Doctor, doctor, what is wrong with us?
There was a broken black chair by the window near the gate. On it there was a thin plastic bag containing some mixed up rice, daal, and probably vegetables or curry. These are the types of bags we normally use for bulk distributions in a charity event for the destitute. The bag lied there as a treat for a medical doctor. It was his meal after coming out of a public hospital in Bogra where he served for five straight days at a Corona unit. The safety protocol demanded that he stayed a minimum of five days in a government allotted hotel for a mandatory Covid test before returning to home or work. His wife, who happens to be my former student, posted it on Facebook sharing her pain and disgust at the way her husband's service was being reciprocated by society. Her post was picked up by an online newspaper, and the story had by now become viral.
The question is simple: how do we treat the most meritorious and committed segment of our society? This said doctor, we are told, studied for 14-years to finish his FCPS and MD. He sat for his public service examination BCS and served in remote areas as per his job requirements. All his efforts and contributions are repaid by negligence, indifference and disrespect. The hotelkeeper simply left the food outside treating the doctor as a pariah. The bag of meal is suggestive of our insolent attitudes towards not only an individual health worker but also for the entire profession who are deemed as the frontline warriors in this battle against the pandemic.
You may ask, "with so many doctors being dead due to Coronavirus outbreak why bother focusing on a trivial bag of meal at a time of dire emergency?" You may even add, "what about those inhuman doctors who treat their patients as nothing but money making machines?" Between these two polar extremes, there are some dedicated souls who are trying their best to serve the nation against all odds. They are not in the news because a news becomes a news only when a man bites a dog. You don't get to hear when a doctor heals a patient (unless she or he is a celebrity). You only get to hear about doctors when they are involved in malpractice or die. In recent times, we have been reading about the alarming rate at which doctors have been dying—in most cases they are senior doctors with years of experience. Their loved ones would post on social media about their sacrifices, where you get to see the human faces behind the number that you come across in the news. The contributions of doctors fail to match the sensation of a celebrity who is perhaps dating someone new or reportedly spending too much time on phones with a colleague.
Often we take the service of a doctor for granted. Doctors become news for all the wrong reasons. Take the heinous murder of Dr Rakib in Khulna on June 15 for instance. In a civilised society, you cannot lynch a doctor over the death of a patient. Doctors are not miracle workers or voodoo magicians from the cave paintings or scrolls of a primitive society. If there is any negligence on the part of a doctor, of course the legal system should be involved to probe into any alleged malpractice. To kill a doctor or beat him or her up just because you can, thanks to your party muscle, is cancerous. Unless there is strong signal from the top, this will not stop. Stern actions must be taken to nab the killers of Dr Rakib and to uplift the dented morale of doctors.
Yes, our doctors are falling ill because of the exposure to the novel coronavirus, but they are also sick of being treated as non-humans. A brief scanning of the news available in both mainstream and social media will clarify this.
Everyone is afraid to speak up because they do not know if they are stepping onto the tentacle of a hydra headed monster that is devouring our health system. Apparently there is a "doctor strange" who has become so powerful that he runs a syndicate; some doctor's association has compared this Doctor Who to a mafia don. Yet there is no action against him. Doctors have been thrown in jail for protesting against low standard PPEs. Doctors have been arrested for predicting the severity of the crisis. Imbued with a similar fear, partly because of the "Dr" before my name, I shall simply point out certain published news, facts and figures available in the public domain or issues being investigated by the anti-corruption bureau.
The first scam was reported when a batch of sub-standard masks was supplied to the hospitals claiming them to be N95. The products were over-priced. Many doctors were forced to buy their own personal protective gear. One thing is clear: the government is willing to spend, but the money is being channelled to middle men. And doctors who relied on these counterfeit products not only became vulnerable to infections but also became potential super spreaders.
One particular contractor is now being investigated for siphoning out hundreds of crores of taka through dodgy purchases. The panel of doctors formed to advise the health ministry during this crisis has gone on record saying that their opinions are disregarded or ignored. It seems a group of middle men in cahoots with some powerful government officials are more interested in buying equipment, building structures rather than implementing them. You see news of a convention centre being developed into a field hospital, but you do not see them going into operation. The urgency to spend money is not matched by the sincerity to make those facilities operational. You read about one DG being removed from his duty, and the minister underperforming or refraining from going to his office. There is a complete lack of supervision and coordination. The bureaucracy looms large. You can't get treatment for non-Covid illness without a test report. And it takes two weeks to get such a certificate. As a result, you see patients running from hospital to hospital, dying on the way, lying in front of the hospital looking for a bed. There are not enough beds to accommodate the patients that we have. And when you see daal-bhat wrapped in a plastic bag for a doctor, you know that there is something rotten in our health system.
According to a recent report, the country has only 6 doctors, nurses, and midwives for every 10,000 people. All our neighbours fare better in terms of doctor patient ratio: in India the figure stands at 7.77, in Pakistan 9.75, in Sri Lanka 9.5, in Nepal 6.5, in Myanmar 8.6, and in Maldives 22.3. These figures do not reflect our development discourse. And the minimum threshold set by the World Health Organization is 23 per 10,000 population.
At present there are total 110 recognised medical colleges in Bangladesh, 36 of which are public, 68 are private, and 6 are army. These colleges could admit about 11,000 students every year. When you look at the total number of registered doctors, you will understand how difficult it is to become a doctor. There are some 86,800 MBBS doctors, and dentists registered with the Bangladesh Medical and Dental Council. Only 20,000 doctors are employed by the government. The ratio of doctors for every 10,000 people in public hospitals is 1.29. The facts also suggest that many of our doctors are not in our health system. One intelligent guess is that they have migrated abroad.
These facts will tell you under what stress and duress our doctors perform. I think they deserve both our material and mental support. Without a proper support base and incentives, our next generation of doctors will be discouraged from entering the system. I know many doctor cousins and friends who do not want their children or relatives to come to the medical profession. This is symptomatic of a system that itself needs healing.
Shamsad Mortuza is a professor of English at the University of Dhaka (now on leave). Currently, he is Pro-Vice-Chancellor of ULAB.
Email: shamsad71@hotmail.com