Five times overcrowded: Paediatric patients spill onto floors at Dhaka Medical

Infograph: TBS

Three-year-old Juraiz Sadman accidentally swallowed a topical allergy medicine meant to be applied to the skin. He was first taken to Ibn Sina Hospital in Kalyanpur, near his home. However, as the case involved poisoning and was considered a police case, the private hospital referred him to a government facility without providing any treatment.

From there, Sadman was taken to Dhaka Shishu Hospital and Institute. But the hospital sent him back, saying there was no facility to perform gastric lavage (stomach wash). With no other option, his family rushed him to Dhaka Medical College Hospital (DMCH). After being taken to the emergency department, he was given a stomach wash and admitted to the children's ward. For two days, he received treatment lying on the ward floor.

Like Sadman, many poisoning patients are not admitted to private hospitals because they are considered police cases. Their last resort is Dhaka Medical, as the hospital does not turn away patients. However, although Dhaka Medical treats everyone, patients and their families suffer due to an acute shortage of beds. With four to five times more patients than available beds, most are forced to receive treatment on the floor. The overcrowding also increases the risk of various infections among patients.

On Wednesday (25 February), a visit to the Children's Medicine Ward number 108  revealed three children sharing Bed number 8 – one aged six months, one two months, and another one year old. Two had saline drips attached to their hands, while another had a cannula inserted. Nearly every bed had two or three children. 

On mats spread on the floor in front of the beds, four more children lay side by side. Some had saline attached; others received saline while lying in their mothers' laps. Nurses were administering injections, doctors were reviewing reports, and relatives were rushing between nurses and doctors with medical documents.

In this 19-bed ward, there were 101 admitted patients on Monday morning. The situation was similar in the other two children's medicine wards, as well as in the paediatric cancer ward and paediatric surgery ward, where patient numbers were three to four times the designated capacity.

Doctors and nurses in the children's wards said that admissions regularly reach four to five times capacity. As a result, most patients receive treatment on the floor. Currently, due to a rise in pneumonia cases, all wards are seeing a surge in such patients.

Six-month-old Safayet from Keraniganj was admitted to Ward 210 four days ago with bleeding from the mouth. He has been receiving treatment on the floor ever since, lying with a saline line attached. In this 14-bed ward, 62 patients were admitted on Wednesday.

A similar situation faces two-month-old Sadia from Jamalpur, who is suffering from pneumonia. She is receiving treatment while lying in her mother's lap on the floor.

Six-month-old Sadika, suffering from a head infection, managed to get half a bed shared with another patient. After developing a brain infection due to high fever, she was first taken from Saidpur in Nilphamari to Rangpur Medical College Hospital, and then referred to Dhaka Medical. She has been undergoing treatment in Ward 207 for 15 days. In the 14-bed ward, about 70 patients like her were admitted. Sadika occupies half of a bed, while either her father or mother stands by her head.

Ashrafunnesa, in-charge senior staff nurse of Ward 208, told The Business Standard, "In the morning shift, we have eight nurses, but there are 101 patients. Each bed has two or three patients. There are patients on the floor as well. If a patient's condition worsens, we move someone else and place them on a bed for suction. Once their condition improves, they are sent back to the floor. We have sufficient oxygen and suction machines, but due to pressure, most patients must receive treatment on the floor."

Professor Dr Lutfun Nessa, head of the paediatrics department at Dhaka Medical College, said that despite the bed shortage, children receive all necessary treatment. "When this hospital was built, it had a certain number of beds, and that number remains unchanged. But the population has increased severalfold. There is no alternative to increasing bed capacity."

Bed shortage prevents admission of all patients

Dr Shahedur Rahman, resident physician at the paediatric outpatient department of DMCH, said that 400 to 500 patients are seen daily in the outdoor department, sometimes even more. "One day this month, 700 patients came. Recently, there has been a sudden rise in pneumonia cases. Most patients are given necessary medicines and sent home. Only those requiring injections are admitted."

He added that 35–40 patients are admitted daily from the outpatient department. Although 60 beds are allocated for children's wards, more than 250 patients are admitted. "Floor admissions lead to infections. Patients come to treat one illness and end up contracting another. So we have no option but to admit only the most critical cases."

Dr Rahman said the number of paediatric patients is increasing, but hospital bed capacity is not. "The budget for children's healthcare must be increased, beds must be added, and manpower must be expanded. In Bangladesh's situation, there is no alternative to Dhaka Medical. So there is no alternative to expanding its infrastructure and manpower."

Doctors said five physicians in the paediatric outpatient department see more than 400 patients daily. Each doctor sees over 100 patients in six hours, making it difficult to devote adequate time to each patient.

They also noted that the paediatric NICU at Dhaka Medical has 40 beds. Although three to four beds become vacant daily, at least 200 patients remain on the waiting list.

Brigadier General Md Asaduzzaman, director of Dhaka Medical College Hospital, told The Business Standard that the pressure is high in all departments, not just paediatrics. Currently, the 2,600-bed hospital accommodates more than 4,000 inpatients daily. Extra patients receive treatment on hospital floors, verandas, and stairways.

He added that after the previous government's 5,000-bed mega project was cancelled, a new proposal has been submitted for a 4,000-bed expansion project to handle the excess patient load.

"However, simply expanding buildings will not be enough," he said. "Steps must be taken to reduce the pressure Dhaka Medical handles. The capacity of other hospitals must also be increased so that patients are not referred to Dhaka Medical for relatively minor complications."