Private Hospitals: Doctors left unprotected

When the country is grappling with community transmission of novel coronavirus, more than one third of doctors at private hospitals surveyed said they have still not been provided with any personal protective equipment (PPE).

It is the duty of the hospital authorities to supply those safety gear to all they employ. Any failure to do so throw the physicians and other patients in those hospitals in grave danger, say experts, as their attention was drawn to the issue.

Eight hundred and twenty six doctors from several hundred private hospitals across the country participated in the survey, conducted online by Bangladesh Doctors' Foundation (BDF), a platform of around 1 lakh doctors and medical students, between April 20 and 26.

Of the respondents, 34.1 percent said they did not have any PPEs. Nearly 37 percent said they received the safety gear while 15 percent complained of poor quality gear, saying those were more like raincoats, unable to protect them from the deadly novel coronavirus.

The rest of the respondents said they were not handed a complete set of PPE, according to the BDF survey.

A complete set of PPE includes head covers, fluid-resistant surgical or N95 masks, disposable gloves, long-sleeved fluid-repellent gowns or aprons, goggles, face shields, and boots or closed shoes.

There are around 5,500 registered private hospitals and clinics across the country, Aminul Islam, director (hospital) of the DGHS, told The Daily Star.

The survey comes at a time when many frontline doctors and medical professionals are contracting coronavirus every day. A sense of alarm has gripped the health professionals over the scarcity of protective gear required to fend off the outbreak, which has so far claimed at least 152 lives. Nearly 6,000 people have already been infected.

At least 373 doctors contracted the virus till yesterday. Of them, 84 were working at private hospitals, 179 at government hospitals and the rest at different specialised hospitals, according to the BDF.

"The main reasons behind the high rate of infection among doctors and other health workers in Bangladesh include the lack of PPE and supply of poor quality safety gear to them," Nirupam Das, chief administrator of the foundation, told The Daily Star.

The spread of the virus at the community level, absence of triage system and patients' tendency to conceal Covid-19 symptoms are also to blame, he said.

The triage system is used to determine which groups of patients should receive treatment and care services based on their clinical status.

Nirupam said although no private hospital formally treats Covid-19 patients, a good number of doctors at private hospitals contracted the virus, which prompted them to carry out the survey.

"We don't know who's carrying the virus. We have to treat whoever comes to us," he said.

He urged the hospital authorities to ensure health safety for all doctors and requested the government authorities to monitor properly.

The BDF's findings also raise questions about the efforts taken up by the health ministry and the health directorate to supply PPEs to doctors.

Although the lack of PPE is a global concern, health authorities in Bangladesh claim to have adequate PPEs in stock. During a videoconference yesterday, Prof Nasima Sultana, additional director general (administration) at Directorate General of Health Services (DGHS), said the government so far collected 1,567,057 units of PPEs and distributed 1,291,098.

Some 275,959 PPEs are left in stock, she said.

Talking on the matter, an expert said handing enough PPEs to doctors was one crucial way to stop the spread of Covid-19 and keeping the physicians safe.

"Without our doctors, this fight can never be won … The safety of doctors, nurses and other healthcare workers have to be ensured first to contain the spread of the virus and save lives," said Prof Muzaherul Huq, former adviser (Southeast Asia Region) of the World Health Organisation.

To ensure that, hospitals must be made germ-free, and quality PPEs, including masks that meet the N95 standard, must be provided to doctors and the other healthcare providers.

He said all doctors and healthcare workers at hospitals treating Covid-19 patients must be equipped with proper PPEs right away.

Besides, medical professionals working at non-Covid-19 hospitals but working at emergency wards or providing services to outdoor patients also must have proper PPEs, Prof Muzaherul Huq added.

The BDF survey also said some 62 percent of the doctors surveyed said they were receiving proper salaries while 12 percent said they got partial salaries. Twenty six percent said they haven't got their salaries.

"We received allegations that many private hospitals were not giving full salaries to doctors. This survey proves those allegations to be true," said Nirupam Das.

"We are requesting all hospital authorities to provide due salaries to the doctors in this crisis period," he said.

A 2018 DGHS bulletin said the number of registered Bachelor of Medicine/Bachelor of Surgery (BMBS) doctors was 93,358 while 9,569 were registered as Bachelor of Dental Studies (BDS) in the country.

A total of 25,615 doctors are employed against 27,409 posts at different facilities under the DGHS, according to a March 2020 report.

Besides, around 75,000 doctors are working at different private facilities, a DGHS official said.

As his attention was drawn to the latest survey, Bangladesh Private Medical College Association President Mubin Khan said "almost all" doctors and other health workers at 69 medical colleges got PPEs and that they had available PPEs in stock.

"It is not possible for me to tell about other private hospitals," he told The Daily Star yesterday.

Asked whether doctors were being given full salaries, he said "almost all" private medical colleges provided full salary for March to doctors and other staffers.

However, the income of the medical colleges dropped significantly. So they might have to think "differently" regarding paying salaries to the staffers for "sustainability", he said.

Replying to another question, he said three private medical colleges were almost ready to treat Covid-19 patients. "The authorities of several other private medical colleges were also working in this regard."

Meanwhile, Bangladesh Medical Association yesterday said a total of 660 medical professionals had so far been infected with coronavirus, which is 11 percent of the total infected people in the country, according to a press release.

Of the 660, at least 295 are doctors, 116 nurses and 249 are other healthcare workers, it said.

The BMA demanded that all the healthcare workers at the hospitals dealing the Covid-19 patients be provided with standard PPE and N95 masks.

It also demanded the introduction of triage system at the non-Covid-19 hospitals and providing doctors, nurses and other medical staff working there with standard PPE and N95 masks.

PVT HOSPITAL INCLUSION

Prof Muzaherul Huq said engaging private hospitals in the fight against Covid-19 was very necessary since it was an emergency situation.

Upon talking to private hospitals authorities, the government can turn some of them into facilities to treat coronavirus patients, he said, adding that the government can borrow ICU beds, ventilators and some other equipment from private hospitals and supply those to these facilities.

The expert also said some private hospitals were relatively expensive. So, the government can subsidies them to provide Covid-19 patients treatment at a low price, he added.