Amid the worsening Covid-19 situation thousands of critically ill patients, mostly requiring respiratory support in intensive care units (ICU), are unable to find the emergency treatment.
The sheer lack of ICU departments in many districts and upazila hospitals shows how grave the situation is. Even worse, many dying patients requiring ICU support are known to simply die at the hospital premises without the emergency support. Most of these patients are referred to Dhaka
With the surge in number of Covid-19 patients the crisis has sharply intensified. There is no ICU in 36 out of 64 districts. Fifteen of the 31 districts at high risk for corona infection do not have ICU.
This crisis has been going on despite Prime Minister Sheikh Hasina’s intervention into the affair. About 10 months ago she had directed to set up ICU units in every district hospital, which is not implemented yet.
Public health experts are blaming the negligence of the Directorate General of Health Services for not setting up ICU units at the district level even after so many days.
According to the relatives of the patients, the second wave of the coronavirus pandemic has created panic situation for many to be admitted to the hospital and get proper treatment.
Health workers also say that the increase in infections and deaths has put severe strain on the care of the infected people.
Many relatives of the infected peoples say that it has become difficult for anyone in Dhaka to get an ICU if they need.
For ordinary people or the middle class, who are looking for ICU beds in government hospitals, the crisis is becoming more pronounced.
Abu Javed, a resident of Chuadanga district, said his cousin’s health condition deteriorated due to coronavirus. Soon he was shifted to Dhaka. The attending doctor at a hospital suggested arranging an ICU bed on emergency basis, otherwise, the patient may die.
They were disappointed as they could not find any ICU bed even after searching in different hospitals. At one stage he was admitted to a private hospital with the help of a doctor.
Ibrahim Majid, a resident of Dhaka, said he had to contact about 50 government and private hospitals to get an ICU for his mother.
Many new variants of the virus, including from South Africa and the United Kingdom, have spread, requiring more oxygen and even ICU facilities.
The lack of proper attention and planning by officials at the directorate of health services (DGHS) is blamed for such grave situation where ICU is not considered ‘emergency’ part of hospitals.
The following description of ICU support in respective hospitals shows the seriousness of the policy makers at the DGHS and of course the officials concerned at the health ministry.
The 250-bed Bangamata Sheikh Fazilatun Nesha Mujib General Hospital in Sirajganj has only four ICU beds. The ICU beds are not yet ready as they lack central oxygen system.
The same situation is at the Natore modern hospital. The 100-bed hospital does not have ICU system. Not only in Sirajganj or Natore, about 36 other districts of the country do not have ICU support.
In order to save lives, critically ill patients are referred to Dhaka from the district towns. In Dhaka, as the infection is on the rise, the pressure is already high.
Former Vice Chancellor of Bangabandhu Sheikh Mujib Medical University and member of the National Technical Advisory Committee on Covid-19 Professor Dr Nazrul Islam said there are ICUs in 28 districts but not in 36 districts. Patients from these districts are coming to Dhaka hoping to get treatment.
“ICUs could not be set up in the district hospitals even after the Prime Minister's directive. It was possible to arrange ICU in 10 months. The Ministry of Health did not pay any attention about the matter,” he added.
According to the Directorate General of Health Services, 11 out of the 31 districts with high rates of infection are in Dhaka division. The highest number of coronavirus infections has been detected in Dhaka division for a week and the number of deaths is also higher in this division.
However, according to the Civil Surgeon's Office, there are no ICUs in six of the 11 districts with high infections area. The districts are: Tangail, Madaripur, Shariatpur, Narsingdi, Rajbari and Munshiganj. There are no ICUs in Noakhali, Chandpur, Laxmipur and Brahmanbaria which are at high risk of infection in Chattagram division.
Narail and Jessore in Khulna division, Naogaon and Natore in Rajshahi division and Nilphamari district in Rangpur division, which are at high risk of infection, do not have ICU facilities.
In all the six districts of Barisal division, more than twice as many new patients have been identified within a week. However, only Barisal Sher-e-Bangla Medical College Hospital in Barisal Division has 12 ICU beds.
In many cases, patients with coronary artery disease need more oxygen than those admitted in the ICU. For this, the district hospitals need to have adequate oxygen supply system, high flow nasal cannula. At least 4 out of 31 districts at risk of infection do not have any high flow nasal canula. Most districts have 1 to 5 nasal cannula. There are around 720 high flow nasal cannulas in the country.
At the ECNEC meeting on June 2 last year, Prime Minister Sheikh Hasina had directed to set up ICU units in every district hospital. At the same time, she said, ventilators should be installed in every hospital and high oxygen supply should be provided. She also instructed to buy necessary equipment for this. Earlier, on April 26 last year, the Prime Minister said ICUs would be set up in all districts of the country.
An official of Directorate General of Health Services said it is possible to set up ICU units at the district level within a week. But trained doctors, nurses are needed to operate the ICU. There is a lack of manpower to set up ICU units at the district level.
Respiratory Diseases Complicated patients with covid-19 need ICU and artificial respiration facilities or ventilation. The World Health Organization says 40 percent of those affected have mild symptoms.
About 40 percent have moderate symptoms. 15 percent have severe symptoms. The complex situation is seen in the remaining 5 percent. Almost all of the patients with acute symptoms and complex and many patients with moderate symptoms have to be hospitalized. Almost all patients with complex conditions need ICU beds as well as ventilation.
According to the Directorate General of Health Services, there are 825 ICUs in the country. Which is very insufficient compared to the need. However, with the launch of Covid-19 Specialized Hospital in Mohakhali last Sunday, 222 new ICU beds have been added to the list. Which is a bit comforting.
