Heart diseases soaring in Bangladesh as treatment is costly, inadequate

by Rashad Ahamad

The number of cardiovascular patients is increasing very fast in Bangladesh, but the government is yet to take adequate preventive measures and create treatment facilities to meet the high demand.

Cardiologists said that, unlike in the past, a large number of young people were also now suffering from the disease and blamed inactive lifestyles and unhealthy food habits for the rapid spread of the non-communicable disease.

According to the latest National Health Bulletin in 2019, heart disease is the leading cause of mortality, morbidity, and hospital admission in the country.

Health rights activists said that cardiovascular disease treatment remains also very expensive here.

Against this backdrop, Bangladesh will observe World Heart Day today like other places in the world with the theme ‘Use heart for every heart’.

The World Health Organization’s latest Non-Communicable Diseases country profiles 2018 said that 67 per cent of deaths occur in Bangladesh due to non-communicable diseases.

Cardiovascular disease is the leading cause of death by non-communicable diseases, which is about 30 per cent or 2.56 lakh deaths.

It was 1.5 lakh, or 17 per cent, in 2014, according to the global health body, which unveils the report every four years.

Health rights activists said that both the treatment facilities and the number of cardiologists were inadequate in Bangladesh, while urbanisation without health infrastructure was also promoting the deadly disease.

According to the Bangladesh Cardiac Society, the recommended cardiologist population is 2.6 to 4.2 for every 100,000 people. On that count, for 17 crore Bangladeshis, the country requires at least 7,000 cardiologists.

But Bangladesh currently has only around 1,000 cardiologists, including 200 cardiovascular surgeons, said Bangladesh Cardiac Society secretary general Abdullah Al Shafi Majumder.

Abdullah Al Shafi, however, said that the situation was improving with the establishment of new cardiac centres through private initiatives.

He estimated that presently there are only 50 hospitals in Bangladesh with cath lab facilities for the advanced treatment of heart patients.

The cath lab is the most basic equipment required in a cardiac unit hospital, consisting of an Angiography X-Ray system.

Of the 50 hospitals with cath lab facilities, 30 are in Dhaka, including six state-run hospitals, he said.

The majority of the hospitals with cath lab facilities are privately owned, which makes heart treatment costly.

The crisis of expert nurses and technicians is also acute, he said.

The National Institute of Cardiovascular Diseases director, Mir Md Jamal Uddin, said there was huge pressure in their hospital for treatment costs here, which is much cheaper than in private hospitals.

Abul Kalam, the attendant of Sathi Begum, 32, a heart patient admitted to NICVD, said that he could find a seat here for his wife two months after she was diagnosed with a block in her heart.

He said that he failed to get Sathi admitted to the hospital several times as the authorities informed him that there was no seat available.

NICVD director Jamal Uddin said they increased the number of beds to 1250 from 450 in recent years yet could not accommodate all patients who were coming for heart treatment.

He said that not only beds, but the hospital also needed more equipment and manpower as it was operating with the same manpower allocated for 450 beds.

‘The number of patients has increased three times, but there has been no change in the recruitment structure in the past 20 years,’ he said.

With the limited manpower and inadequate infrastructure, the hospital was providing treatment to over 1,300 indoor patients and many outdoor patients every day, he said.

On Wednesday, 1,307 patients were admitted to the hospital.

NICVD sent a requisition for 2,400 people, including 1,100 nurses and 400 doctors, in 2021 and was waiting for approval, he said.

Md Delwar Hossain, a resident of Bikrampur in Munshiganj who was undergoing treatment at the NICVD, said that he sold out his land and cattle for his treatment. He spent over Tk five lakh in the two and a half months since his disease was diagnosed.

In government facilities, the fees for surgery begin with Tk 1.10 lakh while the lowest fee in private hospitals is around Tk 3.0 lakh, said medical professionals.

Around 10,000 cardiac surgeries are done in those hospitals each year, they said, adding that a large number of patients also go abroad for treatment.

