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The perception about Bangladesh may have since changed somewhat, but the country still faces many challenges. It has yet to bring economic and political stability and establish the rule of law. Some improvements in its educational and healthcare systems have been made, but more needs to be achieved, especially in the healthcare system.
In Bangladesh, healthcare is offered either through government-run hospitals or through privately-run clinics. The government is the biggest healthcare provider to which all citizens supposedly have equal access, whereas private clinics are for paid clients. But most government-run hospitals, especially those outside the big cities, seem to lack adequate doctors, medicines, medical equipment and technicians.
In big cities hospitals are comparatively better equipped, while in small cities and villages the medical facilities are dreadfully insufficient. But services at government hospitals remain as bad as ever. Recent news reports about a scandal in the country's main hospital in Dhaka reveal the extent of unethical behavior. To promote their private practices, doctors would either not treat patients in the hospital or would refer them to expensive labs outside the hospital even though such services were available in the hospital at reduced rates.
Services available from private practitioners and clinics may be considered better, except in the villages where quack doctors continue to reign. Many private clinics rely on outside facilities for lab tests and x-rays. These facilities, however, are ill-equipped to provide appropriate services, lacking either proper medical equipment, trained technicians or correct management.
The government has also failed to regulate them to ensure quality. Wrong diagnosis followed by incorrect treatment resulting from unreliable lab tests or even misinterpretation of symptoms have become daily occurrences. It is not uncommon in Bangladesh for a person with heart disease to be treated for asthma or a patient with appendicitis to be prescribed for stomach virus.
Thus, the overwhelming majority of people in Bangladesh continue to be deprived of reliable medical services. The general public is clearly trapped in a decayed system. Ironically, the very rich are not affected by this situation, since by virtue of their wealth they can seek medical help outside the country. In fact, India, Singapore and Thailand have become quite popular destinations for the country's rich for obtaining medical services. As a result, each year Bangladesh loses millions of dollars of its precious foreign exchange.
Bangladesh is well known for producing many medical doctors through its state-funded medical schools. Some of them have indeed become top-notch doctors and specialists in various advanced medical fields. But a good number of them have left the country and are now settled permanently elsewhere. Of those who remain, most find the situation not conducive to providing good healthcare service; a few have become money-making machines with little regard for human values.
Bangladeshi expatriate medical professionals including doctors, dentists and pharmacists could play an important role in initiating or bringing about a change. Besides medical professionals, there are other Bangladeshi professionals, such as engineers, scientists and others, who have availed themselves of the country's state-funded education facilities and then established themselves abroad.
Some of these professionals, either out of a sense of moral obligation or personal satisfaction, are now working hard to give back something to their native land through individual projects. Others are looking for worthwhile projects in Bangladesh to support. Since healthcare remains neglected, expatriates could help in this area by pooling their resources. Bangladeshi medical professionals could lead the way.
One way to arrange this would be through an organization modeled after the international NGO "Doctors Without Borders" to provide medical services that may or may not be available in the country, or which may be out of reach of the poor. Qualified professionals could manage the organization, while Bangladeshi expatriate medical professionals would provide the services.
Gains from this arrangement could be threefold: the benefit to the common people, the benefit to the country in saving its foreign exchange, and the pressure it would create on existing medical facilities to improve. Moreover, the expatriate doctors could speed up the spread of the latest medical knowledge through workshops, seminars and short courses in Bangladesh's medical colleges.
Here is how it might work. First, an institution such as "Bangladesh Hospital in Exile" with modern medical equipment would be established, with at least one permanent hospital unit located in Dhaka. Second, a databank of expatriate medical professionals who would donate at least two weeks of their services in a given year would be prepared, and a procedure for rendering their services in Bangladesh would be set up. Those professionals who could not give their time in a particular year would donate a comparable amount of money for the hospital.
Third, a caravan of buses furnished with modern medical equipment including power generators and sleeping arrangements would be obtained. This caravan of buses would be used as a mobile hospital attended by the expatriate medical professionals, and operated from a different place every month. This mobile hospital, similar to the floating hospital presently working in Bangladesh, would be equipped with supplies of common medicines, such as analgesics, vitamins, vaccines, antibiotics, and the like as well as locally recruited nurses and attendants.
The permanent hospital unit in Dhaka would provide the most advanced and specialized medical services mainly through referrals from local doctors. As for the mobile hospital, patients who would need follow-up or specialized treatment could not be helped. But it is expected that its better trained expatriate doctors would be more qualified to give the best diagnosis or advice to patients than would local doctors. The importance of proper diagnosis cannot be overemphasized. Each year, a great many people in Bangladesh either die prematurely or endure unnecessary suffering because of wrong diagnosis by local doctors. More reliable diagnosis or medical advice from these expatriate doctors would be a tremendous help. Patients who would require specialized treatment would be referred to the hospital in Dhaka.
There is another big benefit from the mobile hospital. It is estimated that more than fifty percent of medical situations in Bangladesh are caused by infectious diseases originating from polluted drinking water or improperly disposed human waste. The other serious medical problem Bangladesh faces is lethal arsenic, whose source is also water. It would be a tremendous accomplishment if through this mobile hospital the general public would get appropriate lessons on how to avoid these undesirable things.
Additionally, birth control continues to be a serious problem for the country's underprivileged. Some improvements have been made, but population growth is an acute problem that is not being addressed with the urgency it deserves. Even at the present reduced growth rate of about 2 percent a year, the population of the country will double in about 35 years. This is extremely worrisome for a country whose population density is already one of the highest in the world. Doubling the current population would be a clear invitation to the worst social and environmental disasters, especially since most of the low-lying areas of the country are expected to be submerged under water because of global warming.
As for birth control itself, the "timely withdrawal" method is still the safest and most inexpensive method, though its result is not guaranteed. Considering all aspects, however, it may be the most appropriate method of birth control for the people of Bangladesh. Expatriate doctors or professionals could emphasize the need for birth control, and at the same time motivate the public to adopt this method. They could accomplish this by organizing small discussion groups and by showing videos on the topic to people in areas where they would camp their mobile hospital every month. Rural people would be more inclined to heed the advice of expatriate doctors on birth control and other health-related matters than their counterparts in the country.
There are additional functions the proposed hospital could perform. It could create an interactive Web site to serve as a clearinghouse for expatriate doctors wishing to help during their family visits in a certain area of the country, allowing doctors to post their expertise and availability and permitting local institutions to communicate with them. The Web site could also allow visiting doctors and their Bangladeshi host institutions -- and possibly their patients or students taught by them or local doctors who worked with these visiting doctors -- to record their experiences with each other. This would over time increase the effectiveness of the exchange program by providing information to both sides.
Bangladeshi expertise is now available in almost every medical field and expatriates have the resources to implement a plan to offer their services to the country. A good procedure is needed to pool available resources. Bangladeshi medical associations abroad could certainly take the lead, and with the help of information technology professionals, could easily put together a workable plan. Then other Bangladeshi professional organizations, such as dentists, pharmacists and engineers, could be invited to join. This would be an ideal way for the medical expatriates and others to give back something useful to their native country.
There are international organizations prepared to lend monetary and logistic support. Assistance from those organizations could also be expected and arranged for a venture like this, if and when necessary.
Instead of small individual attempts to help Bangladesh, a lot more could be achieved if the expatriates were to combine their resources and arrange something on a large scale. The dispensing of quality healthcare service in the country would surely be a worthwhile cause to consider for a collective effort. Let us sincerely hope the idea catches on quickly.
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(Mahfuz R. Chowdhury is a professor of economics at C.W. Post Campus of Long Island University, New York. ©Mahfuz R. Chowdury.)
