Md Alauddin and his wife Shima, who gave a single name, are at their wits’ end.
He is a rickshaw puller by trade, and she is a housekeeper. The couple and their two children live at Taltola in Dhaka. Their daughter, Sultana, who was also identified with a single name, has caught dengue and has been receiving treatment at a free bed at Bangladesh Children’s Hospital and Institute since Nov 13.
The state-run hospital bears nearly all of the medical costs for the free bed patients, but Sultana has developed a liver problem that requires medicines unavailable at the hospital. The family have had to pay close to Tk 10,000 for the medicines since Sultana was admitted. Now Alauddin and Shia are struggling to figure out how they will foot the bill while affording rent and buying food amid skyrocketing inflation.
“A doctor at the hospital has been helping us,” said Shima. “We’ve borrowed some money too. I haven’t been able to work for the past few days because I had to care for the young one and rush to the hospital.”
“Their father has a heart condition,” she said. “He can’t work hard. I can’t leave my young child alone to work for very long either. We still have to pay rent. I don’t know how we’ll pay for next month. What will we feed the children?”
The dengue outbreak in Bangladesh has continued to worsen as 2022 draws to a close, with a spike in cases and deaths.
As of Monday, some 53,413 patients were admitted to hospitals with dengue, the Directorate General of Health Services says. However, this does not account for all those who have not sought hospital care despite getting the disease.
The official death toll has soared to record 234 as a new variant of the disease is causing rapid deterioration in the health of patients, meaning those infected have to seek hospital care soon after infection and have to stay for extended periods.
The Aedes mosquito-borne disease incurs heavy expenses for families already struggling to balance their books amid economic instability and rising prices. The families say the cost of dengue treatment is much higher than for other diseases.
The expense depends on the physical condition of the patient after they are admitted to the hospital. But, with the hospital stay, tests, medicine, bed charges, food, and injections of blood and platelets, the cost continues to rise. It is even higher for those who have to stay in hospital for long periods.
Due to the rush of dengue patients, there are no beds available in government hospitals, forcing people to switch to private healthcare. Treatment at government hospitals is not free, and the cost at private hospitals varies according to quality, but they are still more expensive.
The 53 public and private hospitals in Dhaka have treated 34,460 patients so far. Of them, 18,745 received care at the 20 public hospitals, while 15,615 received treatment at 33 private hospitals.
The DGHS does not have information on how many are afflicted with the disease or how many have sought treatment at public and private hospitals for the disease outside Dhaka.
Many families from lower- or lower-middle-income groups, like Sultana’s, have had to borrow from others – their extended family or well-wishers – to cope with the burden. Some have had to borrow a lot.
Sumaiya, a 10-year-old dengue patient who lives in the Vasantek area and was identified with her first name, is also receiving treatment at the Children’s Hospital in a paying bed. Her family says they have already paid nearly Tk 20,000 in medical bills for medicine and tests.
Admitting her to the hospital cost Tk 2,650, it took Tk 3,500 to conduct some tests, the daily blood tests cost Tk 300 and nearly Tk 3,000 is spent on medicines each day, says Sumaiya’s mother Shima Akhtar.
“The daily cost is putting pressure on the family,” she said. “It’s a public hospital, but you still need to buy everything aside from a few medicines. At least the doctors and nurses check on her regularly. But we’ve spent Tk 20,000 in a week and there are also food costs to consider. Our relatives are visiting and we have to pay rent as well. We’re under a lot of pressure. Our income isn’t that high.”
The Department of Social Services is supposed to provide some support to patients admitted to government hospitals, but the amount is very small.
“Assistance is given to patients staying in the paying beds at the hospital,” said Israt Jahan Bhuiyan, the social services officer at the Children’s Hospital.
“We get an allocation of Tk 200,000 per month. But there is a heavy rush of patients. We try to give the money to about 100 patients so they all get a little.”
Eklas Miah, a man in his 60s who works as a caretaker at a home in the Mirpur area, has been receiving treatment at Shaheed Suhrawardy Medical College Hospital for dengue for the past five days.
“The hospital gives me treatment and medicines for free,” he said. “But you need to buy some food from outside the hospital. I have to drink a green coconut or two a day. There are some other costs as well. I don’t earn very much.”
Even people with more means are facing financial difficulties.
Zakia Ahmed, a housewife who lives in the Goran area, is receiving treatment for dengue at Monowara Hospital in Dhaka.
The hospital has billed the family over Tk 100,000 for her stay and there are additional costs as well, according to her daughter Sharmin Sultana.
“We’ve faced many difficulties trying to get the money,” she said. “My father has passed away and we don’t have a source of substantial income. I didn’t have cash and I had to manage it. This expense is putting additional strain on the family and it is a major problem because I will have to pay it back.”
Nine-year-old Siam, identified with a single name, was admitted to a Dhaka hospital with dengue on Oct 29. He did not survive.
His father, Sayedabad resident Abul Kalam Azad, said he admitted his son to a private hospital at the advice of a doctor when his condition deteriorated. Siam was in the ICU for two days and his father had to find Tk 100,000 in a rush for his treatment.
“I work at a transport counter,” he said. “It became very difficult for my family to get by. I borrowed money from a friend, from my relatives.”
“People are suffering from the rising prices of necessities,” said Aslam Hossain, the father of Tanzim Islam, a Shewrapara resident admitted to Dhaka’s Ibn Sina Hospital with dengue. “Having to pay for dengue treatment has made it worse.”
The treatment is quite costly and has had a major impact on their finances, he said.
Naznin Sultana, a resident of the Wirelessgate area of Moghbazar, has admitted her 6-year-old daughter Mehrin, for whom Naznin gave the first name, to the paediatric department of Holy Family Red Crescent Hospital for treatment.
She told bdnews24.com that her daughter had been in the hospital for three days and they had already spent Tk 30,000. They plan to stay until Mehrin recovers.
“They still haven’t given us the full bill. If it stays like this, we will have to spend more. This puts pressure on us.”
Medical bills are higher at private hospitals, said Professor Syed Abdul Hamid, director of the Institute of Health Economics at Dhaka University. Healthcare has also grown more expensive as the price of medicine has gone up.
In 2019, Dhaka Medical College Hospital opened a dedicated unit for dengue patients, he said. If there had been similar units elsewhere, they could have admitted more patients. But, the COVID situation makes it difficult to set up a separate unit. Government hospitals like Dhaka Medical College can take certain steps, but they also have a shortage of capacity, which is forcing people to seek care at private hospitals.
Prof Hamid urged the government to enact all the recommendations for preventing dengue and stressed the importance of ensuring proper capacity for treatment at public hospitals when there is a dengue.
“We should also try and ensure that no one has to buy anything from outside the hospital once they are admitted,” he added.