Shasthya Andolon Against Rid Pharma
Protest against the producer of Paracetamol syrup
Shasthya Andolon organized a human chain in front of the National Drug Administration office in Motijheel, CA in Dhaka. They demanded immediate arrest of five officials of the Rid Pharmaceuticals, including its managing director, accused of causing the deaths of children with poisonous syrup.
Twenty-seven children have died of renal failure after the intake of "Temset" paracetamol syrup of the company. Shasthya Andolon in collaboration with Shasthya Odhikar Andolon o Jote (Health Right Movement) Human Rights orgnisation and workers organization held a human chain to demand exemplary punishment of the people responsible for the incident. They also demanded compensation for the families of the deceased children.
Shasthya Andolon's human chain in front of the Drug Administration was strategic to press home their demand and make the Drug Administration active on the issue.
Drug Administration director M Ismail Hossain met with the SA members as he was entering his office and told the demonstrators that they could not go for action against the accused due to loopholes in the law. He suggested the parents of the children to file cases against the responsible people so that they can go for action.
Farida Akhter, joint convener of Shasthya Andolon, said the drug administration authorities were evading their responsibility in the excuse of lack of manpower. The members of Shasthya Andolon demanded the government should take the responsibility of treatment of the children who fell sick after taking the poisonous syrup and make the pharmaceutical companies accountable.
Among others, members of Shasthya Andolon, Mesbah-uddin Ahmed, Shima Das Shimu, member of Health Right Movement Shashanka Roy, programme manager of Work for Better Bangladesh Mahbubul Alam, president of Bachte Shekho Nari Firoza Begum, and representative from Mukta Shishu Nari Shramik forum Jahanara Sheikh were present.
The news of this event was published in national dailies such as New Age, Nayadiganta, Jaijaidin, Prothom Alo, Sangbad and others. BBC radio interviewed Farida Akhter on this issue. Later on, the owner of the Rid Pharma was arrested and general awareness was created on the issue of Paracetamol use for children. The Shishu Hospital played a very good role in taking care of the sick children and giving concrete evidences of the syrup being responsible for such deaths.
Awareness creation meeting on Swine Flu
The scare of pandemic Swine Flu was spread in Bangladesh during August 2009 and it became a media sensitization almost every day. The Institute of Epidemiology, Disease Control and Research (IEDCR) was active to detect cases of Swine flu in Bangladesh. The Airports were on Alert for the arriving passengers, particularly from the US and Canada. Shasthya Andolon followed the issue in detail and monitored the newspaper reports. In this context Shasthya Andolon organized a meeting on 12th September, 2009 at National Press Club. The SA members raised the question why the scare of Swine flu has been spread without looking at the real causes of the possibility of the disease. The people suffering from common virus fevers are also being detected as Swine Flu patients although the diagnosis did not support it in all the cases.
Farida Akhter, Co-Convenor of Shasthya Andolon said that in September, the SA members noticed that the government has issues directive to use the Tami Flu drug or anti-viral drug Oseltamivir as a remedy for Swine Flu. The Patients having any kind of Flu were standing in line of the government hospital and the IECDR to get the medicine. However, it was not available to all who wanted it. In the meantime, the SA members also noticed that the drug is available in the pharmacies and were sold at a very high price, at Tk. 150 per capsule. For a patient to have 10 capsule at least it costs about Tk.1500. The medicine was also sold at Tk. 180 (a black market price). A garment worker receiving a monthly salary of Tk. 1800 will have to spend all the money only to purchase the medicine. The Ministry of Health gave clearance that this medicine can be taken even without being diagnosed for Swine Flu.
Dr. M Mushtuq Hossain, senior scientific officer of the Institute of Epidemiology, Disease Control and Research gave a detailed view on the situation as he is working in the Institute and facing hundreds of patients waiting to be detected for Swine Flu. He warned that in a tropical country like Bangladesh we get virus fevers during summer season while in the cold countries the influenza is seen more in the winter season. To have flu fever is not uncommon but whether we have Swine Flu or not we need to be careful in dealing with the issue. There is possibility that a vested interested group may take advantage of the situation and made business out of it. The only drug suggested as a remedy for Swine Flu is questionable.
