On the occasion of the 80th anniversary of Dhaka Medical College, Prime Minister Tarique Rahman expressed a simple desire that the physicians of the country won the people's trust through dedicated and compassionate care. If the doctors could do so, patients would not go abroad for healthcare and the country would save $5.0 billion a year. Apparently, the prime minister's expectation is humble but the culture of medical care developed over the decades runs counter to his demand. The entire healthcare system finds itself in an imbroglio because of in-built weaknesses. Flawed healthcare governance and management of hospitals have led to aberration of the system and malpractices, with rare exceptions, by not only doctors but also by other members of hospital staff. In some cases of large medical facilities, it is the employees down the rank who hold, in collusion with a gang of outsiders, the higher hospital authorities a hostage.
However, Bangladesh developed a network of medical facilities in the shape of upazila health complexes almost three decades ago. Also community health centres at lower tiers were added to such health complexes. But infrastructure alone cannot guarantee healthcare for people in rural areas. When doctors continue to remain absent and the facilities lack medical equipment and apparatuses, these facilities are reduced to white elephants. There is no use blaming young aspirant medical graduates who cannot apply their knowledge on account of absence of the required medical equipment. Deepening frustration compels them to return to private chambers in cities and towns. The prime minister made a valid point when he observed that legal measures are not enough for forcing doctors to stay and serve at health complexes. If the conditions are improved enabling doctors to serve patients properly, many of them would stay at their workplaces.
As for the veteran and experienced doctors, they do not lag far behind their counterparts in countries where patients from Bangladesh seek medical treatment. Then why do patients from this country go to those countries for treatment? Here is a catch 22 involving the systemic defects. The rush to the chambers of these select physicians is far too heavy for them to give enough attention to patients. At some point, they become so commercialised that they are not even aware of the disservice they do to their profession. This could be prevented if an integrated chain of medical care could be developed by strengthening the lower tiers of healthcare system.
That allocation for the health sector in this year's budget is only second to education provides cold comfort because there is no proposal for developing a chain of medical care with a bottom-up approach to the system. If such an integrated system could be developed, rural people did not have to rush to health facilities in towns and cities. Now different categories of patients, based on their affordability, seek medical treatment in upazila complexes, hospitals in district towns and government hospitals in Dhaka city. Few of the rural patients can afford the highly costly medical care in cities' private hospitals. Those who can afford go to neighbouring India, Singapore and Thailand, hardly look for treatment in local hospitals. So, equipping upazila health complexes and lower community health centres with required medical equipment is important. Then, a change in the attitudes of not only physicians but also of nurses and other hospital employees may happen gradually.
