Cover Story

What Ails DMCH?

AASHA MEHREEN AMIN and AHMEDE HUSSAIN
Photographs: Zahedul I Khan

The Dhaka Medical College Hospital (DMCH) is the largest public hospital in the country. For those who cannot afford the high fees of private hospitals or clinics, the DMCH is the only hope for getting cured. In the event of an emergency, it is often the only option. Even patients from far-off places in the country come all the way to DMCH in the absence of beds or proper medical treatment in their own districts. But in spite of its crucial role in our ailing health care system, the DMCH is a house of endless horror stories. Rampant corruption, years of unhindered politicisation of the entire institution and an unrealistically poor budget have turned DMCH into a hellhole for the sick.

The first thing that hits one in the face upon entering Dhaka Medical College Hospital (DMCH), which looks more like a medieval mansion in a gothic horror movie, is the noxious, suffocating smell. It comes from a mixture of grimy floors, stale sweat and general claustrophobia of this gigantic maze where inhaling too deeply might make you faint. Pungent enough to make a healthy person fall sick, it is the smell of gross negligence.

Signs of utter disrespect for human life are everywhere. On a busy day when the wards are all filled up, the corridors outside are strewn with sick patients, men, women and babies, some waiting to be healed, others waiting to die.

Nine-year-old Tanvir lies sleeping on the floor outside Ward 35 with a bandage on his head and a saline apparatus next to him. His father informs us that Tanvir fell from the terrace of their flat in Hosni Dalan. "We brought him here and after initial treatment we had to take him home as they told us that there was no bed," he says as Tanvir's mother keeps looking at her son. But Tanvir's condition deteriorated that night and his parents had to rush him back to the hospital. "We have to buy all the medicine ourselves from outside. I got mad because why should we have to buy all this when this is a government hospital and is supposed to provide free medicine?"

Most of the drugs the doctors at the DMCH prescribe come from government-run Essential Drugs Company Limited (EDCL). Drugs that the EDCL does not produce are bought in an annual open tender by the hospital. Usually a purchase committee is formed to assess the need for drugs the hospital has in each fiscal year. "But nepotism and corruption rule most of the purchasing," says Zaman (not his real name), a Class Three employee. He alleges that in most cases the doctors refuse to prescribe the sub-standard drugs that the hospital has purchased through its annual tender, thus forcing the patients to buy drugs from the dispensaries outside DMCH. "Some Class Four employees steal essential drugs and sell them to different drugstores across the country," he adds.

Failing to get a bed many patients stay under the banister with their attendants

According to a senior official of the hospital administration, while the DMCH has a supply of basic drugs and medical supplies like syringes, gauze, saline, etc., some drugs such as expensive antibiotics have to be bought by the patients because they are not available at the hospital medicine store. The official however, evaded the issue of drugs being stolen or sold off outside the hospital.

Standing in the corridor is a young woman trying to soothe her baby -- just over a month old. Parveen Islam had to come all the way from Chandpur when her newborn baby's stomach became abnormally inflated. After being refused from Shishu Hospital and Mitford Hospital because there were no beds vacant, she ended up at DMCH, where, miraculously, she did get a bed. It took 10 excruciating days of tests before the doctors diagnosed the problem: an intestinal complication. "We had to do all the tests outside because the tests done at DMCH are not accepted by the doctors," says Parveen's brother.

Encouraged by Parveen, other people come forward and give their list of grievances. "The nurses are extremely rude, especially the younger ones," says Shaheen, whose niece is a patient.

"The food the cooks give us is substandard and they never give enough rice. We have to buy rice from the cooks for Tk. 5," she continues. Amanullah (not his real name), a ward boy, echoes the allegation and has his own Pandora's box of the evils committed in the hospital. According to him, the cooks sell raw eggs and boiled eggs outside the hospital and cooked food to the patients although food is supposed to be free of cost. "The cooks themselves eat the best part of the food and also give it to the hospital employees' union leaders to keep them happy."

Food, moreover, is not the only item sold to make a quick buck. According to Amanullah, some doctors and nurses form an understanding whereby the doctors over-prescribe drugs of a patient and then the extra drugs are sold off. "Medicine is often stolen by OT (Operation Theatre) ward boys, OT sisters and even doctors," says Amanullah.

But the more obvious anomaly is the unbelievable filth in the wards where many patients are critically injured. Several weeks ago while visiting a patient -- a young garment worker who had been raped and her spinal cord almost completely severed -- we saw scores of little cockroaches all over the walls. Some of them were running up the patient's body. The floor where more patients were lying on was sticky with grime. Two cats freely wandered around the wards, looking for scraps.