He said that the tests for Swine Flu are being conducted under the supervision of the IEDCR in 12 Medical colleges. The IEDCR has warned people not to purchase the medicine over the counter from the Pharmacies. The government should lower the ‘unusual’ high price of anti-viral drug Oseltamivir.
People who already have developed influenza or been infected with swine flu should refrain from travelling to their village homes for Eid festival to prevent further spread of the virus.
Dr Zafrullah Chowdhury, trustee of Gonoshasthya Kendra, said a vested quarter was trying to create panic about swine flu to make quick bucks by selling of the drug and masks. The government fixed the price of the anti-viral drug Oseltamivir at Tk 150 per capsule. It is unusual as the production cost of a capsule is Tk 90. He urged the government to strictly follow the national drug policy to avert such unusual prices of medicines.
Professor Rashid E Mahbub, president of Health Rights Movement, called on the government to make public what initiatives it had taken to protect the poor and slum dwellers, who had no access to healthcare facilities.
AM Zakir Hussain, a health Expert, said that the government should not import anti-viral swine flu vaccine as it could create ‘Guillene Barre syndrome’, a kind of skin disease. He talked about the extensive business of a pharmaceutical company in this drug in many other countries of the world.
Professor Mesbah Uddin Ahmed, child specialist at Gonoshasthya Nagar Hospital, presided over the meeting. Aminur Rasul, Rokeya Begum, Dr. Taskera Noor, Shima Das Shimu, Ashiq Mahmud participated in the meeting.
This meeting was very well covered in the electronic and print media and created a very positive impact on the people.
Women's meeting on health
Shasthya Andolon, UBINIG and Narigrantha Prabartana organized a discussion seminar titled Draft National Health Policy, 2009: A women’s perspective was held on 20 July 2009 at 4 pm at Narigrantha Prabartana. The participants of this discussion were women leaders, women’s organizations, labor organizations, doctors, lawyers, poets, writers, sex workers, homemakers and female government service holders.
The discussants commented, ‘The health policy has been made to privatize the health sector through the government’s declared Draft National Health Policy 2009. Besides, all other health problems of women have been ignored in the draft health policy except for selected reproductive health care. Women suffer from various health problems at different age other than reproductive health, but there is no mention about them in the national health policy. Women also suffer more from arsenic problems, acid throwing, rape, breast cancer, cervical cancer and occupational health problems. But those issues were ignored in the health policy. Vulnerable women of our country do not even get the minimum reproductive health services that were promised in the policy. Based on women’s social conditions, there is no mention in the health policy about health services for them.
The specific demands from the meeting included:
1. There should be governmental arrangements in examining breast and cervical cancers at every level up to Union. There must be mass campaigns so that women can get those health services and they should available at every stage.
2. If a patient dies due to a doctor’s negligence, maltreatment or wrong treatment, there is no system for making any lawsuit or no rule for punishment against that doctor. So, there should be specific rules for this.
3. The malpractice to select the sex of fetus through special imaging should be stopped.
4. The diseases occurring due to lifestyle and also due to development projects should be mentioned and necessary steps should be taken. This needs inter-ministerial involvement.
5. It should be clearly mentioned in the policy that there can be health hazards due to environmental problems; for instance, people, particularly women and children are at risk because of state, political and social impact; also health problems due to natural calamities and accidents.
6. Specific rules and regulations should be made to start health system that protects women’s rights. This health policy has been become ‘treatment-centered’ rather than ‘health-centered’. There should be increased allocation for treatment costs as well as arrangements and research for disease prevention.
7. Concerns of a raped woman have been neglected in the policy. In the Upazilla level hospitals women doctors should only carry out the medical examination of raped women.
8. Complications may arise after carrying out unsafe abortion especially in private clinics. Although there is law against it, there is no implementation.
9. The health problems of sex workers are not given importance. This issue should be incorporated in the national health policy.
10. When, after an accident a patient goes to the emergency, s/he may not have money with her/him. The state should provide these patients free treatment.
