What has happened to the Dhaka Medical College Hospital ?

Mahfuz Anam

Those of our readers who have gone through our correspondents Naimul Huq and Bindu Saha's piece “Midnight nightmare at DMCH” must have had great difficulty in removing the graphic images of haemorrhaging patients not being attended to, severely injured victims waiting for hours for a doctor to see them, patients with fractured limbs being forced to walk or being dragged to x-ray machines because there is no trolley available, etc. We received several phone calls expressing complete disbelief that such things can actually occur in a hospital. The truth is that they do and has been for some years now.

I remember how efficient, patient friendly and clean Dhaka Medical College Hospital (DMCH) was. My first acquaintance with this premier hospital of the country occurred in 1960. This was when, after 13 months of solitary confinement in Ayub Khan's (the first Martial Law administrator of Pakistan who came to power through a coup d'etat in 1958) jail, my father, Abul Mansur Ahmad, was suddenly shifted to DMCH from Dhaka Central Jail as his condition deteriorated to a critical state. He needed to stay in the hospital for several weeks. My mother stayed with him all the time and I accompanied her on most occasions. As a young boy I used to loiter around the huge 2nd floor corridor of the hospital, climb its red coloured stairs several dozen times a day and try to steal into the hospital's only elevator along with some patient as often as I could. The elevator, which we call a lift in Bangladesh, was a novelty at a that time and riding it was a very exciting thing.

I myself needed to be hospitalised for a few days in the late sixties and stayed in a ward. My mother-in-law had an operation in '73, which again gave me a first hand exposure of how good and efficient DMCH was. My last experience at this great institution was when we took our sick father for a series of check ups in early 1979 just a few weeks before he passed away.

Since then a lot has changed, regrettably mostly for the worse. But the question is why? We think it is a systematic flaw. The institution has been forced to lower its standard due to neglect, inappropriate resource allocation, lack of leadership, and interference by the higher authority and of course corruption and lack of management skills.

A Tk. 30 crore, the Asian Development Bank funded new
Operation Theatre (OT) complex consisting of 12 new operation theatre was started a few years ago. About six have been completed and others await completion. A Tk. 15 crore-extension work of the hospital has also been completed including the creation of VIP rooms, some single rooms and other related facilities. Some very expensive and essential machines are also in place that are used for limited hours as technicians qualified to use them are very limited in number.

What is interesting to note is that we see the propensity of going for big renovation and extension protects while there is a definite lack of improving the day to day service of the hospital. As our “Midnight nightmare” story clearly points out, practically nothing has happened in terms of providing better service to the thousands of patients on a day to day basis.

Recently the total bed capacity of the DMCH has been doubled, from 600 to 1,200. However the yearly allocation for MSR (medical and surgical requirement) remains at Tk. 3.97 crore. There is an OCC (One Stop Crisis Centre) fund of Tk. 50 lakhs. Though the number of beds has been doubled, the number of doctors remains at 326, nurses 445, interns 126. Without a commensurate increase in the professional staff there cannot be improved service in the DMCH.

There is another problem that needs to be immediately addressed; and successive governments have shied away from it for reasons completely incomprehensible to us. It is the total taking over of the hospital administration by the so-called class IV employees of the hospital. These employees do menial work like cleaning, providing trolleys, serving food, etc. This group now controls the emergency sections and decides which patients will get admission and which ones will not. Obviously patients who want service have to pay them adequately or they will not even be able to register. There are the private clinics that whisk away patients from DMCH's doorstep with the help of these class IV employees. Doctors, nurses and even the hospital administration are afraid to go against this group for the fear of anything from verbal abuse to physical assault. Some of them are in league with them for the extra money that it brings.

The story of DMCH is sad. But it does not have to be. We urge upon the government, especially the health ministry, to take a determined stand to clean up the DMCH. The first decision should be to set up an autonomous administrative body under a professional board of directors. The government can entrust this body with power and reasonable budget and give the task of running it independently and professionally. If our doctors and hospital administrators can run private hospitals successfully, why can't a great institution like the DMCH be run properly? The fact is that it used to be run better in the past. How was it possible then? Let us learn from our own past experience, add to it all the modern day knowledge and apply it. Let us also remember that hospital management in today's world is a far more complex, challenging and advanced art than it was before. Let us also get away from the view that hospital management and medical knowledge is the same thing.

We want to see our DMCH reach its old glory, and it can. What is needed is a determined decision from the government.