Meeting anaesthesiologist crisis in hospitals

Sometimes, fatalities during even minor surgeries may occur due to improper use of anaesthesia. One might recall that in February last year, a ten-year-old student of Motijheel Ideal School and College died while he was undergoing a circumcision procedure at a private hospital in Malibagh area of the city. The boy was, as reported, administered general anaesthesia against the will of the victim boy's parents, who requested to apply local anaesthesia. Two doctors involved in the incident were reported to have been arrested. Two months before that incident in December 2023, in another case,   a five-year-old boy of a private nursery school in the capital died under similar circumstances in a private hospital in the city's Badda area. It was, again, a case of circumcision in which the doctors allegedly applied excessive dose of anaesthesia. As the reports went, in that case, too, the victim boy's parents were not consulted before applying anaesthesia. More recently, in January this year, a hernia patient admitted at the Shaheed  Syed Nazrul Islam Medical College hospital  in Kishoreganj died after a nurse applied an anaesthetic injection prior to surgery. But the hapless patient never regained consciousness.

As reported, the patient's relatives complained that the anaesthesia was supposed to be administered at the operation table in presence of specialised doctors/surgeons.  But no such doctors were reportedly present there. What is common in these three cases of death during the administration of anaesthesia is that there was no mention of any anaesthesiologist involved. Clearly, none of the doctors or the nurse in the reported incidents had any idea about how to apply anaesthesia, which resulted in the avoidable fatalities.  It sends shivers down the spine to think how many instances of such unintended and/or intended abuse of anaesthetics with fatal outcomes at the private hospitals and clinics across the country have gone unreported! Why are the hospitals and clinics concerned allowing anaesthesia in such a gratuitous manner without consulting experts on the subject? The ministry of health and family welfare should investigate and hold the so-called doctors/nurses in such events to account as well as mount strict monitoring of the hospitals/clinics everywhere in the country to prevent repetitions of anaesthesia abuse. At the same time, the government needs to ensure that an adequate number of trained anaesthesiologists are employed in every private or public hospital to support surgery cases.  

While the indispensability of expert anaesthesiologists in any case of painful surgery in the hospitals cannot be overstated, the fact remains that there are fewer experts in this field than necessary  in our hospitals/clinics whether public or private.  According to the Bangladesh Society of Anaesthesiologists, Critical Care and Pain Physicians (BSACCPP), there are 1,952 enlisted anaesthesiologists including 500 others who are not enlisted. This number cannot meet the demand for this specialised medical service in the hospitals. Mention may be made here of the World Federation of Societies of Anaesthesiologists (WFSA)  which says that there should be five (5) anaesthesiologists per hundred thousand people in a country. But Bangladesh has less than one such expert per hundred thousand people. Needless to say, this is a big gap in terms of this special medical service in the country compared to what is required according to international standards. The reasons for such scarcity of anaesthesiologists in our hospitals are multifarious. 

The anaesthesiologists, it is reported, feel deprived of both in terms of their pay and respect. In fact, surgeons in our hospitals are entitled to a better pay package than the anaesthesiologists do. Naturally, the surgeons are treated with more esteem in society than the anaesthesiologists. Obviously, that is due to mainly to the lack of awareness among the hospital authorities, let alone among the general public about the critical role anaesthesiologists play in medical profession. Worse yet, the  public perception about the issue is also to blame. This is why one hears of so many instances of anaesthesia abuse by little trained or untrained doctors/nurses, even quacks, in the hospitals at the union and upazila levels as well as in the bigger cities including the capital city often leading to unwanted tragedies. This must stop. The authorities must ensure that in every hospital private or public, the names of anaesthesiologists are included in the bill boards along with the names of other specialist doctors. In case of any surgery, the patients and/or their personal attendants must be informed beforehand which anaesthesiologists would be engaged to support the surgeons in particular cases of surgery.

Most importantly, the patents or their custodians must be consulted ahead of any surgery about the procedures to be involved including the type of anaesthesia to be used and if the patients and/or their custodians agree to that. There is no question of ignoring their (patients' or their custodians') opinion both on professional grounds and the fact that they are the customers of the service the medical service providers concerned are going to render.  According to another report of BSACCPP published in the media in February 2024, of the 213 posts available in the government hospitals/facilities, about 107 posts of anaesthesiologists  (from assistant to professor level) were vacant at that time.  Since the report is only a year old,  the situation does not seem to have improved much by now.  In that case, the ministry concerned should  think seriously about the issue and take steps to produce an adequate number of anaesthesiologists from our medical colleges and institutions. At the same time, the government should increase the status including pay packages of the anaesthesiologists commensurate with other medical professionals like surgeons. That would go a long way in meeting the existing anaesthesiologist gap in the country.

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