Calling on physicians to perform better
Saturday, 23 October 2010
The Prime Minister's recent call on physicians to be more mindful about the health needs of the poor may have come from a genuine concern for the weal of the large swathes of people who fall under that head. But one may be pardoned for questioning whether a Prime Ministerial call alone would suffice when the Hippocratic Oath itself is forgotten more often than not by so many good doctors. The general opinion is that errant professionals can get away with misconduct, negligence or wrong treatment because the Bangladesh Medical and Dental Council Act has no teeth.
Ever since the regulatory body was set up in 1973, thousands of doctors have been given licences, and thousands of complaints have been received. But the BMDC allegedly could not act on the complaints, claiming that the majority of the 'cases had not been filed properly.' Some years ago there was a move to amend the Act, so that gross negligence could be addressed and the good name of the profession restored. But the initiative seems to have been permanently cold-storaged !
Consumer activists in some countries are found to be extremely alert about both their public and private medical services. In Sweden there is a vigorous movement going on to keep track of ADR's (adverse drug reactions) among consumers of medicines, and it is followed up with both the prescribers and the manufacturers so that drugs and services are improved and people are sufficiently protected against negligence or abuse.
In India, mainstream newspapers have been found running stories about terrible medical mishaps, and crass commercialism rampant in the mushrooming diagnostic centres, clinics, hospitals and drug manufacturing units, that have been largely unregulated and allowed to go unaccountable for long. Thousands of negligence suits are said to be still pending against various medical practitioners, clinics and hospitals. Such scrutiny is likely to help the health services be more careful. The Consumer Association of Bangladesh should also make itself useful in this regard. Both the public and private health systems can be made to deliver standard services and be accountable, provided citizens' monitoring prevails.
Last year WHO sought to make the health facilities safer and more capable of dealing with emergency situations at all times. This can be said to be particularly appropriate for Bangladesh, given the fact that this geographically vulnerable piece of land is teeming with largely poor defenceless people who are prone to all kinds of natural and man-made disasters. In low-income countries like Bangladesh people are said to be at least four times more likely to die from extreme natural disasters than in the rich world. This is not unexpected, given the fragility of the underfed in terms of physical strength and stamina, though in spirit Bangladesh's people remain quite unbeatable in their legendary resilience.
The UN body's promise of prompt technical support for better case management during emergencies is more than necessary in times like these when emerging and re-emerging diseases can throw a country out of kilter. Enhancement of the government's response capacities, through various WHO-GOB collaborative programmes, should also remain high on the priority list, for the same reasons. For Bangladesh, with one of the world's highest maternal mortality rates and other negative indices pertaining to general health, virtually everyday is an emergency, even though the more dramatic and spectacular instances like super cyclones Sidr or Gorky, terrible tornadoes and tidal bores, devouring floods and erosions make more news than the silent emergencies caused by day-to-day malnourishment, poor sanitation and poor management of scarce resources.
This is not to trivialize the magnitude of the health problems generated by major disasters. Nine of the world's top ten countries for disaster-related deaths due to weather-related phenomena like floods and cyclones belong to Asia and Bangladesh is one of the worst affected. In November 2007, Sidr alone killed some ten thousand people and injured thousands more, according to reports. Government figures put the number of affected to as many as eight million and, it is estimated that about 71 per cent of the health facilities in the periphery of the storm were badly damaged. The economic toll and human suffering from extreme natural disasters are indeed enormous.
It is therefore important to invest in health infrastructure that can withstand hazards, not only to be able to safely serve people immediately but also to have systems in place to ensure continuity of care. A health facility's actual value is said to lie in its non-structural elements, including mechanical, electrical and communications equipment as well as storage and water-heating provisions. It is often damage to these that turns an otherwise good health infrastructure into a mere brick building. WHO information kits claim that only about one per cent of a hospital's budget is needed to have these non-structural elements in place, but this one per cent can protect 90 per cent of the hospital's value.
Unfortunately, a culture of poor management and maintenance in Bangladesh's government-run facilities can be the undoing of even the best health facilities available. This must, and can be overcome through continuous training of personnel in the use and upkeep of essential equipment. It is an imperative if existing facilities and newly established ones are to remain safe and operable whenever needed. A participatory approach to meeting emergency health needs, whereby the community, particularly the youth, comes forward spontaneously, can work wonders. Mercifully, Bangladesh has no dearth of such volunteerism.Programmes for year-round preparedness in emergency health care could grow out of such volunteerism and brigades of barefoot doctors, so to say, could be created, if the energy and urge is channeled sustainably.
