Hospitals out of medicine, oxygen

• 45 govt hospitals have no ICU facilities

• CMSD out of high flow nasal cannula, Remdesivir injection, ventilators, oxygen cylinders 

• Several patients have reportedly died in Satkhira due to shortage of medical oxygen

Amid the escalating number of cases with high transmissibility of Covid-19 in the country, and a striking mortality rate of the disease, there is a crisis of emergency medical equipment in government hospitals and healthcare institutions. Though the third wave of Covid is knocking at the country’s door, the crisis of medicine, injection and oxygen in most of the district hospitals is creating a worrying matter.   

Letters are also being sent to the health department demanding for faster delivery of medicines of Covid. But the department is not able to meet the demand of hospitals and institutions. The Central Medical Stores Depot (CMSD) in the capital has run out of stock of most of the emergency medical supplies. 

At present, corona patients are being treated in 127 public and private hospitals in the country. Of these, 99 are government hospitals. Of them, 45 hospitals have no ICU facilities. Even, there are two such government hospitals in the capital which have no ICU facilities. Meanwhile, emergency high flow nasal cannula has not been provided for critically ill Covid-19 patients in nine districts of the country. Besides, other emergency materials including injection of Remdesivir is also not available. As a result, the critically ill patients of these districts are flocking to the divisional cities or adjoining districts.

The country not only facing medicine and ICU crisis, but also there are news of oxygen shortage also. And the shortage of oxygen now turned deadly. For example, several patients have reportedly died at the Covid-dedicated Satkhira Medical College Hospital amid a shortage of medical oxygen at the facility. A hospital staffer, asking not to be named, said as many as six people passed away during a disruption in the oxygen supply on Wednesday. However, the hospital authorities did not provide confirmation of the deaths. While acknowledging the disruption in the oxygen supply, they said the problem was resolved soon afterwards.

Manas Kumar Mandal, chief of the hospital’s corona unit, said, “Oxygen levels in the hospital had been declining since the afternoon. This was reported in the morning. Since then, oxygen supplies have been brought from Jashore. The oxygen level in the hospital has now returned to normal. “ 

Satkhira’s Civil Surgeon Hussain Shafayat confirmed the deaths of four coronavirus patients, but did not specify the reasons for their demise. However, he said that if there was any negligence in managing the oxygen supply system, it will be investigated. A hospital worker, speaking on condition of anonymity, said, “There was an oxygen crisis and six people died. But I can’t say whether it was down to the oxygen shortage.”

Taj Muhammad Khan, son of 63-year-old Akram Hossain Khan who died in the ICU unit, said the hospital had been experiencing problems with the central oxygen supply for the past few days. But the authorities did not pay attention to that. “There hadn’t been any oxygen since 6 am. The oxygen supply resumed at 8 pm. How will these patients survive? I lost my father because of the negligence of the authorities,” he said. Shafayat said, “There shouldn’t be an oxygen crisis in the Medical College Hospital. Even then, I heard about the disruption. That was immediately fixed. There are more than 70 cylinders besides central oxygen supply. “On the death of the patients, he said, “Several people have died. However, four people died in the corona unit. The health division will look into whether there was any negligence on the part of the authorities. “

Almost half the 26 districts in the three bordering divisions, Rajshahi, Rangpur and Khulna, where Covid cases have steadily surged are caught in a severe health crisis as they lack access to crucial treatment facilities such as ICU beds and central oxygen supply. The absence of basic life-saving facilities is forcing Covid patients to undertake perilous journeys, sometimes covering 100 kilometres or more, to secure beds at divisional Covid hospitals, if they can afford them.

But even general beds are scarce these days at almost all major government Covid hospitals while their tiny ICU units see the queue of Covid patients with severe symptoms grow by the day. Those with strong recommendations are ahead in the race to get ICU beds while ordinary people keep a member of their family outside ICU units to get the news first when someone dies or recovers inside.

There are eight districts in Rajshahi division and two of them Rajshahi and Bogura have access to 44 ICU beds. Excluding the 10 ICU beds at a private hospital, 29 of the 34 ICU beds at government facilities in Bogura are occupied, with the rest five vacant at Mohammad Ali district hospital. Rajshahi division has some of the worst-affected districts such as Natore, Chapainawabganj and Naogaon reporting high Covid cases for more than two weeks.