11. The educational institutes must have health facilities.
12. The government should take care of the health of delivered mothers.
13. Women suffer from health problems due to tobacco farming. Tobacco farming should be stopped on this ground.
14. Women suffering from arsenic pollution have also social problems. This concern must be incorporated in the national health policy.
This meeting created awareness among the women's groups that there is a draft available for health policy and as women there is a need to respond to it. Women's groups have taken up the issue in various forums and demanded their health rights. Special needs of garment workers, sex workers and poor women in slums and in informal sector were mentioned in forums where health policy was discussed.
Women workers and the healthcare system
Women workers at the garment factories, informal sector, construction workers and household maids met together at a meeting organized on 13 May, 2009 at UBINIG to get information about the healthcare system. Following the methodology of Social Analysis System (SAS), the technique Time Line was used to see the changes in the healthcare facilities for the poor working people in the cities. In this Time Line, the participants who were illiterate were asked to think and discuss about the health facilities they have been using since the Bangladesh was liberated as an independent country. The majority of the participants were below 25 years of age, so they could not give information on the health care system before the nineteen eighties. But about 10 women were there who were over 50 years and could talk about the healthcare facilities in Dhaka and other cities such as Faridpur, Barisal etc.
To get a visual picture of the changes overtime, a rope was used starting with year 1972 to ending at 2009 with landmark dates of government changes at different times. It was very interesting discussion and as the workers could not write on cards themselves individual cards were written by UBINIG researchers on the information provided by the women workers. They all said with great satisfaction that till 1980's the government hospitals were providing health care services free of cost. However, the number of hospitals was limited therefore had to go to Dhaka Medical College or to Suhrawardy hospital and get free treatment. In contrast, at present there are more clinics, doctors sitting in the pharmacies, but no free treatment is available anymore. Still the government hospitals are the only hope for them. But the difference is that since most of the government doctors are involved in the private practices, their services have become poorer in quality.
The Garment workers said that they could health services from the government hospitals till 1982 at a ticket price of Tk. 5.00. They used to go to Suhrawardy Hospital more. For very common ailments they went to the local Pharmacies and bought medicine over the counter.
Since the private hospitals are very expensive the garment workers prefer to go to the government hospitals. Here they get free prescription but hardly any medicine. They have to buy the medicine from outside. However, it is still cheaper for as they do not pay for diagnosis cost.
In the mid 1980s, they have observed that more and more clinics are set up, but only for the ric people. The poor cannot get any treatment there.
For the delivery of babies, now the doctors ask for cesarean section operation which is very costly for them, ranging from Tk.10, 000 to Tk.40, 000. In the private clinics, they first look at the clothes of the patient and then talk to them. So the poor get often neglected. They complained that now a days, the doctors do not even touch the patients or even look at them. They partially hear the complaints and start writing the prescriptions.
This was a very useful exercise to get a complete picture of the health care system and to involve the women workers into the discussion. Finally at the end of the discussion it was clear that the health services were much better in the early periods, but with more and more facilities, it is going out of the hands of the poor people.
Interactive meeting with different groups
Several interactive meetings were held in Dhaka and at district levels with local level NGOs, social and environmental groups, school and college teachers, medical professionals and individuals with interest in the health policy issues.
Meeting with farmers and rural women in Chilmari
An interactive meeting was organized in Chilmari upazilla of Kurigram district on 20 March, 2009 with farmers, midwives and rural community. Over 20 men and women participated in the meeting. The meeting was held in a char called Ashtomir Char. The people here face river erosion every year and live in a very poor economic condition. There is no health facility of the government in the char. There is only one midwife who provides maternal health care using medicinal plants. To go to the Upazilla Health centre, they have to spend 7 hours (both ways) and spend about Tk. 500 to Tk. 600. Once they reach the health centre, they do not find any doctor. Sometimes if the doctor is there they give medicine worth Tk. 50 only. There are cases where women delivered dead babies in the boat on the way to going to the hospital, also facing danger to the life of the mother. People do not get treatment facility for common diseases such as diarrhea, fever, skin problems, eye problems etc.
