In Bangladesh, hospitals are places where patients think twice before visiting, due to numerous issues such as hygiene, food quality, overcrowding and ventilation.
Dhaka Medical College Hospital (DMCH) ranks top among the facilities blamed for these issues.
“I never think of visiting public hospitals in Bangladesh, let alone Dhaka Medical College Hospital,” said Tahsin Farzana, a homemaker from a middle-class family.
According to Tahsin, hospitals should provide relief, but in Bangladesh, particularly at public facilities, the conditions are distressing. "The washrooms and toilets in these hospitals are the dirtiest places," she remarked, adding that even attendants feel unwell after a short stay caring for a patient.
Tahsin expressed frustration with the status quo, saying, “This situation cannot be allowed to go on. A hospital should be a place where a patient can heave a sigh of relief, but to expect that in Bangladesh is simply a dream.”
Severe Hygiene Challenges
Cleanliness within hospitals is critical, covering not only wards and operating theatres but also public areas like waiting rooms, toilets and cafeterias.
Experts warn that inadequate hygiene in hospitals contributes to the spread of healthcare-associated infections (HAIs), including drug-resistant bacteria such as MRSA.
Routine cleaning using hypochlorite disinfectants has been proven to reduce infections like C. difficile, particularly when combined with standard disinfectants.
However, data reveals that cleanliness in Bangladeshi hospitals is alarmingly deficient. Only 38% of health facilities nationwide have basic hygiene services, with a stark difference between government (32%) and private (69%) facilities, as reported by WHO and Unicef in their latest JMP report.
A recent study by icddr,b found that only 33% of toilets in government hospitals are clean, with most lacking disposal options for menstrual hygiene products and facilities for disabled patients.
The study, conducted across 2,459 toilets in Dhaka's healthcare facilities, highlights an inadequate user-to-toilet ratio, far exceeding the national standard of 1:6, with government hospitals reaching a ratio of 214:1.
DMCH’s Fight with Mismanagement
Dhaka Medical College Hospital, one of the country's most significant public healthcare providers, faces immense strain.
Patient numbers at DMCH have almost doubled the hospital's intended capacity, severely impacting the quality of care. From wards to corridors, patients lie on floors as the hospital grapples with overcrowding, inadequate beds and a lack of resources.
Hospital director Brigadier General Asaduzzaman Khan acknowledged the numerous complaints, attributing the worsening conditions to both overcrowding and insufficient facilities.
"One toilet serves ten patients. If you accommodate 4,300 patients in a facility designed for 2,600, along with two or three attendants per patient, the pressure on facilities is unmanageable," he explained.
Khan also raised concerns about users’ behaviour, stating, "We strive to ensure cleanliness, but many patients and attendants are unaware of proper hygiene practices, often leaving waste like sanitary pads and plastic bags in toilets, exacerbating the problem."
He also mentioned that staff shortages, especially among the fourth-grade workforce, hinder the hospital's efforts to maintain cleanliness and order.
A study on sanitation in Dhaka's major hospitals was conducted by researchers from the University of Technology Sydney, icddr,b in Bangladesh, and Dhaka Medical College.
It highlights severe issues with toilet functionality, cleanliness, and accessibility, especially for outpatient services, with recommendations for improved resources and management to meet sanitation standards by 2030. The cross-sectional study, conducted between August and December 2022, evaluated toilets in 10 government and two private hospitals to assess their functionality, cleanliness, and user-to-toilet ratio.
The findings revealed that only 68% of government hospital toilets and 92% of private hospital toilets were functional. Cleanliness was even more concerning, with only 33% of toilets in government hospitals and 56% in private hospitals considered clean.
The study also uncovered high user-to-toilet ratios, particularly in outpatient services, where ratios were as high as 214:1 in government hospitals and 94:1 in private facilities.
Alarmingly, only 3% of toilets had bins for menstrual-pad disposal, and less than 1% were equipped for disabled users.
The researchers emphasise that improving sanitation facilities in Dhaka's healthcare facilities is critical to meeting the Sustainable Development Goals (SDGs) by 2030, calling for increased resources, maintenance staff, and leadership from hospital administrators to address these shortcomings.
This study underscores the urgent need for policy interventions to improve basic sanitation and infection control in healthcare settings in Dhaka.
A Call for Urgent Reforms
The situation at Dhaka Medical College Hospital reflects a broader crisis within the country’s healthcare system. The poor hygiene standards, staff shortages, budget constraints, and inadequate facilities at DMCH paint a grim picture of the healthcare services available to the public.
Addressing these issues will require significant resource allocation, dedicated maintenance staff, and, crucially, strong leadership to enforce standards of cleanliness, hygiene, and patient care. With rising patient numbers and deteriorating conditions, the need for reform has never been more pressing.
