Poor hospital hygiene in Bangladesh: Patients concerned about appalling neglect

There is a growing tendency among middle-class patients in Bangladesh to avoid knocking on hospital doors, even in the case of any critical condition. The reasons they describe are not pleasant at all.

Poor hygiene management in hospitals and care facilities, the horrible conditions of toilets, dirty floors, bad smell in the air, overcrowding, noise, 'unfriendly behaviour by nurses and doctors' and surging medical bills are among the reasons why people try to avoid going to hospitals in Bangladesh.

"Maintaining hygiene in hospitals and clinics is extremely important, and then comes the compassionate approach by hospital staff, including nurses and doctors.

That's great amiss in Bangladesh's medical service 'industry'. And this is one of the reasons why many people go abroad for medical treatment," said Shamsur Rahman (not his real name), in his mid-50s.

"In May 2020 when the Covid-19 pandemic was surging at an alarming rate in Bangladesh, I was admitted to a city hospital and had to spend over three weeks there. For the first time in my life, I saw things, I mean hospital management, from inside," he said.

Shamsur Rahman went on saying, "I was taken to the hospital at midnight waking me up from my deep sleep. First, I refused but finally I had to go. I was admitted to the hospital in the wee hours. Seeing the horrific toilet condition, I then planned to escape from it at dawn, but I couldn't as my health deteriorated."

"Unfortunately," he said, "I had to get admitted to a private clinic in the capital again a year later, and this time with dengue. And the dirty toilets frustrated me even more. We're so careless when it comes to the cleanliness of toilets. Unacceptable!"

Hospital authorities must take it seriously how to keep a care facility neat and clean so that patients can heave a sigh of relief right after admission. "Treatment begins with hospital hygiene. The sooner our clinic owners understand this the better... it's a service to humanity," he added.

Tasmin Sultana, a housewife, also shared the ordeals she went through at an NGO-run hospital at Agrabad in the port city of Chattogram.

"I had been there with my dengue-infected little daughter. My daughter was kept in the ICU. But I found the toilet inside the ICU completely unusable. It's so dirty, grimy and sticky! No one can think of such an unhygienic condition at a toilet in a sensitive area like an ICU!"

Tasmin said she attempted twice to use the toilet, but could not, as she felt like vomiting. "Later, I booked a cabin and used the toilet there. This is very disappointing as wards and cabins are not cleaned properly and timely; neither are done the hospital wastes. Bedcovers are also dirty and are hardly changed regularly."

Syed Mostak Ahmed, a senior journalist, recently got his mother admitted to a Covid-dedicated hospital in the capital as she was suffering from pneumonia.

"The hospital's outlook is very good, but the condition inside is very dirty and unhealthy. Its floors at its different wards, including child one, are not cleaned and beds are damp, toilets are dirty and handwashing facilities are murky, and no soap is there. Medical wastes are seen found dotting here and there," he said.

Narrating their stories of sufferings, Shamsur Rahman, Tasmin and Mostak Ahmed depicted a dismal picture of hygiene practice in Bangladesh's public and private hospitals.
Health experts said lack of monitoring, shortage of manpower and space, mismanagement, poor waste management system, widespread corruption and irregularities and staff's insincerity are the major obstacles towards ensuring a healthy and patient-friendly environment in the country's care facilities.

Talking to UNB, Public health expert MH Chowdhury (Lenin), chairman of the medicine department at the Health and Hope Hospital, said there is a tripartite role to play in maintaining hygiene and a healthy atmosphere in any care facility.

"First of all, those who run the hospitals should ensure proper hygienic, clean and sanitation systems. Secondly, the staff those who're employed to do this job must work sincerely. Finally, those who use the hospital facilities need to play a responsible role in keeping that clean," he said.

For example, the expert said, after using a toilet, the user should pour and flush water without littering the floor. "If anyone of these three parties doesn't play their respective role properly, then it'll be difficult to maintain hygiene and cleanliness. In countries like ours, we're reluctant about performing our respective duties, and this is the main problem," he said.

While taking a license, Lenin said, hospital authorities accept the condition of maintaining standard operating procedure to ensure hygiene.

"If any hospital doesn't maintain this, it's a punishable offence, and we need to regulate it through proper monitoring and surprise inspections by the authorities concerned. Law should be enforced strictly in this regard," the expert said.

He said most hospitals in Bangladesh are extremely understaffed, but the number of patients is much higher than their capacity. "So, in many cases, they can't maintain the standard operating procedure."

Besides, he said, the number of visitors to hospitals in Bangladesh is unusually high and it hinders hygiene management and hospital atmosphere. "So, we've to control the number of visitors."

President of Swadhinata Chikitsak Parishad Dr Iqbal Arsenal said the healthy atmosphere in a hospital mainly depends on its architectural design, management and service delivery.
"A hospital needs to have a well-planned system of sanitation, ventilation and effective waste management to ensure a clean and healthy atmosphere, but our hospitals unfortunately lack those," he observed.

Dr Iqbal said mismanagement and lack of adequate manpower are also major obstacles towards improving the quality of healthcare services in Bangladesh.