Saad Hammadi spends three nights at the Dhaka Medical College Hospital and reveals how packs of corrupt doctors, ward boys, and nurses are now running the hospital
After a 24-hour struggle for life, Dipali Karmakar (62) finally lost the battle. Dipali, a mother of three sons and a daughter had suffered a brain haemorrhage when she was hit by a motorbike on the Dhaka-Khulna highway in front of her house on November 02. The nearbyFaridpurSadarHospitaldid not have any expertise for brain injuries and the doctors referred her to theDhakaMedicalCollegeHospital, urging her family that time was of the essence.
‘We came all this way frantic every moment of the way, only for my mother to die like this? The doctors ruined all the possibilities of her survival despite our efforts,’ says Shwapan Karmakar, a son of the deceased. Dipali’s family members complained that none of the doctors at the DMCH looked at her since her admission at the hospital. Even the 24 hours Dipali spent at the DMCH, she was breathing but unconscious, and there was a possibility of her survival if the doctors took care of her, her son believes. Moreover, she was not even given a bed to rest and was lying unconscious on the floor of a room which was a doorway to the upper floors. Dipali was among 20-30 other patients who were also lying on the floor of the hospital waiting for care, as is the common scene at the DMCH.
‘At one point my mother stopped breathing in her sleep and the doctors and nurses finally found the time to come and declare her dead,’ cries out Shweta Karmakar, Dipali’s daughter.
‘We had no idea that the DMCH is so terribly crowded and patients have to wait for days to find treatment if any at all,’ says Shwapan. While the wards are packed with patients at any time of the day, the condition is worse for patients waiting outside the wards and lying on the floor for days unattended by doctors.
According to a recent investigation by the Berlin-based corruption watchdog Transparency International Bangladesh (TIB), 20 per cent patients do not get seats at the DMCH and on an average spend four days on the floor before receiving care.
Mukul Islam (30) has a hearing problem in his left ear. In his first consultation, the doctor at DMCH advised Mukul to visit him at his private clinic. While the DMCH consultation was only a matter of Tk 5, Mukul’s visit to the doctor at his private clinic cost Tk 500.
All that the doctor told him was his operation will be better done at his private clinic at the cost of Tk 20,000. Mukul could not afford the money and thus the doctor referred him back to the DMCH where he said he will do his operation.
‘Since then it has been almost a month I am at the hospital without any consultation,’ says a helpless Mukul. ‘The duty doctor comes everyday and prescribes medicines like the Paracetamol and Histacin, which are taken for fever and cold respectively but I have none of the problems,’ he says.
‘I am staying in the veranda of ward 14 because there is not any space inside and there are patients who are worse off in the ward. The food here is awful,’ says Mukul.
According to insiders, food worth tens of thousands of Taka is wasted everyday at the DMCH, as many patients do not take hospital food for which there is government allocation.
The allegation is however denied by a deputy director of the administration department. ‘We are not aware of such complains. Patients are satisfied with the quantity and quality of food as per the government allocations,’ says the deputy director unwilling to comment on any of the allegations brought against the hospital and its policymakers.
‘The duty doctors keep postponing my operation. I have to bear with the problems in the government hospital because I do not have any alternative. I am a salesman in a pharmacy and I do not have the money to afford expensive treatment in some private clinic or hospital,’ says a disheartened Mukul.
The DMCH is overcrowded to the extent that every corner of the hospital is filled with patients. Most of these cornered patients like Dipali and Mukul are often unattended by the doctors and when patients like Dipali die because of inattention of the doctors, the authorities overlook the cases.
At its present capacity, the DMCH has a total of 1,700 beds of which 1,441 are general beds, 143 paying beds, 43 double-bed cabins and 30 single-bed cabins. Around 1,400 outdoor patients and 184 emergency patients seek treatment from the DMCH everyday on average, reveal figures at the health ministry.
Third and Fourth Class Employees’ influence on policymakers
The DMCH is bursting at the seams. Over 2,000 patients are accommodated within the general wards against its capacity of 1,441. Worse is the fact that there are only a handful of medical officers to attend to this huge number of patients.
‘Only two emergency medical officers are there on an eight-hour shift basis to attend trauma patients whereas at least six to seven surgeons are necessary to attend such cases,’ says a doctor of the hospital.
The entire trauma bloc is officially looked after by only three medical officers for a patient capacity of over 60 to 80 accommodated in two wards. The 100-bed burn unit with 10 wards and 5 operation theatres has only three medical officers to look after. Meanwhile, insiders point out that that corruption inside the hospital has reached astronomical levels, happening in plain sight and broad daylight, with the shelter of the country’s policymakers.
‘Lack of responsibility and bureaucratic tangles over decision-making have tarnished the image of theDhakaMedicalCollegeHospital,’ says a doctor of the hospital. A number of senior doctors have resigned from the hospital in the running year due to the deteriorated state of the hospital, thanks to the policymakers, claims a doctor of the hospital.
