Dysfunctional tools make cancer treatment paralysed

Reza Mahmud :

The National Institute of Cancer Research and Hospital (NICRH), the country’s principal center for cancer treatment, has increasingly become a source of suffering for many patients.

A recent government impact assessment report reveals that 41.35 percent of patients face harassment while seeking treatment. While using ambulance services, 54 percent of patients complained of misconduct by staff.

Severe shortages of medicines, many expensive machines remaining non-functional for long periods, and acute staff shortages have raised serious questions about the quality of services at the hospital.

These findings emerged from an impact assessment conducted by the Implementation, Monitoring and Evaluation Division (IMED) of the Planning Commission.

Typically, IMED carries out such assessments after the completion of a project to evaluate how far it has achieved its objectives and how beneficiaries are being served. The report was prepared based on on-site inspections, verification of construction quality, review of procurement documents, data verification at multiple levels, and interviews with local beneficiaries, administrators, and other stakeholders.

The assessment was conducted by a third party, Yusuf & Associates, and included interviews with 348 individuals and 12 case studies. The report was submitted to the Planning Commission last December.

When contacted, eminent cancer specialist Dr. Habibullah Talukder Raskin told The New Nation on Wednesday, “Huge mismanagement paralised the cancer treatment in Bangladesh. You see, while there were only six radiotherapy machine in the country’s lone cancer hospital all of those became dysfunctional at a time in 2021-22, set a grave example of mismanagement in the sector.”

He said, the concern authorities have to be more sincere to overcome such mismanagement to give life saving treatment to number of cancer patients.

Amid this situation, World Cancer Day observed in Bangladesh on Wednesday, under the theme “United by Unique.”

According to the report, out of 121 types of equipment at the hospital, seven critical and costly machines, including a multi-slice CT scanner, have been non-functional for a long time.

Due to insufficient maintenance budgets, MRI machines, CT scanners, and linear accelerator machines are almost inoperative.

The NICRH upgradation project began in 2003 and was scheduled for completion in 2006. However, after seven revisions, it was completed in 2020, meaning a three-year project took 17 years to finish.

The original allocation was Tk 120 crore, which eventually rose to Tk 217 crore. IMED’s report states that more than Tk 3.14 crore was paid to contractors without laboratory testing of construction materials. Additionally, in violation of PPR-2008, contractors were paid an extra Tk 6.36 crore through a single item beyond authorized limits.

Rise in Patient Numbers

A review of hospital authorities’ records shows that patient numbers have increased significantly over the past few years in outpatient, inpatient, and emergency departments. Comparing data from 2015 and 2023, average daily outpatient visits increased by nearly 72 percent, from 477 to 820 patients. During the same period, the number of admitted patients rose by about 126 percent, from 215 to 486. The sharpest increase was seen in the emergency department, where daily patient numbers jumped from 12 to 56, an increase of nearly 367 percent.

The Real Picture of Patient Suffering

Jubeda Begum, a resident of Netrokona, came to the oncology department yesterday for chemotherapy. She said it took six months to get a serial, but there was no opportunity for admission. After receiving chemotherapy, she must return to Netrokona. Treatment costs here are somewhat lower than in private hospitals, but the suffering is severe. Each chemotherapy session costs Tk 22,000, with an additional Tk 4,000 for medicines and travel. “Our family has been almost completely impoverished due to treatment expenses,” she said.

Drug Shortages and Slow Services

Due to medicine shortages at the hospital, many patients are forced to buy extremely expensive drugs from outside. Poor patients suffer the most as a result. Surveys show that 16.12 percent of patients complained about slow services, 8.88 percent cited unwillingness of service providers, and 40 percent reported administrative non-cooperation.

Non-functional Equipment

Because of a lack of maintenance budgets, the hospital’s MRI and CT scan machines have remained out of order for long periods. On-site inspections found that advanced equipment, including linear accelerators, remain practically unusable due to lack of repairs. As a result, many tests from the radiotherapy and radiology departments must be done outside the hospital, which is extremely costly and time-consuming. For many poor patients, bearing these costs is nearly impossible.

Harassment and Denial of Services

Patients reported that treatment is being delayed due to non-functional equipment. Some alleged that radiotherapy machines are deliberately not repaired so that patients are referred to private hospitals. Experts say that patient suffering could be significantly reduced by introducing separate counters for specific (target) patient groups, faster service systems, and digital serial systems.

Former Health Sector Reform Commission member and cancer specialist Professor Dr. Syed Akram Hossain said there are 800,000 to 1 million cancer patients in the country, with around 200,000 new cases each year. About 150,000 people die from cancer annually. Due to long-standing inadequacies in cancer treatment facilities, many patients have sought advanced treatment abroad, leading to significant foreign currency expenditure. Those unable to go abroad have suffered without proper treatment. Considering this reality, he said, the government must strengthen cancer treatment infrastructure and enhance the capacity of research institutions.

Professor Dr. Golam Mohiuddin Faruk, President of the Bangladesh Cancer Society, said that to take preventive measures based on the situation, hospital-based and population-based cancer registries are urgently needed. So far, this has not been fully implemented in the country. The Bangladesh Cancer Society and research institutes are trying pilot projects with government support. Without increasing service capacity, patient suffering will not decrease.

Hospital Director Dr. Md. Jahangir Kabir said, “Although the hospital has 500 beds, it is effectively operating with manpower for only 300 beds. Due to shortages of specialist doctors and skilled nurses, patients are not receiving quality services. Patient pressure has increased significantly. We have purchased two new therapy machines and taken initiatives to repair non-functional equipment. However, without increasing manpower, ensuring quality service will be difficult.”