All patients are equal, but some are more equal than others
Over 100 days of Covid-19 in Bangladesh have brought with it more than one lakh recorded cases of coronavirus and over 1,300 recorded deaths in the country. All over the world, limited levels of testing have made it difficult to understand the real extent of community transmission of the virus. This is all the more true in Bangladesh, which still has one of the lowest levels of testing in South Asia. Different media outlets have also cast doubt on the official death toll, arguing that deaths at home from coronavirus are not making it to official counts. This suggestion seems to be corroborated by the few funeral service providers in Dhaka who are dealing with burying deceased coronavirus patients. Their records seem to suggest they have already handled 1,000 funerals in the capital alone, although it is not clear whether all of the dead were infected.
Anyone with a family member or a friend who is a part of our collapsing healthcare system must have by now heard of the desperate pleas for ICU facilities in hospitals, public and private, which are full to the brim. All across the city, those who have the means are panicking—stocking up on medicine, pulse oximeters and even oxygen cylinders. The menacing touch of coronavirus is no longer trained only on garments workers, maids, drivers and the "uneducated" classes who were "foolishly" traveling between districts and crowding at bazaars. Now, the net is closing in on all of us.
Against this terrible backdrop, the death of one five-year-old boy from Chattogram may have eluded your attention. A photo of his lifeless body, lying on a gurney outside Chattogram Medical College Hospital (CMCH), appeared in this daily on Wednesday, while his grandfather is seen collapsed on the floor next to him. I don't know what is more heartbreaking—that cold, little form against the cold steel, or the image of that elderly man, clad only in a simple lungi, clutching his head with his hands in a paroxysm of grief.
Shaon was playing on the road next to his house, in the city's Steel Mills area, when he was hit by a three-wheeler. Shaon's father told reporters that the boy immediately started bleeding from his nose, and they rushed him to the CEPZ Hospital in Chattogram, about four kilometres from the scene of the accident, where they refused to treat him. His family then took him to South Point Hospital, another ten kilometres or so away, where he was again refused treatment. They tried the Ma o Shishu Hospital, less than three kilometres away, where they were, once again, turned away. In their final attempt to get urgent medical attention for this injured child, they travelled another seven kilometres to Chattogram Medical College Hospital—the furthest hospital from where the accident happened but the closest public one—where the child was pronounced dead from excess blood loss. Was it the accident that killed him, or that desperate 24 kilometres his family travelled in the hopes of keeping Shaon alive?
Of course, this is not the only such case. When Suman Chakma, a DU student suffering from cancer, died on April 6, after several hospitals in Dhaka refused to admit him, the prime minister herself asked: "Why will patients return? Why will patients die after moving from one hospital to another for treatment?" Her instructions to investigate the involved parties seem to have been ignored by the relevant authorities, since there has still been no reported investigation on the matter. Perhaps the most publicised case was the death of Gautam Aich Sarker, additional secretary to the food ministry, who succumbed to coronavirus at Kurmitola General Hospital on May 9, a day after being admitted with kidney complications. According to his family, he was denied treatment at several hospitals because he was Covid-19 positive, including Labaid Hospital and Dhaka Medical College Hospital. After his death, a common question that was asked was—"how could such a senior government official struggle to get medical care?"
This simple sentence betrays a grim truth about Bangladesh. Our healthcare system, like so many of our institutions, is in the grip of a structure of power that disproportionately relies on personal spheres of influence, turning healthcare into a commodity for the consumption of the highest bidder, rather than the right of every citizen. Now that the coronavirus has spread like wildfire and we are seeing hospitals buckle under pressure, this has become all the more obvious. Even those who have the means and personal relationships with the relevant authorities are struggling, competing for the rare empty ICU bed. Ordinary people—like school teacher Abdul Gafur from Chattogram's Patiya upazila, whose two-month-old daughter died on June 13 because of the limited ICU facilities at CMCH (after being turned away by a private hospital)—do not have the same luxury. This lack of ICU facilities has become the marker of our public healthcare crisis, created by decades of mismanagement, inefficiency and chronic underfunding. In the direst of times, the people of Bangladesh do not have access to emergency medical care unless they can afford to pay for it. During a pandemic, even money is not enough—you need influence as well.
These spheres of influence are not just limited to patients, but extend to healthcare providers as well. Take for example the case of 22-year-old Habiba Sultana. She was a nurse at the Ibn Sina Hospital. Yet, she struggled to get admitted to her own workplace after a brain stroke, because her Covid-19 clearance certificate had been misplaced. By the time she reached the ICU, it was too late. If this was a member of Ibn Sina's upper management, would this have happened? A lot of the fury sparked by these recent cases of negligence has been directed at attending doctors, but even within hospitals, there are varying structures of power.
This is especially true in public hospitals, which tend to be saturated with politically motivated appointments. Do ward "boys", cleaners or even nurses get the same level of personal protective equipment that doctors do? Can a junior doctor demand to be tested for coronavirus after treating Covid-19 patients? Can even senior doctors protest when their administrations decide to deploy them in the battle against coronavirus without proper facilities? In private clinics and hospitals, healthcare is simply another consumer good in a capitalist economy—if you can't pay for it, you could be on death's doorstep and the hospital has the right to shoo you away. Can a doctor in a private hospital, even if he/she is not morally bankrupt enough to turn away a critical patient, speak up against management without fearing the loss of their jobs, especially when the law does not criminalise their negligence?
A health ministry circular from last month, stating that hospitals and clinics cannot refuse treatment to patients, Covid-19 or otherwise (if they have the requisite facilities or equipment), seemed like a step in the right direction. However, the Supreme Court has recently stayed almost all the High Court directives on this matter. Among other things, the stay applies to the directives on death of or denial of treatment to a patient due to negligence being a criminal and punishable offence, as well as the directives on informing people of the number of ICU beds in government hospitals, making ICU bed management more accountable, and launching an ICU hotline.
Now more than ever, we needed a healthcare system that is open, accountable and accessible for patients from all walks of life. The health inequality in this country is not simply an issue of funding, but also an issue of social justice. We must acknowledge that healthcare is not a luxury, but a fundamental human right. All those who are deprived of this right should have access to some form of legal redress and justice.
Shuprova Tasneem is a member of the editorial team at The Daily Star.
Her Twitter handle is @ShuprovaTasneem.