Nishat (not her real name) was only 15 years old when she began experiencing symptoms such as joint pain, stiffness and swelling. Over time, additional symptoms emerged, including chest pain, dry eyes, shortness of breath and a butterfly-shaped rash on her face covering her cheeks and the bridge of her nose.
Her condition became so severe at one point that she had to be transferred from her home district Barguna to the capital, Dhaka, and admitted to a private hospital.
Despite undergoing numerous tests, doctors were unable to diagnose her condition. They treated her assuming it was Polyarticular arthritis. After several months, she started to feel better, and it was believed that the treatment was effective.
This was far from the truth. Nearly three years later, her symptoms returned, and this time they appeared even more severe. Chest pain and shortness of breath became more prominent, and doctors in Dhaka diagnosed it as tuberculosis.
Once again, she underwent treatment for several months until her symptoms were brought under control, only for them to resurface six months later. Nishat's parents decided that enough was enough. They had received advice from many to take Nishat to India where the 'diagnostic system was more efficient than that of Bangladesh.'
Indeed, after seeking treatment in India, Nishat's disease was finally identified as lupus, a condition in which the body's immune system attacks its own tissues and organs. She began receiving treatment accordingly, and two years later, Nishat appears to be doing better than before.
"According to doctors, this disease can never be completely cured. However, they suggested that with proper medication, it can be kept under control," says Nishat, further emphasising that had she delayed seeking treatment in India any longer, she wouldn't have been able to remain optimistic about her prognosis.
Nishat is among approximately 2.5 lakh Bangladeshis who seek medical treatment in India annually. Furthermore, according to data from India's Ministry of Tourism in 2021, the influx of medical tourists from Bangladesh had surged by 83% over the previous three years. A huge majority of medical tourists — 54.3% — who had visited India in 2020 were from Bangladesh.
Needless to say, the trend of Bangladeshis seeking treatment in India is rising every year. This begs the question, why do so many Bangladeshi patients prefer India as their medical destination instead of relying on the country's own healthcare system?
As it stands, the healthcare services in Bangladesh are largely deemed inadequate by the majority of patients seeking medical care in India for various types of critical treatments and surgeries. They also express concerns about the lack of dedication and efficiency among Bangladeshi doctors, with many casting doubt over the accuracy of the diagnostic system within the country.
Most critical patients seek treatment in their respective hometowns first, but are eventually referred to specialists in Dhaka. Despite shelling out significant sums of money for regular check-ups and diagnostic tests, they often encounter unpleasant experiences.
Many of these patients feel that specialist doctors in Dhaka do not take the time to thoroughly listen to detailed descriptions of their ailments, and this frustration leads them to seek better treatment in the neighbouring country.
Jasim Hawlader, who recently underwent heart surgery in India, shared that his initial preference was to have the surgery done in Dhaka. However, he was dissuaded from doing so by his relatives. His decision to seek surgery in India was also influenced by the perceived lack of sincerity and assurance from the Bangladeshi doctors.
"In the end, I concluded that it would be best to have the surgery in India. This way, it would provide me and my family with the assurance that I received the best possible treatment," Jasim explains.
According to Dr Be-Nazir Ahmed, a public health expert and former director of the Directorate General of Health Services (DGHS), the primary reason people are losing faith in Bangladesh's healthcare system is the decline in the quality of public hospitals.
Dr Be-Nazir noted that two decades ago, 80% of the population relied on public hospitals. However, that figure has since plummeted to just 20% due to dissatisfaction with the services provided in public healthcare facilities.
Furthermore, he elaborated that the quality of service in private hospitals also leaves much to be desired. Test results often vary among different pathology labs, which erodes people's trust in them.
"Additionally, the shortage of specialist physicians in the country forces each specialist to see hundreds of patients daily, leaving them with limited time to address each individual's concerns, typically just two or three minutes per patient," he said, adding that all these factors collectively contribute to the middle-class population's decision to seek better treatment in India.
Dr Gopen Kumar Kundu, an Associate Professor of Neurology and Deputy Director (Admin) at the Institute of Pediatric Neurodisorder & Autism (IPNA), also highlighted the shortage of specialist physicians in the country.
"Specialist physicians consistently strive to provide their utmost effort to each individual patient. However, more often than not, they are unable to fully meet that goal because they are required to attend to a significant number of patients every day," explained Dr Kundu.
It's worth noting that according to the World Health Organisation's health worker density in South Asia data, in 2020, there were six doctors for every 10,000 patients in Bangladesh. The number is 25 in Singapore, 23 in Malaysia, 21 in Maldives and 12 in Sri Lanka.
Furthermore, according to a 2017 BMJ journal publication, the average duration of physician consultations in Bangladesh in 2015 was a mere two minutes, while in countries like Sweden and the United States, it is as high as 21 minutes. Interestingly, the same journal reported that the average length of physician consultations in India was also just two minutes.
Nevertheless, the prevailing perception among Bangladeshi patients seeking treatment in India is that Indian doctors are more engaged and eager to attentively listen to all of their concerns, be they relevant or irrelevant.