In this meeting, the rural people in the Char area felt very good that they could share about their problems and could develop a relation with health groups. Later on, few members of the Char meeting were invited in the National seminar.
Meeting with NGOs in Dhaka
A meeting was organized on 7 April, 2009 on the occasion of the World Health Day to interact with different NGOs working with the rural communities, health, environment and development issues. The NGOs attending the meeting were HEED, Bangladesh, Gonoshthya Kendra, Chikitshak Sangsad, Members of ADD of Narigrantha Prabartana, PIACT Bangladesh, SPACE, PMTC, IVDC, Nari Uddoyog Kendra, Nongor, Gono Unnayan Prochesta , Dhaka Community Hospital etc. About 28 members participated in the meeting.
During this time, the government was talking about introducing User Fee. Therefore the discussions were more directed towards the usefulness of the User Fee or whether it may impinge upon the poor people's right to health care.
Dr. Salek Ahmed and Rokeya Begum shared about their experience about health care in Char areas of Kurigram, particularly about people's expenses in transportation to reach the health centre. In response to the information that Kurigram char people spend about Tk. 500 - Tk.600 t reach upazilla health centre, Heed Bangladesh gave information that Chittagong Hill Tracts people spend about Tk. 1000 to receive medicine worth Tk. 20 to Tk. 30.
The issues of Community clinics were discussed. Dr. A M Zakir Hossain responded by saying that there cannot be any health care system which is uniform. The health services must be designed according to the needs of people in specific geographical locations such as char, hilly areas and other remote regions.
Interactive meetings in Jessore, Khulna and Sylhet
Three interactive meetings were held with women led NGOs working at the district level. They were given the proceeding of the seminar (Bangla version) and they could be made aware about the draft health policy. It was found that none had any idea about such initiative by the government. However, they found it a good opportunity to be able to express their opinions about what should be in a health policy. Later on some organizations presented written recommendations about health policy.
The suggestions from Jessore included that the drafting committee must include both government and non-government members, there should be coordination between government and private health care, women's health needs must be addressed, increased allocations for health and upazilla level hospitals must have gynecological doctors, pediatrics and surgeons.
The organizations in Khulna emphasized on the need for health care of infants, and adolescent girls. They talked about Union health centers to be equipped with medicine as well as qualified doctors, stopping private practices of the government doctors. The over the counter selling of unlicensed drugs should be stopped. The importance of homeopath medicine was emphasized.
In these interactive meeting over 25 to 30 members were present in each meeting. Later on they contacted Shasthya Andolon secretariat UBINIG expressing their interest to become members of Shasthya Andolon and to carry out activities on health issues.
Meeting with NGOs, environmental organizations and women's organizations
An interactive meeting was organized on 5 November, 2009 with various organization in order to engage them with Shasthya Andolon and to interact on the question of the National Health Policy. In this meeting about 23 participants attended representing organization like BPKS, IVDC, SPACE, Church of Bangladesh, Odhikar, Bachte Shekho Nari, Unnayan Dhara Trust, Barscik, Narigrantha Prabartana, Sramabikash Kendra, UBINIG, Cancer Welfare organization, FEMA etc.
The participants were already aware of the national Health policy as they have followed the newspaper reports and some have attended the National Health seminar. Rokeya Begum of UBINIG shared information on the recently introduced increase of User fees in the Upazilla Hospitals. Although the upazilla hospitals visited in November, did not implement the policy. But in Dhaka Suhrawardy Hospital and the Medical College has increased the User Fee. The Outdoor fee has increased from Tk. 5 to Tk. 10 and the Admission fee has increased to Tk. 15. The paying bed has increased Tk. 102.50 to Tk. 225, Cabin from Tk. 430 to Tk. 475 and the general cabin from Tk. 230 to Tk.375. The charge for X-Ray has increased from Tk. 120 to Tk. 200. In the same way, the diagnostic cost has increased at all levels. The Attendants of the Indoor patients have to pay Tk. 20/- per entrance time.
