Health scare in hospital toilets: 'falling ill' while trying to get well

The floor is strewn with water, mud, and blood, the sink is crammed with waste, and the taps are leaking or missing

Ranjana Akter, a woman from Gazipur, came to the outpatient department of Shaheed Suhrawardy Medical College Hospital with her 4-year-old daughter for treatment. After waiting in a long line for tickets and to see a doctor, she eventually needed to use the toilet.

However, in such an urgent situation, she could not find any washroom for women in the outpatient department, despite searching for about 10 minutes. Finding no other option, she approached two intern doctors, but even they did not know where the toilets were located.

One of them said there was no washroom for the patients below. However, there was one under the stairs that she could use.

What Ranjana found near the loo under the stairs was shocking enough to make her gasp.

At first glance, the toilet looked like a deserted cave. A sign on the entrance read ‘Dental Student Hostel, Toilet (Female)’. To the right of the door was a booth for collecting coronavirus samples.

The interior of the loo was even more horrifying. In the dim light of a flickering bulb, the place took on a ghostly appearance. Two wheelchairs lay abandoned against one wall. The dustbin looked like it had not been cleaned for years. The stench made it difficult to breathe.

Plaster was peeling off the walls in many places. The floor was a mess of water, mud, and blood. The sink was filled with dirty papers, tissues, sanitary napkins, diapers, and mobile phone covers.

Standing in front of the lavatory, Nazma Sultana said, “It’s impossible to stand here because of the stench. On the other hand, a leaking tap has completely flooded the floor. It feels like I might fall.”

There are only three toilets for women in this hospital’s outpatient department, all in the same deplorable condition. Women are forced to use these filthy washrooms while standing in line.

From May 18 to 24, a tour of several government hospitals in the capital revealed the same situation. Recently, the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) conducted a study on 12 government and private hospitals in Dhaka. It found that 68 percent of the toilets in government hospitals were structurally usable. However, only 33 percent of the toilets were clean.

Researchers from icddr,b in collaboration with the University of Technology Sydney, Australia, and the Directorate General of Health Services, DGHS, of the Ministry of Health and Family Welfare, conducted the study.

A tour of about 25 toilets in various wards of the Suhrawardy Hospital found them all to be dirty. The orthopaedics and traumatology department's wards 102, neurosurgery's wards 104 and 105, and the physical medicine department's ward 208 were in nearly the same condition.

Ward 102 has 40 beds. There are 12 washrooms for patients and their relatives, three of which are locked. One of the two sinks is completely unusable because its tap is broken. Almost every toilet door is rusted and broken at the bottom. The floors and walls are covered in algae, mud, and stench.

Patients in the neurosurgery department are in a very risky situation. But the condition of the washrooms in wards 104 for women and 105 for men in this sensitive department is the most precarious.

Both wards have narrow entrances littered with garbage. Inside, there are six small washroom stalls, several with broken doors. Dirt has accumulated around the toilets, walls, commodes, and sinks over a long period. Although there are places for ablution and washing feet, it doesn't seem like they are used.

Three rubbish bins in the bathing area were emitting a strong stench. Several nurses and duty doctors of ward 104 stated they had separate washrooms, which appeared quite clean from the outside.

The Department of Physical Medicine is somewhat an exception. Its washrooms are less dirty. They have plastic doors, and the floors are less filthy. Bleaching powder is frequently sprinkled in the small washroom stalls. However, there was no soap by the sinks; there were also dirty trash receptacles here.

In front of this department, there are four washrooms for prisoners, three of which are locked, and of course, they are filthy and stinky.

About 2,000 patients use the outpatient department of the Suhrawardy Hospital daily, and 200 use the inpatient (indoor) services. The hospital has just over a thousand toilets and 27 cleaning staff.

Discussing the deplorable condition of the washrooms, Swapan Chandra Sutradhar, head assistant of the hospital’s administration branch, told bdnews24.com: "Although there are posts for 37 sweepers, only 27 are working. It's impossible to keep so many toilets clean with so few people. Therefore, there are 70 outsourced workers for cleaning the toilets."

He added, "The cleaning workers work in shifts. They are divided into shifts from 7 in the morning to 2 in the afternoon."

THERE ARE BASINS, BUT NO TAPS

The toilets at the National Institute of Kidney Diseases and Urology are in dire need of repair.

On May 21, a tour of the nephrology department's male and female wards showed that nearly every washroom's floor was covered in water, mud, and leftover food. Upon entering, one is confronted by a large open garbage bin swarmed with flies. The stench of rotten food makes it difficult for patients to enter.

The female ward in the nephrology department has 44 beds. Each has six toilets and bathing areas. There are a total of 12 basins, but only one has a tap. There is no soap for handwashing.

