The pitiable state of our healthservices
Tuesday, 16 March 2010
Shamsher Chowdhury
One of the major problems with our administration is that it focuses on the facade rather than the content. It indulges in stunts too. Whenever there is a failure it hastens to create new laws, claiming to make them compatible to the changing times! There may be some element of justification in all this but the truth remains that in most cases, it is a ploy to hide the administration's failures. Take any of these laws and rules of procedures, be it in the field of labour laws like the laws governing the readymade garment (RMG) workers, laws on human rights protection, women's rights, rights of the disabled, so on and so forth. Has new or revised laws bettered the situation in any way?
Decade after decade implementation of such laws has not only been poor but also disastrous. It is my considered opinion that the laws and rules of procedures in any field are adequate enough to deal with any and all contentious issues facing the country. Problems lie with their implementation. I have no hesitation in saying that the present administration tops the list in revising and formulating new laws and rules. It has now become one of its hallmarks.
Of late I have been hearing a lot about a "new" health policy. No matter how good or a lofty move this may be, I am rather skeptical as to whether it would better the prevailing conditions of our health services I am of the strongest opinion that if there is no real change in the mindset of our service providers -- both doctors and other related work forces -- there will be no improvement of the scenario no matter what. We should therefore first put the existing house in order before we talk of formulating new and revised policy/s.
It is also my impression that of all the public service institutions the weakest is our health services. Making a turn-around for the better would not be an easy task. But there are a number of flaws in our system which, given the required political will and related moral and ethical calling, could be bettered.
When I talk of health services, my main focus is on curative services rather than preventive. There have been some preventive measures that we can rightfully boast about, such as child immunisation programmes.
For all practical purposes it is impossible for ordinary people to gain access to health services at private clinics and hospitals. These can be accessed only by the rich and the affluent. For any sickness involving hospitalisation or prolonged medical services requiring extended drug administration and monitoring, chances are the patient and his or her family will be in dire distress and ultimately decide to leave the patient in the hands of God.
The state of our public hospitals is in an abominable condition. These have become veritable centers of corruption. Mafia and terror gangs control and manage their affairs. Despite statutory provisions for certain drugs to be provided free at public hospitals in their outpatient departments, chances are that nine out of 10 times these are never provided to the patients. The most horrifying situation exists in the area of emergency services, tales of which we often see in the media. Doctor's consultancy services are so uncertain that patients are often left unattended in the corridors.
This situation notwithstanding, the country and the administration seem to be boasting about the recent development in medical services of a handful of "modern" hospitals/diagnostic centers in the capital city and other metropolitan cities, particularly in the private sector. Yes, they may be modern but their services are inaccessible to over 80 per cent of the population of the country due to their prohibitive cost.
This is the broad view of the state of our health services. I would now like to briefly illustrate a few critical aspects that have largely contributed to the prevailing situation.
To this day no one really knows as to what is the actual consultation fee being charged by a consulting physician and the rationale for it. For example each individual physician charges as he or she pleases. The worst of all, they hike the fees chargeable at will and are unwilling to provide you with a money receipt. Without exception, the consultation is one sided, with the doctor already writing the prescription within minutes of the patient entering his or her chamber. Most doctors operate in an impersonal and detached way. The impression one gets is that all they are interested in, is "collecting money".
The other problem with most 'consulting' physicians is that, frequently they prescribe drugs that are out of reach of the common man costwise, without indicating any alternative whatsoever of a cheaper brand capable of producing the same results. My years of dealing with doctors have revealed to me that this is mostly done in collaboration with drug manufacturing companies.
Health services anywhere in the world, are of course, linked to drug manufacturing companies, pricing and marketing of their products in which patients are sucked in. The Department of Drug Administration is the main body that is entrusted to oversee such functions particularly in relation to the drug manufacturing companies. To put it mildly, the Department is in a shambles. Sub-standard drugs can be manufactured and freely marketed. Only recently scores of children died due to the administration of some analgesics/syrups produced by a local company. A media report has it that over forty per cent drugs are spurious. There are allegations that many drug companies even provide regular cash incentives to physicians to promote their products.
The other most important factor that has become a stumbling block in providing quality health services is the deplorable state of our nursing services. There is a serious dearth of qualified nurses and overall nursing services. This is one of the major causes as to why most people, requiring hospitalisation for a major surgery or requiring prolonged hospitalisation, go to neighbouring India where such services are not only available but also cost comparatively less.
This commentary would be incomplete without a few words about the way some of our better known diagnostic centers operate. There is a nexus between the diagnostic centers and doctors. In most cases, referee doctors over-prescribe tests beyond what is needed for detection or diagnosing a specific ailment or a disease. It is now a common knowledge that this is done on a reciprocal basis. The prescribing doctor gets a percentage of the amount billed, while the center's coffer keeps getting fatter.
Epilogue
The truth of it all is this; that our health services are totally devoid of morality and ethics with the key players in the chain being the doctors, the hospitals, the clinics and the diagnostic centers. They have all turned themselves into a some kind of ATM card, capable of withdrawing ready cash with patients seeking their services as their bankers.
