A child perishes, a woman’s fate placed in limbo

It has been more than a week since 31-year-old Ali Ahmad became a father for the first time, but he has had very few joyous moments to hold the baby in his arms. He has been in a race against time.

After his wife's cesarean delivery on April 15, he rushed from one hospital to another in the capital and contacted everyone he knew, seeking to get an ICU bed for the new mother Syeda Sadia Mahmud.

Rejected everywhere, Ali finally got her admitted to the Kuwait Bangladesh Friendship Government Hospital, a facility dedicated to coronavirus patients.

Sadia ended up there because she developed breathing distress a day after the baby was born. She stayed on an isolation bed with an oxygen mask to help her breathe, until her Covid-19 test result came out on Thursday. 

Healthcare providers at the Kuwait Bangladesh hospital had to be cautious that Sadia did not contract the virus from Covid-19 patients.

Had she tested positive, only then would she have been shifted to the ICU at the Kuwait Bangladesh hospital. Since the test result was negative, a private healthcare facility allowed Sadia's admission there. 

While her fate was hanging in the balance, at least six children died at Dhaka Shishu Hospital in similar circumstances over the last three weeks. They were denied ICU support over concerns of possible coronavirus transmission to other ICU patients. 

The latest death was counted on Tuesday morning.

A child, named Abdullah by his parents just three months ago, succumbed to pneumonia. When he arrived Monday night after a long journey of 120km from Faridpur by an ambulance amid the lockdown, he should have been taken to the ICU right away.

"His condition was critical, but the hospital had to wait for the child's Covid-19 test result," a doctor said requesting not to be named. Abdullah could not wait for the result.

"Whether he tests positive or negative, the hospital or the healthcare system cannot deprive him of treatment. Who should be blamed? The patient? No. Doctors? No," said the doctor with anger in his voice.

Abdullah's result returned negative on Friday.

Many in the healthcare system might see Abdullah's death as an unintended repercussion of a "further damage control" mechanism but Be-Nazir Ahmed, former national consultant at the Directorate General of Health Services (DGHS), said it was the hospital management that went wrong.

"In an emergency case when a patient needs ICU care, the patient must receive treatment regardless of whether tests can be done or if test results are available," he said.

To elaborate on his point, he said ICUs could be divided using red, yellow and green labels. "Green ones would be for those who are Covid-19 negative and red ones for novel-coronavirus-infected patients," he clarified.

"Those whose status is yet to be identified would be treated in the yellow-labeled ICU," he added.

The correspondent reached out to an epidemiologist, Kinkar Ghosh of the Shishu Hospital to understand what could have been done for Abdullah.  

He said all hospitals, that have an intensive care unit, should have one or two isolated beds. However, to his knowledge, there are no isolated beds in private or public hospitals across the country.

Whatever the solution might be, according to Be-Nazir Ahmed there should be clear contingency planning and guidelines on hospital management in times of a pandemic such as the novel coronavirus – not only for Covid-19 patients but for all patients.

He shared a similar experience of his own a week ago when he felt chest pain and went to the city's United Hospital.

"When they discovered that I had fever, they simply refused to treat me. I had to explain that I worked with Covid-19 patients and was fully aware that I was not infected and had I been infected, I would not have gone there," Be-Nazir told The Business Standard.

At this point, the hospital agreed to provide the necessary medical intervention to Be-Nazir who has a stent implanted in his heart.

"My case is an exception to the healthcare available and accessible to the public. I am a doctor, so is my wife. We have access to resources that an average person may not," he said.

"Alongside forming the guidelines, a centralised system should play the role of implementation, supervision and monitoring, and whenever there is a flaw, it should be fixed," he added.

"The DGHS or the health ministry should be the focal point," Be-Nazir said. 

No data is available on the patients, such as Sadia or Abdullah, but every life matters. When emergency care is what lies between life and death, the patient can in no way be denied treatment.

Sadia's sample was collected on Saturday. Ali was yet to get the result as he talked to The Business Standard on Tuesday.

Sadia, 27, had heart issues before she went under the knife, which was why Ali had repeatedly asked the management of a private hospital in Dhanmondi if it could provide intensive care when needed.

"I was assured of the ICU facility all along and for that I brought my wife from Khilgaon [where the family lives] to the hospital that is quite expensive," Ali, a software engineer, said.

Sadia was fine on April 16, but a day after she started coughing and showed signs of breathing difficulties. Looking at an X-ray of her lungs, a cardiologist of the private hospital suggested that she contracted a lung infection, but that was not due to the novel coronavirus.

Despite this, the hospital insisted on releasing the patient.

"I have sent my child home. My wife cannot breathe even for two to three minutes on her own," Ali said before receiving the test result.

Two days later, he said, "By the grace of God, we are all fine."