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Better equipped hospitals offer women, children better chances of survival

© UNICEF/BANA2012-00870/Ahsan Khan
Dr. Pratab Ranjan Chowdhury treats patients at his desk at the IMCI corner at the Derai Upazila Health Complex in Sunamganj on 2 June 2012.
By Julhas Alam

DERAI, Bangladesh 19 June 2012: One-and-a-half-month-old Kadirul Islam was lucky enough to get to the hospital after he developed difficult breathing, it was not too late. 

His mother, 21-year-old Shahin Ara Begum had no idea about what complications her baby was going through. After a few sleepless nights, a local health worker alerted her that the baby might have pneumonia and asked to take her baby to the government hospital in this Derai sub-district in Sunamganj district without any delay as she noticed the “warning signs of pneumonia”.

“I talked to my husband and within hours we came here,” Shahin says. “What’s going on, I had no idea.”

“We are here for 10 days,” she says, sitting by his bedside at a Child Care Unit at Derai Health Complex, a 31-bed government hospital.

That unit has been separated from a bigger ward with a newly installed partition. It has five-beds with two beds in the adjacent verandah because of a  shortage of space.

The baby was given powerful antibiotics as doctors in the hospital diagnosed him with pneumonia and his case was severe.

Shahin says that the doctors have given  injections and have assured her of her baby’s recovery.

Ashutush Das, the hospital’s head doctor, says the possibility of the baby’s survival is now brighter given the early detection and quick intervention taken by them. Ashutush says a further delay could have been fatal for the child.

But now Shahin and her day-labourer husband have some hope.

Shahin says she wishes to go back home soon as she dreams that her toddler will become a  man someday.  “Please pray for us,” she says staring at her baby as she softly touches his forehead.  

Bangladesh has made remarkable progress in reducing under-five child mortality because of massive immunization against deadly but preventable diseases.

But this impoverished South Asian country of 150 million people needs to do more to drastically cut death rates under 28 days of a child’s birth. Pneumonia is the second largest killer of children under five years of age after drowning in Bangladesh.

Most of the under five deaths take place within seven days of a child’s birth, and of those deaths, 50 per cent take place within 24 hours of a child’s birth.

UNICEF provides support to the Government of Bangladesh to build a new health delivery regime by cutting deaths of under-five children.

© UNICEF/BANA2012-00879/Ahsan Khan
Quaderul Islam, 1 and half month old, suffering from pneumonia, is held by his mother Sohinara Begum at the Derai Upazila Health Complex in Sunamganj on 2 June 2012.

Officials and experts say it  is possible to cut death rates through an integrated approach of basic healthcare facilities and building awareness. If infection prevention is possible, 50 per cent deaths that now occur within 28 days of a child’s birth could easily be reduced.

The UN set a target of reducing the under-five mortality by two-thirds between 1990 and 2015. The current child mortality rate in Bangladesh is around 2 per cent.

In a new report titled,  “Pneumonia and diarrhea: Tackling the deadliest diseases for the world’s poorest children” released this month (June) by UNICEF, says the prevention and treatments for pneumonia and diarrhea often overlap, and include such basic steps as: increasing vaccine coverage; encouraging breastfeeding and hand-washing with soap; expanding access to safe drinking water and sanitation; and disseminating oral rehydration salts to children with diarrhea and antibiotics to children with bacterial pneumonia.

Anthony Lake, UNICEF Executive Director, says that scaling up simple interventions could overcome two of the biggest obstacles to increasing child survival, and help give every child “a fair chance to grow and thrive”.

As prevention is the key, Bangladesh with the help of agencies like UNICEF introduced a new combination vaccine to protect its children against five killer diseases in one injection, including for the first time, the deadly bacterium Haemophilus influenzae type-b (Hib) that causes some severe forms of pneumonia and meningitis.

And this introduction is paying off.

Better facility-based care:
Dr. Ashutush says in his hospital the number of patients have increased in recent years, thanks to better facilities and new corners to provide healthcare treatment to pregnant women and children.

He says under a scheme, styled “Maternal, Neonatal and Child Survival (MNCS)” the hospital is now better equipped despite lots of hurdles.

The project, funded by UNICEF/AusAid and implemented by the Government of Bangladesh in partnership with NGOs, was initiated in 2009  with an integrated approach of better healthcare facilities aimed at reducing maternal and child deaths in line with the UN-set MDGs.

Under the project, they set up a corner specially dedicated to pregnant women and the new mothers. The corner, which is a single room equipped with a bed and oxygen cylinder, has been set up under the MNCS project to provide ante-natal and post-natal care to the women.

Separately, the hospital has set up a corner, styled “Integrated Management of Childhood Illnesses (IMCI)” to provide services to the children down with diseases like pneumonia. Up to 50 children take service from this IMCI croner daily, says Ashutush.

Dedicated medical staffs, despite an acute shortage of staffs, are assigned in these special units installed under the MNCS scheme.

Dr. Ashutush says, the installation of these corners has revolutionalized the mindset of the hospital staff.

“It has created a new sense of responsibility. Now, it comes to our mind that these people, pregnant women and children need special care. This is important,” he continues.

He says under the scheme, they often provide financial aid to any vulnerable woman when there’s any emergency to send her to the district hospital if the case is severe involving delivery. The project has also allowed them to install Instant Power System (IPS) as power cut is severe in this power-starved nation, which regularly struggles to feed its factories and other service facilities with uninterrupted electricity.

The project has created an option to maintain the hospital’s sole ambulance as they spend up to Tk5,000 a month for maintenance.

The hospital has a diesel-run generator and it also needs almost regular maintenance. 

It has now an ARI machine, and most importantly, it has a nebulizer machine to help a child with severe breathing problem for pneumonia infection.

“Earlier, we used to wait for money from the government, a process that often requires long time because of official formalities, for the repair of the ambulance. But now we can easily do that, we have money to do that,” he says.

Despite encouraging developments, challenges in this facility are still overwhelming. As Dr. Ashutush says poor road condition in the sub-district, which has 224 villages and 226,345 people, often makes it difficult for patients to reach the hospital in case of emergency.

The hospital can accommodate a small number of patients as it has only 31 beds, and many patients take shelter in the corridors.

 Health promoters: Agents of change
The ticket counter is abuzz with patients as they wait for Tk 3 (less than one cent) pass to take service from this hospital. Among others, Anita Biswas Nondi accompanied by five pregnant women are waiting to get service from the counter of the Derail Health Complex.

Anita says she routinely goes around her neighborhood and looks if there is any woman who is pregnant or any child with a complication.

She sits with them and  tries to find out about their family background and the family attitude towards that particular pregnant woman.

“I take note of it and decide what to do immediately,” she says as she waits near the ticket counter along with the patients she has brought to the hospital.

She says she examines children with fever or any other complications under the MNCS guideline. She refers them to the hospital when she suspects something serious on the basis of the danger signs.

Anita always carries a “timer” provided under the MNCS programme to check frequency of breathing when she sees a child with fever or breathing problem.

She advises the pregnant women to go to doctors at least four times during her pregnancy.

“I help them prepare a birth plan for the newcomer. I encourage the pregnant woman to save some money for the upcoming baby,” she says.

“I am happy to see the smiling faces of the mothers I assist. The relationship I build with them lasts long. Now they treat me as their family member,” she happily says.



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