Ignoring instructions given by the Directorate General of Health Services, doctors outside of Dhaka are still referring non-critical patients to other district or divisional level hospitals.
The DGHS has given doctors the instructions before to continue treatment of non-critical patients at their own hospitals instead of making them undertake long journeys for better treatment, said Sanya Tahmina, line director of Communicable Disease Control at the DGHS.
“We always advise not to refer a dengue patient, even if critical, to other hospitals as it may deteriorate their condition due to the journey,” said HM Nazmul Ahsan, associate professor at the Shaheed Suhrawardy Medical College Hospital.
As a patient’s blood pressure may fall suddenly and problems during fluid management may arise during the journey, it may deteriorate their condition further, he said.
When a patient remains in shock syndrome or is in critical condition, then we suggest doctors to get the patient into a better condition before referring them, he said.
“We suggest using an ICU ambulance to take a patient to another hospital,” he added.
“Dengue treatment is possible in every hospital in the country even in Upazila level and if they want to refer them then they will have to ensure fluid during the journey,” Sanya said.
Oftentimes, guardians of patients want to shift them from upazila level hospitals to district or divisional level hospitals, even though the condition of the patients are not critical, sources of different upazila-level hospitals said.
Sumaia Aktar, 18, from Patuakhali’s Mirzaganj upazila, was infected with dengue and admitted to Dumki Upazila Health Complex on August 14.
Family sources said after being diagnosed at the complex, she was referred and admitted to Sher-E-Bangla Medical College Hospital (SBMCH) on August 16 and died there on August 19.
It took around two hours to reach SBMCH from Dumki, they said.
Dr S M Bakir Hossain, director SBMCH said Sumaia was admitted in the hospital with symptoms of diarrhoea and had blood in her urine.
On August 18, she was transferred to the intensive care unit (ICU) after her condition deteriorated. She died despite their best efforts, he said.
Health and Family Welfare official of Dumki Upazila Health Complex Dr Shahin said they referred her to the SBMCH next day as her pressure fell and she was suffering from diarrhoea.
He said they referred only critical patient to SBMCH for better treatment.
Civil Surgeon of Patuakhali district Dr Hedayatul Islam said a trend is being observed that many dengue patients are being referred to district level hospitals from upazila health complexes.
Guardians of the patients in many cases tried to take them to divisional level hospitals for better treatment due to better road communication.
“We are trying to motivate doctors not to refer patients unnecessarily,” he said.
Though a critical dengue patient in many cases needs ICU facilities, there are no ICUs or CCUs facilities in upazila level government health complexes across the country. Even many district level government hospitals also do not have the facilities.
Since August 8, hospitals outside Dhaka are receiving more dengue patients than those in the capital due to huge number of people travelling outside Dhaka for Eid.
Experts have termed this particularly alarming given the state of healthcare facilities in rural areas.
DGHS data shows a total of 59,592 patients admitted to different hospitals across the country till yesterday, of which 23,846 are outside Dhaka.
According to the DGHS there are 390 ICU beds in government hospitals across the country.
Assistant Director of the DGHS control room Dr Aysha Akhter said 60 patients are now undergoing treatment in ICUs in Dhaka.
There are 140 government hospitals at the district level and above, with 31,260 beds in total, while 524 hospitals with 20,026 beds in the upazila level and below, said Dr Satyakam Chakraborty, line director of DGHS’s hospital services management.
The number of private hospitals and clinics across the country is 5,055 with 90,587 beds, he said.
Anamul Haque, civil surgeon of Faridpur General Hospital said there were eight upazila health complexes in Faridpur.
But only three of the eight upazila health complexes have pathological test facilities. So, most of the dengue patients have been admitted to FMCH for treatment.
THREE PEOPLE DIE OF DENGUE
Three people died of dengue in Dhaka and Barisal yesterday with the number of the deaths rising to 110. However, official figure is 47.
Gias Uddin, 40, died after being diagnosed with dengue at Dhaka Medical College Hospital at 6:30am yesterday, while another person died of dengue at Suhrawardy Hospital yesterday, hospital sources said.
In Barishal, Monir Hossain Chowdhury, from Barishal’s Mehendiganj, died after being infected with dengue at SBMCH yesterday, hospital sources said.
(Our Faridpur, Barishal, Mymenshingh and Jhalkathi correspondents also contributed to the report)