Children Perish Awaiting ICU Care
A critical shortage of Pediatric Intensive Care Unit (PICU) beds across Bangladesh, exacerbated by a surging measles outbreak, is leading to tragic and preventable deaths of children, forcing desperate parents to navigate an overwhelmed healthcare system. Six-month-old Gouri, a firstborn, recently died at Rajshahi Medical College Hospital while awaiting a PICU bed, her family’s anguish echoing the plight of many others struggling to secure vital specialized care for their ailing children, according to a report by `প্রথম আলো`.
The crisis highlights a profound systemic gap in the country’s healthcare infrastructure, where parents often receive news of their child’s death while desperately searching for an available PICU slot. Physicians are increasingly advising emergency PICU admissions for children, particularly those affected by measles, only to find no beds available.
বিজ্ঞাপন
Gouri’s father, Sohag Kumar, recounted his harrowing experience, stating, “By the time a serial number for ICU admission became available, my Gouri was no more. I tried, the doctors tried, but everyone already in the ICU was in critical condition. The queue couldn’t be broken. The government should increase ICU beds if it can.” The child died on April 18 in the hospital’s measles isolation ward.
While the country has a total of 1,372 adult Intensive Care Unit (ICU) beds across 74 medical colleges, district, specialized, and general hospitals, the Health Directorate has not provided a separate, comprehensive count for pediatric PICU beds. This lack of data underscores the unrecognized scale of the challenge.
বিজ্ঞাপন
The problem is not new; a severe ICU shortage came to light during the COVID-19 pandemic. At that time, a High Court order revealed only 733 ICU beds in government hospitals. Efforts to expand capacity followed, with a November 2022 Health Directorate report indicating 1,169 total ICU beds in both government and private facilities. Despite this increase in adult ICU capacity, the children’s sector remains critically underserved.
Many district, and even some divisional, hospitals lack PICU facilities entirely, leading to critically ill children, especially those with measles, being referred to Dhaka. However, even hospitals in the capital are now struggling to accommodate the influx of patients. For instance, the director of Sher-e-Bangla Medical College Hospital in Barishal, Brigadier General A. K. M. Moshiul Munir, confirmed that patients requiring such support are transferred to Dhaka. Similarly, an assistant professor in the pediatric department at Rangpur Medical College Hospital, A. N. M. Tanvir Chowdhury, noted that most patients needing ICU support must be referred to Dhaka due to the absence of facilities there.
The current measles outbreak has intensified the demand for PICU services. From March 15 until recently, the country recorded 34,662 individuals with measles-like symptoms, with 23,348 hospitalized and 4,856 confirmed cases. Tragically, 273 children have died during this period, comprising 47 confirmed measles-related deaths and 226 deaths from associated symptoms. Health officials anticipate the outbreak could persist for another one to one-and-a-half months, indicating a sustained need for pediatric intensive care.
The human toll extends beyond those waiting for beds. Mahfuzur Rahman, a garment factory electrician from Savar, spent 20 days shuttling his 11-month-old daughter, Maliha, between hospitals in search of a PICU after she developed measles symptoms and pneumonia. His journey spanned Ullapara, Ashulia, MR Khan Shishu Hospital, and Bangladesh Shishu Hospital and Institute in Dhaka before Maliha succumbed to her illness on April 12. He incurred over 250,000 taka in treatment costs, selling his wife’s jewelry and borrowing money, only to lose his child.
Another harrowing case involved 10-month-old Soha Moni from Madaripur, who died from measles and pneumonia on April 10 at the Respiratory Care Unit (RCU) of Bangladesh Shishu Hospital and Institute. Her uncle, Rashedul Islam, described how Soha was moved through four hospitals, including Infectious Diseases Hospital, which had an ICU but lacked ventilators for children under six years old. Dr. Sribas Pal, a junior consultant overseeing the ICU at Infectious Diseases Hospital, confirmed that while the hospital utilizes its seven ICU and five High Dependency Unit (HDU) beds for measles patients, it lacks the necessary life support for young children.
Even when PICU beds are available, financial constraints can be a death sentence. Eight-month-old Md. Noman Falak died on April 13 at Kushtia Medical College Hospital after his grocer father, Md. Sakibur Rahman, had to bring him back from a private PICU in Rajshahi due to the exorbitant cost of 50,000 taka for just two days, including travel. Lacking a PICU, doctors at Kushtia Medical College Hospital resorted to a makeshift “headbox” made from a perforated plastic box to provide oxygen—a solution they describe as “better than nothing.”
Professor Md. Mojibur Rahman, director of Shishu-Matri Health Institute and Hospital in Matuail and a consultant at Bangladesh Newborn Hospital, affirmed the severe shortage of PICU beds, skilled personnel, and equipment nationwide. He reported that his Newborn Hospital has a 38-bed PICU for measles and five free beds for street children, which have seen three deaths. The Shishu-Matri Hospital has an eight-bed measles ward and a three-bed PICU, having admitted 190 symptomatic measles patients. Professor Rahman stressed the urgent need for oxygen services, training, and essential medical equipment.
A `প্রথম আলো` report from March 28 had highlighted the dire situation at Rajshahi Medical College Hospital, where only 12 ICU beds were allocated for measles-affected children, while 30 to 50 children awaited care. In March alone, 12 children died there, with nine succumbing even after being admitted to the ICU.
The prohibitive cost of private intensive care is a significant barrier for low-income families. Dr. Md. Mushfiqur Rahman, who works at a private NICU in Jashore and a PICU in Dhaka, advocated for the government to establish PICU facilities in all 64 districts, emphasizing that while expensive for individuals, it is feasible at a state level.
Public health expert Abu Jamil Faisall underscored that the absence of PICU services, even in district hospitals crucial to the healthcare system, represents a structural crisis in health management. He noted that many hospitals with ICUs lack the skilled doctors and nurses to operate them effectively. “We talk about improving healthcare quality,” Faisall stated, “but advanced healthcare requires emergency preparedness. Children with measles need immediate treatment, including oxygen if necessary. If a PICU isn’t available, alternative solutions must be utilized.”
Source: Prothom Alo Bangla
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