Bangladesh News

Facilities available at the 1,700-bed Dhaka Medical College and Hospital (DMCH) are inadequate to meet the demand of patients who throng there every day for treatment.

Experts say the hospital, running with one-third of the manpower it needs, is also making ill use of its available — though inadequate — infrastructure and logistics.

On an average some 2,500 patients receive indoor service from the hospital round the clock.

According to hospital sources, the total manpower of DMCH stands at 2,027 at present including 246 doctors in 48 units under 24 departments and 653 nurses. Meanwhile, 172 posts of doctors, nurses and other class three and four employees remain vacant.

Experts say, the size of the hospital demands at least triple the manpower it possesses at present. There has been no recruitment at the hospital since 2004 and the existing number of staff is on the decline because of retirements.

There are, however, some professors, associate and assistant professors and honorary physicians, other than the staff, who are attached with the medical college and are considered visiting experts at the hospital.

Dr Mohammad Faizullah, assistant director of the hospital, says at least 650 additional manpower, including doctors, are needed to deal with the existing patient load which is already beyond the capacity of the hospital.

Experts say that a hospital providing 24-hour service must have at least three shifts, as it is not possible for any person to work round the clock. At present the DMCH staff capability means that only the needs of a single shift are met, on paper. In reality these employees are scattered to work round the clock at the hospital.

In practice, this inadequacy of the hospital leads to its rundown service. The picture after 2:30 pm is totally different from that of the morning hours. The professors, associate and assistant professors are on duty only between 8:00 am to 2:30 pm.

So though the hospital admits patients round the clock, those who come in the afternoon do not get the expert attention they need.

Though it is said that the professors and assistant professors remain ‘on call’ all throughout the day, in actuality specialist doctors are busy with their private practice from the afternoon onwards and not available at the hospital.

Dr Faizullah said, “There is no mechanism to keep specialist doctors available round the clock. As the hospital lacks manpower there is no provision for shifts here. So we have to rely on intern doctors though they are supposed to work under the supervision of experienced doctors,” Dr Faizullah said.

The situation is no better with support staff with often a single staff nurse in each ward to look after 40 to 60 patients.

Under the ‘Expansion and Modernisation of Dhaka Medical College Hospital’ project in 1994 the number of beds were increased from 800 to 1400 and subsequently to 1700 in 2003 through an administrative order providing only drugs and Medical and Surgical Requirements (MSR).

It did not increase the manpower, infrastructure and or other ancillary facilities of the hospital, which experts point out, jeopardised the very purpose of the increase in beds.

The majority of the patients who throng DMCH belong to the middle and lower middle classes who cannot afford treatment at the city’s many private hospitals.

SEAT CRISIS
Though the number of beds at DMCH has been increased, it still stands short of meeting the increasing demand. This excessive burden puts pressure on the quality of treatment provided.

One-third of the patients at DMCH are not able to get beds but are admitted and forced to seek treatment from floor beddings all year round. Visitors walk past these patients lying on the floors, exposing them to dust and dirt and increasing the risk of infection. There also remains a concern for minimum privacy.

It’s often even alleged that patients are sometimes released before cure to make room for more critically ill ones.

One of the worst crisis is seen at the neurosurgery department of the hospital. There are only 62 beds here, which is less than half of the requirement. DMCH is the only hospital with a department for neurosurgery and other public hospitals also refer their patients here.

BROKERS
It is alleged that a group of brokers exploit the situation by extorting money from poor patients, promising to get them seats in return.

During a visit to the hospital this correspondent found an elderly patient from Sylhet lying in a corridor behind the outdoor department waiting for a broker to get him a bed. The patient, in his mid-sixties, said that he had been waiting there for two days since someone promised to get him admitted. The miscreant had even taken away the man’s prescription from the outdoor department.

The hospital authority has taken no further steps than putting up posters saying ‘Beware of brokers’ on its wall to tackle the situation.

OUTDOOR SERVICE
The complaints at the outdoor department of DMCH are almost endless. The sufferings of patients seeking treatment here begin with the absence of any help desk here. Patients buy a ticket for Tk 6.00, though the government rate is Tk 5.50.

After that they wander about, as they are often clueless about which department or direction to go to. This is particularly a huge problem for the illiterate patients who don’t understand which nook or corner of the hospital to go to.

A man in his mid thirties standing in a queue, said, “I have come to see a doctor for my eye, but didn’t know where the department was. No one at the ticket counter told me where to go. I asked at least eight different persons to find out the right section. I have been standing in this queue for 15 minutes now. After I submit the ticket, they will write down the name of the doctor who will see me.”

“I wonder if there will be time left for him to see me today,” Mohiuddin lamented.

Another patient complained that ultimately when they do go to a doctor, it’s often of little help.

“The doctors even don’t want to hear our problems and begin to write down prescription before we have finished talking, “ he said referring to the Medical Officers (MO) at the outdoor department.

“It feels like they are more happy to just get us out of their rooms,” another patient said.

The Resident Physician countered this allegation by saying, “a Medical Officer has to attend to around 200 patients every day between 8:00 am and 2:30 pm. How much time do you think that gives him for each patient? Only 1.5 minutes on an average? What kind of service is possible within this short time?”

An on-duty MO echoed his sentiments by adding, “Though the number of patients in the outdoor has increased a number of folds, the number of doctors has not been increased. Since the 1970s there are only four MOs on duty in the outdoor section, whereas there should be at least eight.”

There are other problems in the hospital. As the hospital is under the authority of the ministry of health and family welfare, bureaucratic red tape often slows down the purchase and repair of its medical equipment. The supply of medicine and logistics is also inadequate and often not based on need.

There is a blood bank in the hospital but often doesn’t have any stock of blood when needed. Patients are left to manage from different sources outside the hospital.

The Intensive Care Unit (ICU) with only 12 beds, and the Coronary Care Unit (CCU) with 25 beds, see long queues all the time. Patients with very critical conditions rushing to these sections everyday are often disappointed about getting the right medical help on time.

The Executive Committee of the National Economic Council (ECNEC) has approved the proposal of building a 600-bed wing at DMCH under its ‘Expansion and Modernisation of Dhaka Medical College Hospital’ project. Construction in this regard has already begun.

This new hospital will also serve as a teaching hospital for undergraduate and postgraduate medical students and the students of nursing institute, authorities said.