When ICU beds are scarce

Md. Shaheen, a man in his late 30s, was a poor electrician in Feni. In a bike accident, he sustained severe head injuries last month and needed advance treatment in intensive care unit (ICU) facilities. He was taken to Chattogram, Dhaka and back to his hometown. But nowhere did he find an affordable ICU bed. His family contacted at least 10 hospitals in these three districts. But he was turned away from all public hospitals as there was no ICU accommodation there. On the other hand, private hospitals were too costly for Shaheen's family to keep him there even for a day. Eventually, he died after a four-day struggle for survival. 

Shaheen's case is not an isolated one. Many patients across Bangladesh die on their way to Dhaka hospitals as there are no ICU facilities in district hospitals. According to the media, there is no ICU service in the government hospitals in at least 22 districts. Some district hospitals including Bagerhat and Madaripur have ICU facilities but they are now out of order. Allegededly, it is quite impossible for most people to get an ICU bed in a government hospital if they do not have connections and clout. ICU and HDU (high dependency unit) beds in public hospitals always remain fully occupied with more than 15-20 patients remaining on the 'waiting list'. In many cases, patients are brought to the hospital in a critical condition, requiring emergency ICU support. But the patients die due to lack of ICU facilities. There are some state-run hospitals where ICU beds are not operational as they lack skilled manpower. What do these hospitals do if an ICU bed is required? They just refer patients to Dhaka city's hospitals. However, it is unfortunate that not all Dhaka hospitals are equipped with ICU facilities either. For example, the National Institute of Traumatology and Orthopaedic Rehabilitation, a 1,000-bed hospital where many critical patients take admission every day, does not have ICU service.

Most patients admitted to hospital do not require treatment in an intensive care unit. But for those who do, ICUs mean the difference between life and death. A full-fledged ICU is an essential part of every hospital. In line with international standards, a 100-bed hospital should have at least five ICU beds. However, the number of ICUs is quite insufficient compared to the population of Bangladesh. The country does not have more than 2,500 ICU beds for its 170 million people. According to the Directorate General of Health Services, currently the number of ICU beds in the government hospitals is 1,126. Unconfirmed reports put the number of ICU beds in private hospitals at nearly 1,000. These ICUs are too insufficient to meet the demand of a country like Bangladesh, where road accident is still one of the leading causes of death. The need for increasing ICU support should be on top of the country's priority list. Accident victims often get seriously injured and may succumb to their injuries if they are not treated urgently at ICUs. However, those who do not find ICU beds in state-run inexpensive hospitals, have to take treatment from private facilities spending more than Tk 40,000 every day. So, setting up ICU beds in every government hospital is a crying need to save lives.

In early 2021, the second wave of the Covid-19 pandemic in Bangladesh exposed, to the shock of many, the woeful state of the country's intensive care infrastructure. At that time, many patients had to die for want of ICU support. To ensure that no one suffers from the lack of ICUs in district hospitals, the government then took a decision to set up 540 ICU beds in 10 medical college hospitals and 43 district hospitals under the World Bank's Covid-19 Emergency Response and Pandemic Preparedness project. Ten ICU beds were supposed to be set up in each of the 43 hospitals. However, the project has not yet been implemented and district hospitals are still functioning without ICU facilities. It may be easy to point to the pandemic for the ICU crisis. But Covid-19 did not create this particular crisis. The underlying problem is the decades-long decline in the number of hospital ICU beds and the government's failure to address the issue.

The Covid-19 pandemic is now over. But the healthcare authorities should start working right now to tackle future health crises in a prepared and disciplined manner. Public hospitals do not need fancy entrances and administration blocks at the moment. Instead, focusing on improvement of emergency and critical care service can revolutionise Bangladesh's health sector. ICUs have the capacity to provide immediate and lifesaving care to patients who might otherwise die without it. There should not be any more Shaheens to die due to the lack of ICU facilities. ICUs must be set up in all the district hospitals that lack these facilities. Adequate staff and equipment must also be provided. Infrastructure alone cannot provide treatment. That medical equipment lying uninstalled and unused for years in various hospitals very often hit news headlines. Even after being installed, these are not used for lack of skilled technicians. So, it is time to initiate a coordinated move towards developing a full package of ICU facilities for district and upazila health facilities. 

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