Bangladesh’s public hospitals have no dedicated doctors, staff for ICUs

The intensive care units of the public hospitals have been running with a manpower crisis for years.

Doctors, nurses and other staff are borrowed from other departments of the hospitals to keep the ICUs up and running. The ICUs are where patients are admitted with severe and life-threatening illnesses and injuries that require constant and close monitoring.

Take Dhaka Medical College Hospital (DMCH), the largest public hospital in the country.

There are no dedicated doctors for its 20-bed ICU, and doctors from the anaesthesiology department usually look after the patients in the ICU, hospital sources said.

However, they have to call doctors from other departments like neuromedicine and nephrology, whenever required. This in many cases creates problems because the doctors have to come either after performing duties in their own wards or leaving their patients unattended, Abdur Rahman, ICU in-charge at the DMCH, however, said they usually get quick response whenever they call doctors from other departments.

"Whenever we ask any doctor to come, they do it. So, we make do with what we have at hand," he said.

"What if you need a specialist at 3 in the morning?" asked one of these correspondents.

"We manage it .... somehow," Rahman said, after a brief silence.

On manpower shortage, he said the ICU has only 26 nurses whereas their number should be around 100 to run it properly.

"We have drawn the authorities' attention several times in this regard, but to no avail," Rahman, who himself is actually from the anaesthesiology department, told The Daily Star.

The picture is somewhat the same or worse in all other government-run general hospitals with ICU facilities.

Rajshahi Medical College Hospital too has no dedicated manpower for its 10-bed ICU, hospital director Brig Gen AFM Rafiqul Islam said.

"We are running the unit by calling in physicians from other departments and that too is insufficient ... But we are trying our utmost to provide the best possible service to the patients," he added.

Brig Gen Md Fashiur Rahman, director of Mymensingh Medical College Hospital, said the same about the hospital's ICU.

Prof Maswood Ahmed, who was in-charge of the 12-bed ICU in Chittagong Medical College Hospital till July 7, said a dedicated team of physicians, nurses and staff is very important for the ICU to properly function.

"During my tenure, I requested the authorities more than 20 times but to no use," he said.

Prof Rashid-e-Mahbub, president of the National Committee on Health Rights Movement, said treatment in the ICUs requires involvement of physicians from different disciplines like cardiology, pulmonology, anaesthesiology, neurology and medicine.

But here, he said, the ICUs are run mainly by the anaesthesiologists. "I don't know how effective that is."

"In the absence of a guideline, everyone is dealing with the matter as they wish. There's no accountability here."

The government, more specifically the health ministry in consultation with professional bodies like the Bangladesh Medical Association (BMA) can formulate a guideline in this regard, said Rashid, also a former president of the BMA.

Prof Md Shamiul Islam Sady, director (Hospital and Clinics) of the Directorate General of Health Service, admitted the existing manpower crisis in the ICUs.

The ICU services require a multi-disciplinary approach and a huge logistic and manpower support, he said. "But, we are working to mitigate the problem by creating new posts and filling up the vacancies."

A new discipline titled Critical Care Medicine has been introduced in the medical colleges and when doctors with this expertise will start working in the ICUs, things will get better, he added.