Sohel Reza Choudhury, Professor at the National Heart Foundation Hospital and Research Institute, said that the number of heart patients is on the rise due to unhealthy lifestyles and food habits.

He said that excessive salt, sugar, junk food, and inadequate physical exercise are among the main causes of heart diseases, adding that stress and hypertension are also contributing.

Bangabandhu Sheikh Mujib Medical University Hospital cardiology Professor SM Mustafa Zaman said that tobacco and alcohol were another two causes of the disease.

‘We want a ban on tobacco that is also responsible for some other diseases,’ he said.

According to the WHO, 26 per cent of the adult population in Bangladesh is physically inactive, 23 per cent use tobacco, 21 per cent have high blood pressure, eight per cent have diabetes, and three per cent are obese.

Zaman said that millions of people are unaware of the disease but they are suffering.

‘It is a silent killer. People having heart disease, in many cases, do not have symptoms, and thus casualties increase,’ he said.

He asked for screening of all those aged over 18.

Health Service line director Masud Reza Kabir said that the government introduced the Non-Communicable Disease Corner in 54 hospitals across the country to check all types of NCDs, including cardiac diseases.

The government is working to expand it to 200 by 2023 and across the country by 2025, he said.

He said that the government is also working to set up hospitals in all divisions with cardiac facilities.

The country has no rehabilitation and post-surgery care services, which doctors said prevented surgery patients from returning to normal life.

published on New Age

Waterways disappear as rivers die in Bangladesh

by Rashad Ahamad

Inland waterways, once the prime mode of transportation in Bangladesh, have declined fast as many rivers, canals, and other water bodies have disappeared in riverine Bangladesh over the past decades.

Due to geographical location, inland waterways were the main mode of transportation in Bangladesh, a country part of the largest delta in the world, but that mode has changed due to erroneous policies in communication development, experts said.

The authorities had destroyed the popular, cheap and safer waterways and instead had expanded only road transportation, facilitating the deaths of many rivers, they said.

In this context, World River Day will be observed across the country today. The day is observed across the world on the fourth Sunday of September.

The River and Delta Research Centre chairman, Mohammad Azaz, blamed river grabbing and pollution, water scarcity from upstream and climate change for decreasing water transportation in Bangladesh.

Khalid Mahmud Chowdhury, state minister for shipping, claimed that governments after 1975 followed a wrong transport development policy, allowing waterways to shrink.

He claimed that successive governments’ ‘business-oriented transportation plan’ prioritised the road while ignoring rail and waterways.’

He stated that Bangladesh used to have 24,000 kilometres of waterways, but this number has now drastically decreased.

‘Awami League government is now working to make 10,000 km of waterways as per our election pledge,’ he said.

He also said that they had dredged 53 rivers already and that the dredging work in some rivers was in progress as the government had bought 50 heavy dredgers and initiated the process of procuring 35 more. Several sea ports and 35 river ports were upgraded.

The government has adopted the Delta Plan 2100 with a special focus on rivers.

Bangladesh Inland Water Transport Authority statistics showed that in 1975, there were 223 river routes and about 8,489 kilometres of navigable waterways in the rainy season in Bangladesh and 5,287 kilometres in the dry season.

At present, about 5,900 kilometres of waterways are navigable in the rainy season and only about 3,800 kilometres of waterways are navigable in the dry season on 188 routes.

Amid the reality, Bangladesh is set to observe World River Day with the theme ‘Waterways in Our Community’ emphasising both protecting rivers and restoring waterways.

RDRC chairman Azaz said that over 500 rivers in the country disappeared in the past 50 years, while the number of canals that disappeared was much higher, with no study available.

The National River Conservation Commission reported 770 rivers across the country. According to RDRC, the number was 1,274 during the war of independence in 1971.

Jahangirnagar University urban planning professor Adil Mohammad Khan blamed professionals for accepting the wrong development policies of the government and development partners.

‘Just see, in Dhaka, box-culverts were made by blocking canals,’ he said, citing an example.

He also said that many unnecessary roads were constructed in the haor areas, where people once mostly used boats for transportation.

