All of the 26 ICU beds in the Kuwait Bangladesh Friendship hospital cannot be made operational due to manpower shortage, many patients are being turned away every day

Though there has been a large spike in coronavirus cases, Kuwait Bangladesh Friendship Government Hospital -- the country's first hospital dedicated solely to treat such patients is still handicapped with shortage of manpower and other necessary equipment.

According to information from the health directorate, 192 intensive care unit (ICU) beds are dedicated to Covid-19 patients in the country, of which 26 are in this hospital. However, 16 of the beds in the hospital are still empty because there is no skilled manpower to attend to them.

A doctor of the ICU department of Kuwait Bangladesh Friendship Hospital tells The Business Standard that neither are there adequate numbers of doctors and nurses nor are there enough support staff to keep all the ICU beds in the hospital prepared.

Currently, there are 9 doctors for the 10 running ICU beds. Four of them have joined just this week. Initially, there were 10 nurses but now 27 nurses are working there.

The doctor says this number of doctors and nurses is sufficient for 10 beds but they are not enough to support 26 beds.

However, he says the greatest difficulty they are facing now is that there is no government-employed support staff. Their tasks are being done by outsourced staff.

One ward boy handles 8-10 patients in a single shift, he says, adding that they are facing tremendous inconvenience as working for more than three hours wearing personal protective equipment is very difficult. For this reason patients are also not getting proper care.

Because all of the 26 ICU beds in the hospital cannot be made operational due to manpower shortage, many patients are being turned away every day.

Besides, there is a lack of laboratory facilities in the ICU of the hospital.

According to international guidelines, there must be 4 syringe pumps for each ICU bed but in Kuwait Bangladesh Friendship Hospital there are 10 syringe pumps for the 10 running ICU beds.

The doctor says they are also facing difficulties in using ICU ventilators, dialysis machines and portable x-ray machines because of a low load capacity electricity connection.

The electricity substation in the hospital is not of sufficient capacity to provide power to the 26 ICU beds and support equipment, he says adding that they have to shut off the electricity circuit to a part of the hospital to have enough power when they use the CT Scan machine.

Like Kuwait Bangladesh Friendship Hospital, Kurmitola General Hospital – also dedicated to the coronavirus response – has been suffering from shortage of manpower and a lack of logistic support. There is no central oxygen line at the ICU of the hospital, for which doctors are facing difficulties in providing patients with cylindered oxygen.

Scarcity of critical care medicine specialists and anaesthesiologists

There are a total of 1,200 ICU beds, including 192 dedicated to coronavirus patients, in the public and private-sector hospitals across the country, but there is not enough skilled manpower to operate those.

Trained doctors and nurses are needed to operate an ICU. At present, the country has a requirement for at least 600 critical care medicine specialists. However, only 30 doctors have so far earned MD degrees in critical care after the course was introduced in the country in 2008.

Only Dhaka Medical College, Birdem, and Bangabandhu Sheikh Mujib Medical University currently run postgraduate courses in critical care medicine.

Pointing to the shortage of doctors and nurses with expertise in critical care, Prof Mohammad Omar Faruq, president of Bangladesh Society of Critical Care Medicine tells The Business Standard that on an average three doctors complete the course in critical care in the country every year, which is very low for the actual need.

None of the nurses in the country is trained in critical care, he mentioned.

"There is no institution to educate nurses in critical care. Nurses who provide critical care services at ICUs have basically learned by working with others. They do not have any formal education on this subject."

Anaesthesiologists are primarily responsible to operate ICUs in the country but there is also an acute shortage of anaesthesiologists.

Dr Debabrata Banik, president of Bangladesh Society of Anaesthesiologist says around 2,500 trained anaesthesiologists work in all public and private hospitals in the country.

The shortage of anaesthesiologist was being felt for long, however, the crisis has become more critical following the outbreak of Covid-19.

Appointment of medical technologists suspended for 11 years

At this critical time for fast test results, there is a shortage of highly trained lab technicians but there has not been any recruitment of such personnel in the last 11 years.

