Tongi disaster exposes a weakness in Bangladesh’s health sector

The Tongi factory disaster has exposed a serious weakness in the government’s health system in Bangladesh.

The government spent millions of dollar to buy heavy equipment, but the biggest public hospital of the country, Dhaka Medical College Hospital which also has the busiest emergency centre, is running without CT scan services for nearly two months. The only MRI machine is also out of order.

But it came to light only on Saturday when many of the victims of the Tampaco Foils Ltd factory boiler explosion were rushed to the hospital.

State Minister for Health Zahid Maleque, and new director general for health services Prof Abul Kalam Azad hurried to the DMCH, and arranged special ambulances so that those who needed CT scan can be transported to the Mitford Hospital in the old town.

But a patient, taken to the Mitford Hospital at 3pm, was found waiting for nearly one and a half hour as the department closed the service after 2pm. The 50-year-old Jahangir could not have his CT scan until the hospital director called back the staff at 4.30pm.

Head of the Radiology and Imaging Department of the DMCH Prof Md Mizanur Rahman told bdnews24.com that they had only one CT scan machine for the whole over 3,000-bedded two wings of the hospital.

“We have informed the relevant authorities following our rules when it ran out of order. Our director also keeps insisting to get it repaired soon,” he said.

He said they were also demanding additional CT scan machines for the department.

The Director General, Prof Azad who took the charge on Sep 1, told bdnews24.com that process was underway to buy five CT scan machines.

“We have decided to give one of them to the DMCH,” he said, adding that the existing machine would also be repaired soon. “I just came to know this today,” he said.

But this is not new in Bangladesh’s health sector. The country has a track record of buying sophisticated medical equipment, but many of them remained idle either due to lack of manpower for running those or lack of maintenance.

There are also allegations that hospital staff keep those machines non-functional intentionally so that they can send patients to nearby private facilities.

Head of the Mitford Hospital’s Department of Radiology and Imaging Dr Ruyed Hossain Rubel also acknowledged such a nexus when he argued in favour of the decision to close his department’s CT scan service after 2pm.

A doctor of the Mitford Hospital’s Department of Radiology and Imaging also acknowledged such a nexus while arguing in favour of the decision to close the department’s CT scan service after 2pm.
 
“It’s cheaper than that of private facilities, so sometimes private patients come here after office time to have the CT scan. That’s why we keep the service closed unless some emergency situation arises after 2pm,” the doctor told bdnews24.com, requesting anonymity.

One of that model, was to keep a portion of the ‘users’ fee’ collected from patients to a fund so that the hospital can repair equipment on its own immediately.

It is about a decade that the users’ fee was introduced. It pushed up the diagnostic test charges in public hospitals such as a CT scan costs minimum Tk 2, 000 at DMCH.

But the government could not decide on that proposal to keep the equipment functional all the time.

The government also thought to introduce Public Private Partnership (PPP) model under which private company would install and run heavy equipment in public hospitals with government set rules and charges.

But it has not been implemented yet.

Last year, the directorate general for health services, on a pilot basis, signed an agreement with an Indian firm to set up dialysis machines in different hospitals for kidney patients. The company, Sandor, would invest Tk 250 million for the next 10 years.

The new Director General told bdnews24.com that the health ministry was also concerned over how to keep equipment functional “properly”.

He said they were also focused on having “an acceptable solution” to this decade-old problem. “We’ll start discussing the issue again”.

The death toll in the Tongi packaging factory explosion stood at 24, so far. At least 12 injured, of them four at the burn unit, were found at the DMCH at 3pm when eight took first aid from the emergency.