‘Embankment to control flooding also restricted vessel movement,’ he said.

He said that as rivers were not in use, they lost navigability, were grabbed, polluted and eventually died.

Green activists said that the Local Government Engineering Department and the Roads and Highways Department have constructed most of their bridges and culverts, narrowing rivers and decreasing navigability.

Flat bridges and culverts restrict boat movement in local waterways.

Abdus Sattar, once a boatman who used to carry goods from Ghatail in Tangail to different destinations including Mymensingh, Dhaka, and Narayanganj, said that after the construction of a low-height flat bailey bridge on the Jheenuk River, he had to sell his boat as he couldn’t move under the bridge.

The Jheenuk River, a branch of the Jamuna River, flowing over Bhuyapur and Ghatail, is now all but dead. There is no water flow in the river in the dry season. Domestic and industrial waste polluted the river, where hardly any fish is now available, said Sattar.

‘I made my living as a boatman until the bridge came here in 1995. I tried to remain in the profession even after a few more years. Later, I switched to farming,’ said Sattar.

The LGED claims to have built 36,311 bridges to complete its 330,831 kilometres road network across the country, while the RHD claims to have built 4,404 bridges and 14,814 culverts in its 22,418 km length of 992 roads.

Green activist M Hamid Ranju said that he used to go to Mirpur in Dhaka from Genda of Savar by boat even in the 90s, carrying goods with other traders.

He said that his mode of transportation has changed since Bill Bagheel choked and dried out being left uncared for and the expansion of the Dhaka-Aricha Highway.

He said that at one time, every family in his area owned at least one boat. Now motorcycles or cars have replaced boats in many families.

The National River Conservation Commission chairman, Manjur A Chowdhury, said that alongside illegal grabbing and earth-filling, some transboundary issues were also behind the death and disappearance of rivers and waterways in Bangladesh.

He explained that many rivers were silted for lack of water as the water flow was restricted upstream.

The commission has identified 60,000 river grabbers so far across the country.

Bangladesh Environmental Lawyers Association chief executive Syeda Rizwana Hasan said that in the name of road network development, the rivers and canals were killed in a planned way.

Professor Emeritus and river expert Ainun Nishat said that any action that harms the river and its natural environment was illegal and also a violation of the constitution.

‘But it is happening continuously,’ he said. ‘The officials of LGED and RHD responsible for the action should be brought to book,’ he added.

The Bangladesh Poribesh Andolon general secretary, Sharif Jamil, said that if the waterways could be protected, the rivers and canals would remain protected.

‘A river is part of an ecosystem. It is a lifeline, a livelihood and many more. With the death of many rivers, everything collapsed,’ he said.

Published on New Age

Dhaka heritage Bara Katra partially demolished, more sites at risk

by Rashad Ahamad

A portion of the listed Mughal period heritage structure Bara Katra in Dhaka, the capital city of Bangladesh, was demolished violating law and the High Court directives for the preservation and protection of relics and monuments of ancient period.

The Department of Archeology tasked with the conservation of historically important sites has failed to take any pragmatic measures as many other heritage sites run the same risk, activists and experts said.

‘Apart from the archeological sites listed with the DoA, there are many other sites that had already disappeared and many are at risk,’ said the chief executive of Urban Study Group Taimur Islam.

‘Though Bara Katra was declared heritage, the archeology department did not take any measures to protect it in past decades. It was routinely demolished and grabbed.’

Taimur Islam mentioned that Patuatuli Mosque and the Amligola Havely of the Mughal era were among the structures completely demolished while Chhota Katra and many others were partially demolished.

According to Jahangirnagar University archaeology professor Sufi Mostafizur Rahman, Bangladesh lacks policies to protect archaeology and there is hardly any accountability on the part of the authorities concerned.

‘We fail to realise the significance and priority of heritage,’ he said.

‘Bara Katra was a very significant historical and heritage structure that could attract a huge number of tourists if the authority could preserve it.’