Prof AJM Salek, plastic surgery specialist resigned from the hospital in June last year out of disappointment over the hospital management. Prof Jahangir Kabir, one of the best cardiac surgeons of the nation has left the DMCH along with general surgeon Prof Khademul Islam within a passage of last one year.
As irregularities persist within the hospital and the third and fourth class employees influence the decisions of policymakers, most doctors express their disappointment and are planning to quit the DMCH, says an inside source.
‘More often the juniors do not follow the instructions of the senior doctors. The seniors on the other hand fear risk with the patients if instructions are not timely followed by the hospital staff and thus a dispute arises,’ explains a doctor.
‘Private hospitals on the other hand are hiring these doctors with salaries as high as Tk 15 lakh per month excluding fringe benefits, so why would anyone waste time in a chaotic state-run hospital,’ says another doctor on the pipeline to leave the hospital.
Against the capacity of patients, the doctors officially appointed in the hospital are absolutely insufficient, says an insider. Moreover, the entire hospital is dependent on honorary medical officers who work voluntarily at the hospital without any accountability to the management or policymakers. The hospital has very few recruited doctors while accumulating the part timers, interns, honorary medical officers and full timers there are 594 doctors employed by the government at the DMCH.
Investigation reveals that insincerity and negligence of doctors are one of the reasons behind the sufferings of the patients. The TIB investigation disclosed that 71 per cent patients did not find doctors at the outdoor during duty hours.
Authorities claimed the presence of doctors and nurses round the clock in every ward. ‘Patients cannot be left alone at any period of time,’ says a high official of the hospital. At 4:00 AM, of Tuesday, last week, when this correspondent took a walk on the first floor of the hospital, four doctors were present at ward number 1 and 2, but no doctors were at their seats in any of the wards 3 to 12. The ward 35 had a nurse present but asleep while ward 33 had no doctor on that floor. The wards 34 and 36 were also operating without doctors. This summed up the entire scenario of the first floor with four doctors and a nurse serving 16 wards with over 500 patients.
In one of the wards a woman was screaming in pain. Her screams continued, but no one came to her aid.
The DMCH can accommodate more patients than any other hospital in the country; however the number of patients that take admission everyday is way beyond its capacity.
Crimes and Corruption at DMCH
Over the years, the DMCH has turned out to be a haven for numerous crimes and corruption carried out in connivance with the staffs and doctors who control its inner workings. Beginning from unsafe blood transfusions to overcharging for various pathology tests and prescription and collecting bribes in every stage along the treatment procedure, patients are victimised everywhere.
A doctor of the hospital told New Age that brothers (male nurses) and ward boys of the hospital attend to patients dressed as doctors, and then advise them that the DMCH does not have the capacity to treat them and they should contact such-and-such clinic for treatment. For this the DMCH ward boys and brothers are given handsome commissions. Jewel, a male nurse at the burn unit of the DMCH has been involved in such an offence, says one insider. As per information, he identifies himself as a DMCH registrar and visits patients in a private clinic at Uttara, he added.
‘These crimes happen on the very first day of admission of patients,’ says a doctor helpless against the power of third and fourth class employees.
The moment an ambulance stops with a patient at the gateway of the emergency division at DMCH, the first person to attend the ambulance is a broker with a trolley. These brokers pretend to serve the patients as if on humanitarian grounds but the whole process of performing the duty of a ward boy and guiding the patients and its guardians to each direction is plotted.
Beginning from finding a bed at some ward room, to doing tests and purchasing medicines, these brokers earn commission from everywhere. The tips for carrying the patient and finding bed are only a bonus for the brokers at the DMCH.
The investigation by TIB reveals that 32 per cent patients at DMCH have to pay bribes for seats, Tk 188 per seat on an average.
A 10 per cent commission is what most brokers earn from the nearby pharmacies out of each prescription, a broker tells New Age.
Over the years the brokers have established their network so strong that even from the diagnosis and tests available within DMCH, the brokers find a commission that too from within the government fee.
‘On each CT scan worth Tk 2,000 within the DMCH, they receive a commission of Tk 100,’ says a source aware of the illicit businesses within the hospital. Brokers in connivance with the third and fourth class employees rule over the hospital and influence many of its activities.
More than a hundred brokers are active at the hospital cumulating both men and women. Having stayed overnight at the hospital I realised that a number of brokers, as many as around 15 out of the lot work at the late hours of night while majority start joining them as early as 6:00 in the morning.
‘Seeking the help of a broker eases the whole process of consulting a doctor and getting reports fast,’ says Mosharraf Mintu, an elder brother of a patient who believes that is the best way to get things done at the government hospital. Besides, these brokers help all the way only for token amounts. Around 63 per cent of the patients claimed to have received treatment after paying the brokers, reveals the TIB investigation.
When Dipali died last Friday, a doctor and nurse came to complete her formalities. During that period a broker in the guise of hospital staff joined the family of the deceased to help them pack up, however his intention was firm to exploit the family and make some money out of them. The broker advised Dipali’s son Shwapan to pack the unused medicines and return them to the pharmacy from where he purchased them.
