300-bed plan cut down to half, equipment rust in storerooms
The under construction 150-bed building of national cancer institute and the unused CT scan machinePhoto: STAR
Delay in implementing an extension project for the National Institute of Cancer Research & Hospital (NICRH), coupled with shortage of resources and dysfunctional equipment, is hampering treatment at the hospital.
In May 1993, the health ministry took a decision to upgrade the 50-bed NICRH to a 300-bed facility and then to a 500-bed one in the second phase. But the decision could not be executed in the last 15 years.
Due to fund constraints the ministry revised the project and decided to make it a 150-bed hospital, which was approved by Ecnec in December 2003.
The new building for the 150-bed facility is now incomplete although it was supposed to be finished by June 2006, officials said. The construction work is going on at a snail's pace.
Afsar Uddin, sub-divisional engineer, PWD, said the first phase of the building has almost been completed. "We will start the second phase once the Saudi fund for that phase is available," he said.
Asked about the delay he said the deadline has been revised to June 2008.
"It took time to evict the slum on the plot. The contractor also delayed in work," the PWD engineer said.
The 50-bed institute is now struggling to provide services to hundreds of patients coming from across the country.
"NICRH is the lone government hospital for cancer treatment. But we do not have adequate resources to treat a cancer patient,” said a doctor.
“Only 50 beds are not adequate to meet the demand. Besides, we are unable to provide full OT service, ICU, full-capacity indoor service, extended capacity day care and cabin facilities," he said.
Expecting that the building would be completed by June 2006, 90 percent of the equipment for ten new OTs, ICU, washing plant and kitchen were procured which are now lying idle unpacked in the storerooms.
"We have procured state-of-the-art sterilisation equipment for central sterilisation store department or CSSD, which will work in an organised way to provide sterilised clothes and equipment to surgeons before every operation. But these are now lying idle in the stores," said another doctor.
Doctors at the Radiology Department said PET or positron emission tomography machine is needed for proper diagnosis of cancerous parts, metastasis (spread of disease), and detection of tumour.
"The nuclear medicine department is trying to bring PET machine," said Dr Mozizul Haque, in-charge of the Radiology and Imaging Department.
On average over 100 patients come to the Radiology Department every day.
At present the department has expensive CT-scan, MRI, X-ray and ultrasonogram machines. But the MRI machine has not been working for the last two weeks because its CPU is out of order, said sources.
The supply of imaging films for the MRI and CT-scan machines is much less than the requirement. "At present the department has only 100 imaging films, which we bought locally as the CMSD [Central Medical Store Department] does not supply imaging films," said a medical technologist.
"We do CT-scan of our staffs and dummies to keep the machines running or they would be damaged for not being used," he said.
Electro-medical engineers are needed for proper maintenance of the machines. Without proper maintenance, machines may start to degenerate after the warranty period of two years, said doctors.
As the department does not have a generator, these machines shut down abruptly when electricity goes off, raising risks of early damage.
Generator is also needed to prevent evaporation of helium level, which should be at least 50 percent in the MRI machine, the doctors said.
Due to long tender process and bureaucratic tangles it takes time to fix machine parts and keep them running round the year.
At the pathology section, the electrolyte machine is not working for the last four months due to lack of chemical reagents needed to run the machine.
"Electrolyte machine tests the sodium, potassium and other mineral levels in blood. As the machine is not working the patients have to do the tests from outside which is quite expensive," said a pathologist.
"We gave requisition for reagents in August last year. In the last couple of months at least six reminders were given. But we are yet to get the reagents due to the long tender process," he added.
"These kinds of problems arise because the government offices are not dynamic," the pathologist said. “So we need autonomy.”
Asked, Prof AMM Shariful Alam, director, NICRH, said the reagent supplier has been given a letter one month ago. "We cannot purchase large number of imaging films at a time due to shortage of funds," he said.
The institute has three linear accelerators and two cobalt machines for carrying out radiotherapy. There are only two honorary physicists to look after the expensive machines when at least 20 are needed.
Prof Shariful said they have proposed for creation of posts of physicists.
The institute does not have an ICU. However, Prof Shariful said there will be 32 cabins and an 8-bed ICU in the new building. “Central oxygen system has been set up for the ICU," he added.
Though institutional practice of doctors at the institute was recommended at the beginning of the project, it has not been implemented till now.
"Had there been institutional practice, the doctors could have done private practice staying at the hospital. It would have compelled them to stay at the hospital till 7 in the evening. A percentage of their earning could also be donated to the institute," said a doctor.
"Institutional practice would have doubled the output of the expensive machines by serving more patients," he said.
Doctors said the institute should be given autonomy as all kinds of work including procurement and supply are delayed due to bureaucratic tangles.
"When we apply to the ministry for a faulty machine part it takes at least six months for them to allocate the money. When the money is available after six months, by that time another part of that machine or another machine goes out of order. Then we apply for more money," said a doctor.
“The ministry officials delay the fund allocation,” he said. "It is a vicious circle within which we are going round and round.”
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