An intensive crisis
Out of 52,807 beds in government hospitals, only 211 are in Intensive Care Units
On the morning of August 13, locals of a remote village in Hatia, Noakhali, discovered a young man lying on the side of the road unconscious. Bablu Hossen, 19, had been hit by a heavy vehicle the night before as he was making his way back home inside the village. He had sustained injuries to his head and was lying in a pool of blood.
Bablu's family members and locals rushed Bablu to the Hatia Upazila Health Complex. The doctors there patched up Bablu's injuries and sent him to the 250-Bed Noakhali General Hospital.
"The doctors there told us Bablu needs to be kept in intensive care," says Didar Uddin, Bablu's brother. "The Sadar hospital did not have any ICU."
Keep updated, follow The Business Standard's Google news channel
Bablu's family brought him to Dhaka and tried their luck at a private hospital, but quickly realised they would not be able to afford it.
They then brought Bablu to the Mugda General Hospital where they finally managed a spot for him at the ICU. But this time, the doctors at Mugda Hospital told Didar that they did not have adequate facilities to treat patients with neurological symptoms and told him to take Bablu to the Dhaka Medical College Hospital.
After eight days of tireless effort, Bablu's family finally managed to get him a bed at the ICU in Dhaka Medical College Hospital.
Many critical patients like Bablu suffer horribly because of the lack of ICU facilities in the hospitals of the country. The condition of many patients deteriorate because of the lengthy process in securing a bed in the ICU.
Many even die.
There are only 211 ICU beds in the government hospitals of the country, according to the Directorate General of Health Services. There are 1,078 ICU beds in private hospitals, according to the Bangladesh Society of Critical Care.
The World Health Organisation says 10 percent of the beds in a hospital must be in the ICU. At least four percent is considered a minimum.
The Health Bulletin 2018 of the health directorate mentions that there are 52,807 beds in government hospitals, so there needs to be more than 5,000 ICU beds available, or at least 2,112. But the actual number is only 211, which is less than 1 percent of the total number of beds.
According to the health directorate, the 36 medical colleges and one dental college in Bangladesh, have only 13 ICUs. In other districts, only two hospitals have an ICU – one in Cox's Bazar and the other in Pabna.
Doctors say neuro patients and those critically injured in road accidents need ICUs the most. But they suffer because of the lack of ICUs in the district hospitals.
"We transfer many patients, especially ones that have been critically injured in road accidents, to Dhaka because there is no ICU here," said Dr Mizanur Rahman, resident medical officer at the 100-Bed Narsingdi District Hospital.
"The condition of most patients deteriorates on the way. If we had an ICU and the necessary support, it would be possible to treat many critical patients in district hospitals," he added.
Dhaka Medical College Hospital is the largest among the government hospitals with 2,600 beds. Every day, more than 3,000 patients get treated there. But the hospital has only 32 beds in the ICU whereas the actual need is for more than 200.
"Of the 32 beds, two have been occupied by GBS [Gullen Berry Syndrome] patients. They need to be in the ICU for a lengthy period. One patient has been in the ICU for 96 days," said Dr Subroto Kumar Sarkar, assistant professor of Critical Care Medical Department at DMCH.
"Among the rest of the beds, only one or two get vacated every day. But the number of applications is 40-50. Recently, the demand for ICUs has increased because of the dengue outbreak," Dr Subroto said.
It is necessary to maintain ICU admission criteria along with increasing the number of beds to solve the crisis, he added.
"The outcome will be better if we can maintain the criteria. Dying patients and last-stage cancer patients should not be in the ICU. A chance must be given to other patients," he said.
It is easier to get an ICU bed in private hospitals because they have more beds, but they are also very expensive. There are also allegations against many private hospitals of keeping dead patients in the ICU to increase the bill.
The ICU expenditure in a mid-range private hospital (50-200 beds) is Tk30,000-40,000 a day. The figure is Tk70,000 or more in a hospital with more than 250 beds.
"Many middle-class families become impoverished after admitting their patients to the ICU of private hospitals. Many have been transferring their patients to Bangabandhu Sheikh Mujib Medical University lately. Every month we get many applications for waiving ICU bills," said Dr Debabrata Banik, former chairman of Anaesthesia and Intensive Care Medicine Department of the medical university.
According to the Health Department, the National Institute of Cardiovascular Diseases has 28 ICU beds. Sylhet Osmani Medical College Hospital has 16 and Chattogram Medical College Hospital has 12.
Mymensingh Medical College, Suhrawardy Medical College, National Institute of Diseases of the Chest and Hospital, Rangpur Medical College and Gopalganj General Hospital each have 10 beds in the ICU.
The National Institute of Cancer Research and Hospital has eight, the National Institute of Traumatology and Orthopaedic Rehabilitation eight, National Institute of Neurosciences and Hospital six, Sheikh Abu Naser Specialised Hospital eight, Mitford Hospital nine, Satkhira Medical College Hospital six, and Pabna, Sirajganj, Jamalpur and Manikganj medical colleges have two ICU beds each.
Admitting the crisis of ICU facility, Health Secretary Md Asadul Islam said government hospitals have far fewer ICU beds than required. But the government has taken an initiative to add 500-600 ICU beds. Gradually ICUs will be provided in every district of the country. At the same time, the number of anaesthesiologists and nurses will be increased.
Meanwhile, at the ICU at Dhaka Medical College Hospital, Bablu continues to suffer.
"He still has not regained consciousness," said Didar on September 17, more than a month since the fateful day when Bablu was discovered by the road.
