As Bangladesh grapples with a severe dengue outbreak, families face a dual struggle not only against the disease itself but also against the escalating costs of treatment
Published : 17 Aug 2023, 01:53 PM
"I'm at a loss," says a despondent Morzina Begum as she reflects on the mounting treatment expenses for her son, Zubair, an eighth-grader who is battling dengue at Moghbazar's Holy Family Red Crescent Medical College Hospital.
"They're always taking blood samples and administering saline to him. We have to buy most of the medicines. Although the hospital provides one or two [medicines], we'll have to pay for them at the time of his discharge."
The cost of a bed at the hospital is Tk 1,100, while nurse and doctor visits also come with charges, according to Morzina, a resident of Aftabnagar.
When bdnews24.com spoke to her on Monday, Zubair was showing signs of improvement after five days in hospital care.
Yet, Morzina remains unsatisfied with the hospital's services.
"Yesterday, they told me the bill for three days would be Tk 15,000. We were already expecting a figure like that."
"Even though we spent so much money, the nurses here aren't treating us well, especially the ones working the night shift. They seem irritated when we talk to them. But they're working here voluntarily, so they should provide good service, right?"
Habiba, Zubair's sister, says the quality of the hospital's services was not commensurate with the fees they were charging.
"They charge twice as much compared to other places. Plus, there are a lot of mosquitoes here."
As Bangladesh grapples with one of the worst dengue outbreaks on record this year, the alarming spike in cases has stretched government hospitals to their limits.
Many have been forced to go to private healthcare centres as government hospitals are turning away patients either because they are at full capacity or lack adequate facilities.
Due to the high costs of treatment at private facilities, many families are facing financial hardships. To deal with the situation, some low- and middle-income families have been left with no choice but to take out loans.
Worried about the comparatively high dengue mortality rate, relatives of patients are anxious that they might need to incur substantial expenses to ensure the recovery of their loved ones from the mosquito-borne illness.
As dengue cases increase, the financial burden on affected families also rises. Those who come to hospitals, as well as those looking after dengue patients at home, are facing higher expenses in addition to tests and doctor visits amid a cost of living crisis.
Mahmudul Hasan Shakeel, a dengue patient, was lying on a bed in the medicine ward at Holy Family Hospital as his mother fed him rice. Shakeel, a graphics designer, was initially at Mugda Hospital, but after spending one night there, his mother, Rashida Akhtar, brought him to Holy Family in hopes of finding better care and facilities.
"Renting a bed here costs Tk 900, and we have to buy all the medicines. But we chose a private hospital anyway because my son's health is the priority," said Rashida.
"His fever started a week ago, but we thought it was just a normal fever. However, three days ago, he started vomiting, so we got him tested for dengue, and the result came back positive. His platelet count was 14,000."
The family was advised to take Shakeel to a hospital with an intensive care unit. "We rushed him to Mugda, but even after getting a bed there, there was no improvement in his condition. That's why we came to this private hospital."
Addressing the concerns expressed by patients and their families, Dr Rumana Nazneen, deputy director (administration) at Holy Family Hospital, said, "In times of a pandemic, nurses also experience significant stress due to the high intake of patients. Some nurses here are focusing on managing fevers with paracetamol. Remember, we are all human."
"People often think government services are free, but there are many costs involved. You have to buy medicines, and there are intermediaries. When people choose private care, they expect VIP treatment by paying more. They need to understand that there are limits."
The hospital has treated 1,408 dengue patients so far this year, three of whom have died, according to Rumana.
FAMILIES JUGGLE MEDICAL BILLS AND BUDGETS
Mojibur Rahman Khan, a resident of Dakshin Banasree, was admitted to the Dhaka Cantonment Board's Siraj-Khaleda Memorial General Hospital on Jul 6 with dengue fever. After eight days, his bill came to Tk 20,000.
His son, Taukir Ahmed, who works at the Cantonment Board, says employees like him get a concession at the hospital. "Treatment costs are halved. So admitting him here not only ensures better medical care but is also more cost-effective."
"That's why I decided to bring him to this hospital instead of one in Banasree. Due to the special facility [for board employees], we spent a total of Tk 30,000, which is half of what a normal patient has to pay."
