Kim, coordinator of civil society body Sangkhubdha Nagorik Andolon in Sylhet, said the government should have increased the number of health professionals for ICU and facilities months ago considering the infection rate.

"There are some facilities in private hospitals, but where will the general patients go? ICU beds at government hospitals must be increased as soon as possible," he demanded.