LC issues lead to severe shortage of surgical equipment

Nazrul Islam Palash, 12, from Bogura's Sonatola upazila was diagnosed with congenital heart disease in June last year. After conducting various medical tests on Palash, doctors at the National Institute of Cardiovascular Diseases on 23 June told his parents that he required surgery and asked them to buy a number of surgical devices including an oxygenator for the procedure.

But, the surgery is yet to be performed because Palash's father Mokhlesur Rahman could not manage the oxygenator – a device that substitutes the heart during a bypass surgery and exchanges oxygen and carbon dioxide in the blood of a patient.

Abdus Salam, a sales representative of a company named DWB that imports oxygenators, told The Business Standard that his company could not import the device due to LC issues since Mokhlesur pre-ordered one on 5 July last.

Salam further said his company currently has 354 pending pre-orders for oxygenators. The device is usually imported from China, Taiwan, and Japan, he added.

Sources at the National Institute of Cardiovascular Diseases told TBS that usually, about 300 patients undergo heart bypass surgery, open-heart surgery, and valve replacement at the institute every month. But, since last July, a paltry 20-30 surgeries are being performed there every month due to the scarcity of oxygenators.

Prof Dr Mir Jamal Uddin, director of the cardiovascular diseases institute, said, "Suppliers have informed us in writing that they are unable to supply oxygenators for now. They did not give any assurance as to when they will be able to supply those either."

All patients need an oxygenator for any operation including heart bypass surgery, he mentioned, adding, "Surgeons, however, are performing some emergency surgeries only in some elderly patients through the 'beating heart' procedure. But, surgeries on children have been completely stopped."

Not only oxygenators but also all other important surgical equipment are in short supply in the country as the opening of import LCs has remained paused since November last year owing to dollar shortages, seriously hampering major surgeries such as heart surgery, bypass surgery, neurosurgery, kidney surgery, and orthopaedic surgery hampered seriously, according to industry insiders.

Doctors said surgeries for heart diseases have been disrupted for the past seven months in about 15 public and private hospitals of the country, including the national heart disease institute, National Heart Foundation Hospital, and Dhaka Medical College in the capital.

On average, 100-120 valves are required in the country every month. Except for a few private hospitals, valve replacement work is closed in most hospitals.

A doctor of the National Heart Foundation wishing anonymity told TBS that all hospitals are facing a shortage of necessary equipment, so they are forced to send back the patients home.

He said there are many patients who immediately require valve replacement and many of them may not survive if their valves are not replaced quickly. But, due to a crisis of valves, treatments of many patients have been halted.

Leading Electro Medical is a company that imports and supplies various types of equipment including valves, pacemakers, rings, and oxygenators.

A director of the company told TBS, "Now there are problems from two sides. Opening LCs has become difficult in Bangladesh and principal companies can no longer trust Bangladesh. Shipments against the LCs we opened in October and November last year have arrived. The principal company submitted the documents but the bank could not make the payment due to dollar shortages."

He also said a shipment of some products arrived at the beginning of December, adding, "Earlier several LCs were opened every month, and about $2 million worth of equipment used to be imported every year. But LC opening has been stopped for the last 4-5 months, leaving us in absolute uncertainty.

"We thought everything would be fine starting in January. But that is not happening. We approach the banks every day, but they say there are no dollars. Earlier, we used to request hospitals to take our products. Now the hospitals have given our phone numbers to patients to find out if valves and pacemakers are available. There is demand in hospitals but we are not able to supply."

Health ministry's intervention yields no outcome

On 4 January 2023, the Health Service Division under the health ministry wrote to the Financial Institutions Division requesting measures to allow LC opening for medical equipment imports. A copy of the letter was also sent to the Bangladesh Bank.

The Bangladesh Medical Device Instrument and Hospital Equipment Dealers and Manufacturers Association in December stated that importers are not able to open LCs for the import of life-saving medical devices since last November, said the letter.

But, the central bank has not yet issued any instructions to banks in this regard, although it has asked banks to open LCs for the import of consumer goods, sources at the central bank and the finance ministry said.

Asked, Dr Md Anwar Hossain Howlader, secretary of the Health Services Division told TBS, "LC issues are disrupting all types of imports. The Ministry of Finance, the Bangladesh Bank, and the NBR have been requested to allow LC opening for the import of medical devices."

Initiatives will be taken soon to resolve the issue, he said.

Former health minister AFM Ruhul Haque said the government should allow LC opening for the import of medical equipment considering these devices as everyday essentials.

He also suggested that the government can take an initiative to bring in medical devices in exchange for various exportable products to the source countries.

Heavy reliance on imports

According to the Bangladesh Medical Instruments and Hospital Equipment Dealers and Manufacturers Association, the country has a demand for Tk10,000 crore worth of medical devices annually while 70% of the demand is met through imports. Among the locally produced items, most are disposable. Some orthopaedic products, surgical disinfectants, hospital furniture, home care devices, electrocardiograms, and other small instruments are manufactured locally on a small scale.

Almost 100 types of equipment needed for almost all types of major surgeries such as heart surgery, bypass surgery, neurosurgery, kidney surgery, and orthopaedic surgery have to be imported from abroad, said Rafiqul Islam Masum, president of the Bangladesh Indenting Agents' Association.

Imported high-tech devices widely used in the country's hospitals and clinics include cardiac stents, cardiac pacemakers, artificial heart valves, digital blood pressure monitors and devices, hearing aid devices, blood bags, urine bags, dialyser tubes, medical ventilators, and digital thermometers. For neurosurgery, clamps, curettes, drill bits and impactors, elevators and spreaders, hooks and probes, retractors, scissors, spatulas, and suction tubes are very crucial. And all of these equipment are totally import dependent.

Masum went on to say that even the paper sheets used for X-rays and ultrasounds are also totally dependent on imports.

Hospitals can't start operation

The construction of the 250-bed Barguna district-headquarters hospital was completed one and a half years ago, but the hospital is yet to come into operation because necessary equipment and machineries have not been installed yet.

The health ministry floated a tender in May last year for the purchase of about 119 types of machinery and equipment for the hospital.

An official of Abhi Enterprises – one of the three firms that have been awarded the work – said, "About 80 types of these machines are import-dependent. Since we could not open LCs, we are not able to import them. And we have informed the health ministry about this in writing."

Dr AM Shamim, founder and managing director of Labaid Group, told TBS the start of their new cancer hospital has been halted because they are not being able to import important equipment over LC issues.

Looming crisis of pharma raw materials

Md Sherajul Islam, president of the Bangladesh Pharmaceutical Importers Association said large pharmaceutical companies are now running their production process using stockpiled raw materials as they cannot import new shipments due to the LC crisis. But if the LC situation does not improve, medicine production might be disrupted by May-June this year.