When Mohammad Sayed, a rickshaw-van puller in Kallyanpur, Dhaka, had a brain stroke at 10am, he was immediately brought to the emergency unit of nearby Shaheed Suhrawardy Medical College and Hospital.
The urgency of the situation seemed lost on hospital staff as the patient was mad to wait for his serial for hours. When the doctor finally saw him, the 50-year old was asked to get a CT scan.
The patient and his younger brother rushed to the radiology department, away from the emergency ward, to perform the test. There, they met another long queue.
But an ailing Sayed could not wait anymore, and he eventually passed out by the time his name was called at around 1:30pm. After he was brought back to the emergency unit with the report of the CT scan, doctors asked him to get admitted to the hospital.
After going through all these procedures, his treatment finally began after 2:00pm – four precious hours after the stroke.
While every minute after a stroke or an injury is considered as a golden hour, like Sayed, many other patients in Bangladesh have to go through such lengthy processes before getting medical care. Apart from this, many hospitals outside the capital do not even have adequate facilities for emergency care.
Moreover, the country has an acute crisis of specialised doctors for emergency patients. Most hospitals run their emergency units with an emergency medical officer flanked by some interns.
"Golden hours are vital and emergency treatment is most likely to be successful during this period. Death rate usually drops if the patient is provided with emergency response during this time," Dr Humayun Kabir, president of the Bangladesh Society of Emergency Medicine, told The Business Standard.
He said many patients arrive at hospitals late owing to traffic congestion. They do not get proper treatment as most of the emergency units do not have adequate infrastructure and medicine specialists.
Emergency treatment unavailable at night, on weekends
Medical tests remain suspended at night and during weekends at most of the emergency units of government hospitals. The units also have a severe doctor crisis.
"The situation is worse outside Dhaka. Most of the hospitals in remote areas do not have any emergency medical facility," Suhrawardy Hospital Surgery Department Registrar Dr Rajib Dey said.
"Most of the district-level hospitals do not have medical testing facilities in the emergency units at night," he added.
The Business Standard contacted the Goalondo Upazila Health Complex over the phone on January 26 to verify the claim. The hospital said it suspends electrocardiogram, or ECG, after 2:00pm every day. Emergency unit patients of the health complex have to perform the test from private clinics after 2:00pm if they require it.
The computerised tomography scan (CT scan) remains suspended at Suhrawardy Hospital too after evening. Private clinics are the alternatives if any patients require the test.
No emergency unit at BSMMU
Md Jasim Uddin, a private sector employee, appeared at the Bangabandhu Sheikh Mujib Medical University (BSMMU) after an accident at the nearby Shahbagh intersection.
He looked for the emergency department. He phoned a previously-known physician as he failed to find it. The doctor informed Jasim that the lone medical university of the country does not have any emergency unit.
Although the foundation stone of the emergency unit was laid at BSMMU in 2015, there has been no further progress since then.
BSMMU Vice Chancellor Prof Dr Kanak Kanti Barua said they have completed all preparations to introduce the emergency unit.
"The road in front of BSMMU is off-limit due to the metrorail project. The emergency unit could be introduced by February 15 if the road is opened now," he said.
Dhaka medical only has full-fledged emergency
Only the Dhaka Medical College Hospital (DMCH) has full-fledged emergency facilities.
A one-stop emergency centre was established in 2019 at the DMCH with four intensive care units, six high-dependency units and five observation beds. Moreover, there are ECGs, nebulizers, X-ray, ultrasonography, CT scan and blood test facilities at the hospital.
The five-bed observation room has facilities including ECG, nebulizer and cardiac monitor to treat accident victims. The hospital also has a 3-bed neurosurgery and head trauma emergency room and a decontamination room for patients who have been exposed to toxic chemicals.
The hospital has round-the-clock specialised physicians on orthopedics, neurology, neurosurgery, cardiology, gynecology and pediatrics.
No emergency medicine course available
Emergency treatment requires a specialised group of medical personnel with special skills. However, hospitals in Bangladesh run the important unit with physicians who have no specialised training.
Bangladesh Society of Emergency Medicine President Dr Humayun Kabir says excessive bleeding, cardiac arrest, eclampsia or snake bites are serious conditions which require specialised doctors.
"Specialised doctors manage emergency rooms in developed countries. They have emergency medicine courses to train specialised medical personnel."
Under the emergency medical course, a physician is put into an emergency drill with gynecology, pediatric or cardiac cases. The physician performs the immediate lifesaving activity and forwards the patient to respective departments for further treatment.
"But the emergency room in-charge in Bangladesh are mainly medical officers and interns who only admit patients," said Dr Kabir.
Visiting Dhaka's National Institute of Traumatology and Orthopedic Rehabilitation and the Shaheed Suhrawardy Medical College and Hospital, the remarks were found correct.
The hospitals appoint one or two emergency medical officers with three to four medical interns for emergency services.
Shaheed Suhrawardy Hospital has eight emergency doctors. Three interns are assigned daily under a doctor for emergency patients. They are tasked with treatment, observation and admitting new patients at the same time.
The emergency unit of the hospital can perform minor operations and electrocardiogram. However, patients have to go to the radiology department for a CT scan or an X-ray.
What experts say
Medical experts advocated for a major overhauling of emergency medical treatment to reduce deaths. They called for training specialised doctors and changing the infrastructure of emergency rooms.
Prof Dr Omar Faruq, president of the Bangladesh Society of Critical Care Medicine, said it was upsetting that the country was yet to introduce a course on emergency medicine.
"Currently the emergency departments only admit patients. However, the departments were supposed to stabilise the patient and then admit them," he said.
He added that most of the emergency patients do not have their finances prepared prior to treatment. The private hospitals therefore do not stress on emergency treatment and refer the patients to government facilities.
Doctors said that neighbouring India, Sri Lanka and even Nepal have emergency medicine courses to produce specialised doctors. No course could even commence though the Bangladesh Society of Emergency Medicine has formulated a curriculum.
However, Directorate General of Health Services Director (Hospital) Dr Md Aminul Hasan said that the process of introducing an emergency medicine course is ongoing.
He said the emergency departments at government hospitals will be overhauled, commemorating Mujib Borsho – birth centenary of the Father of the Nation Bangabandhu Sheikh Mujibur Rahman.
"Dhaka Medical-like one-stop emergency centres will be set up at a number of hospitals this year. It will gradually be expanded to other hospitals as well."