Health management disparity-2: Oxygen, ICU shortage in districts to blame

As Covid-19 pandemic raged through Bangladesh, the lack of affordable oxygen and ICUs (intensive care units) have left thousands to struggle to breathe at hospitals outside Dhaka.

Many critical patients have not got access to key life-saving treatment facilities, thus losing battle to the lethal pathogen.

The FE gathered data and its analysis show that around 70 per cent or 371 ICUs are located in Dhaka division alone, while Barisal has only 10 ICUs.

There are a total of 545 ICUs at the government facilities across Bangladesh, Chittagong division accounted for nearly 13 per cent or 69 ICUs.

But most part of the limited facilities are occupied by the affluent class of the society, leaving almost no space for others.

Such a disparity is also obvious when it comes to oxygen supply as almost half the country's 10,582 oxygen cylinders are available only in Dhaka and Chattogram.

On the other hand, at 289 Mymnesingh has the lowest number of cylinders and Barisal has 465 containers.

Most of the central oxygen tanker facility is installed in different government and private hospitals in Dhaka.

Liquid oxygen is delivered and stored in giant containers on hospital grounds before being transformed into gas and piped to the patient's beds.

This is much more efficient than transporting oxygen in compressed gas cylinders, as is generally done in poorer countries.

Without this infrastructure, hospitals instead rely on cylinders. Even then, oxygen is only routinely available in hospitals.

Deaths of two key men of a couple of Chittagong-based large business groups had gone viral on social media as the lives of the duo were cut short due to the lack of ICUs and oxygen.

They were Morshedul Alam, a director at the S Alam Group, and Mohamad Yunus, managing director Esack Brothers.

Affluent people from outside Dhaka rushed to Dhaka and had to count hefty bills in getting treatment at super-expensive private healthcare hospitals.

They paid huge amounts of money ranging from Tk 1.0 million to Tk 2.0 million for ICUs, oxygen and other facilities at the private hospitals. Yet, some survived out of sheer luck while others had to succumb to the pathogen.

With no cure for Covid-19 found until now, oxygen remains a key element of the treatment. As lungs become damaged by the virus, some people do suffer badly due to severe fall of oxygen level in the blood, which is medically known as hypoxemia. For some patients, the situation eventually turns fatal. Oxygen buys time for a patient's immune system to clear the virus.

The price of a 6.8 cubic metre cylinder of oxygen (a "J" cylinder), enough to treat an adult for roughly a day, is usually Tk 1000, including all accessories. But, it meteorically shot up by Tk 3,000 to Tk 4000 when the disease was at its peak between April and July.

Mohammad Shafi, an employee at Meghna Petroleum, said that he purchased a cylinder gas at Tk 3000.

On the other hand, Mohammad Iqbal, a resident at Khulshi area at Chittagong city told the FE, "We talked with a private hospital to admit my father-in-law for ventilation, but after a few hours, the hospital declined to admit as they spiked price and another patient was admitted."

He said his father-in-law would have survived if had he got the artificial breathing facility.

ICUs usually cost Tk 1.5 million to install, but what it makes it expensive is the 24-hour observation by a doctor.

In the private sector hospitals, it costs between Tk 30,000 and Tk. 50,000 a day but it soared even to Tk 100,000 in many hospitals, especially in Chittagong, where fatalities were high compared to rate of infections.

Shafat Ahmed Opu, whose chartered accountant father Farid Uddin Ahmed died at Anwar Khan Hospital in Dhaka, had to pay Tk 1.3 million for a 21-day treatment.

"They asked for Tk 1.6 million. We persuaded them to lower the bill to Tk 1.3 million," he said.

Mr Opu came to Dhaka for his father's better treatment out of belief Chittagong had no such facility.

As oxygen is regulated as a pharmaceutical drug, companies have to register with the Drug administration and department of explosives to produce it. Thus the businesses require more stringent systems to test the oxygen for impurities and record its journey, so that it can be recalled if there is an issue.

The state-run regulator drug administration said there are four registered medical oxygen producers and they were summoned hurriedly after the news of price spike in oxygen spread.

