Covid gone, district ICUs forgotten

Eighteen out of 27 ICUs set up in district hospitals during the coronavirus pandemic are now non-functional as the manpower trained to run the units started to move elsewhere on deputation with the Covid threat fading out.

Experts say the authorities could have used the ICUs for non-Covid critical patients after the pandemic, instead of wasting resources when there is a shortage of care units across the country.   

When the urgency to have more units became evident during the first wave of the pandemic, Prime Minister Sheikh Hasina issued a directive on 2 June 2020 to set up ICUs in every district hospital.

There were only 14 ICU beds in two district hospitals in 2019. 

In line with the directive, the Directorate General of Health Services managed to install 202 ICU beds in 27 district hospitals with the revenue budget and local contribution.

With Tk2.50-Tk3 crore spent on every 10-bed ICU unit, the total cost to set up these units, including the purchase of equipment, stood at around Tk70 crore, according to the health directorate.

Bangladesh Medical Association Secretary General Ehteshamul Huq Choudhury said it is a waste of money that these ICUs are being left unused.

"The authorities should be more proactive in ensuring that the manpower is available in the district hospitals," he said.

State of the ICUs

The Business Standard visited seven of the district hospitals where the 27 units were set up and talked to the authorities of 18 others over the phone only to find a grim picture.

For example, the 8-bed ICU facility set up during the pandemic in Bogura 250-bed Mohammad Ali District Hospital was found out of operation.

The 6-bed ICU in Moulvibazar 250-bed District Sadar Hospital has also been closed since the number of Covid patients declined. The unit never had a ventilator.

In Naogaon 100-bed District Hospital, a 2-bed ICU unit was set up during the pandemic. However, lacking manpower and equipment, it was never operational, not even during the Covid period. Now the two beds are being used for respiratory and cardiac patients.

Only the 18-bed ICU in Chattogram District Hospital was found fully operational, however, lacking some maintenance staff. 

Lack of manpower

According to the guidelines for ICUs in India, the unit needs staffers like consultants and residents, nurses and other staffers. In ICU, an artificially ventilated patient needs at least one nurse at the bedside at all times.

There should be at least six consultants of different levels, two coordinators cum registrars, 12 senior and junior medical officers and nurses, four ward boys and eight cleaners to run a 10-bed ICU day and night, Prof Omar Faruq, president of the Bangladesh Society of Critical Care Medicine told The Business Standard.

However, the operational ICUs in district hospitals are suffering from a lack of dedicated doctors and nurses. 

For instance, the 10-bed ICU at Tangail District Hospital is operational but it has no specialist doctor. Only one of the three anaesthesiologists recruited during the Covid period remains but works in the operation theatre. 

Doctors from the medicine department run the ICU and there is no dedicated nurse for the unit.

Khondoker Sadikur Rahman, assistant director of the hospital, said they have sent several letters to the health department informing the issue.

A similar situation exists in district hospitals of Gopalganj and Madaripur.

The government recruited 409 anesthesiologists in 2021 to deal with the pandemic. They were assigned to upazila and district hospitals.

However, many of them have moved to different hospitals in Dhaka on deputation and they were replaced with new staffers.

Acknowledging the issue, Professor Dr Ahmedul Kabir, additional director general of the DGHS, told TBS that there are no Covid patients in the ICUs of the district hospitals.

"Therefore, the anaesthetists are deputed to other tasks. They are sent to wherever there is a manpower shortage," he added.

Experts say only critical care specialists can serve the ICUs as they know best which medicine to prescribe in an emergency situation.

There are 82 critical care medicine specialists in the country; of whom 50% work in private hospitals. If these doctors are assigned to the district hospitals, the ICUs can be appropriately managed, they said.

As many as 1,800 doctors, nurses and staffers from 43 districts and 27 medical college hospitals across the country were trained for ICU management at the district level by the Bangladesh Society of Anaesthesiologists, funded by Save the Children and USAID.

Dr Debabrata Banik, president of the society, told TBS that they trained 15 nurses from each district hospital as the running of ICUs is heavily dependent on them.

However, these medical personnel are now deputed to other jobs.

Acting Director (Hospitals and Clinics) of DGHS Sheikh Daud Adnan said the ICUs that were opened to deal with the pandemic will soon be used to treat non-Covid patients.

"We have taken information about ICUs of all hospitals. Manpower will be provided where it was needed," he said.

The Health Bulletin 2018 of the health directorate mentions that there are 52,807 beds in government hospitals, so there needs to be more than 5,000 ICU beds available, or at least 2,112. But the actual number is only 211, which is less than 1 percent of the total number of beds.

According to the health directorate, the 36 medical colleges and one dental college in Bangladesh, had only 13 ICUs. In other districts, only two hospitals had an ICU – one in Cox's Bazar and the other in Pabna.

Another ICU project nears deadline

There is another project to build ICUs in 50 district hospitals and 10 medical college hospitals taken up in April 2020 under Covid-19 Emergency Response and Pandemic Preparedness (ERPP) project funded by the World Bank.

The target was to implement the project by 30 June this year.

However, health officials said ICU equipment has been installed in only 10 of the medical college hospitals, but they are yet to be operational. 

Besides, the work in 13 district hospitals is in the final stage and more hospitals are in the pipeline.

Project Director Dr Shah Golam Nabi Tuhin said the World Bank has not confirmed whether it will extend the project deadline.

The completion of the project was delayed due to various reasons, including changes in the project director, the increase in dollar price, and the issues of purchasing equipment, he added.