Roksan Ara, who recently went to India with her daughter as an attendant, recounted a fascinating experience in this regard. During their initial visit to a physician in Kolkata, she mentioned her intention to visit her father's grave in the city. Two weeks later, when they returned to the same doctor, she was pleasantly surprised when the physician inquired about her visit to her father's grave.
"It's surprising that the doctor even remembered such small details, which underscores their genuine sincerity and care," Ara shares.
According to a recent research study published in May of this year, titled "Determinants of Decision-Making and Satisfaction Among Bangladeshi Patients Seeking Medical Tourism in India," it was found that over three-fourths of the participants had travelled to India for self-treatment.
Of the 388 participants, 14% were cardiology patients, followed by cancer (13%), other diseases (13%), gastroenterology (11%), rheumatic disease (7%), neuro (6%), kidney (4%), eye (4%), ENT (4%), gynaecology (3%), liver (3%), orthopaedics (3%), lung (3%), endocrinology (3%), risky tumour (3%), tumour (2%), infertility (1%), haematology (1%), plastic surgery (1%), knee replacement (1%), and diabetes (1%).
Additionally, 11% of the study participants travelled to India to diagnose their health problems, which is a prerequisite to providing appropriate treatment and medication. Patients often mention that although some medical technologies are available in Bangladesh, they have lost faith in doctors and their use of these technologies.
According to Priya Sen, an International Patient Coordinator specialising in India-Bangladesh healthcare connections based in Kolkata, Bangladeshi patients are not just travelling to India for complex medical conditions; nowadays, they are also going for even minor ailments. Full-body check-ups in India have gained particular popularity among Bangladeshis due to their lack of confidence in their own country's diagnostic system.
"The cost of a high-quality full-body check-up in India starts from as low as Rs 5,000, and it can go up to Rs 10,000. In most cases, the diagnostic reports are highly accurate. Remarkably, some individuals even travel from Bangladesh for something as routine as monthly haircuts," Sen noted.
Many Bangladeshis also travel to India for cosmetic treatment or laser skin resurfacing, which are not generally available in Bangladesh, added Sen. She further pointed out that it is possible for Bangladeshis to access free medical treatment in various government-run hospitals. However, many Bangladeshis lack the knowledge of how to seek appropriate medical care in India.
"Most people are only aware of Kolkata and Chennai as a medical destination, but there are numerous other healthcare destinations available, tailored to specific medical conditions," she added.
However, the role of a patient coordinator like Priya goes beyond just guiding patients to the right doctors. Seeking medical treatment in India is a lengthy and intricate process for Bangladeshis, starting with obtaining appointment letters from preferred hospitals, then dealing with visa applications, immigration procedures, finding accommodation in Indian cities and managing currency exchange, among other things.
"There is still no way for Bangladeshi tourists to legally transfer money in India from their country. So, they are compelled to resort to Hundi," said Sen. Hundi is an informal cross-border money-transfer system that bypasses the legal banking system.
Considering the significant number of Bangladeshis travelling to India each year for improved medical care, India's renowned Desun Hospital is in the process of establishing a facility in Bangladesh. The estimated cost for this venture is approximately Tk1,000 crore, and the hospital is actively searching for suitable land in Dhaka, Chattogram, Khulna and Sylhet.
The hospital's Managing Director Sajal Dutta made the announcement last month. According to him, Bangladeshi doctors would serve in the facility but Desun would seek to bring in some nurses and technicians from India. Indian doctors would also pay visits occasionally to share experiences with their Bangladeshi counterparts.
However, Dr Be-Nazir doesn't believe setting up an Indian hospital will change the country's healthcare system overnight. He emphasised the need for a comprehensive overhaul of the healthcare system in Bangladesh, "we must revamp the healthcare system in our country from its very foundations. Otherwise, a handful of new hospitals will be insufficient to cater to a population of 20 crore people."
Meanwhile, according to reports, Bangladeshis spent Tk 99.33 billion on treatment abroad, while the total expenditure by the outbound tourists was Tk 336.80 billion in the 2018-19 FY.
Consequently, a 2021 research paper titled "Why Bangladeshi Patients Prefer Outbound Medical Travel? An Analytical Study" recommended urgent measures, stating, "the Bangladesh government should immediately boost the health sector and develop global standard diagnostic centres, medical colleges and hospitals.
So, the responsible authority should take appropriate policies, actions and guidelines to induce investment by the public-private partnership (PPP) and the private and foreign sectors for developing new diagnostic centres, hospitals and medical colleges at a world-class level."
The key goal, however, is to bring back the faith in people's minds, said Dr Dhanonjoy Kumar, co-author of the paper, and also an Associate Professor of the Department of Management at Islamic University.
"Based on my conversations with Bangladeshi patients who travel to India for medical care, it's evident that they have completely lost faith in the country's healthcare system," he said.
Moreover, the fact that political leaders and policymakers themselves seek medical treatment abroad only adds to the scepticism surrounding the country's healthcare system. "Unless this trust is reinstated, the inclination to seek treatment in India or other countries cannot be diminished," Dr Dhanonjoy concluded.