The neglected side of our health sector

Most of the time when we hear the term "health sector", we picture doctors in crisp, white aprons with silver stethoscopes around their necks.    

However, it took us a pandemic to realise that other than doctors, the health sector also requires skilled nurses, medical technologists, biochemists, biotechnologists and microbiologists to function properly.

Although they are not trained as doctors, these professionals are equally important in the health sector. 

Bishnu Sarker, a phlebotomist (blood sample collector) at DigiLab had to complete a four year diploma course to become a medical technologist. 

After completing his studies, he worked in two diagnostic centres but never came across any government recruitment circular. 

In fact, it has been 11 years since the government recruited technologists. 

Bishnu could bag a job in the private sector, but around 30,000 medical technologists like him are unemployed. Of them, 15,000 are lab technologists.

Even then, 5,000 medical technologists graduate every year from around 90 institutions across the country. 

The President of Bangladesh Medical Technologist Association (BMTA) Md Almas Ali Khan said there are only 3,155 government appointed medical technologists in the field out of the 30,000 registered ones. 

Amidst such chaos and mismanagement, the Ministry of Health and Family Welfare appointed 5,054 nurses and 2,000 doctors to fight the pandemic, but did not hire any new medical technologists. 

Almas Khan said that although there was an instruction to appoint 3,000 medical technologists, he has not heard of any progress yet. 

On June 30, Bangladesh witnessed the highest number of deaths in a day – 64. However, the number of tests is still not sufficient.

Patients are not receiving adequate treatment at  hospitals, and both doctors and nurses admit to this. There is a shortage of ICU beds and necessary equipment. The available ones are not helping much as there are few people who can operate them. 

According to the World Health Organisation (WHO) standard, each hospital should have one doctor for three nurses and five medical technologists.

According to that ratio, we should have around three lakh nurses and five lakh medical technologists for 102,997 registered doctors in Bangladesh (source: Directorate General of Health Services, DGHS). 

In reality, the number of registered nurses is only 73,000 and not all of them are employed. 

The country has around 86 undergraduates and 250 diploma nursing colleges (public and private) that produce 15,000 nurses every year. According to

Bangladesh Basic Graduate Nurses Society, every year only about 5,000 nurses get recruited.

According to BMTA, three technologists have died and many more have been infected with the coronavirus. 

Yet, neither have they been provided with quality PPE, nor have they been included in the government's incentive plans. 

The condition of microbiology and biotechnology departments

While medical technologists are praying for better days,  microbiology and biotechnology graduates from the country are leaving for abroad every year.

Graduates of genetic engineering, microbiology, pharmacy, biotechnology or biochemistry are usually trained to be researchers, virologists, biochemists, epidemiologists etc. 

They can easily work in  hospitals along with our doctors. 

But there is a very little scope for them to do so, which is why they are either forced  to change their discipline or leave the country for better opportunities.

Sharmistha Goswami, a junior researcher from Children Health Research Foundation of Bangladesh, said that MBBS students study microbiology, biotechnology or biochemistry when they are in third year. They are supposed to work with  host bodies and their whereabouts. 

Microbiologists are supposed to work with viruses and bacteria and explore the nature of parasites. 

To conduct such researches, students from biological science backgrounds should be recruited in hospitals as well. 

"In our country, doctors are appointed as microbiologists, biotechnologists, virologists and biochemists. And we are deprived of job opportunities," she said.  

She added, " We have only two government and two private research centres where students from biological science can apply. The job openings are insufficient compared to the number of graduates.

Sharing their plight, she pointed out to a recent government job circular that invited students from fisheries department to apply for the post of microbiologist.

Hossain Adib is a fourth year student of Genetic Engineering and Biotechnology at University of Dhaka. Before the pandemic, he was planning to go abroad and becoming a scientist. 

Explaining his decision, he said that there is no technical post for them in the Bangladesh Cadre Service (BCS) examination. 

The toppers can become faculty members in universities, but the rest suffer from lack of job opportunities.

Dr Mohammad Rafiqul Islam, president of Bangladesh Society for Microbiology, Immunology and Advanced Biotechnology (BSMIAB) said that microbiology and biotechnology are taught in 25 public universities. 

In technical universities, the yearly expenditure behind each student is one lakh and in general universities, the cost is 50 thousand. 

He said that 700 biotechnology students and around 1,500 microbiology students graduate every year.

"This pandemic could be a very good opportunity for microbiology and genetic engineering students to explore their knowledge and expertise," he said. 

 "Our health sector is not inclusive at all. We could easily utilise our graduate students in coronavirus testing as they know about Polymerase Chain

Reaction (PCR) machines and could employ them in research work. But we did not do it because we thought the sector should be run by doctors only," said Dr SM Mahbubur Rashid, assistant professor of Genetic Engineering and Biotechnology, University of Dhaka. 

He opined that students who completed their honours and masters from biological science departments can be recruited as microbiologists, biotechnologists and biochemists in hospitals and diagnostic centres rather than doctors who studied microbiology as a subsidiary course or took an MD degree afterwards. 

"But they are not given the chance," he said. 

Dr Mahbubur Rashid pointed out that although the government has instructed all universities to include subjects like genetic engineering, microbiology,  pharmacy, biotechnology and biochemistry, it has not expanded the sector where the graduates can actually work.  

"It is a waste of money if we cannot keep them here or force them to change their discipline," he said.

Addressing the condition of the country's health sector, he urged policymakers to be inclusive in their decision-making. 

He said, "You do not need only doctors to run the health sector. You need technicians, researchers, you might even need students from statistics to keep better record of  data, you might need computer science engineers to work on websites and you need policymakers who understand all of these."

He further said that  in order to develop the health sector and make it more efficient, there should not be any discrimination in recruitment and there should be some major reconstructions on the ground to make the sector more inclusive.