The stink from the bathrooms waft into the corridors; the floors are wet and muddy with discarded food strewn all over. "In such unhygienic conditions how can sick patients survive, especially those who run the risk of contracting infections?" asks Shaheen.

"The ayahs are supposed to clean everything," says Sharmin, a patient's sister, "but if we don't give them money they refuse to do it."

Class Four employees, who include the Sweepers, Zamadars, and Sardars are not transferable. This, Zaman believes, has given them perpetual immunity from any administrative action for negligence of duty. "They cannot be transferred as long as the case is 100 per cent proven against them," says Zaman.

Class Four employees have their own union, which is affiliated with both the ruling and the opposition parties. And though the union leaders draw their salary year in and year out, they seldom lift a finger as far as work is concerned. "There are seven ward-masters in the whole hospital, and around three Sardars work under them," says Zaman. On an average, he continues, a ward master has to supervise 150 people. "But, most of them," Zaman alleges, "do not even turn up at work." And like their supervisors, most Class Four employees who work under them regularly shirk their responsibilities.

The DMCH administration turns a blind eye to this, as they are large in number and most Class Four union leaders are involved in party politics. "You can't do anything if a ward boy or an ayah misbehaves with you. Once a Director General reprimanded a sweeper for not cleaning the ward properly; that DG was later transferred because his political power outmatched that of the sweeper's," Zaman recalls.

In fact ward boys can hardly be seen at the Emergency Unit of the hospital where they are supposed to attend to the patients. In the absence of the ward boys, a gang of brokers, in connivance with the Class Four employees, runs a thriving business of luring patients to nearby private clinics. "After grabbing the patients, the brokers huddle them into a waiting ambulance to take them to the nearby clinic. Each broker usually makes from Tk 4,000 to 6,000 a month. And the commission is about Tk 200 for a delivery patient and Tk 500 to 1,000 for general surgery like hernia, cleft-lip and minor burn," writes Shamim Ashraf in a Daily Star report.

The list of allegations is endless. Getting a trolley for carrying a patient costs Tk 100; relatives have to pay Tk 1,000 at the morgue to get the dead out of the hospital. Duties of DMCH's Blood Bank are sold every night to outsiders who buy blood from drug addicts. All the revenues earned are distributed equally among different unions.

"Everyone in the DMCH wants to work in the blood bank," says Zaman. Other most sought-after departments, according to Zaman, are Ticket selling, Pathology and Morgue.

During one of our visits to the Emergency unit we witnessed several individuals (including one of us) being charged Tk10 for an admission ticket when the official rate printed in bold on the wall was Tk 5.50.

According to an official who preferred anonymity, unless complaints are in written form, there is little the administration can do.

"We have received written complaints from letters and we have taken action against the employee concerned in the form of a suspension or cancellation of his yearly increment or retaining the salary. We have to get the name of the offender to do anything," says the official.

There are worse horrors ahead. On Wednesday September 22 when we enter DMCH, we are pleasantly surprised by the apparent clean look in the ground floor corridors. The floors look reasonably clean, the walls have been freshly whitewashed and miracle of miracles, there are only faint traces of the formidable smell that otherwise characterises DMCH. But it only takes a flight of stairs up to Ward 35 to realise that nothing has changed. Outside the corridor the body of a hit and run accident is lying with a sheet drawn over the head. A man lifts the sheet to see the mutilated face. He admits that he is not a relative, or even a patient in the hospital. Just someone randomly loitering around with morbid curiosity. Fatema Begum, the relative of a patient says, the dead girl was a garment worker who had been hit by a bus. "She was left here all night without any saline and died at seven in the morning," she adds.

At this time it is already 2pm in the afternoon, i.e., over seven hours. Right in front of the body, three other patients lie helplessly in the corridors. One of them, a young woman called Moina, is lying on a dirty piece of foam. It is hard to tell whether she is sleeping or unconscious. Her attendant, a stranger who happened to be in the same place as her when the accident took place, says that Moina was hit by a double-decker bus. During moments of lucidity she had given him her name and the area where she lived. The man had paid for all the medicine she needed but her relatives still had not been contacted.

Opposite Ward 35 is Ward 35A, which is cramped, dark and damp. Patients and their attendants are jam-packed together, making the air difficult to breathe. Again, the floor of the ward is covered by scores of patients who are still waiting for beds. The overnight facelift downstairs is attributed to the Saudi Arabian Health Minister's recent visit to the hospital.

