Threefold patient load strains Chattogram kidney services

Highlights

• 86 patients for 30 beds
• 22.5% of population suffers from kidney disease
• Patients crowd floors and corridors
• Bribery allegations in every ward service
• Government's Friday dialysis suspension criticised
• Private dialysis available on Fridays at high cost

A severe bed shortage, allegations of unofficial payments and the suspension of routine dialysis on Fridays have compounded the suffering of kidney patients at Chittagong Medical College Hospital (CMCH), where 86 patients are currently admitted against just 30 designated beds.

Patients are receiving treatment on ward floors, verandas and even outside the main entrance of the kidney disease department. The situation has created immense pressure on doctors and nurses struggling to manage nearly three times the department's capacity.

Professor Dr Md Nurul Huda, head of the CMCH Kidney Disease Department, said there is no specific study explaining the rise in kidney patients in Chattogram. However, he said improved diagnostic facilities and increased availability of specialists have led to more cases being identified and referred to hospitals.

Research data show that more than 3 crore people, or around 22.5% of Bangladesh's population, suffer from some form of kidney disease. Every year, 30,000 to 40,000 people develop kidney failure. Although around 40,000 patients require dialysis annually, only 10,000 receive the service.

Infograph: TBS

Due to financial hardship, about 90% of dialysis patients discontinue treatment within three to four months. Nearly half of them die within two years. Only around 1% of patients needing dialysis receive a kidney transplant.

Patients allege unofficial payments

Several patients and relatives alleged that ward attendants and temporary workers wearing CMCH-logo T-shirts routinely demand "tips" or unofficial payments for services.

A man from Bandarban Sadar, who came with his elder sister, said he had been staying on the hospital veranda for five days due to a lack of beds.

"People wearing CMCH-logo T-shirts keep pressuring us for money in the name of tips," he said. Nobody wants to help without payment," he alleged.

A patient from Boalkhali made a similar complaint. Lying on a veranda bed with a catheter attached to his neck, he said he had to purchase a catheter from outside for Tk3,000, although it was supposed to be supplied by the hospital.

"Although I received a receipt for the official Tk500 catheter insertion fee, I had to pay another Tk300 as a tip in the ward," he said.

Friday dialysis suspension raises concerns

Relatives of a patient from Guimara in Khagrachhari alleged that despite being admitted in critical condition on Thursday night with a serum creatinine level of 21.91, the patient could not receive dialysis on Friday.

According to the family, they purchased a dialyser filter, catheter, bloodline and other medical equipment from outside for more than Tk4,500 because supplies were unavailable. After paying the official Tk500 fee, a ward worker allegedly demanded an additional tip while promising dialysis on Friday.

The family said the patient eventually underwent dialysis under the government system on Saturday morning after paying Tk300 as a tip.

Professor Dr Md Nurul Huda acknowledged the pressure on the department.

"Although the approved bed capacity is 30, we often have 80 to 100 admitted patients. As a result, patients are forced to receive treatment in corridors and near staircases," he said.

He said the department currently has only 18 dialysis seats under the government system. Routine dialysis is usually suspended on Fridays for equipment maintenance and staff weekly rest.

"However, we provide dialysis in extremely urgent situations," he added.

Regarding catheter shortages and allegations of unofficial payments, he said patients receive catheters free of charge when government supplies are available. He stated that specific allegations had previously led to action.

He also noted that the dialysis centre on the ground floor of the main CMCH building operates under a Public-Private Partnership (PPP) model and is outside the department's direct control.

The PPP centre operates on Fridays

While government dialysis services remain closed on Fridays, a different picture is seen at the PPP-operated Kidney Dialysis Centre on the hospital premises.

The centre continued providing dialysis services throughout Friday, charging between Tk3,000 and Tk4,500 per session. It can accommodate 31 patients at a time and serves around 100 to 110 patients daily through four shifts.

CMCH Director Brig Gen Mohammad Taslim Uddin said the hospital administration would investigate the allegations.

"There are some management-related challenges in kidney dialysis services. Emergency services for admitted patients should remain available at all times. The delay in Thursday night's dialysis may have occurred due to administrative and workload-related reasons," he said.

On allegations of extra charges by workers wearing hospital-logo clothing, he said, "I am looking into the matter. There is no rule allowing collection of money beyond the government-fixed catheter insertion fee. Strict action will be taken if any irregularity is proven."

According to CMCH data, the nephrology department currently has 34 doctors, including the department head, six associate professors, a junior consultant, a registrar, an assistant registrar, an indoor medical officer, a transplant coordinator, two dialysis medical officers, two MD residents and 16 Phase-B doctors.

Outside CMCH, Chattogram Maa-O-Shishu Hospital provides dialysis services to around 700 patients every month using 11 machines. The first dialysis session costs between Tk2,500 and Tk3,000. Islami Bank Hospital Chattogram also offers dialysis treatment.

Chattogram Civil Surgeon Dr Jahangir Alam said uncontrolled lifestyles, smoking, diabetes, hypertension, obesity, pesticide-contaminated food and unapproved herbal medicines are among the major causes behind the increase in kidney disease.

He said the health department is focusing on awareness and healthy lifestyles because dialysis and transplantation remain extremely expensive.

The civil surgeon also said the government plans to introduce around 200 kidney care beds at the under-construction Kidney, Cancer and Heart Disease Institute near Chattogram Medical College Hospital to help manage the growing patient load.