Emergency medical services hampered for dollar crisis

Zarif Mahmud: Hospitals in the country have to rely on imports from abroad for medicine ingredients, chemicals, raw materials and emergency medical equipment. In particular, almost 100 percent of equipment for heart disease, orthopedic, eye, cancer, general surgery, neurological disease treatment and surgery needs to be imported. Presently, the current dollar crisis is hampering their importation. Due to the lack of equipment, the number of major surgeries in the country’s hospitals is also on the way to decrease, said those concerned.
Heart surgery is the most feared. Disruption is also occurring in the treatment of non-communicable diseases including orthopedics. Due to the dollar crisis, it has become quite difficult to open LCs (letters of credit) with banks for importing medical equipment. Due to reduced imports, supply has now fallen to half of demand, officials said.
Disruption of import of emergency equipment for treatment of non-communicable diseases increases the risk of death of patients in addition to disruption of treatment. According to the sources of Bangladesh Medical Instruments and Hospital Equipment Dealers and Manufacturers Association, the country requires at least Tk 10,000 crores of medical equipment and medical devices annually. About 90 percent of this has to be imported. Apart from heart disease treatment, important and complex surgery equipment like neuro surgery, kidney surgery, orthopedic surgery also has to be brought from abroad regularly. Besides, Bangladesh is mainly dependent on imports for important medical equipment including disease control and disinfection equipment.
Among the non-communicable diseases in the country, heart patients account for the highest number of deaths. 100% of the equipment used in the treatment of heart disease in the hospitals of Bangladesh has to be imported. These devices and equipment include heart rings, valves, pace makers, oxygenators. There are no accurate statistics on the number of surgical heart devices implanted in Bangladesh every day. However, an analysis of data from the Department of Medicine Administration, National Heart Institute and Hospital and Bangladesh Medical Instruments and Hospital Equipment Dealers and Manufacturers Association showed that there are four companies that import heart disease treatment equipment in the country. Around 3,000 pacemakers, 4,000 to 6,000 oxygenators, more than 35,000 rings and around 150,000 valves are required across the country annually. At present, the importing companies are not able to meet even 50 percent of this demand.
Talking to the officials of three organizations that import this important equipment for the treatment of heart disease, heart valves and oxygenators are imported in the country from Japan and the United States. Due to the dollar crisis, the importers are facing difficulties in bringing this equipment for more than a year.
Akramul Kabir, general manager (import) of Unimaid, a private importer said Daily Industry, “There is very little LC for the last one year. Now there is no LCE. And for the past three months I have not been able to order any heart rings. No organization is able to do LC properly. Our purchase order of 2000 oxygenators have been cancelled. Some have flown in from the US. It costs more. If this crisis continues, the situation will be very bad.
The supply of these equipment is now limited due to reduced imports. Importers say they are facing difficulty in paying the price of their imports due to volatility in the exchange rate of the dollar. The price of the dollar after placing the purchase order is increasing at the time of payment. The cost of some of this equipment is determined by the Department of Drug Administration. As a result, there is no opportunity to adjust the loss due to the increase in dollar exchange rate after bringing to the country.
On the condition of anonymity, the executive director of a company that imports medical devices and life-saving equipment told, “There is no oxygenator, a very important equipment for heart bypass surgery. The LC problem is now at its peak. If the current situation continues, the supply chain will collapse in the next five-six months. Where earlier I could open an LC every month, now I can open an LC every two-three months. Half of the capacity requirement is being met in this year. Importing companies are unable to meet even 50 percent of the demand. Same picture in other tools. Even if there is no shortage of pace makers in the world market, we cannot import them. It has been one and a half months since I applied for LC on valve import. But the bank cannot open. The heart ring is also not being brought regularly.
