At Bangladesh’s only orthopaedic hospital, patients’ desperation is an opportunity for middlemen

When Momena, a diabetic woman in her 60s, fractured a vertebra, her son Mosharraf rushed her first to a private clinic, where an X-ray confirmed the break and doctors told him she needed immediate surgery.

The clinic referred them to the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) in Dhaka's Sher-e-Bangla Nagar, the only government hospital in Bangladesh dedicated entirely to bone and trauma care.

But what followed was three weeks of waiting, extortion, and watching his mother deteriorate — a prolonged nightmare.

As the only dedicated, specialised government facility for traumatology and orthopaedics in the country, NITOR, commonly known as Pongu Hospital, represents the final line of hope for thousands of road crash victims, industrial accident survivors, construction workers with shattered limbs, elderly patients with fractures, and everyday citizens suffering severe bone injuries.

People travel from the remotest corners of the nation to its gates in Dhaka, carrying the broken bodies of their loved ones, expecting to find the highest standard of state-sponsored care.

Instead, what many find is a sprawling, chaotic labyrinth where human vulnerability is heavily monetised, and medical care comes attached to an unbearable psychological toll.

The official narrative points to an overwhelming crisis of capacity, where the staggering rush of patients wildly outnumbers the available beds. But a closer look inside the wards, corridors, and administrative offices reveals a darker reality.

An entrenched syndicate of middlemen, both insiders and outsiders, locally known as dalals, effectively controls who gets a bed, who gets a trolley, and who gets pushed into the shadows.

When Mosharraf brought his mother to NITOR's emergency unit, he was told that since two days had passed since the accident, she no longer qualified for emergency treatment. Rather, she would need to be treated at the outdoor unit.

Momena was kept waiting in the outdoor section. The doctors who eventually visited her confirmed she required surgery within a week. Mosharraf began desperately hunting for a cabin bed and a serial number for the operating theatre.

But the bureaucratic machinery of the hospital quickly ground him down. The very same administrative staff who noted the urgency of a one-week window suddenly informed him that no surgery could be scheduled for at least three weeks. Furthermore, due to an alleged severe seat crisis, they entirely refused to admit her.

"First, they asked us to wait till 1pm and said it's not possible to admit the patient before that. So we waited till 2pm, and they were not admitting my mother. When we asked again, they told me to come the next day."

Taking an elderly, diabetic woman with a shattered waist back home and transporting her again the next morning was medically and logistically impossible. So they waited, stranded in the misery of the hospital corridors.

The administration's claim of an absolute bed crisis is a familiar refrain echoed across the hospital grounds. Hundreds of injured patients are routinely seen lying on the cold floors of the wards and spilling out onto the balconies, their limbs wrapped in bandages and casts.

Many patients with less severe injuries are turned away entirely, told by doctors to take primary treatment from the outdoor unit and go home. But there is also a parallel system running alongside this visible scarcity — an artificial crisis manufactured by a syndicate that knows exactly how to profit from a family's desperation.

While Mosharraf was searching for a bed, a man appeared.

"The person in charge of the ticket for admission and the operation serial, at room 13 on the first floor, came and said that if I give Tk50,000, the surgery can happen immediately. Then another person took the prescription and papers from my hand and wouldn't return them. So I became doubtful about the whole process."

Mosharraf had a journalist contact who had a direct line to the hospital director. That connection got him an audience. Even then, the ward staff stalled. He needed a signed order from the director. When he went to get it, the Ansar guard outside the director's room would not let him in. He had to call the director again, through the same contact, to be allowed to enter. Only after the director personally intervened did the ward finally admit Momena and assign her a bed.

The surgery was scheduled just before Eid.

The director of NITOR, Dr Md Abul Kenan, is not unaware of what happens in his hospital. He acknowledges the severe capacity issues but maintains that the administration is actively fighting the syndicate.

"The hospital has 1,000 beds, which is less than the necessary number as patient pressure increases day by day," Dr Kenan stated. "So it becomes difficult to give every patient a seat. Those patients who don't have that much of a serious case, we just provide them treatment in the emergency unit, and sometimes we keep them in the outdoor unit till they get a bed. It's not possible to accommodate this number of patients here. We really don't have the space."

When asked about the middlemen, he said, "Every government hospital has that system, and it exists here as well. But I have taken many steps to reduce it. Even this week, I caught three of them. Whenever I get complaints about it, I immediately take action."

Hundreds of injured patients are routinely seen lying on the cold floors of the wards and spilling out onto the balconies, their limbs wrapped in bandages and casts. Photo: Mehedi Hasan

However, Dr Kenan expressed frustration with the legal process that follows an arrest. "Even if I catch them and hand them over to the police, they come out of jail, or they do not get taken in properly, and the police let them go. This is not in my hands; I can only hand them over. To punish them is the duty of the police. They have to ensure the punishment; people will not stop this. Because they know they can easily get out of it, why bother to change? Yet I will do my work, and I can say that after I came here, I have heard people saying that this syndicate has weakened."

But the reality inside is different. Even a brief spell at the lift or in the lobby would shatter the director's optimism when measured against the daily reality of patients and their attendants. Two nurses near the ninth-floor lift were arguing, one demanding to know how much the other had received for a bed, then turning to a man nearby to ask how much he had paid her.

They said since the counter is closed, they can't give me a ticket. They asked for Tk2,500. I got them down to Tk2,000. The private clinic where I had her first X-ray done charged Tk1,200. Here, in a government hospital, it was Tk2,000 for the same thing at 4 in the morning. They are always cashing on your vulnerability.

Mosharraf, son of a patient at NITOR

When asked what they were talking about, one of them said it was a personal matter. Then they claimed they were discussing tips for services rendered.

The conversation inside the lift immediately latched onto the incident, with weary visitors venting their profound frustrations. One attendant muttered, "In the name of a tip, they would rob you. The tip you feel obliged to give, or you are obligated to give, or otherwise they won't give any service, is not a tip. Then why are we paying in the first place?"

Others joined in, "Everywhere we have to give money. Without money, they won't give a bed, they won't give a stretcher. While we are already paying for the trolley and bed, we have to pay extra to the one who is carrying it."

When it was mentioned that the director had taken steps, was catching the dalals, and the numbers had decreased, the reaction from one of the lift passengers was explosive.

"Who told you that? Nothing has changed. People come and people go, but this system remains the same. Everyone working here is related to this system. Just to show off, they catch a person and leave him right after clearing the gate. If they want to solve it, then how come the same broker returns?"

The man went on to detail the sprawling architecture of the syndicate, painting a picture of an inescapable trap.

"Every staff member working here is connected to the syndicate, starting from the ambulance driver to the nearby medicine shop. These nurses will take your prescription and take you to their preferred shop, saying that if you don't buy from that particular shop, the medicine won't work, or that others have fake medicine. Then they collect some sort of percentage from their referred patients."

The extortion extends all the way to the hospital gates. "When you look for an ambulance, they will take you to their people, saying if you hire that ambulance, then you will be able to take the stretcher to the ambulance lobby. Otherwise, they don't have permission to enter. So when you take your preferred ambulance, it is not allowed inside, and they do not take the stretcher outside. You have to even pay them for it. This kind of harassment is unbearable."

Listening to this litany of abuses, another person standing quietly in the corner of the lift summarised the entire NITOR experience in a single sentence: "You get traumatised seeking service from a traumatology hospital."

On the 10th floor, in one of the cabin units, a woman named Amena was sitting outside her brother's room. He had come in after a motorcycle accident. She had managed to get him a cabin bed, something hospital staff routinely say is unavailable for weeks.

"They will always tell you the same thing," she said. "But it works when you give money. And if they say there's no empty cabin, they're lying. The one right next to ours is empty right now."

The process, as she described it, is not even particularly hidden. You go to the first floor, to the person who handles admissions and operation serials. You ask him to step aside. You have a private conversation. He tells you the price.

"If you have money and a connection from above, you can get surgery within a day or two," she said. "We had that kind of connection, so we didn't go through as much as others are going through. But even then, we had to pay extra for the bed. And everyone who set foot in the cabin — the cleaner, the nurse who came to check the pulse, the trolley carrier — everyone demanded money."

She paused, then said, "In front of me, a nurse harassed a woman and her son because they didn't tip her enough. They had already paid for the trolley, but the nurse just left it there and walked away because she didn't get what she wanted."

Back in Mosharraf's account, once his mother finally had a bed and a surgery date, the billing didn't stop.

"They made us buy everything needed for the surgery, and they wouldn't tell us everything at once. I had to go to the medicine shop countless times while the surgery was happening. They'd come out of the OT and hand me a slip — go buy this, go buy that. Just for the surgery period, I spent over Tk13,000 on medicines. Then, for the stretcher, I paid Tk600, and the four nurses inside the OT asked for a tip. They said they wouldn't take my mother to the room if I didn't give it to them. So I gave them Tk500."

The surgery was done. Around 4am, postoperatively, an emergency X-ray was needed. The ticket counter was closed.

"They said since the counter is off, they can't give me a ticket. They asked for Tk2,500. I got them down to Tk2,000. The private clinic where I had her first X-ray done charged Tk1,200. Here, in a government hospital, it was Tk2,000 for the same thing at 4 in the morning. They are always using your vulnerability and cashing in on it."

After the surgery, Momena barely responded. Her family asked nurses repeatedly; each time, they were told it was normal post-operative shock, that she would recover. "I told them so many times to check carefully since she wasn't responding, but nobody listened. They kept saying it happens after surgery and she'll recover soon." Eventually, a doctor checked her pulse and had her moved to the ICU.

She stabilised, slowly. But in the ICU, patients were dying around her — two in a single day in beds adjacent to hers. Whatever ground she had recovered, she lost again. She stopped responding, stopped talking. "She was so afraid she barely answered when we called her. So we thought, we have to get her out." The family applied for discharge. They were made to sign a bond accepting full responsibility for any consequences.

A nurse from NITOR now comes to their home in Savar for wound dressing.

The profound, life-altering shock of entering Pongu Hospital is not an isolated phenomenon. Hasan Jamilur Rahman Saikat experienced a similar awakening when his father was involved in an accident. Initially treated at the National Institute of Neurosciences & Hospital (NINS), they were referred to NITOR for specialised orthopaedic care.

Like Mosharraf, and like countless others, they were greeted by the immediate refusal of a bed. But it was not just the lack of a bed that struck Saikat; it was the visual horror of the hospital floor. Every inch of space was occupied by broken bodies.

"After spending a few hours at NITOR, I felt I didn't have any regrets or dissatisfaction about my life," Saikat reflected, deeply moved by the suffering surrounding him. "Because the people who were there, the situation they were facing, I cannot imagine facing them myself. I will never complain about my life. I am so much better off."

Saikat had to utilise personal connections, calling administrative personnel to finally force an admission that the staff initially claimed was impossible. Even then, his father was relegated to the floor.

While Saikat was spared the direct approach of the bed brokers, he slammed headfirst into the aggressive ambulance syndicate detailed by the furious man in the hospital lift.

"When we came with the ambulance from another hospital, many hospital staff came to me asking how much they would take? How much are they taking for the stretcher? They even told me we cannot allow another hospital's ambulance here inside."

Saikat refused to be bullied by the staff attempting to block his transport, but the sheer audacity of the syndicate left a lasting mark. "There was definitely a circuit of brokers there for the ambulance driver, the staff, the nurses," he said.

Unable to subject his father to the conditions and the predatory environment of NITOR, Saikat ultimately abandoned the government system entirely. They shifted to a private hospital, where the operation was successfully performed.

Yet the memory of those hours at Sher-e-Bangla Nagar remains vivid and deeply unsettling. "I will not forget how horrible that experience was," Saikat said, echoing the sentiments of thousands of citizens who have walked through those gates seeking healing, only to find themselves treated as prey. "I cannot believe how a specialised hospital can be this much worse."