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Take the example of 50-year-old Rahima Begum, who went to the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR) in Dhaka--the largest public orthopedic hospital of the country--in mid-June for treatment to her elbow after falling from the roof of a one-storey building. The doctors at the hospital ignored her when admitted and the following morning, Rahima was released. After four days, she went back to the same hospital due to her unrelenting pain. Staff members at the hospital discouraged her attendants from admitting her, frightened them about further deterioration to her condition because of the public doctors' negligence, and instead, the brokers encouraged her and her relatives to visit a private clinic nearby, assuring her of better treatment there at the cost of 10,000 takas (US$142).
In the evening, at the clinic, Rahima was wheeled into the operating room where doctors informed that the procedure to operate on her elbow, would take 30 minutes. However, after three hours, the doors of the operation theater remained closed, and no one from the clinic came to meet her relatives. Around midnight relatives found Rahima's dead body in an ambulance in a dark lane at the back of the clinic--an alleged attempt to surreptitiously take away the dead body. A son of the deceased woman subsequently lodged a murder case with the local police station against the brokers as well as two doctors.
Sadly, this tragedy is not an isolated case. Another incident, with disregard for life, took place in May, at a public hospital in Rajshahi, a city in northwestern Bangladesh. A woman by the name of Mrs. Sima, 22, was taken to the Rajshahi Medical College Hospital (RMCH) in critical condition. She had been suffering from inflammation of the brain caused by a viral infection and pneumonia, according to the doctors' diagnosis. On the afternoon of the following day, Sima's condition deteriorated, and she started bleeding profusely through her nose.
Sima's husband, Shahabul Islam, a guard at the Chapainawabganj district jail, rushed to the on-duty doctor and asked her to attend to his wife immediately. Because of the doctor's sluggish response, Shahabul attempted to drag the doctor toward his wife's bed by holding her hand. In the process, the doctor stumbled and fell. Other doctors, interns, and hospital staff gathered around the man and beat him. The police had to rescue Shahabul from the blows of the doctors. The interns of the hospital subsequently went on strike, which resulted in Sima's death as she received no medical attention in the hospital's emergency room and died the following morning. Hundreds of other patients left the hospital fearing that they too would be neglected and left to die without treatment.
The director of the hospital, who is a brigadier general in the army, allegedly arranged another beating in his office for Shahabul, this time by the Rapid Action Battalion (RAB). The two beatings forced Shahabul to seek admission to the Rajshahi Jail Hospital with fractures to his limbs and other injuries.
It is ironic: a man who took his wife to a recognized public hospital to save her life had to struggle for his own survival after witnessing his wife's death without treatment. Moreover, doctors, who are supposed to be the saviors of people's lives, are killers in Bangladesh! This irresponsible attitude of doctors in the country has developed over decades due to the decline in values, education, training, ethical and professional commitment and accountability.
Everyone in Bangladesh knows that medical doctors in public hospitals either own or have a contractual relationship with private clinics. For doctors, public service is a false identity. Their true identity is making money through their private practice or business. They appoint public hospital staff members as brokers to bring clients to private clinics instead of properly treating them in public hospitals. Even if people are treated in a public hospital, they are forced to visit private clinics for a diagnosis so that doctors can earn fat "commissions."
In public hospitals, from the time patients arrives for treatment, the staff encourage them and their relatives to move to a private clinic to seek "better treatment." Simultaneously, doctors neither seriously listen to the patients nor explain their health problems and discuss possible treatments, including the diagnosis and medication. As a result, patients and their relatives always remain confused about the role of the doctors as well the possibilities for treatment for alleviating their suffering.
The greed of Bangladesh's doctors is also reflected in their relationship with other health care professionals. They rarely delegate responsibilities to other medical specialists, such as physiotherapists, psychologists, counselors, nurses, speech therapists and so on, who are often looked down upon as lower class members of the health care profession in Bangladesh.
Moreover, medical equipment in public hospitals is intentionally kept "out of order" for years, in anticipation of increasing the business of private clinics and earning commissions. A patient cannot expect a simple pathological or radiological examination in public hospitals. Ultimately, patients are forced to go to private clinics and spend money far beyond their financial capacities. This culture has established a new group of millionaires in Bangladesh--the owners of private clinics. In addition, hundreds of people who can afford to do so--rich and middle-class patients--go to hospitals abroad, to avoid the local hellish health care service, while a lack of governmental monitoring helps sustain such systems at home.
Those in Bangladesh with serious illnesses or injuries painfully learn about the country's corrupt and inept health care system through their experiences, often paying the price, with their lives, like Rahima and Sima. While the conscience of the authorities has been in deep slumber for decades, these officials never reflect on their irresponsible behavior, often fatal to patients. The ongoing corruption in the public health care sector--the irresistible greed, ignorance of behavioral science, lack of ethical and professional commitment by doctors, and the preoccupied brokers of such business--hold the lives of many, hostage, while the group of so-called health care professionals dig graves for the common Bangladeshi people.
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(Rater Zonaki is the pseudonym of a human right defender living in Sylhet in Bangladesh who has been working on human rights issues in the country for more than a decade and who was a journalist in Bangladesh in the 1990s.)