Ever since the regulatory body was set up in 1973, thousands of doctors have been given licences, and thousands of complaints have been received. But the BMDC allegedly could not act on the complaints, claiming that the majority of the 'cases had not been filed properly.' Some years ago there was a move to amend the Act, so that gross negligence could be addressed and the good name of the profession restored. But the initiative seems to have been permanently cold-storaged !
Consumer activists in some countries are found to be extremely alert about both their public and private medical services. In Sweden there is a vigorous movement going on to keep track of ADR's (adverse drug reactions) among consumers of medicines, and it is followed up with both the prescribers and the manufacturers so that drugs and services are improved and people are sufficiently protected against negligence or abuse.
In India, mainstream newspapers have been found running stories about terrible medical mishaps, and crass commercialism rampant in the mushrooming diagnostic centres, clinics, hospitals and drug manufacturing units, that have been largely unregulated and allowed to go unaccountable for long. Thousands of negligence suits are said to be still pending against various medical practitioners, clinics and hospitals. Such scrutiny is likely to help the health services be more careful. The Consumer Association of Bangladesh should also make itself useful in this regard. Both the public and private health systems can be made to deliver standard services and be accountable, provided citizens' monitoring prevails.
Last year WHO sought to make the health facilities safer and more capable of dealing with emergency situations at all times. This can be said to be particularly appropriate for Bangladesh, given the fact that this geographically vulnerable piece of land is teeming with largely poor defenceless people who are prone to all kinds of natural and man-made disasters. In low-income countries like Bangladesh people are said to be at least four times more likely to die from extreme natural disasters than in the rich world. This is not unexpected, given the fragility of the underfed in terms of physical strength and stamina, though in spirit Bangladesh's people remain quite unbeatable in their legendary resilience.
The UN body's promise of prompt technical support for better case management during emergencies is more than necessary in times like these when emerging and re-emerging diseases can throw a country out of kilter. Enhancement of the government's response capacities, through various WHO-GOB collaborative programmes, should also remain high on the priority list, for the same reasons. For Bangladesh, with one of the world's highest maternal mortality rates and other negative indices pertaining to general health, virtually everyday is an emergency, even though the more dramatic and spectacular instances like super cyclones Sidr or Gorky, terrible tornadoes and tidal bores, devouring floods and erosions make more news than the silent emergencies caused by day-to-day malnourishment, poor sanitation and poor management of scarce resources.
This is not to trivialize the magnitude of the health problems generated by major disasters. Nine of the world's top ten countries for disaster-related deaths due to weather-related phenomena like floods and cyclones belong to Asia and Bangladesh is one of the worst affected. In November 2007, Sidr alone killed some ten thousand people and injured thousands more, according to reports. Government figures put the number of affected to as many as eight million and, it is estimated that about 71 per cent of the health facilities in the periphery of the storm were badly damaged. The economic toll and human suffering from extreme natural disasters are indeed enormous.
It is therefore important to invest in health infrastructure that can withstand hazards, not only to be able to safely serve people immediately but also to have systems in place to ensure continuity of care. A health facility's actual value is said to lie in its non-structural elements, including mechanical, electrical and communications equipment as well as storage and water-heating provisions. It is often damage to these that turns an otherwise good health infrastructure into a mere brick building. WHO information kits claim that only about one per cent of a hospital's budget is needed to have these non-structural elements in place, but this one per cent can protect 90 per cent of the hospital's value.
Unfortunately, a culture of poor management and maintenance in Bangladesh's government-run facilities can be the undoing of even the best health facilities available. This must, and can be overcome through continuous training of personnel in the use and upkeep of essential equipment. It is an imperative if existing facilities and newly established ones are to remain safe and operable whenever needed. A participatory approach to meeting emergency health needs, whereby the community, particularly the youth, comes forward spontaneously, can work wonders. Mercifully, Bangladesh has no dearth of such volunteerism.Programmes for year-round preparedness in emergency health care could grow out of such volunteerism and brigades of barefoot doctors, so to say, could be created, if the energy and urge is channeled sustainably.