Built-in between 1,644 and 1,646 AD by Mir Abul Qasim, diwan (chief revenue official) of Shah Shuja, second son of emperor Shah Jahan, Bara Katra, a Caravan Sarai, stands at Chawk Bazar on the north bank of Buriganga River.

At present, over a hundred shops and dozens of residential units have popped up in the Bara Katra complex while its core zone is being used as Jamia Hossainia Ashraful Ulum Madrassah.

Due to its misuse, the Mughal-era structure has almost decayed while a major portion of it has been blocked by illegal occupation, thereby losing its glory day by day.

According to the Detailed Area Plan of the Rajuk, the capital development authority, the agency is committed to protecting 250-metre radius from the boundary of the heritage structure, but a lot many were found adjacent to dozens of heritage sites, destroying their beauty.

Local people said that one Ali Hossain, who claimed the ownership of a five-katha land at a portion of the structure, started demolishing the structure since mid-July.

Ali Hossain claimed that he had owned the land since 1978.

Experts said that it was a crime if anyone destroyed any heritage structure even if it was on their own land after the archeology department declaration.

The department was tasked with the protection of heritage and can file cases against anyone for violation of the law.

Archeology department director general Ratan Chandra Pandit said that after being informed by local residents, the department stopped demolition but did not take any legal action against anyone.

‘Why did the department not file case and why is it reluctant to do so? What is the interest of the officials concerned?’ asked Taimur Islam.

Asked about it, Ratan Chandra Pandit said that a number of the heritage sites were on the personal property so they could not protect them while they had a lack of budgetary allocation and manpower crisis.

‘If the mayor takes conservation initiative, the department will give full technical support with its expertise,’ he added.

Visiting the spot, Dhaka South city mayor Sheikh Fazle Noor Taposh on Wednesday again upheld his election pledge to conserve the heritage of Dhaka by preserving the architectural sites including the Bara Katra.

Historians and archaeologists demanded a complete survey and documentation of heritage sites and structures and their proper preservation for posterity.

They said that the protection of heritage was a legal obligation of the department according to the Antiquities Act 1968 as well as a signatory to the UNESCO World Heritage Convention of 1972.

Urban Study Group, campaigning for the conservation of the old town, particularly its heritage sites and structures since 2004, has a list of 2,800 structures including 700 grade one heritage in old Dhaka including structures built during the pre-Mughal period, Mughal period and colonial period.

Archeology department officials, however, said that it had a list of 517 heritage sites across the country, 37 of them in the capital.

In August 2018, the High Court issued an order not to demolish any of the 2,200 heritage sites of old Dhaka after the USG filed a writ to conserve them.

Rajdhani Unnayan Kartripakkha identified 75 structures in the capital as heritage structures, bringing down the number from 92. In 2009, Rajuk earmarked four areas covering 13 streets as heritage sites in November 2017.

In 2018, the government bought for Tk 331.7 crore the historic ‘Rose Garden Palace’ on 2.4235 acres (146 kathas) of land at KM Das Lane of Tikatully in old Dhaka where the Awami League was formed.

Rose Garden was on the list of the department though it was maintained by its owner.

Bara Katra was first declared a heritage by the British in 1909 but it was canceled in 1922, and again in 1956, it was listed as heritage but again canceled in 1968.

Finally, in 1989, the Bangladesh government listed Bara Katra as heritage without demarcating its area.

Published on New Age

Mental healthcare remains ignored in Bangladesh

by Rashad Ahamad

Mental healthcare has remained largely ignored in Bangladesh, with incidents of suicide increasing over the years and a great many suffering from depression.

At least 364 students alone committed suicide in Bangladesh over the past eight months this year while the country counts more than 10,000 annual deaths, on average, from suicide, but there is little pragmatic action on the part of the government to prevent such deaths.

Against this backdrop, Bangladesh today observes World Suicide Prevention Day 2022 as elsewhere around the world with the theme ‘Creating Hope through Action’ set by the World Health Organisation for this year.

