In 1883, the American poet Emma Lazarus wrote a sonnet about the virtues of diversity and inclusion. The poem, written to raise money for the construction of a pedestal for the Statue of Liberty, ends with a powerful message: "Give me your tired, your poor, your huddled masses yearning to breathe free, the wretched refuse of your teeming shore… I lift my lamp beside the golden door!" Fast forward to 2020, and in the middle of a pandemic in Bangladesh, a revision of these iconic lines in line with the present reality is in order. Seeing how some hospitals are profiting off people's misery and providing "special" treatment to the rich and powerful, their motto can be summarised in the following: "Give me your affluent, your noble-born, your finest and strongest… I welcome them with open arms."
At least, this is the message we get from a tell-all report by The Daily Star about the exclusionary policy being adopted by some private hospitals that gives preferential treatment to powerful individuals and professional bodies while discriminating against other patients—ordinary folks who are suffering as much but have neither the political clout nor the backing of a professional body to get them the care they deserve.
According to the report, a number of professional bodies have secured beds for their members and families at several private hospitals in Dhaka. On June 11, Bangladesh Judicial Service Association signed a deal with the Universal Medical College Hospital Ltd to provide treatment to lower court judges suffering from Covid-19 and other diseases. The deal was signed at the law ministry. Not to be outdone, Bangladesh Police on May 5 "hired" an entire hospital (Impulse Hospital) for two and a half months for treating its members. Besides, the Directorate General of Health Services (DGHS), in a letter signed by the DGHS director (hospital) and sent out on June 18, asked three private hospitals—Holy Family Red Crescent Medical College Hospital, Anwar Khan Modern Medical College Hospital and Japan East West Hospital—to provide treatment to the members of the Supreme Court Bar Association who are infected with the coronavirus.
Most recently, on June 20, Bangladesh Medical Association (BMA) sought similar services from the health ministry. In a strongly-worded letter, the association urged the health minister to dedicate Bangabandhu Sheikh Mujib Medical University (BSMMU) or any other hospital for treating doctors infected with the virus. It gave the ministry three days to do so, or else the latter would be responsible for "any situation that may arise". Among other instances is a government move to improve healthcare facilities at Sarkari Karmachari Hospital for the treatment of public officials. Every ministry has by now formed a quick response team to provide assistance to their infected staffers. General public hospitals are also not immune to such attempts by powerful, well-connected individuals.
These initiatives and decisions have sparked some unsettling questions. Since when is it okay to "book" entire hospitals or hospital beds for certain people? Since when is healthcare the privilege of a few and not a basic right for all? Are we to witness more of such colonisation efforts in the health sector in the coming days? Should we accept this as the new normal where access to treatment for the common people will be contingent on availability of beds left by the influentials?
There is no disputing the truth that members of these associations and institutions have as much right to healthcare as any member of the public. Some of these groups, particularly doctors and police officers, have been at the forefront of our fight against Covid-19 and continue to provide crucial services. Until June 20, 30 members of the police reportedly died from the virus and at least 8,544 others got infected. According to an estimate by the BMA, around 3,500 health workers including over 1,100 doctors have been infected with the virus, while 44 doctors died from infections. The question, therefore, is not if they deserve treatment—they most certainly do—the question is if they deserve more, and in a manner consistent with institutional discrimination. And the fact that such behaviour has been condoned, even promoted, by the highest echelons of power in Bangladesh lays bare not just vulnerabilities in its hospital system, but also gaping healthcare disparities facing ordinary people.
These disparities, confounded by Covid-19, have been well-documented. Since March 8, when the country confirmed its first coronavirus case, there have been multiple reports of ordinary people desperately moving from one hospital to another without getting treatment. They are more likely to be turned away. They are more likely to be disproportionately affected in terms of access to testing facilities. They are more likely to die or suffer from hunger, impoverishment and other associated risks. One recent incident saw the nurse of a private hospital in Dhaka dying after being denied treatment by the very hospital she worked at. Another saw a five-year-old boy from Chattogram, who was hit by a three-wheeler, travelling a distance of around 24 kilometres in the hopes of getting treatment. His family tried, unsuccessfully, to get him admitted in four hospitals before he was pronounced dead. As Shuprova Tasneem of The Daily Star rightly asked: "Was it the accident that killed him, or that desperate 24 kilometres his family travelled in the hopes of keeping Shaon alive?"
A common thread running through these heartbreaking episodes is the victims' "ordinariness", their having no power or connections that could qualify them for treatment.
But to be fair to those now seeking preferential treatment, their intervention is not the only reason shrinking the space for ordinary patients. The crisis is also reducible to a number of pre-existing factors including the for-profit mentality of private hospitals, expensive treatment, corruption and mismanagement in public hospitals, spheres of influence within hospitals affecting admission decisions, a general lack of ICU beds and other facilities, lack of timely and adequate interventions from the health authorities, etc.
As a result, ordinary Covid-19 patients are not the only ones being elbowed out of crucial hospital services. Think of patients needing routine treatment. This constitutes what I call Bangladesh's second public health emergency: the crisis that is quietly threatening lives alongside the coronavirus. Many hospitals, overwhelmed by Covid-19 patients or simply fearing infections, are refusing to provide treatment for other diseases and life-threatening conditions. The situation has reached a point where people are simply afraid to have anything to do with sickness lest they needed to confront the challenges of hospitalisation.
The practice of denying treatment by hospitals, both private and public, has continued despite repeated instructions and warnings from the government. Some hospitals demand Covid-19 clearance certificates before hospitalisation, ignoring the fact that it takes days, even weeks sometimes, to get test results. Is there a disconnect between the messages given by the authorities and that received by the hospitals? What emboldens the latter to rubbish official instructions like they are garbage? Who is in control of our health sector, really? The long-term consequences of the chaos caused by the unequal access to healthcare are symptomatic of an unexploded bomb, slowly waiting to go off.
It is time the top brass of the DGHS and health ministry were brought to account for their continued failure in providing direction, reigning in the disruptive influences in hospital management, and establishing an equitable system in healthcare. And the hospitals—all hospitals—must stop granting preferential treatment to a fortunate few, leaving out the vast majority of the people. This is not just unethical; it sets a dangerous precedent for the future also. We are already saddled with too many problems and loopholes in our response to the pandemic. We don't need another to add to our misery.
Badiuzzaman Bay is a member of the editorial team at The Daily Star.