The issues of the services provided by the Private hospitals, especially big Corporate hospitals like Apollo and United were discussed. In the name of giving VAT to the government, the patients are charged higher prices. The quality of doctor's care is much below the standard than those of the government hospitals. Everybody agreed that it is the bad management in the government hospitals that is a problem but treatment by the doctors is good. However, in the Health Policy the management issues are not discussed.
In this meeting many case studies were presented on the basis of own experiences describing wide range of issues of problems in the health care system. One of the problems is that the doctors use the patients for experiments with newer medicine. For example Firoza Begum of Bachte Shekho Nari experienced that for a burn injury the doctor used two different kinds of medicine unnecessarily, even though the first medicine worked.
There is no policy to deal with disabilities in our country. There are over 15 lakh people suffering from various forms of disabilities. Even in the draft health policy the use of the term "Bikolanga" for persons with disabilities is derogatory. There is no mention of the blindness as well as speech disabilities. Abdul Kader of the Bangladesh Disability Forum (BPKS) showed a draft of health needs for the people with disabilities, which they have already submitted to the government.
Another form of interactions with other organization was that Shasthya Andolon members were invited by Bangladesh Paribesh Andolon, WBB Trust, SUPRO, Shasthya Odhikar Andolon and Jote etc. to speak and to interact.
In general the interactive meetings have been very useful in involving various organizations outside the members of Shasthya Andolon and get their views on the health situation in the country and what should be included in the National Health Policy. As the health policy must be multi-sectoral, such interactions have been very effective.
WORKSHOP
Kurigram district: The health needs of Char people must be met
UBINIG hosted the meeting of Shasthya Andolon in Chilmari, Kurigram on 19 March, 2009. It was attended by 57 participants including NGOs, district and upazilla health personnel, Upazilla chairmen Union Parishad members and chairmen, farmers, midwives, Pallichikitshak and journalists. The workshop was chaired by Nazmul Parvez, Assistant Professor of Chilmari Degree College. The Chief Guest was M Kafil, Upazilla Chairman and the Special Guest was Abul Kashem Sarkar, Principal Chilmari Degree College and UP member of Ramna union.
Dr. Jalaluddin of DDH Foundation talked about a 100 bed hospital in Chilmari started in 1994. But this hospital does not provide services anymore, so people have to go to Kurigram or to Rangpur for treatment.
The Union Parishad members and chairmen talked about providing health services to the people in remote Char areas through re-establishing Community Clinics. However, the participants were very critical of the absence of doctors in the Upazilla hospitals. There is a need to change the attitude of the doctors towards people living in the remote areas.
A midwife of Korai Barisal char said the poor people in char areas are deprived of health services. She provides services to the pregnant women and helps them in the deliveries. But for complicated cases, she has to refer to the hospital, which becomes very difficult because of lack of proper transportation facilities.
Farmer Abdul Karim of Ashtomir Char said, after crossing the Brahmaputra river and spending over Tk. 600 as boat fare, they come to the upazilla health centre but do not get the services. This is very much of a problem to the people, therefore people are reluctant to come to the hospitals.
Another farmer of Khamar Bashpata char said, we do not know what a health policy is? We never heard of such policies in the past.
In general the discussion was around the poor health condition of the people and their deprivation of the services. There is no doctor for giving health care if someone gets sick. Their economic condition is so bad that they cannot even go to Chilmari hospital. For ensuring health for all, the government needs to provide health facilities to every corner of the society. The then Awami League government established Community Clinics but they never functioned. If the government wants to declare a pro-people health policy they need to open these community clinics. These community clinics should be developed in rural areas where people can get health facilities easily.
The special guest said that the health sector remained always neglected in the government planning. Although so much foreign aid has been received since liberation of the country, yet the health sector remained in a very poor condition. This is mainly because of lack of policy and planning. The local government should also be involved in the management of the healthcare services of upazilla hospitals.
The Chief Guest, M Kafil, Upazilla Chairman expressed his doubts whether the government will really listen to the voices expressed by the people in such remote areas. It is very important to have a health policy, but it must be pro-people. It must ensure the rights of healthcare as fundamental human rights.