To provide physical healthcare there is a network of over 15,000 hospitals and thousands of other facilities in function but for mental healthcare, there are only two institutes— Pabna Mental Hospital and the National Institute of Mental Health and Hospital in Dhaka.

Experts said that people in the country don’t count mental health as an issue while the government largely ignored responsibility.

Aachol Foundation, a social organisation initiated by students, published a survey report on Friday at a virtual press conference, mentioning that at least 45 students commit suicide in the country every month.

The actual number, it said, must be much higher as the organisation collects information on only the reported cases.

‘Although suicide is a very sad incident, it is largely ignored by families and society,’ said Dhaka University psychology professor Kamal Uddin Ahmed Chowdhury, also a clinical psychologist.

Professor Kamal did not see any initiative by the state to prevent such untimely deaths, he said, adding that the incidents of suicide are increasing in modern life due to increasing stress in life.

Pointing out that suicide is a crime in the country, he observed that people subjected to criminal blame the person who committed suicide while the reasons that compel him/her to take own life are left unidentified and unaddressed.

‘We should focus on the reasons that cause the deaths,’ he said.

According to the clinical psychologist, the country’s education system and social structure are failing to keep people mentally healthy, resulting in increased suicides in society.

‘Students should be taught how to control emotions so that they can refrain from committing suicide,’ said Tansen Rose, founding president of the Aachol Foundation, which works primarily to sensitise students to the importance of mental health.

Having surveyed 150 national and local newspapers and online portals, the foundation found that 364 students committed suicide between January and August 2022. Of them, 194 were students of schools, 76 from colleges, 50 from universities while 44 studied in madrassahs.

According to the report, the highest 221 victims were girls, nearly 61 per cent of total, and school students represented slightly more than 53.3 per cent.

The report revealed that 25 per cent of the victims ended their life over heartbreaks in romantic relations while other major causes were pride, 24.73 per cent, family disputes, 6.59 per cent, rape or sexual harassment, 4.67 per cent.

Another significant number of people made attempts at suicide, according to the report.

Between March 2020 and June 2021, 151 students committed suicide in the country, while the figure was only 11 in 2018 and 19 in 2017, according to Jahangirnagar University’s Students Welfare and Counselling Centre.

Kaan Pete Roi, a non-profit organisation that provides free-of-cost emotional support over the phone to prevent suicides, reported that they had received 43,500 phone calls since 2013. Twenty per cent of them called the organisation with suicide risks, including 5 per cent with high risks, said it.

The organisation disclosed that 18.7 per cent of people in Bangladesh suffer from mental health problems.

Ashik Abdullah, the organisation’s head of training and outreach, said that 52 per cent of them were female.

‘When someone is in depression if she/he can find someone to listen to or caring support it greatly helps the person,’ he said.

The main purpose of the Kaan Pete Roi is to listen to the heart of anyone without judging the person, he noted.

Activists and experts said that families in many cases hid the actual number and causes of suicides to avoid police procedures.

There are some charities in the country promoting mental health while some universities have psychology department for educational purposes, they said.

But, they pointed out, that the government has no system to take care of people’s mental health.

National Institute of Mental Health director Bidhan Ranjan Roy Podder said that the government was yet to have a programme to prevent suicides.

the government has, he mentioned, realised the necessity and adopted the National Mental Health Strategy 2020–2030 and the National Mental Health Policy in 2022, the implementation of which is yet to start.

He further said that the government had announced that counselors would be appointed to educational institutions while a multi-sectorial programme would be given emphasis on the strategy to keep people’s mental health sound.

Professor Kamal Uddin suggested creating adequate empathetic space for the children in the family, stopping victim blaming and providing recreational and sporting opportunities for the refreshment of people’s mind and bodies.

He also emphasised bringing about changes in the education system, which pushes students into the mad competition and establishing facilities for their mental counseling at door steps.

‘Until the reasons for suicide are not uprooted, suicides would not stop in society,’ he said.

Observing that everyone’s mental strength and control over emotion is not equal, he suggested that training could help individuals to enhance these capacities.

Published on New Age