Last week has been a happening spell, in an untoward sense, for the public health landscape. From Chittagong to Khulna to Rangpur, a litany of serious lapses, irregularities and unauthorised hospital activities has come to light. They touch a new low in the massively unregulated public and private sector healthcare and diagnostic services.
In Chittagong, for example, following the death of a child allegedly due to neglect at Max hospital, a mobile court slapped a fine of Tk 10 lakh on it in pursuit of different allegations including penalising CSCR with Tk 4 lakh worth of fine.
This triggered a wholesale closure of private sector hospitals in Chittagong by their owners. In fact, the general secretary of hospital and lab owners' association Dr Liaquat Ali Khan, also the executive director of the accused Max hospital, issued the order for shut-downs across the board. The president of BMA Chittagong branch, little wonder, expressed his solidarity with the private hospital owners! Dr Khan told journalists, in an apparent move to salve himself, that the doctors of private hospitals may feel free to serve patients in public sector hospitals.
Earlier, in Khulna, a doctor was arrested by a law enforcement agency on alleged criminal charges. As soon as the allegations were made, the hospital was shut down as doctors went on strike.
In Rangpur, when a patient died after an operation at the unlicensed “Rangpur Modern Hospital”, the so-called authority of the outfit fled the premises leaving behind the dead body of the victim.
What the heart specialist and general secretary of Patient Welfare Foundation, Dr Rakibul Islam, has had to say resonates with us: “If in the professional community any one commits an offence, he shall be dealt with according to the law of the land. If, on the other hand, any wrong is done to him it's the duty of his professional colleagues to stand by him.”
Then he hits the nail on its head: “You can't aim to extract demands by holding the patients to ransom.”
Denial of treatment to patients by an arbitrary shuttering down of services by a hospital management and doctors in reaction to a certain action against them is untenable. For, it amounts to punishing the poor patients twice, first by not attending to their urgent need for medical attention for no fault of their own at all; and second, by taking them hostage to the reactive professional demands, crossing the threshold of proportionality.
This is a cathartic version of the Hippocratic Oath and the complementary World Medical Association (WMA)'s Declaration of Geneva. Reading between the lines we will find actually where we are currently impinging on.
While the Hippocratic Oath sets out the historical and philosophical roles of the medical profession, the WMA's Declaration of Geneva encapsulates the basic noble principles and values of being a doctor.
Together, they are a comprehensive affirmation of the value of the profession and they complement the guidance on ethical standards and professionalism provided by the Australian Medical Association (AMA)'s Code of Ethics (Declaration Geneva; WMA, 2006).
Here it goes, in a slightly abridged form: “At the time of being admitted as a member of the medical profession:
I solemnly pledge to consecrate my life to the service of humanity;
I will practise my profession with conscience and dignity;
The health of my patient will be my first consideration;
I will not permit considerations of age, disease or disability, creed, ethnic background, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient's value;
I will not use my medical knowledge to violate human rights and civil liberties, even under threat.”
Out-of -pocket (OOP) payment by individual citizens for healthcare, moreover, amounts to 67 percent of the total expenditure as against the government' paltry 23 percent. The per capita health cost in urban areas was estimated at Tk 3,083 and that in rural Bangladesh is put at Tk 1,894.
The 67 percent of the health cost being borne by our citizens may have an add-on or a subtraction, depending on how our private sector facilities catch up with the services many of our patients pay for in the neighbourhood. We must aim at weaning a slice of medical tourism away from India, Thailand, Malaysia, Singapore, Hong Kong. What are our state-of-the-art facilities in public sector doing? The frog-leaping here can come about only with our well-to-do and the NRBs bank-rolling first class medical facilities in the country.
Meanwhile, our doctors and specialists can do a world of good to the noble profession by sparing time to know the patients' mind and explaining their line of treatment to them. Rather than receiving rationed, unconnected dollops interspersed with intermittent diagnostic tests, the patients look for an epitome of trust in a doctor.
Shah Husain Imam is adjunct faculty, East West University, a commentator on current affairs, and former Associate Editor, The Daily Star.