A patient’s need for specialized surgery has exposed a critical gap in public eye care, with the absence of intensive care facilities at a leading government eye hospital forcing doctors to refer him elsewhere.
Mustafa Kamal, in his 60s, travelled from Shikarpur village in Barisal's Uzirpur upazila to the National Institute of Ophthalmology and Hospital in Dhaka for treatment. Doctors diagnosed a tumour in his eye socket (orbit) and recommended surgery, but his heart disease raised concerns about post-operative complications and the need for intensive monitoring.
Kamal said the operation was initially scheduled at the hospital but could not be performed there because it does not have an intensive care unit (ICU).
He was advised to seek treatment at another medical college hospital. He subsequently contacted Dhaka Medical College Hospital, Shaheed Suhrawardy Medical College Hospital and Mugda Medical College Hospital but failed to secure an operation date.
After visiting several hospitals over a number of days, he was told by Dhaka Medical College Hospital that he would have to wait nearly two months for surgery.
Kamal said he had met another heart patient while seeking treatment at the eye hospital. Unable to undergo surgery there, the patient eventually had the procedure at a private hospital.
Kamal said he had met another heart patient while seeking treatment at the eye hospital. Unable to undergo surgery there, the patient eventually had the procedure at a private hospital.
"I do not have the financial means to undergo surgery at a private hospital," he said.
Like Kamal, other patients with heart conditions are struggling to access complex eye surgery because of the absence of ICU facilities at the specialised hospital.
Although the hospital offers a wide range of surgical services, it lacks an ICU. Doctors said some patients require general anaesthesia and close monitoring after surgery, making intensive care support necessary in certain cases. Without such facilities, they have to be referred to other hospitals.
Patients said transferring to another hospital means going through fresh registration, securing a new appointment and undergoing additional tests. This delays treatment and increases the financial and emotional burden on patients and their families.
Doctors, however, said not all eye surgeries require ICU support. Routine cataract operations can generally be performed without intensive care facilities. However, depending on a patient's physical condition, the type of surgery and the anaesthesia required, some complex procedures may necessitate close monitoring.
Patients with heart conditions, in particular, require additional precautions before and after surgery, they said.
Dr Sayeed Mehboob Ul Qadir, director of the National Institute of Ophthalmology and Hospital, told Dhaka Tribune that the hospital had never had an ICU since its establishment. He recently assumed office and is working to address patients' basic healthcare needs.
"I cannot comment on matters that predate my joining. The hospital provides necessary surgical procedures free of charge. However, fees are charged for certain diagnostic tests in accordance with government regulations," he said.
The director said general anaesthesia was not necessary for every eye surgery involving heart patients. Many procedures could be performed using local anaesthesia or anaesthetic eye drops.
However, some procedures, including retinal surgery and certain eye muscle operations, may require general anaesthesia. Heart patients undergoing such procedures may need ICU support, he said.
Patients with heart conditions who require general anaesthesia for eye surgery are advised to undergo the procedures at other government medical college hospitals equipped with ICU facilities, he added.
Asked about the difficulties patients face in securing appointments at those hospitals, Dr Qadir said patient numbers exceeded available capacity, resulting in long waiting periods.
Regarding plans to establish an ICU, he said: "Setting up an ICU is not something I can do alone. It requires adequate space, manpower and technicians. I will certainly take the initiative if there is an opportunity to establish one through discussions with the Ministry of Health."
Hospital's capacity and services
The National Institute of Ophthalmology and Hospital began its journey in 1979 with 100 beds inside the Shaheed Suhrawardy Hospital Complex in Sher-e-Bangla Nagar, Dhaka. In December 2007, it moved to its own premises in Agargaon and began operating as a 250-bed hospital.
It is now one of the country's leading specialised and referral centres for eye care.
According to hospital sources, around 4,000 patients visit its outpatient department every day. They receive various diagnostic and treatment services for a nominal ticket fee of Tk10.
The hospital also accommodates an average of 220 to 250 inpatients daily. Its outpatient and emergency departments together provide services to around 600,000 to 700,000 patients annually.
To cater to this large number of patients, the hospital performs an average of 60 to 80 minor and major surgeries every day, including around 50 to 60 phacoemulsification procedures for cataract treatment.
Overall, approximately 27,000 to 28,000 eye surgeries are performed at the hospital each year.
The hospital currently has 250 beds. To cope with the growing patient load, there are plans to expand the facility into a 10-storey building and increase its capacity to 500 beds, the director said.