Newlywed Ishrat Jahan Saima was admitted to Al-Manar Hospital in Mohammadpur on Jul 29 with dengue fever. Three days of treatment set her back Tk 35,000 in hospital charges alone.
“I was in the cabin. This [Tk 35,000] is only the hospital bill. In addition to this, there's the cost of medicines. Altogether, I spent around Tk 50,000 in three days."
Although dengue can usually be treated at home, Saima didn't want to take any chances with her health.
"I stayed home for the first three days after being diagnosed with dengue. But when my platelet count dropped below 100,000, I decided to get admitted."
"I checked all the government hospitals, but there were no available beds. I even looked at Ibne Sina, Popular, and LabAid, but they were full. There was an available bed at a hospital in Mohakhali, but it was too far from my home."
Despite the hefty bill, treatment at the facility had not always been up to the mark, according to Saima.
"For the first two days, I didn't receive good service -- it was average. But on the last day, after raising the issues with the authorities, the service improved."
Although Saima's condition has improved, she worries that it will take her family some time to make up the costs of her treatment.
"I had dengue two years ago and was home at the time. I also had COVID. However, I've never experienced such severe symptoms of dengue before. Although I've recovered now, it will still take a while to overcome these unexpected expenses."
At the end of last month, Shaikh Abdullah, a journalist at The Business Standard, a Dhaka-based newspaper, was admitted to Islami Bank Hospital in Shahjahanpur for dengue. Later, he was transferred to BIRDEM in Shahbagh. He spent Tk 67,000 over five days in these two hospitals.
"During the first three days at Islami Bank Hospital, my condition worsened, and I needed four bags of blood, which the hospital provided. So, for those three days, my bill was Tk 25,000," he said.
"But when my condition didn't improve in three days, they recommended moving me to a place with an ICU, so I was taken to BIRDEM. I stayed in intensive care for 30 hours, and the cost was Tk 34,700. The following day, as my condition improved, they transferred me to a regular bed, which cost Tk 8,000."
On the quality of services, Abdullah pointed out that being in the ICU understandably raises expenses. "Nevertheless, in terms of regular care, there's little contrast between the two hospitals. I did incur a consultation fee of Tk 4,500 (1,500 per day) to see a senior doctor at Islami Bank Hospital, which I felt was quite steep."
'UNCHECKED COMMERCIALISATION' OF HEALTHCARE
"The expenses at private hospitals in Bangladesh are already high for the average person. Doctor's fees, bed charges, and medication costs have all risen. More importantly, medical expenses in Bangladesh don't match people's incomes. The expenses are much higher compared to what the middle class earns."
"For those with higher incomes, these costs might be manageable. Even then, when people fall ill, they're compelled to seek private care and end up borrowing money to cover medical expenses."
Saima, who is currently receiving treatment at Al-Manar Hospital, says that it's becoming increasingly difficult for regular people to afford such expenses.
"My husband covered the medical bills. He works as an engineer for a private company outside Dhaka, earning a monthly salary of Tk 30,000-32,000. Yet, he had to pay Tk 50,000 all at once. It's challenging for people like us to manage."
Mushtuq Husain, an adviser to the Institute of Epidemiology, Disease Control and Research (IEDCR), believes the government should take steps to regulate the costs of healthcare services in the country.
"The healthcare sector is a crucial area for citizens. The government should prioritise this sector by reviewing national and international laws to curb excessive costs."
"Dengue treatment shouldn't be so expensive if it's in line with guidelines. Moreover, dengue has become an epidemic. During any epidemic, the government should bear the responsibility for all medical expenses and ensure that patients receive care in all hospitals, whether public or private, just as they did during the COVID-19 pandemic.
"The same approach could be adopted for dengue, providing services either free of charge or at minimal cost."
Highlighting the escalating 'commercialisation' of the country's healthcare sector, Mushtuq said, "Healthcare shouldn't be treated as a business. It should be safeguarded. Personally, I'm against commercialising healthcare and education. Many of us establish charitable hospitals not for profit, but for the betterment of healthcare."
"Healthcare can't be treated as a commodity. It's the government's duty to oversee it. However, in our country, private institutions are often opened, and unnecessary treatments, medications, and tests are given under the pretext of healthcare. These issues aren't limited to private facilities, there are also irregularities in government hospitals."