Dying in the dark: Critical care in a bad shape
A patient seen in the photo is getting treated in an ICU at a private clinic in Dhaka city. Critical care support provided in ICUs are scarce, expensive, unequally distributed in Bangladesh. Photo: Tareq Salahuddin
Critical care or intensive care medicine can be the difference between life and death for patients with critical illnesses. Critical care services, usually provided in the Intensive Care Unit (ICU) are scarce, expensive, unequally distributed in Bangladesh. In many instances, it is substandard and runs as a profitable business. Urgent action is needed to reform critical care services in order to save people who are dying in the dark. Most patients present in hospitals with critical illnesses in Bangladesh lack access to safe post-operative care, intensive care beds, trained staff and evidence-based tools in local context to treat common syndromes. A study published in 2010 in the Ibrahim Medical College Journal showed that 90 percent of all ICUs in Bangladesh were located in the city of Dhaka. Only three ICUs are located in government hospitals and three in government supported autonomous institutions. Rest of the ICUs are in private hospitals and clinics. There is no common standard protocol to run these ICUs and management strategies vary greatly. Due to the disproportionate distribution in urban and rural locations, many people in dire need of ICU care face significant hurdle accessing critical care services. Inadequate and very small-scale government services can fill the need of only a small fraction of the large Bangladeshi population, who cannot afford such costly treatment in a private setup. Since the establishment of first ICU in the National Institute of Cardiovascular Diseases (NICVD) in 1980s, 40 ICUs was established in Dhaka city till December 2007. As it is a profitable healthcare business, the number now has been increasing dramatically in Dhaka city, especially in private setup. However, authority concerned is turning a blind eye to the standards of such units. There are many cases of unnecessary admission that imposes a huge financial burden to the patients and their families. The aforementioned study reveals a significant number of deficiencies including ICU doctors and nurses who do not have basic life support or cardio pulmonary resuscitation (CPR) training. Again, many pharmaceuticals take ICU as business ground and increasing sell of drugs by alluring doctors in the ICU to use costly latest generation antibiotics indiscriminately for treatment. The practice along with improper infection control facilities leading to the spread of antibiotic resistance, surge of infection rates, increase mortality in ICUs and of course — higher bill. Prof Dr Mohammad Omar Faruq, Head of the Department of Critical Care Medicine, BIRDEM and also the President of the Bangladesh Society of Critical Care Medicine recommended that an ICU should be set up in every government medical college on priority basis. Simultaneously, training facilities and number of teaching medical professionals should be expanded. The high cost of critical care can be lessened by implementing a co-payment system where the government and the patient will jointly contribute to the cost. Prof. Faruq also suggested formulating a standard practice guideline and appointing an active monitoring body. "Unlike most of the running ICUs, the ideal ICU should be run in a close system where the In-charge of the ICU will be the prime decision maker and will coordinate everything rather than an ICU being run on multiple decisions by different physicians" he opined. Where there is dire need of ICU admission, many people do not have a choice. Rather they have to watch their dearest one dying in the dark. Pricey treatment, long queues in limited government services and undue stay of some patients in ICUs make the critical services more critical.
For all latest news, follow The Daily Star's Google News channel.
Comments