Mohammad Ayub Hossain, director of the director general of drug administration (DGDA), said, "In the meeting, producers denied these claims and assured them of smooth supply. After the meeting, we have not seen any such report yet. We're also monitoring both supply and prices".

At the same time the DGDA also gave no objection certificates to two business entities to market their industrial oxygen converted into medical one, considering the demand of the latter.

"With these two, now six producers are supplying oxygen and there is no supply shortage of the life-saving gas," he added.

On the other hand, producers say that the demand for oxygen fell drastically during the lockdown due to unprecedented fall in the number of non-Covid patients.

They argued that only a small number of corona patients usually require oxygen.

While the majority of people with Covid-19 have mild symptoms, 14 per cent will need oxygen in hospitals and 5.0 per cent will need mechanical ventilation in intensive care, according to medical experts.

"During April-June period, our sales dropped by 50 per cent. But it jumped from July and the growth continues," deputy general manager at the Spectra Oxygen Limited Maklesur Rahman Ripon said.

He refuted the allegation of overpricing, saying that they did not raise a single penny from the government-fixed rate.

A section of such traders supplied industrial oxygen taken from Chittagong rod factories, which is believed to be detrimental to health, sector insiders alleged.

Producers said there may be retailers who had increased the prices. But retailers said they had to purchase it at higher prices.

The medical oxygen is the form of gas used to maintain enough oxygen level in blood. Medical cylinders are completely emptied and cleaned every time they are refilled requiring extra costs.

Lawyer Tanjibul Islam, a director at the Linde Bangladesh, told the FE, "We have done everything we can to secure supply throughout the pandemic."

He said, "We are committed to making sure that oxygen is supplied to as many patients as possible."

He said many places in the country lack enough facility to store additional volume of oxygen, which caused the problem.

On the other hand, some hospitals alleged that the oxygen separating entries have delivered empty but capped cylinders unethically to capitalise on a health emergency.

Seeking anonymity, an official at Sorakri Kormochari Hospital in Dhaka, a Covid-dedicated hospital, said they became watchful after finding suspicious increase in their daily demand for oxygen there.

"So, we started monitoring the supply and found a total of 31 cylinders delivered recently by Spectra empty and those were sent back," he said.

Then they had a meeting with the firm where it blamed pressure-related problems for it.

The Spectra refuted the allegation.

In the meantime, law enforcement people launched crackdown on errant oxygen traders, who adopted an unethical way to cash in on the pandemic as some started to stock for better price and some filling gas in the cylinder unethically and unauthorised way.

Director of Chittagong Medical College and Hospital SM Humayun Kabir admitted the regional disparity in case of access to Covid-19 treatment.

He said he has recently received too many phone calls from high-ups like lawmakers and deputy commissioners of various districts requesting him to accommodate their patients at the ICUs.

"I took the load amid various limitations. If the district facilities were well-equipped, I did not need to bear the additional pressure," the CMCH boss said.

Terming central oxygen storage at a hospital essential, Mr Kabir said smooth flow of oxygen for patients cannot be maintained properly through cylinders.

"The district facilities should be modernised with their own central oxygen tanker, he added.

As the supply crunch grew acute, some companies, NGOs and charitable organisations came up with cheaper oxygen.

Two leading steel makers --Abul Khair Steel and GPH Ispat--came forward to supply medical oxygen to the patients.

GPH Ispat is the biggest industrial oxygen producer in Bangladesh. It produces 300 tonnes oxygen a day, 70 per cent it consumes to produce rod while the remaining 30 per cent for medical purposes.

"We're supplying 1,000 cylinders a day in Chattogram at free of cost," Jahangir Alam, managing director at the GPH Ispat said.

S Alam Group also financed installing central oxygen tanker at Chittagong general hospital soon after one of its directors expired contracting the deadly virus.

A longer-term solution for hospitals is to build their own oxygen plants. It can cost from Tk 100 million to Tk 200 million, but investing can ensure oxygen access across a large area.

The government has planned to install tankers at all district healthcare facilities gradually. Currently, some 28 hospitals, mostly public, have the facility.

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