Zaman blames the utter indifference that is so palpable all over the hospital, on the politicisation of the DMCH administration. "If you do not support the ruling party you will not be able to work in DMCH," he says. "Whenever a new government comes to power, the first thing the health ministry does is issue transfer orders," Zaman continues. "Opposition party followers will be marked out, and they will be transferred to far away places outside the capital," he explains.

In fact, immediately after coming back to power in 1996, the Awami League (AL) transferred many doctors to different mufassil towns for their involvement with the then opposition Bangladesh Nationalist Party (BNP). That deplorable practice was repeated when the BNP came to power in 2001.

To make matters worse, every doctor in the hospital is actively involved in national politics. "All the appointments made here are political," Zaman says. "There are some posts that an opposition party-member can never hold," he continues. According to Zaman all the Resident Physicians, General Physicians, ENT Surgeons and Eye Surgeons are active members of the ruling party and they were appointed by the health ministry. In most cases, a doctor's skill, experience and training take second place over political affiliation.

o why is the most important hospital of the city in such a sorry state?

Low salaries and lack of facilities contribute significantly to the resentment among many DMCH doctors and nurses on government payroll. Recently, around 73 nurses of DMCH (2,000 countrywide) have not been getting any salary for the last four months due to a bureaucratic glitch. But even in normal circumstances, nurses feel they do not get paid enough for their services. A nurse's basic salary is Tk. 2,225, and with rent and other allowances included, it comes to about Tk. 4,900.

"We have no quarters and have to commute from far-off areas every day," says Rahina Akhter, a senior staff nurse who has been working at DMCH for the last 21 years. "Some nurses come from as far as Gazipur and security is a big problem," adds Rahina, who is the Chairperson of Bangladesh Diploma Nurses Association. Morjina Akhter, General Secretary of the Association and also a senior staff nurse, adds that nurses do not get other basic facilities like attached bathrooms in the duty offices or a canteen to eat their meals or even dressing rooms to change in. Supervisors are also very few. There are only 31 supervisors for the 6,500 nurses at the hospital.

Doctors too, are ill-paid, especially considering their heavy workload. A government-appointed Indoor Medical Officer (IMO) gets around Tk. 6,800 at the entry level. Apart from regular duty from 8pm to 2:30am or 2:30am to 12pm, IMOs also have to do regular night duty. Many IMOs therefore have private practices outside DMCH.

"We are not supposed to work anywhere else but how can we support our families with such low pay?" says an IMO who now gets around Tk. 8,000 per month.

According to the hospital's accounts section, DMCH's budget for 2004-2005 is 27 crore 18 lakh 79 thousand taka. This includes 2 crore 5 lakh taka for salaried first class employees, another 5 crore 92 lakhs for 'non-gazetted' employees, about 8 crore taka in allowances and 10 crore 74 lakh 95 thousand in medical supplies (including Medical Surgical Requirement, MSR) and 80,000 taka for vehicle repairs. An extra 23 lakh taka was allocated to buy a car for a high official and 20 lakh taka for office furniture.

But this is only about 30 percent of the hospital's required budget. According to the Accounts Officer, a proposal had been given for a budget of about 78 crore taka but was brushed aside.

Apart from lack of funds, officials at the hospital complain about a severe shortage of manpower. The hospital has expanded from 800 beds to 1700 beds but the number of fourth class staff has remained at 900. Now out of this number there are 367 vacancies.

The most pressing need at the moment is to have more beds. The present 1700 beds are not enough, a dearth that leads to the overcrowding on the floors of the wards with patients overflowing into the corridors. "We try not to turn away any patients," says a high official of the hospital.

"We proposed an expansion of 600 beds two years ago. The government has not taken the final decision yet," he says. "Medical technology, in addition, has to be updated and for that you need more funds."

On a regular busy day, the hospital is in a chaotic state with patients taking up whatever space they can find, even under the staircase. Every day at least 1,000 patients come to the hospital's Outdoor Section. In crisis situations such as after August 21st's bomb blast in Purana Paltan, staff at DMCH were working round the clock and could barely cope with the rush of severely injured people. Patients being left for days without being operated on and acute shortage of blood were reported.

Still, in the case of an accident or any other emergency, DMCH is the only place where patients are not normally turned away as is the case in other hospitals and clinics. Its importance for ordinary people cannot be emphasised enough. But unless the government recognises the crying need of a major overhaul of the hospital, whatever limited healthcare it now provides the poor, will increasingly substandard.

Copyright (R) thedailystar.net 2004