The Community Clinics must be set up at an accessible place so that farmers and other rural people can go for services whenever they need. The lack of doctors in the Upazilla hospital and the lack of equipment such as X-Ray machines, Ambulances must be addressed in the policy.
Workshop in Kushtia district: Private clinics must be regulated
UBINIG hosted the Shasthya Andolon meeting in Kushtia district on 10 October, 2009 at the Nabapran Akhrabari in Cheuria. The workshop of over 62 participants was chaired by Farhad Mazhar, Managing Director UBINIG. The Chief Guest was Mayor of the Municipal Corporation, Kushtia and the Special Guest was Chairman of Chapra Union Parishad of Kumarkhali upazilla and Dr. Mizanur Rahman, Medical Officer of Kushtia Sadar Hospital. Dr. Mizanur Rahman replaced the Civil Surgeon who agreed to be the Chief Guest in the meeting, but later on regretted.
The workshop was attended by representatives from various NGOs, local government representatives, School and college teachers, health workers, lawyers, medicine sellers, farmers, midwives, women writers and journalists.
As the workshop was held after the declaration of Draft National Health Policy, 2009 and also after the National meeting organized by the Shasthya Andolon, the participants were given in their folder the copies of the proceeding, which was very helpful for the participants.
Farida Akhter introduced the activities of Shasthya Andolon and the issues taken up such as the Paracetamol case, Swine Flu, User Fee etc. She emphasized on the strengthening the services of the government hospitals as the we have a good human resource in terms of doctors and nurses.
Abdul Jabbar, the photographer of UBINIG showed a photo narration of the situation of government hospitals and the rapid expansion of private clinics in Kushtia. The doctors from the government hospitals are practicing in the private hospitals and are earning huge amount of money. The private clinics are set up as hotels or as any house without ensuring proper atmosphere for healthcare. Even an underground hotel is now being turned into a private clinic.
Dr. Mizanur Rahman of Kushtia Sadar Hospital emphasized on the problems faced by increased number of patients in the outdoor services - almost 200 - 300 per day, but due to lack of doctors the treatment cannot be provided to all those who need the services. The allocation of budget is very low, therefore the medicines cannot be provided. The number of beds in Kushtia Sadar hospital has been increased from 100 to 250, but no proportionate increase in the number of doctors. Although government has achieved the target of MDG 4 by reducing the child mortality rate from 165 to 65 per thousand, yet the overall situation needs to be improved.
Sabdul Islam, Chairman of Kumarkhali union Parishad said that although the services in the government hospital in inadequate yet the number of patients in increasing day by day. Poor people have no alternative but to go to the government hospitals. But unfortunately the environment of the hospitals is dirty and unhygienic with bad smell. He emphasized on the cleanliness of the government hospitals.
The link of the government doctors with the private clinics has become a major source of exploitation of the patients. The doctors are less interested in surgery to be done in the government hospitals, they refer to the clinics where they are working. The patients have to incur high price for operation done in the private clinics.
The farmer Aminul Islam Gain talked about tobacco farming as a major cause of disease and also use of pesticides and chemical fertilizers are leading to health hazards. But such issues are not covered in the health policy.
Anwar Ali, Mayor of Municipal Corporation said that the privatization of health facilities is causing economic hardship to the people. The doctors in the clinics do not look at the patients nor listen to their complaints. They give diagnostic test, which is a business itself. The cost of the diagnostic test ranges from Tk. 14 to Tk. 4000. So the poor people have to borrow money for treatment in the private hospitals. The rich people can afford to go to Dhaka or to Singapore, Thailand, India for treatment. But the poor die without any treatment.
The Chairperson of the workshop Farhad Mazhar said that it is the duty of the state to provide health care to the citizens. But due to the imposition of the policies by the World Bank, IMF and other international agencies, the state is liberalizing the policies of privatization. He emphasized the role of the local government representatives in monitoring the services of the government hospitals. The principles of Alma Ata Declaration for Primary Health care must be followed in order to ensure health for all people, particularly the poorer people of the country.