The ‘Narail Express’, doctors and health care

M Serajul Islam | Published: 00:00, May 14,2019 | Updated: 00:38, May 14,2019


— New Age

Mashrafe Mortaza could climb in politics the same heights as in cricket if he showed the same courage with his concerns about the healthcare system that is largely anti-people.

THE member of parliament for Narail, Mashrafe Mortaza, is a popular cricketer that millions of his fans have lovingly nicknamed as the ‘Narail Express’. His popularity in Bangladesh has no limits. A great deal of it has been earned not just by his great cricketing abilities but also by his character and personality. This popular national hero came under attack of some doctors on the social media recently after videos of him expressing anger and disgust over what he saw on an unannounced visit to Narail General Hospital on August 24 had gone viral on the internet. He had found all the four doctors of the hospital absent, two, including the one in charge who had joined the previous day, without authorised leave. Mashrafe spoke to him over phone in Dhaka.
Mashrafe was in Narail to do what was his official duty — to oversee the development work of the government in his district. He was, therefore, within his legal limits to visit the hospital to find out how it was performing. And the actions he took upon finding that the doctors there had left the hospital in God’s care was something that should have brought from the member of parliament much sterner words than what he had said in the videos to incur the wrath of some doctors. The comments from the public on the videos expressed the deep contempt that Mashrafe had not shown notwithstanding the fact that he was visibly angry and upset.
All these bring to focus the reaction of some of the doctors who attacked Mashrafe on the social media. One of them who is also chief executive officer of a television channel made out the case for the doctors. He highlighted the limitations within which the doctors work, all correctly pointed out. For instance, he rightly flagged the doctor-patient ratio at 1.2 doctors per 10,000 people and 0.12 specialists for the same number to underscore the pressure on the doctors. He also correctly underlined the hardships and the length of time it takes to be a doctor in Bangladesh. The chief executive officer unwittingly also highlighted the unbelievable predicament of patients in Bangladesh in flagging the case of the doctors.
Normally, the Facebook status of a chief executive officer of a private television channel should not have been my concern. Nevertheless, I chose to write upon it because the officer exposed many other weaknesses about doctors and the medical profession, albeit unwittingly. He asked patients rhetorical questions and utterly exposed why doctors despite their importance and indispensability to the people are so unpopular. He asked that if patients believe that doctors are ‘butchers’ (which by the way is a general perception among many about doctors and hospitals), why do they still go to their chambers when doctors do not bind them in ropes to take them there?
The chief executive officer’s rhetoric was very insensitive that doctors often raise in their defence. Doctors worldwide take what is called the Hippocratic Oath upon entering the profession which is a moral and ethical commitment to using their knowledge for healing patients, irrespective of their caste, colour, sex or creed and irrespective also of how much effort they give to become doctors. The mentality expressed by the chief executive officer through his rhetoric notwithstanding the fact that there is substance in most of them are nevertheless the antithesis of the Hippocratic Oath that should land him in trouble in case he is also practising medicine. Unfortunately, in Bangladesh, doctors (and hospitals) for mysterious reasons are totally secure from prosecution for malpractice or for more fundamental violations of the Hippocratic Oath.
The chief executive officer stated in his Facebook status that people think the doctors are gods and reminded his readers that they are not. He got his perception right but in reverse. The patients, not the doctors or hospitals, are reminded almost every time they visit a doctor or a hospital how insignificant they are. Most of them wait to be seen by the doctor like they have committed a crime. And few among the patients or their attendants who muster the courage to ask doctors questions are more often than not reminded that medical science is not for people like them and it would be a waste of time to explain anything to them. The god-like attitude, if there is any in our healthcare system, comes entirely from the doctors and the hospitals.
Mashrafe’s visit to Narail Hospital revealed a lot of what ails Bangladesh’s health sector and there is a lot of it. He visited a government facility where patients are treated free to a large extent. It is also where doctors get their training and the time for preparation for higher degrees to become specialist and abandon these facilities later to join the lucrative private sector. What Mashrafe discovered in the Narail hospital is, however, nothing new. If he visits other such facilities, he would find the same situation.
Doctors work in government health facilities in a way as if they owned them although they are employees posted there to serve people. They remain absent from their duties more often than not because most of them have private practice simultaneously with their government jobs that are in Dhaka and other big cities from where they earn much more than what the government pays. Doctors in government hospitals are the only government employees in the country who are allowed to ‘moonshine.’
The major ills of our health sector are, however, in the largely unregulated private health sector that has sprung in our midst like mushrooms since 1971. People are aware that government hospitals are unable to serve their needs for reasons the chief executive officer correctly pointed out with rhetorical questions. They, therefore, seek treatment in private health facilities with considerable encouragement from doctors at government hospitals where they meet the gods of healthcare in Bangladesh. In the days gone by, when illnesses did not mean cancer, or kidney failure or diseases related to the heart, lungs or stomach, the government facilities while grossly inadequate were still places where people could be treated. These days with the new genres of diseases that the government hospitals cannot or do not treat, the vast majority of the people have to go to private-sector hospitals and clinics as they have no other options.
These hospitals and clinics are so prohibitively costly that some of them are sarcastically but rightly called the five-star hospitals. People except for the handful of the super-rich have to beg or borrow to be treated there. And the irony is that some of those who own these five-star hospitals fly abroad for treatment with the super-rich. And there are other realities in private health care that give doctors and hospitals the god-like power and create a predicament for the patients that do not exist in the countries where there is the rule of law. Doctors in developed countries remain in a mortal fear that if their treatment went wrong, they could be sued for malpractice and would need to pay heavy penalties for which they insure themselves at huge premiums. Doctors and hospitals of Bangladesh are blissfully free of these disadvantages.
Mashrafe has struck the right chord with the people of Bangladesh by rendering his voice with the people who suffer from one of the worst predicaments among peoples worldwide with their healthcare. He could climb in politics the same heights as in cricket if he showed the same courage with his concerns about the healthcare system that is largely anti-people. He could concentrate on binging laws to the private health sector to hold doctors and hospitals responsible against malpractice and ways to execute the laws. He could focus on finding out the possibility of private health insurance to help millions who become paupers when a major illness befalls them.
The healthcare system in Bangladesh is one of utter despair. The vast majority of the people live in the mortal scare of contacting the dreaded diseases that are now commonplace like cancer, kidney failure, heart disease, et cetera. They have to beg or borrow for their treatment of these diseases or pray to God for mercy. The doctors and hospitals in the country could show a little compassion for these unfortunate people by reminding themselves once in a while of the Hippocratic Oath that guides their profession and business.

M Serajul Islam is a retired career ambassador.

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