The country has one anesthesiologist for every 76,000 people, according to Bangladesh Society of Anesthesiologists
Bangladesh lacks the number of specialized anesthesiologists needed for the proper functioning of a healthcare system, putting the lives of patients on operating tables at risk.
Health experts said a lack of recognition, insufficient space for clinical practice, lower wages, ignorance on the part of the government and the stressful nature of the job are some of the factors discouraging physicians from specializing in the field, despite it being the backbone of surgery and emergency health services.
The World Health Assembly in 2015 passed a resolution making surgical care and anesthesia a part of universal health care.
According to the Lancet Commission on Global Surgery, there must be a team of 20 anesthesiologists and obstetricians for every 100,000 people. Four to five members of the team are supposed to be anesthesiologists, which means Bangladesh requires one anesthesiologist for about 25,000 people.
However, Bangladesh has a total of only 952 physician anesthesia providers (about one anesthesiologist per 200,000 people), according to the World Federation of Societies of Anesthesiologists.
According to the Bangladesh Society of Anesthesiologists, Critical Care and Pain Physicians (BSACCPP), the number is 2,200. This amounts to one anesthesiologist for 76,463 people.
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BSACCPP also said anesthesiologists in Bangladesh are the lowest paid among those in the Indian subcontinent region.
BSACCPP President Prof Debabrata Banik said 500 more anesthesiologists are in the making, as they are in the process of completing Diplomas in Anesthesiology (DA) or Doctors of Medicine (MD) or in the first part of the Fellow of College of Physicians and Surgeons (FCPS) program.
“Ten years ago, we had only 750 anesthesiologists. The sector is progressing rapidly but still way behind the requirement,” he said.
An anesthesiologist is responsible for anesthesia and overall medical management during a surgery. They help optimize the comorbid conditions of patients for their safe outcome during the perioperative period (before, during, and after a surgical procedure).
Beyond the operation room, they manage postoperative pain, chronic pain of cancer, labour analgesia, in cardiac and respiratory resuscitation, in blood transfusion therapies, respiratory therapies, and ICUs.
Medical students uninterested
As anesthesiologists usually have to work in hospitals and there is little scope for practicing a as a clinician, medical students in the country rarely choose to specialise in anesthesiology, experts said.
From 2014-15, students showed some interest in the subject as these specialists were allowed to practice as clinicians as part of pain management.
Prof Debabrata Banik of Bangabandhu Sheikh Mujib Medical University (BSMMU) said being a hospital-based physician would not be a problem for anesthesiologists if they were well paid like their counterparts in developed countries or other South Asian countries.
“In Nepal, anesthesiology is one of the three most popular choices for medical students, but in Bangladesh it is nowhere near the top three,” he said.
Head of the anesthesiology department at Dhaka Medical College Dr Mozaffar Hossain said the country already had a crisis of anesthesiologists, and they now have to split further into those who can work in ICUs and those who cannot.
In 2015, the government had announced incentives for new anesthesiologists, but the initiative did not materialize, he said.
‘Surgeries being delayed’
Several anesthesiologists, seeking anonymity, said the shortage of such physicians was leading to a number of surgeries being delayed.
Most of the time, hospitals end up hiring anesthesiologists who are unqualified and inefficient to save money.
In many mid-level hospitals, a single anesthesiologist may manage three or four operations at the same time, compromising the safety of the patients, they said.
Prof Debabrata said: “Although postgraduate anesthesiologists are being produced each year, specialists in particular matters, such as cardiac issues, are rare.”
What can be done?
Chairman of Bangladesh Health Rights Movement and eminent healthcare expert Prof Rashid E Mahbub said the government has to take initiatives to create more anesthesiologists to ensure essential surgical and anesthesia care. “If necessary, they should provide incentives for the service.”
Directorate General of Health Services (DGHS) Program Manager (upazila health service strengthening, referral system and medical waste management) Dr Md Azizur Rahman Khan said they have appointed a number of anesthesiologists at upazila level hospitals.
“But it is true that we have not been able to provide them with necessary logistical support to work till now,” he said.