Angura Begum, a woman over forty from Mymensingh, was cleaning dishes and plates at a basin. She told bdnews24.com, "I can't tell you how difficult it is. We have to wait hours to use the basin. You can't even complain to the sweepers about the dirty bathroom. They just yell back, 'Can't you keep it clean?'"

The cleaning workers come to clean in the morning and at noon. However, they were not seen even at 4pm that day.

The male ward in the nephrology department has 55 beds, and the number of toilets, bathing areas, and basins is the same as in the female ward. However, there are taps on four basins. The floors are covered in water, mud, urine, and dirt, and clothes hang on ropes, as seen elsewhere.

Despite attempts, it was not possible to speak with anyone from the hospital about the condition of the toilets. The institution's website does not provide any contact phone numbers.

LIKE AN ABANDONED PLACE

At the entrance to the washroom, rotten food is scattered about. Rusty pipes have broken, and dirty water floods the floor. There are five toilet chambers, but only two are usable. There are two bathing areas, but there is no tap in either. Algae have formed on the two places for washing feet. Plaster is peeling off in places, and the walls are covered in black dirt.

This is the situation of the washrooms in ward 155 in the 'A' block of the Bangladesh Shishu (Children’s) Hospital and Institute in Agargaon.

Three women were cooking on a stove outside the washroom. They said “what better can you expect from a government hospital's bathroom"!

Ward 155 has 35 beds, accommodating more than 70 people including patients and their relatives. On the other side of the ward, there is another washroom and bathing area, but the condition there is as deplorable as usual.

Ward 158 has seven washroom and bathing chambers. There are two places for ablution and washing feet, and there are three functioning taps and two broken ones among the places for washing faces and hands. Like the other toilets, this one also has an unhealthy environment.

Professor Dr Jahangir Alam, the director of the Bangladesh Children's Hospital and Institute, told BDNews24.com, "The work for repairing the toilets is ongoing. It will be part of a continuous project.

"Moreover, work has already started to increase the number of toilets. The construction of a new building will begin in a few days. Then there will be no problem with the number."

DOG ROAMING AT THE ENTRANCE OF THE WASHROOM

At the Dhaka Medical College Hospital, a dog was roaming at the entrance to a washroom for women (indoor department). The sign outside read 'women's bathroom', but due to the crisis, men also have to use it.

Inside, there are six small washroom and bathing chambers. Three taps are broken, causing water to spill all the time. As a result, even the outside area is flooding. Every washroom is covered in dirt and algae. The stench is so bad that patients and their relatives are covering their noses with cloth to use the toilet.

Next to ward 112, the men's toilet also has mud, dirt, stench, and dirty water.

At the emergency department, two large garbage bins are placed at the entrance to the toilet. There is one bathing area and two washrooms. People standing in line are using dirty and unhygienic washrooms.

There is also a public washroom for the outpatient department. However, on May 23, it was found locked in the afternoon. Garbage was piled outside.

The dire condition of the washrooms and the suffering of people were acknowledged by the hospital's director, Brigadier General Md Asaduzzaman.

He said, "People are getting free services in government hospitals, but they are not getting quality toilets. So, a public-private partnership could be a good solution to the toilet issues in all government hospitals.

“A draft letter has been prepared for creating and maintaining clean indoor toilets with the financial support of the cleanliness sector and NGOs. The ministry is also positive about this."

The director added, "There is no issue with the number of toilets, but keeping them clean is the biggest challenge. Ignorance of the toilet users and the shortage of sweepers are two reasons for this situation. If there was a designated sweeper for each toilet, they would be clean, but that's not feasible. Also, no cleaning staff has been hired for a long time."

For the current fiscal year, approval has been obtained for civil work to repair the toilets, Director Asaduzzaman added.

"The hospital director does not have any funds, so even if we want, many tasks cannot be undertaken. More than 30 codes are given for funding. We cannot go outside these codes. Therefore, we are limited to the list provided by the ministry. Moreover, approvals take a long time to come through, which creates new problems."

Efforts to reach the Director General of the Health Directorate, Professor Abul Bashar Mohammad Khurshid Alam, to inquire whether any measures are being taken to address the poor condition of the toilets in government hospitals were unsuccessful, as he did not respond to multiple phone calls or text messages.

TOILET SERVICES BY BHUMIJO

An NGO named Bhumijo, in collaboration with Dhaka Medical College Hospital, operates two public toilets in the outpatient department. Due to their cleanliness, these facilities have become quite popular. One is available from 6am to 3pm, and the other is accessible 24 hours a day.

Mozammel Hossain, an employee stationed in front of the toilets, told bdnews24.com: "Each day, over five hundred people use these services."