—Dr Shamsad Mortuza—

Exactly five years ago, on March 8, the Institute of Epidemiology, Disease Control and Research (IEDCR) announced that three patients had tested positive for COVID-19. Ten days later, the first official death was reported. Subsequently, we witnessed nightmarish lockdowns, frantic searches for ventilators and ICUs, bodies being dumped in the streets, eerie burials with no attendants, separation of families, oxygen shortages, and food crises. Government hospitals were overwhelmed, while private hospitals started charging exorbitant fees. We saw both the naked face of corruption and negligence, and the selfless service of some frontline fighters.

The pandemic, which now seems like a distant memory, exposed the fragility of our medical infrastructure. The experience should have served as a catalyst for reform and revitalisation of the sector. Instead, trust in local healthcare continued to wane, and the tendency to seek treatment abroad increased manifold. In 2023, there was a 48 percent spike in the number of outgoing Bangladeshi patients compared to the previous year. As many as eight lakh people are believed to travel abroad for medical purposes annually, spending almost $5 billion. Both spectrums of patients—the affluent flying out to Singapore, Thailand, the UK, or the US for check-ups, and the desperate exhausting their resources to afford treatment in neighbouring countries—have contributed to outbound medical tourism.

This rise is both a symptom and a consequence of the authorities’ failure to facilitate a decent healthcare system. Until recently, Bangladeshi patients comprised nearly half of India’s medical tourists. Hospitals in Chennai, Kolkata, Bangkok, Singapore, and Kuala Lumpur have translators and dedicated help desks for Bangladeshi patients. The institutionalisation of services is evident in the aggressive marketing by the hospitals’ local agents, who openly advertise packages that include visas, doctors’ appointments, air ambulances, and even accommodations. Many of these agents direct patients to specific clinics not for medical suitability but because of profitable arrangements. Since our hospitals already receive an overwhelming number of patients, they seem least bothered by this exodus. On the contrary, some even benefit from referral fees paid by their overseas counterparts.

The huge amounts of money spent in foreign currencies should have been enough incentive to streamline our healthcare infrastructure. But we failed. To rub salt in the wound, our once-friendly neighbour now appears to be weaponising its healthcare. Reports of visa restrictions, strict regulations, and an unspoken chill when dealing with travel requests have jeopardised the treatment of many patients. Our government’s search for alternatives is evident in promoting Kunming, China as a medical destination. Malaysia is also becoming a popular destination. However, shifting dependence from one foreign country to another is far from an ideal solution.

Let’s give credit where it is due. Many of our doctors are world-class, holding international credentials and some even working in some of the best hospitals in the world. But those who have returned home are trapped in a system that discourages competence, professionalism, and ethics. Doctors are notorious for working inhumane hours, resulting in frequent fatal errors. The public sector is plagued by politicisation, where party allegiance trumps merit, and doctors, too, often act as party cadres with ambitions that don’t chime with their Hippocratic Oath. Then, there is this unholy nexus between doctors and diagnostic centres that exploits patients’ vulnerability and ignorance. Bureaucratic policies have also deepened rifts within the healthcare system. The ongoing strike by diploma health technicians, demanding recognition as “diploma doctors,” is yet another symptom of this convoluted bureaucracy. We live in a system where labels matter more than quality.

We are also living in a time when the centre cannot hold—things are falling apart. The post-July uprising sentiment is about redress, and long-repressed anger is now finding every possible outlet. In many cases, patients’ families have translated their frustration with the healthcare system into attacks on doctors. The doctor-patient relationship is on the verge of collapse. Physicians are scared of retribution, while families mistrust medical services. With the system routinely failing both stakeholders, the blame remains justified.

Public frustration deepens when they see their leaders continuing to seek treatment abroad. Political elites and business tycoons flaunt their medical trips, traveling overseas even for minor ailments. When ordinary citizens see their own leaders avoiding the system they govern, how can they be expected to trust it? If a nation’s rulers do not rely on local healthcare, why should its people?

We need radical reforms, beginning with a shift in mindset. Those responsible for failing to secure and develop domestic healthcare services must be held accountable. Modernising public hospitals should be a top priority. Perhaps funds recovered from corruption cases could be reinvested to purchase the latest medical equipment. Prevention and diagnostic care must be prioritised to prevent patients’ conditions from worsening. Government tax relief should encourage philanthropic projects to build state-of-the-art facilities where top doctors choose to stay rather than migrate abroad. The Bangladeshi medical diaspora—comprising surgeons and specialists working in the Global North—can also be engaged in training local doctors, offering virtual consultations, and using AI to improve our medical standards. A tiered health financing system, where wealthier patients contribute more, could help subsidise care for the poor. Health insurance must be meaningful, not ornamental. And as a show of genuine reform, our leaders must develop the habit of seeking medical care locally.

As a country that has survived many challenges, resilience is our essential spirit. With so many brilliant doctors and medical professionals, defying the odds is not impossible. Identifying and removing the system’s corrupt elements is crucial for meaningful change. We must hold our policymakers accountable and demand a healthcare system that does not force citizens to beg, borrow, or flee for medical care. Without timely intervention, we are likely to remain just as helpless as before during the next pandemic, or the next public health crisis.

—————————————————————-

Dr Shamsad Mortuza is professor of English at Dhaka University.