National Institute of Cardiology and Hospital (NICVD) is the largest institution for the treatment of heart disease in the country. There are 1,250 beds in this health care institution of the government. From January to September of this year, 35,000 major surgeries and 13,5000 medium surgeries were performed at the hospital. On the condition of anonymity, some doctors of the hospital told that the shortage of oxygenators is very high here. As a result, bypass surgery is routinely interrupted. The number of surgeries has almost halved. Apart from NICVD, treatment of heart disease in other government hospitals is also severely disrupted. If this situation continues, the risk of life of heart patients will increase.
Director of NICVD Professor Dr. Mir Jamal Uddin told, “We are getting less quantity of equipment. The overall situation should be taken into consideration. Treatment must be continued at any cost. Earlier the crisis was more. I invited tenders for the oxygenator. But it could not be bought. Tenders have been called again. In the meantime, a purchase order has been placed for about a quarter of 200 pace makers and 400 rings. Valves and oxygenators could not be procured. Tenders have been invited for this. I hope the crisis that exists now will be resolved soon.
Apart from heart disease, the hospitals of the country are not able to bring necessary equipment to treat diseases like cancer, long-term respiratory system diseases and diabetes. Apart from this, shortage of many equipment required for orthopedic surgery implants in injured persons has also become evident, said various hospital authorities.
Bangladesh Medical Instruments and Hospital Equipment Dealers and Manufacturers Association President Sharif Uddin Ahmed told, “Due to the dollar crisis, import problems have arisen. The dollar exchange rate calculated at the time of LC is increasing at the time of payment after importation. If the LC is not opened as per requirement, then it is normal that the demand is not met. Due to these reasons, the importing companies are now going through a lot of complications. If the dollar crisis increases, there will be no end to the danger. About 90 percent of the medical equipment and devices required in the country have to be imported. Especially those imported by the government on its own initiative, the problem is not so much. However, private importers are going through a tough time.
Senior officials of at least 10 public and private specialized (tertiary) hospital authorities in the country told that they are facing various complications while treating them due to low supply of equipment. Some hospitals have reduced the number of surgeries. Some hospitals do not perform any surgery except the absolutely necessary and essential ones.
Chief Operating Officer of Square Hospital Isam Ibn Yusuf Siddique said, “There are complications with LC in the bank. Some equipment is imported on own initiative. But in most cases, we have to rely on local importing companies. Now equipment supply is less than usual. Reducing supply naturally affects health management.
According to the information of the Department of Health, at least three and a half lakh major surgeries are performed annually in government healthcare institutions in the country. And about 1.5 lakh medium stage surgeries are done. However, the exact number of surgeries performed in private hospitals is not known.
In the current situation, some hospitals have to come out of the plan to increase the scope of services, said the managing director of LabAid Group AM Shamim. He said, “Earlier where LCs were opened with large amounts of dollars, several small LCs are being opened in different banks. Now investors in private health institutions have stopped importing large equipment. Supply has dropped by as much as 50 percent in some cases. Some hospitals are not expanding the range of services.
Director of Dhaka Medical College Hospital said that there is no shortage of medical equipment imported by the government in government hospitals. However, it has been found that other hospitals, their authorities are running into problems when they go to import by inviting tenders on their own initiative.
National Orthopedic Hospital and Rehabilitation Institute is the highest specialized institution at government level for orthopedic treatment in the country. 19,000 major surgeries and 15,500 medium surgeries were performed in the 1,000-bed hospital in the last nine months.
Hospital doctor and general secretary of Bangladesh Orthopedic Society (BOS) Professor Dr. Md. Jahangir Alam told, “Due to not being able to open the LC, importing companies have limited the supply of medical devices and equipment. The crisis is more in the case of implant equipment which has to be imported from USA or Europe. But those brought from India are less of a problem. As the government institutions collect something in the government process, there is relatively less crisis in the government institutions.
If this problem is not solved immediately, the concerned people fear that the situation will worsen in the coming days. Evercare Hospital Director (Medical Services) Dr. Arif Mahmud told, “Due to global problems, problems have arisen in the supply system. Due to various problems including the dollar crisis, there is a fear of further increase in the future. If the crisis continues, treatment will be disrupted.