Bangladesh is only country in world where doctors out numbers nurses!
Safique Ahmed M.D.
To: alochona@yahoogroups.com
From: ezajur.rahman@q8.com
Date: Sun, 6 Jul 2008 09:23:39 +0300
Subject: [ALOCHONA] Nursing In Tatters
Nursing In Tatters
Nurses missing in nursing
No recruitment in public hospitals in 5 years
Courtesy New Age Daily Star 6/7/08 Mahbuba Zannat
Firoza, a 22-year-old burn patient, was screaming in pain when the ward assistant (Aya) was changing her bandages. The aya was removing the gauze mercilessly from the wounds on her chest, hands and abdomen; she was never trained for this and had many other things left to do.
Trained nurses usually do this job in hospitals of Bangladesh but as there are very few nurses, the ayas do it alone.
"As the number of nurses is inadequate here and they are busy with other work, it is the norm here that the ayas would change the bandages in exchange for Tk 100," said a relative of a patient complaining to The Daily Star correspondent about nurses' poor quality training, behaviour and non-cooperation.
However, doctors and nurses defended themselves saying that their inadequate numbers hinder good services to patients. The doctors and nurses also talked about the nurses' not getting promotion and the lack of quality training for them.
Recruitment of nurses in public hospitals is halted for last five years. In 2003, 1,034 nurses were recruited and since then no recruitments were made even though every year around 1,200 nurses graduate from government nursing institutes and approximately 10,000 nurses are unemployed at the moment.
"Here we do not get a nurse to give saline to a patient when we need them to do it," said Project Director of Burn and Plastic Surgery Unit of the Dhaka Medical College Hospital (DMCH) Shamantalal Sen adding that if the shortage of nurses continues, patients will die without getting proper care. He said it is not possible to provide good service to 234 patients on an average day at the Burn and Plastic Surgery Unit with only 31 nurses.
It is very difficult to provide good service to such a large number of patients with only two nurses per shift working in one section of the unit, he said.
The unit has seven sections and at least 7-8 nurses are required per shift in each section to provide a reasonable service to patients, nurses told The Daily Star adding that the situation gets even worse in the afternoon and night shifts when only one nurse is available in a section.
They said 20 nursing posts are now vacant under the project as the decision of appointing nurses is not getting the go-ahead from the secretary concerned.
Around 2,000 patients receive in-door treatment at the 1,700-bed DMCH on an average day but only 559 nurses are there to take care of all patients including at the operation theatres, emergency wards and the out-door section, DMCH sources said.
It is a common scene across the country as the government remains quite indifferent to nursing issues, they said.
"As there is no strong professional body of nurses, their demands are often unmet. At the same time there is a lack of political will in developing nursing service in the country," said AM Zakir Hussain, former director of Primary Healthcare and Disease Control. He said posts have been created for doctors even at union levels but no nursing posts were created during the last five years.
Since most nurses come from less privileged class of the society, the level of their self-esteem is often low and their remuneration package is also not satisfactory, which are enough to hinder good nursing service in this country.
Division among the nurses is also an issue because of which their lone association has been inactive for long.
The Directorate of Nursing also has to work under pressure from the Ministry of Health and Family Welfare, which does not allow the nurses to have their own independent body.
According to the report of Bangladesh Health Watch titled "The State of Health in Bangladesh, 2007", the country lacks at least 2.80 lakh nurses. The number of doctors is almost double the number of nurses, which should be the other way around.
The number of registered nurses is only 22,555 and the nurse to population ratio now stands at 1:6342, according to Bangladesh Nursing Council (BNC) reports.
The international standard for nurse to patient ratio for general patients is 1:4 and for critically ill ones it is 1:1, which is not attainable under the present socio-economic condition of Bangladesh.
The 46 government nursing institutes along with 19 private institutes allow 2,280 nurse aspirants a year to study for diploma in nursing, which is quite insufficient, sources say.
Promotion of nurses is also very slow and a nurse has to stay many years just being a senior staff nurse before getting a promotion.
"It creates dissatisfaction among the nurses and gradually they lose their interest in work. A sense of deprivation among them is one of the main reasons behind the deteriorating service," said Deputy Registrar of Bangladesh Nursing Council Suraiya Begum. She said last year around 125 nurses were promoted after a long wait.
Even though the population and the number of patients have increased significantly, the number of nurses and nursing supervisors have not increased at all, she went on to say.
According to the Directorate of Nursing, there are 729 posts of nursing supervisors and 153 of them are vacant since 2006.
A proposal was made in 1999 to create 800 new posts for nursing supervisors and the authorities had agreed to it but it is yet to materialise even though eight years have gone by.
Based on an ordinance, the Bangladesh Nursing Council (BNC) has been operating for more than 58 years and there is no distinct regulation at all for this autonomous body. It even lacks the manpower to take necessary action against any wrongdoings of nurses, sources said.
Similarly, Directorate of Nursing neither has a complete structure nor the manpower. It has been running for the last 16 years with workforce sent there on deputation. It also does not have a fully-fledged director but an acting director.
Promotion process is so sluggish at the Directorate of Nursing that many retire soon after getting the post of acting director of the directorate. In 2004 Khadijatul Kobra went into retirement only after working three months as the acting director of the directorate.
Even though the National Plan of Action in 1994 recommended complete independence of the directorate, no steps were taken in the last 14 years to this end.
The i'm Talkaton. Can 30-days of conversation change the world? Find out now. __._,_.___
[Disclaimer: ALOCHONA Management is not liable for information contained in this message. The author takes full responsibility.]
To unsubscribe/subscribe, send request to alochona-owner@egroups.com
Change settings via the Web (Yahoo! ID required)
Change settings via email: Switch delivery to Daily Digest | Switch to Fully Featured
Visit Your Group | Yahoo! Groups Terms of Use | Unsubscribe
__,_._,___