A slew of expensive and key medical machinery is either left unutilised or has been out of order for years in the government hospitals and health complexes of Khulna, forcing patients to rely on private clinics and diagnostic centres that provide subpar services at exorbitant prices.
According to sources, equipment such as the MRI, CT scan, X-ray, ultrasonogram, neurosurgical microscope and even a Tk8 crore 6 MV linear accelerometer (Linac) – used for radiotherapy of cancer patients – has remained out of service for a long time but the authorities concerned have not taken any steps to fix them.
Meanwhile, banking on the situation, hundreds of private hospitals and diagnostic centres, many of which are not authorised, have sprouted in the Khulna metropolis and upazilas over the past few years.
Transparency International Bangladesh (TBS) says the government hospitals have failed to provide necessary health services to people due to the negligence of the health ministry and a lack of goodwill of the physicians.
Md Aminul Islam, an engineer at Shaheed Sheikh Abu Naser Specialised Hospital – the only super-specialised hospital in the southwestern region of the country – told The Business Standard (TBS), “The neurosurgical microscope machine bought at a cost of crores of taka years ago for brain tumour surgery has not been installed yet. Besides, an MRI and a CT scan machines in the Radiology Department went out of order long ago.”
In addition, an Exercise Tolerance Test (ETT) machine for heart patients, a Cath Lab and an angiogram machine have also been out of order for almost two years, he said.
“We have informed the higher authorities several times regarding these issues. Medical services are being disrupted as these crucial machines are not functioning,” Aminul Islam added.
Khulna Medical College and Hospital (KMCH) is also facing a similar situation. According to hospital sources, one of the two CT scan machines, the only 300 mA X-ray machine, and two of the six ultrasonography machines in the Radiology and Imaging Department are out of order.
Apart from this, a 6 MV linear accelerator (Linac) machine of the Radiotherapy Department at KMCH, which was purchased in 2011, has remained boxed at the hospital for more than a decade.
According to the hospital director’s office, the linear accelerator machine – used in radiotherapy for treating cancer patients – was purchased for the National Institute of Cancer Research and Hospital (NICRH) on 15 May 2011. However, the machine was sent to KMCH on 29 May 2012 as there was no bunker at NICRH.
What is interesting is that the KMCH did not have any bunker (with eight feet thick walls for radiation safety) at the time to accommodate the accelerator machine. Hence, the machine has lain in its box in front of the Oncology Department of the hospital to this day.
On 17 November 2015, a delegation from Varian Medical Systems, a US company that supplied the machine, visited the KMCH and said that Tk7 crore is required to make a bunker and install the machine at the hospital.
The Ministry of Health, however, did not want to spend the money and wanted to take the machine back to the NICRH, but the cancer institute never took the machine as it was damaged due to prolonged abandonment.
According to the Radiotherapy and Oncology Department of KMCH, about 1,600 cancer patients received treatment there last year.
Assistant Professor of the Radiotherapy Department Md Mukitul Huda told TBS, “Three types of treatment are given to cancer patients – chemotherapy, radiotherapy and surgery. We provide chemotherapy and surgery here, except radiotherapy.”
“We received the Linac machine to provide radiotherapy to patients but being boxed for more than a decade, it has become useless,” he said, adding that radiotherapy patients are referred to various hospitals in Dhaka.
However, speaking to patients, TBS found that KMCH physicians advise patients to go to different private hospitals in Dhaka for radiotherapy so that the doctors concerned could get a commission from the money paid by the patients.
KMCH Director Dr Rabiul Hasan told TBS, “A new six-storey Radiology and Imaging Department building is being constructed in our hospital. Once completed, adequate manpower and machinery will be provided by the ministry. Patients of the hospital will not have to take additional services from outside.”
The upazila-level hospitals of Khulna have also been given modern medical equipment but not sufficient manpower. As a result, ECG, X-ray, ultrasound, anaesthesia, and autoclave machines and instruments used in pathology have been damaged while lying idle for a long time.
Most of the health complexes in nine upazilas of Khulna do not have adequate doctors, lab attendants and ward boys and technicians.
According to the Khulna Civil Surgeon’s Office, there are anaesthesia machines in upazila health complexes but they have never been used due to a lack of anesthesiologists.
“The anaesthesia machine is very sensitive and cannot be operated without an anesthesiologist,” said Khulna Civil Surgeon Dr Sujat Ahmed.
“The government has given enough equipment to our upazila-level hospitals. But due to low manpower, the medical equipment cannot be utilised,” the civil surgeon added.
Speaking of the run-down conditions of government hospitals, TIB Socheton Nagorik Committee’s Khulna District President Md Kudrat-e-Khuda told TBS, “There is corruption involved in the purchase of the Linac machine that has been lying idle at KMCH.”
“Contractors prepare the list of equipment for various hospitals. The ministry procures the goods through contractors and sends them to the hospitals. But the ministry does not care whether the hospitals have sufficient manpower or administrative infrastructure. So, it is clear that there is corruption in these purchases,” he said.
Regarding the growing number of private hospitals, Kudrat-e-Khuda said “Commercial diagnostic centres have been established in private hospitals. By referring patients there, government doctors get regular commissions from there. They do not care about the out-of-order machines because if these machines start working then their commission will stop coming.”
“Hospitals in China are run by the government. Private companies, contracted under Public Private Partnership (PPP), carry out testing in these hospitals. Test fees are determined by the government. Doctors cannot refer patients outside on a commission basis,” he said, adding that if something like this can be implemented here then patients will get their desired services from government hospitals.
Private hospitals and diagnostic centres growing in Khulna
According to Khulna Civil Surgeon and Divisional Health Office sources, currently, the number of private clinics and diagnostic centres in Khulna city and in upazilas is 367. Some 69 of these private institutions have been set up in the last two years and not all of them are registered.
On 26 May last year, the Directorate General of Health Services ordered the closure of all illegal hospitals, clinics and diagnostic centres in the country within 72 hours.
After that, the administration conducted raids in Khulna and ordered the closure of 39 unlicensed clinics and diagnostic centres in the metropolis. Many institutions at the upazila level were also closed down for a brief period of time, but currently all of them are open.