Health care: A quantum leap is possible

Poverty alleviation, healthcare and education are the three focal points in the newly adopted Sustainable Development Goals (SDGs). The Bangladesh government has attached due importance to healthcare. The concerned authorities have sent in strong messages for the physicians as regards their stay in rural stations and dispensing sincere services to the ailing people. But what appears to be lacking is activating the entire medical administration - the ministry people, the Bangladesh Medical and Dental Council, the civil surgeon offices and the hospital superintendents - for effective monitoring and enforcement of the laws, directives and measures for real improvement on the ground in proportion to whatever level of health budget is being allocated.         
In the countryside, for no successful cure for a critically ill patient or a surgical trailblazing work did a hospital in Kishoreganj made headlines in the newspapers and was editorially commented. Only the hospital building and little healthcare facilities were the stuff that made news. This is only a cross-section of condition of healthcare across the country. As if to give a bit larger view, soon another piece of news told a similar tale of a Patuakhali hospital: hardly any necessary medicine, few truant medicos and rare care of the sort ailing people need. In the case of Patukhali general hospital, it is alleged that the number of doctors is inadequate, and many of them are busy running their own chambers or private clinics.
Medical equipment is bought with huge amount of public money but there is hardly anyskilled manpower to operate it. Patients are forced to depend on private diagnostic centres for disease investigations. In another major irregularity, there is 'certificate business'. Certificates are given for Tk 500 to far higher figures in proportion to the nature of cases in which these medical documents are used. About the dysfunctional Itna hospital, only luck decides life or death of a critically injured person or a patient of heart attack as it takes over three hours to reach district headquarters from the backwater area by boat and over an hour if a bus is available. A newspaper editorial says "It is unfortunate that pregnant women have to face lengthy travel to district headquarters for safe delivery. More serious patients with injuries or having cardiovascular complications may not survive that journey but they have no choice". Yet the public pay for such healthcare colossi.
These, however, stand out as case studies of the situation in other areas of the countryside. Hospitals and healthcare in most other parts of the country's rural areas, in particular, give no better news either. In October 2015, an elderly person otherwise active in his family affairs in a Rajshahi village complained of chest complications in the morning. He was taken to the best public medical facility in the division by a microbus. Family members said he was in his senses all the way and even after admission in the hospital. There were tests given and done. But he succumbed to what physicians said to cardiac arrest. During the fairly long time, he had not reportedly received the right treatment a cardiac patient needs in such emergencies.
There have been myriad other cases of patients reported dead in the way from a village to a district hospital or medical college hospital. Why are there the Upazila hospitals, some of which fairly big and upgraded? Pregnant women whose families can afford the cost move to the district headquarters for safe childbirth. Despite the fact that there are health complexes in all Upazila headquarters for which huge amounts of taxpayers' money are being spent from the public exchequer. The countryside - for that matter, the country as a whole - is in need of specialised healthcare facilities for the old. Geriatric and palliative medical facilities are of utmost need for the ageing and aged people, euphemistically called senior citizens of the country.
Apart from quality of medical treatment and medicines, there is an urgent need for price control on drugs and medical tests. Prices of medicines - both local and imported ones - as well as diagnosis charges are going beyond the reach and affordability of even middle-class people, not to speak of the common multitudes. One that undergoes bypass surgery or stunting following angiogram and, fortunately, gets a new lease of life, by spending a few hundred thousand of Taka has to remain on medicine lifelong. Several thousand Takas, on average, are needed every month for drugs, special diets and periodical checkups. How many can survive this way in this poor country when their real income fall and medical bills soar?
Allegations are rife that medical multinationals, drug cartels and various associations and trade unions have their hand behind making healthcare increasingly costlier along commercial lines. There should be a holistic approach to the problems long prevailing and newly arising in this vital sector of healthcare. Trust deficit in this field related to life and death itself is a fatal malaise that forces those who are well-off and others who can manage millions somehow to go abroad for treatment and diagnosis to their satisfaction. Surprising enough is that the public figures like the Ministers, MPs, high officials and politicians of the country run abroad for simple medical check-up throwing their critically diseased poor voters at the care of the physicians whom they do not rely upon.    
So the con-trick is another evil which is also not foreign to the health sector. A report based on 2011 findings says some 150 thousand patients, particularly from the affluent section of society, go abroad for treatment every year for lack of sophisticated healthcare facilities in the country, causing huge financial losses. Another report of the same year says some 500 thousand people visit India alone annually, and 25 per cent of them go for medical treatment, particularly in Bangalore and Kolkata.
However, a number of success stories in the country's medical sector have recently been reported. Some brilliant physicians are also coming up, doing some critical surgeries and treatment. True, medicos are not life-givers, but life-keepers for sure. That is - and should be - the guiding spirit in service to humanity. A quantum leap is possible, if only conditions are made conducive and favourable.

The writer is a retired Professor of Economics, BCS General Education Cadre.
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