At present there are 30 Polymerase chain reaction (PCR) machines in 21 labs across the country. PCR machines are used for analysis of samples of DNA and infectious agents.

The labs can test 5,000 samples a day, but there are not enough lab technologists to even run 3,000 tests in a day as yet.

Assistant Professor of virology department at Shaheed Suhrawardy Hospital Dr Jahidur Rahman says from collecting samples to testing in PCR, several steps are needed to be maintained properly.

"For this, we need skill, manpower and setup. Few labs in the country have these three elements," he says.

Dr Jahidur Rahman says frontliner technologists are required for both sample collection and laboratory tests. However, the government has not recruited any medical technologist in the last 11 years.

Moreover, the qualification of sample collectors from patients is also questionable as many of them have not had proper training. Experts say improper sample collection will result in wrong test results.

This becomes critical at this time as undiagnosed coronavirus patients will spread the disease at community level. Therefore, collecting samples with trained personnel is the critical part to detect a coronavirus patient.

Recruitment of laboratory technologists for collecting samples and conducting tests is very urgent at this moment, Dr Jahid stressed.

It has been learned that around 30,000 medical technologists are currently unemployed. Of them 15,000 are lab technologists.

The government has not recruited any medical technologists after 2008. A job circular for medical technologists was issued in 2013, but the recruitment could not go ahead as a case against the circular is now under trial at the Appellate Division of the Supreme Court.

However, former secretary general of Bangladesh Medical Technologist Association Selim Molla has urged the government to press into service the 15,000 jobless medical technologists at this moment of crisis.

He says the government can recruit them on contractual basis until the lawsuit is over .

Interrupted power supply harms treatment at hospitals during peak demands

Even though there is a lower power usage now because of the countrywide shutdown, power supply disruption is a problem in the hospitals.

load-shedding is threatening the treatment of coronavirus-affected and other patients undergoing treatment at different hospitals.

Especially, patients at ICU and ventilation units could be the worst sufferers if oxygen supply and the monitoring process go off due to load-shedding and if there is no alternative electricity supply.

Continuous electricity supply is a must for these units, says a doctor at Birdem General Hospital.

Earlier this month, Kuwait Bangladesh Friendship Government Hospital, the main treatment facility of the country for the coronavirus affected patients, was struggling with load-shedding and low voltage problems.

The problems were solved by the Dhaka Electricity Supply Company (Desco) 10 days ago on request from the hospital authorities, says Md Kausar Ameer Ali, managing director of Desco.

He claims there is no load-shedding in Desco's distribution areas. The company supplies electricity in the Dhaka North City Corporation areas.

"The problem that the city dwellers are facing is not load-shedding, rather it is an interruption which happens due to system trip and load exchange. This is part of the system," Ali explains.

He claims that there is no reason for load-shedding as his company has enough electricity to supply.

Earlier, Desco used to supply 900 megawatts of electricity in its areas, which has now declined to 500 megawatts.

Consumers outside of Dhaka, especially those in Barishal, Bhola, Noakhali, Feni, Khulna, and Jashore are the worst sufferers of load-shedding.

Electricity users in these areas have to face two to three hours of power outage every day.

When asked, BREB chairman Major General Moin Uddin (Retd) said they cannot protect the supply system against natural elements.

"Storms, and rains are a part of this season. These natural events are the prime reason for the power supply disruption as they damage our distribution systems," he says.

"Sometimes, we also turn off the supply to avoid any accident," he added.

However, consumers are unhappy as they are not getting uninterrupted electricity supply while the country has a capacity to generate 22,000 megawatts of electricity against a demand of only 8,000 megawatts.

Same time in the last year, distribution companies supplied around 11,000 to 12,000 megawatts of electricity on an average across the country.

Now, the demand has dropped to 75,000 to 8,000 megawatts due to the nationwide shutdown imposed to curb the coronavirus outbreak.