‘I bought medicines worth Tk 710 but they remained unused. When I went to return them, the pharmacy salesman accused me of breaking a seal of one of its products worth Tk 360 and slashed the amount. I could not protest because I did not check the product when I purchased and I was fooled,’ said a heartbroken Shwapan. Behind the scene, the broker who accompanied Shwapan secured his percentage of commission from the pharmacy out of the returned product. DMCH brokers are crucial players in the drug trafficking syndicates inside the DMCH drugs distribution centre.
During the overnight stay in the hospital, this reporter witnessed first hand how drugs from the hospital are sold on to drug addicts.
At 3:00 AM a patient was carried to the X-ray room downstairs by a broker. ‘He went up to the nurse and asked for pethidine, and apa (nurse) has asked me to manage him,’ the broker was overheard saying to a hospital staff. I waited for sometime outside the X-ray room and approximately after 20 minutes they came out and the drug user who had been wheeled in, in a trolley, now walked out.
The huge empty space of land between the burn unit and the emergency division where a bridge is currently under construction to link the two departments is used as a den by the drug addicts. Earlier at around 1:30 AM I took a walk into the area to find out what goes on in that large vacant place in the darkness. There is a search light placed at the other end of the land, which was turned off after every few minutes for quite sometime. And every time the place was darkened, I heard the security guard there whistling in a manner that was some form of a signal. I walked down to the end of the area and found two young men sitting on a bench covered by a tin shed. As I walked on, one of the men said, ‘Bhai, this place is not safe for you. Leave right now.’
However, in minutes I convinced them that I was only a patient’s guardian and was roaming around to find some company. ‘And may I know why it is not safe for me?’ I asked.
‘People come here for taking drugs and you do not seem to be one of them,’ said one of the men.
The two were drivers of the privately owned ambulances that stand in the long queue outside the DMCH. According to them, there is a great deal of corruption in the way the use of privately owned ambulances are given preference over the DMCH-owned ones.
‘Bhai, all these ambulances are actually microbuses. We only convert the seats into a bed to serve the purpose of ambulance,’ one of them said.
‘The ambulance that I drive is owned by the president of DMCH third grade employees association and local BNP leader, Akbar Hossain Khoka. He has a total of three ambulances, two microbuses and one converted ambulance.’
The windows of these microbuses are painted so that people do not realise that they are simple microbuses installed with sirens, he said. There are around 55 privately owned ambulances that only serve the DMCH patients on rent. Most of them are owned by the employees and doctors of the hospital. According to them, the DMCH ambulances are shown to be out of order while the private ambulance services do brisk business.
Only three out of the hospital’s total 11 ambulances are functioning but they are used by the doctors and senior staff for their personal use. The remaining seven are reportedly out of service.
According to insiders, hospital wards are allotted to ambulance owners. ‘Akbar is unofficially allotted four wards of the DMCH. The wards are 1 to 4 each having at least 30 patients. Patients of these wards will only be taken by Akbar’s ambulances,’ he said.
‘At least five to 10 dead bodies come out of the four wards everyday. Out of the three microbuses that Akbar owns, there is a net monthly return of Tk 2.5 lakh.’
Meanwhile, the other lucrative business that is outsourced to private operators is the sale of medicines. ‘Except for the saline which is sealed with DMCH logo, all the medicines are sold outside,’ says one doctor. Even though as per the regulations patients are supposed to get medicines from the DMCH free of cost, the doctors advise them to buy the medication from pharmacies located near the hospital.
This is a common practice as the doctors and staff involved in the drug trafficking ring get a good percentage of commission out of the prescriptions,’ says another junior doctor. Most medicines are unavailable within the hospital pharmacy as the ring sells them on to the neighbouring pharmacies.
The neighbouring pharmacies on the other hand are involved in a number of unethical business practices that include selling spurious medication and charging high prices for them, knowing that most buyers will pay them in desperation or ignorance.
Sources inside the government hospital express their frustration about lack of control over the third and fourth class employees. They are the major role-players in the drug trafficking.
There is a separate form available for medicine prescription that has to be signed by a doctor in order for a patient to receive the prescribed medicines free of cost from the medicine distribution corner of the hospital. Employees and brokers involved in the drug trafficking ring steal these forms and forge signatures of the doctors to collect medicines from the counter, reveals investigation by the TIB.
‘Prescriptions are prepared for every patient admitted in the hospital however, by the time the medicines reach to the patient under a formal procedure, the quantity is reduced by 80 per cent,’ says a registrar of the hospital. The 80 per cent is shared between the ward boys, brothers, nurses, the doctors who prescribed the medicines and others involved in the process. Moreover, even the laboratory chemicals and X-ray films that are required by the doctors and technicians themselves are sold to diagnostic centres for a profit, reveals the TIB investigation.
The irregularities within the DMCH have been reported several times and more recently the TIB has published its investigation on the hospital activities but despite repeated allegations, the policymakers remain indifferent to the state of the hospital.
The story was first printed in New Age Xtra on November 17, 2006