Living by an oath

Mannan Mashhur Zarif
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In 2006, according to the World Health Report, Bangladesh was among 57 countries with a serious shortage of medical professionals -- doctors, paramedics, nurses and midwives. It may seen ironic as the country claims success in managing to develop a network of medical colleges, nursing and paramedical institutes, where graduates are taught to provide healthcare services and treat people. But with almost 4000 patients per doctor, and one of the poorest nurse-doctor ratios in the world, the existing flaws of the healthcare system seem more apparent.

There has been no significant improvement of the situation in the last six years. Despite the outpour of thousands of medical graduates every year, their contribution to society upon entering professional life is viewed with scepticism and sometimes, utter dismay.

“It's the lack of integrity and devotion to one's profession that is the root cause of the deteriorating healthcare system in the country,” said Dr. Irfan Rahman, Lecturer, Community Medicine at a Private Medical College. “As students we were taught not to treat a patient but to heal. But once we enter the rat race of our professional career we tend to overlook this basic principle.”

“The youth,” he further added, “can contribute so much more even although it is a well known fact that experience is pivotal in the practice of medicine. One needs institutional guidance coupled with firsthand knowledge of the subject through dealing with patients.”

A health system consists of all organisations, people and actions whose primary intent is to promote, restore or maintain health. It is the infrastructure through which services required by the target population is delivered.

Health service delivery, workforce, information, products, financing and stewardship are the six building blocks for strengthening of the health system in a country.

In the national perspective the public sector is largely used for out-patient, in-patient and preventive care (for example, vaccination, health education etc) while the private sector is used largely for outpatient and in-patient curative treatment care.

Photo: Kazi Tahsin Agaz Apurbo

Back in 2000-2001, one community clinic was established for every 6000 of the rural population. The government in tenure has revitalised the public healthcare services by making the clinics operational.

These service points have some unique characteristics, the most noteworthy being the fact that they are managed by a Community Clinic Management Group that includes local public leaders and representatives.

“This may prove to be a positive addition to the prevailing system,” believes Dr. Rahman. “It will help bridge the gap between the care-givers and the patients, thus doctors, who seem aloof from their social surrounding, may come closer to the people.”

Vacancy rates in health complexes at the upazila levels is much higher than in those of the major cities and is almost completely incomparable with the prevailing rate in Dhaka. Different studies have also demonstrated a wide discrepancy in the quality of the services provided by the urban and the rural workforce.

“The entire healthcare system is based in Dhaka,” says Dr. Rahman. “Not only do you get all the best doctors, the state of the art facilities etc in Dhaka, most of the post graduate courses are offered only in the capital. Unless there is decentralisation of the entire system, the whole healthcare sector will suffer.”

The '90s saw a boom in the private medical sector -- in providing education and also in providing curative measures. Although it was expected that stringent measures would be taken to make the private sector in par with the public, differences remain.

There is a growing recognition of the need for regulatory bodies for health professionals that can work more closely with the related government agencies to ensure the quality of health workforce education and practices.

Medical professionals are some of the most respected people in Bangladesh. As a student body, they have made significant achievements. Sandhani, for instance, is a glaring example, which has received the highest civilian award -- Shadhinota Podok -- from the Government of the People's Republic of Bangladesh.

Sandhani is truly a success story for the medical community. These students are barely in their early 20s but collectively they have achieved a feat unmatched. Through its efforts in the field of voluntary blood donation and posthumous eye donation they remain one of the pioneers in this social movement.

As a community plagued by accusation of insincerity, lack of devotion and misconduct, for doctors, Sandhani serves as an example of what can be achieved by the youth.

“Truth be told, there have been contributions by medical doctors in their youth by providing service to the people by not only utilising their expertise but also as a human being,” believes Dr. Muhammed Rajib Hossain, a graduate of Sir Salimullah Medical College and a social, healthcare activist.

Recently, a Bangladeshi doctor became the first ever recipient of the Gates Vaccine Innovation Award that seeks to acknowledge outstanding achievement in advancing work in vaccine-preventable diseases. Dr. ASM Amjad Hossain inspired his team of health workers to go the extra mile in bringing children under the umbrella of vaccination, for which they underwent a laborious routine.

Not only did they provide vaccination for the targeted children, they meticulously surveyed pregnant women in their targeted population so as to document a tentative date for the child-to-be-born's polio vaccination.

In 2006, 19,300 more children were fully vaccinated than the year before. In 2009 and 2010, an additional 28,000 children were fully vaccinated. These strategies have since been put into practice with thousands of field workers in other parts of Bangladesh, and have served as a model to be adapted in other countries.

Dr. Hossain's story is equally thought provoking, as he too, like many others, devotes his time in social activism, raising health awareness amongst the rural population.

At the Goichacia village in Netrokona he helped his friend Richard Hubbard, an American medical student, set up a school and healthcare facility -- The Susan Hubbard School and Children's Home.

Unlike most social workers who usually work in areas known to them, Dr. Hossain and his team made best use of the available conditions and set up the institution. Today, he and his Bangladeshi friends try to pass on the light of knowledge and the tool of better living in a remote part of the country.

Doctors, when they graduate, are taught to take the Hippocratic Oath, as millions of doctors have done before them. Unfortunately, few abide by the rules, most lead a life alienated from the basic teachings they are provided in medical colleges.

With some amount of merit and sincerity anyone can get a medical degree but only those who honour their profession and maintain a proper code of conduct are true doctors -- the healers. For the medical professional must guide their life with principles. They should live by an oath.

Mannan Mashhur Zarif is Sub-editor, Star Lifestyle.