The writer can be reached at e-mail:
One of the major problems with our administration is that it focuses on the facade rather than the content. It indulges in stunts too. Whenever there is a failure it hastens to create new laws, claiming to make them compatible to the changing times! There may be some element of justification in all this but the truth remains that in most cases, it is a ploy to hide the administration's failures. Take any of these laws and rules of procedures, be it in the field of labour laws like the laws governing the readymade garment (RMG) workers, laws on human rights protection, women's rights, rights of the disabled, so on and so forth. Has new or revised laws bettered the situation in any way?
Decade after decade implementation of such laws has not only been poor but also disastrous. It is my considered opinion that the laws and rules of procedures in any field are adequate enough to deal with any and all contentious issues facing the country. Problems lie with their implementation. I have no hesitation in saying that the present administration tops the list in revising and formulating new laws and rules. It has now become one of its hallmarks.
Of late I have been hearing a lot about a "new" health policy. No matter how good or a lofty move this may be, I am rather skeptical as to whether it would better the prevailing conditions of our health services I am of the strongest opinion that if there is no real change in the mindset of our service providers -- both doctors and other related work forces -- there will be no improvement of the scenario no matter what. We should therefore first put the existing house in order before we talk of formulating new and revised policy/s.
It is also my impression that of all the public service institutions the weakest is our health services. Making a turn-around for the better would not be an easy task. But there are a number of flaws in our system which, given the required political will and related moral and ethical calling, could be bettered.
When I talk of health services, my main focus is on curative services rather than preventive. There have been some preventive measures that we can rightfully boast about, such as child immunisation programmes.
For all practical purposes it is impossible for ordinary people to gain access to health services at private clinics and hospitals. These can be accessed only by the rich and the affluent. For any sickness involving hospitalisation or prolonged medical services requiring extended drug administration and monitoring, chances are the patient and his or her family will be in dire distress and ultimately decide to leave the patient in the hands of God.
The state of our public hospitals is in an abominable condition. These have become veritable centers of corruption. Mafia and terror gangs control and manage their affairs. Despite statutory provisions for certain drugs to be provided free at public hospitals in their outpatient departments, chances are that nine out of 10 times these are never provided to the patients. The most horrifying situation exists in the area of emergency services, tales of which we often see in the media. Doctor's consultancy services are so uncertain that patients are often left unattended in the corridors.
This situation notwithstanding, the country and the administration seem to be boasting about the recent development in medical services of a handful of "modern" hospitals/diagnostic centers in the capital city and other metropolitan cities, particularly in the private sector. Yes, they may be modern but their services are inaccessible to over 80 per cent of the population of the country due to their prohibitive cost.
This is the broad view of the state of our health services. I would now like to briefly illustrate a few critical aspects that have largely contributed to the prevailing situation.
To this day no one really knows as to what is the actual consultation fee being charged by a consulting physician and the rationale for it. For example each individual physician charges as he or she pleases. The worst of all, they hike the fees chargeable at will and are unwilling to provide you with a money receipt. Without exception, the consultation is one sided, with the doctor already writing the prescription within minutes of the patient entering his or her chamber. Most doctors operate in an impersonal and detached way. The impression one gets is that all they are interested in, is "collecting money".
The other problem with most 'consulting' physicians is that, frequently they prescribe drugs that are out of reach of the common man costwise, without indicating any alternative whatsoever of a cheaper brand capable of producing the same results. My years of dealing with doctors have revealed to me that this is mostly done in collaboration with drug manufacturing companies.
Health services anywhere in the world, are of course, linked to drug manufacturing companies, pricing and marketing of their products in which patients are sucked in. The Department of Drug Administration is the main body that is entrusted to oversee such functions particularly in relation to the drug manufacturing companies. To put it mildly, the Department is in a shambles. Sub-standard drugs can be manufactured and freely marketed. Only recently scores of children died due to the administration of some analgesics/syrups produced by a local company. A media report has it that over forty per cent drugs are spurious. There are allegations that many drug companies even provide regular cash incentives to physicians to promote their products.
The other most important factor that has become a stumbling block in providing quality health services is the deplorable state of our nursing services. There is a serious dearth of qualified nurses and overall nursing services. This is one of the major causes as to why most people, requiring hospitalisation for a major surgery or requiring prolonged hospitalisation, go to neighbouring India where such services are not only available but also cost comparatively less.
This commentary would be incomplete without a few words about the way some of our better known diagnostic centers operate. There is a nexus between the diagnostic centers and doctors. In most cases, referee doctors over-prescribe tests beyond what is needed for detection or diagnosing a specific ailment or a disease. It is now a common knowledge that this is done on a reciprocal basis. The prescribing doctor gets a percentage of the amount billed, while the center's coffer keeps getting fatter.
Epilogue
The truth of it all is this; that our health services are totally devoid of morality and ethics with the key players in the chain being the doctors, the hospitals, the clinics and the diagnostic centers. They have all turned themselves into a some kind of ATM card, capable of withdrawing ready cash with patients seeking their services as their bankers.
The writer can be reached at e-mail: