A health system shows its true character not in how it manages routine illness, but in how it responds when a life hangs by a thread - after a highway crash, during a heart attack, when a child's pneumonia turns severe, or when a newborn fights for survival. By that measure, Bangladesh is falling short.
Dr Zubaida Rahman, Vice-Chairperson of Ziaur Rahman Foundation, disclosed alarming statistics of the state of healthcare. There are about 1.7 beds in ICUs and nine beds in general hospitals per 100,000 population in the country. Even worse is the fact that 38 out of 64 districts do not have an ICU facility at all, and almost 80-90 per cent of the ICU beds exist in Dhaka alone. These statistics suggest one of the biggest problems in the country's healthcare system.
Critical care is not just a specialty anymore; it is a basic need. Heart attacks, stroke cases, serious infections, surgical interventions, injuries, poisonings, respiratory failures, burns and emergencies facing newborns - all of this requires critical care immediately and without this care, chances of survival become considerably lower. Unfortunately, such care remains inaccessible to most citizens of the country residing in regions other than Dhaka.
Every year, critically ill individuals are transported from district towns to the capital, in an attempt to save their lives, spending many hours stuck in congested roads as they become more and more critically ill by every passing moment. Many patients do not survive the journey. Others reach the hospitals but every ICU is fully occupied. This is no mere logistical problem, rather it is a question of life and death on a national scale.
There are positive things to say about Bangladesh. Life expectancy is up, deaths of mothers and children are down and there has been explosive growth in the number of medical colleges and private hospitals that train thousands of physicians every year and even attract foreign students. However, intensive care facilities have not developed alongside this general improvement. The number of new medical colleges has surged while ICU development has not received enough attention.
This issue is most prominent during emergencies when thousands of people lose their lives each year due to road accidents; the cause is not always the accident itself but delayed medical attention to advanced trauma and critical case. This happens to stroke victims, cardiac patients and children with infectious diseases, as seen in the case of measles outbreak where children have developed life-threatening complications while local hospitals do not have enough ICU beds or paediatric critical care unit facilities to provide them.
In addition, natural disasters can make the situation much worse, as one of the most disaster-prone countries in the world, Bangladesh has to face cyclones, floods, building collapses, and accidents that can result in a surge of hundreds of critical patients within hours which will be hard for the existing system to cope with.
What's needed is a coherent national strategy for critical care. First, every district hospital - starting with the 38 that currently have none - should get functioning ICU facilities and medical college hospitals outside Dhaka should be brought up to the same standard as those in the capital. Second, specialised training for critical care doctors and nurses needs serious expansion. This expertise goes well beyond general medical training. Thirdly, the delivery of trauma care must be an integrated system of ambulances, emergency departments and ICUs operating in tandem from the moment of an accident up to discharge. Lastly, health financing must make critical care an issue of national importance. Failure to do so means paying its costs in terms of avoidable deaths and social and economic costs.
The use of technology may help to fill some of the void in terms of telemedicine connections between district hospitals and city specialists which may facilitate better decision making and reduce unnecessary transportations. The use of standard protocols and ICU electronic monitoring may help improve the quality of care as well as encouraging private sector involvement through public-private partnerships in setting up critical care units in other parts of Bangladesh outside Dhaka.
It is true that Bangladesh has set out to become the regional leader in medical education, but such aspirations sound empty when citizens in cities like Dinajpur, Sunamganj, or Satkhira cannot receive basic intensive care. No child should die because there is not a functioning ICU within several hundred kilometres and no one's hopes should depend on an available ICU bed.
The alarm bell has been sounded by Dr Zubaida Rahman. Bangladesh has already shown how much it is capable of accomplishing when it comes to its public health efforts; the next challenge will be to see if the same success story be replicated in case of ICU.
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