If we talk about the medicine and ICU shortage then there is huge number of examples and also several media reports which can describe the crisis. The Covid positivity rate is now hovering between 30pc and 32pc in Naogaon, a bordering district of the country. Amid the wide spread of infection, many Covid patients have become critically ill. Since Naogaon General Hospital does not have an intensive care unit (ICU), it is referring patients to the hospitals in Rajshahi and Bogura.

According to the CMSD, it has been possible for them to supply materials as per the demand of the hospitals till May. But now they are running out of stock. At present CMSD does not have any high flow nasal cannula, Remdesivir injection, Cavid-19 testing kit and ventilator. The stock of oxygen cylinders has come down to five thousand. There are also 600 oxygen concentrators and 100 ICU beds.

As of last April, CMSD had 39 per cent of the total demand for medical equipment and medicines. At that time, the department of health asked for 3,091 high-flow nasal cannulas, 2,216 oxygen concentrators, 937 ICU beds (with monitors), 736 ventilators and 21,279 oxygen cylinders from CMSD. On the other hand, there were 330 high flow nasal cannulas, 2,200 oxygen concentrators, 307 ICU beds, 107 ventilators and 8-10 thousands oxygen cylinders were in stock. Besides, 6 lakh 33 thousand 759 injections of Remdesivir, 10 lakh 59 thousand 814 RT-PCR test kits and a large number of personal protective equipment were sought. But due to the complexity of procurement and lack of management, the supply of these equipments could not be ensured even after two and a half months of demand.

Experts say that if ICUs had been set up on an emergency basis in every district town following the prime minister’s directive a year ago, Covid fatality could have been lower. In the meantime, a third wave of the pandemic has reached the remotest corners of the country, increasing the death risk amid the absence of ICU support.

According to the Directorate General of Health Services, there is no ICU for Covid patients in 5 districts of Dhaka division, 8 districts of Chattogram, 6 districts of Rangpur, 2 districts of Sylhet, 4 districts of Barisal and Khulna each, 6 districts of Rajshahi and 2 districts of Mymensingh division.

Prof Nazrul Islam, noted virologist and member of the National Technical Advisory Committee on Covid-19, said that the Covid toll in district hospitals was on the rise. “I think a separate body has to be formed to deal with Covid-19.” Under the World Bank’s Covid-19 Emergency Response and Pandemic Preparedness project, each district will have a 5-bed ICU to be set up at a cost of Tk 2.12 crore. About 3,500 health workers will also be trained, so they gain skills to provide intensive care.

Project Director Azizur Rahman Siddiqui said the Public Works Department had planned to set up ICUs in 43 districts. The construction designs of 13 units were readied a month ago. It will take about one and a half months to complete the construction, after which medical equipment will be brought with help from UNESCO. “When the ICUs are ready, we will give training to health workers,” Azizur said.

Meanwhile, two ICU beds have been sent to Naogaon from the Central Medical Stores Depot, but those are useless without anesthesiologists or critical care medicine specialists and nurses. Officials from the Directorate General of Health Services said ICU beds could not be set up at district hospitals due to the manpower crisis.

“We have enough ICU beds and ventilators. But we cannot put those to use because of the inadequacy of skilled manpower.  The number of anesthesiologists in the country is low, and the lengthy recruitment process is delaying their appointment,” said Dr Farid Hossain Miah, director (hospitals and clinics) at the health directorate.

Debabrata Banik, president of the Bangladesh Society of Anesthesiologists, said that more than 1,000 anesthesiologists were now working in the private sector and the government could provide ICU services to critically ill patients by recruiting them on an emergency basis.

Three months back, Prime Minister Sheikh Hasina directed the Cabinet Division to appoint 450 anesthesiologists, but due to bureaucratic tangles, appointments have not been done yet.

“The posts of junior consultant will be filled up by those who have completed post-graduation in anesthesia. If we give them seven days’ training, they will be able to manage Covid patients.”