‘Capacity must increase to manage patient load’

Dhaka Medical College Hospital (DMCH) Director Brigadier General Md Asaduzzaman is set to complete his tenure and return to the Bangladesh Army within the next few days. During his tenure, the hospital took several initiatives to address manpower and bed shortages, improve cleanliness, control broker networks, expand diagnostic services, and increase ICU and CCU capacity. Work has also progressed on a new Development Project Proposal (DPP) to expand the hospital to 4,000 beds. He spoke to The Daily Observer reporter Arifur Rahman Rabbi about his tenure, the challenges facing the hospital and its future plans.

What was the biggest challenge you faced when you took charge of DMCH?
Asaduzzaman: The biggest problem was the shortage of manpower and infrastructure compared with the patient load. There was no major shortage of doctors because we have trainee and resident doctors. However, there is a shortage of doctors in the anaesthesia department and nurses. Against 2,600 beds, we have around 2,300 nurses. The shortage of support staff is even more severe. There were around 1,000 permanent and daily-wage workers, although the hospital operates in three shifts.

Around 6,000 patients visit the outpatient department and about 2,000 the emergency department every day. More than 4,000 patients remain hospitalised. More manpower is needed to handle this huge workload.

What have you been able to do to increase manpower?
Asaduzzaman: There had been no new recruitment for nearly 15 years, and around 250 to 260 posts were vacant. We contacted the ministry and took initiatives for recruitment. Eventually, approval was given for 72 posts. In addition, 30 project workers were made daily-wage employees and around 100 more workers were added.
In total, about 202 workers have joined. They include drivers, computer operators, office assistants, and laundry and tailoring workers. This has made day-to-day operations somewhat easier.

How much has the long-standing problem of cleanliness improved?
Asaduzzaman: Cleanliness has improved significantly compared with the past. Along with regular monitoring, I personally took part in cleanliness drives every Saturday. Garbage accumulated on rooftops, sunshades and other areas was removed.
However, the number of toilets remains inadequate compared with the number of patients. There are also problems with the professional training and management of cleaners.
I believe cleanliness management should be handled professionally by a separate organisation. An initiative has been taken to introduce such a pilot system in part of DMCH. If it succeeds, it could be implemented in government hospitals across the country.

How much has diagnostic capacity increased?
Asaduzzaman: Around 4,000 to 4,200 patients are treated as inpatients and 7,000 to 8,000 as outpatients every day. It is not possible to conduct tests for all of them, and the cost of reagents is also very high.
Even so, we have increased our diagnostic capacity. A new automated machine and another laboratory have been introduced in the pathology department. As a result, the number of tests has almost doubled. When I took charge, revenue from diagnostic services was around Tk 39 crore. It rose to Tk 52 crore in the last fiscal year.

What causes the shortage of free medicines?
Asaduzzaman: The main problem is the budget. The medicine budget is allocated for 2,600 patients, while the actual number is around 4,200. So the same budget has to be distributed among more patients. If the budget is increased, the supply of medicines can also be increased.
Another issue is the procurement policy. Previously, 75 percent of medicines were purchased from the government-owned Essential Drugs Company Limited (EDCL) and 25 percent from the open market. I believe allowing greater scope for competitive market purchases would enable us to buy more medicines with the same budget.
I raised the issue with the authorities, and a decision has been made to purchase 50 percent from EDCL and 50 percent from the market.

What measures have you taken to control broker networks?
Asaduzzaman: We warned Ansar personnel, doctors, nurses and employees so that outsiders could not enter the hospital and lure patients away. Operations have also been conducted with the assistance of law enforcement agencies.
However, it is difficult to eliminate brokers through raids alone. When patients do not get beds or ICU facilities, they have to go elsewhere. Brokers take advantage of this situation. If we can provide beds, perform operations quickly and provide the necessary ICU support, their opportunities will be reduced significantly.
Is it possible to ensure one patient, one bed?

Asaduzzaman: Personally, I believe every patient should have a bed. Patients cannot be satisfied if they receive treatment on the floor or in overcrowded conditions.
But Dhaka Medical is a hospital where we cannot easily turn anyone away. Patients are referred from many places and come here as their last resort. Therefore, without increasing capacity, it is difficult to stop keeping patients outside designated beds.

What are the hospital’s future plans?
Asaduzzaman: Since 2017, there had been a project to expand Dhaka Medical to 5,000 beds. It was cancelled after the change of government in 2024. Now work is underway on a new DPP for 4,000 beds.
If the necessary budget, manpower and infrastructure are increased alongside the 4,000-bed expansion, it will be easier to manage the patient load. There are also plans to gradually replace the hospital’s 122-year-old buildings.

What was the most memorable achievement during your tenure?
Asaduzzaman: The Coronary Care Unit previously had only 19 beds. We used an adjacent rooftop space to create a new ward. This nearly doubled the CCU’s capacity and allowed us to accommodate many more patients.
We also made the systems for depositing fees, collecting samples and issuing tickets at the outpatient department easier. Around 30 ICU beds have been added across different units. An ultrasound complex has also been established, and the previously closed bone marrow transplant unit has been reopened.

What was the most emotional period of your tenure?
Asaduzzaman: The most difficult time was treating those injured during the July movement. Young men and women arrived with gunshot wounds to their chests, heads, necks, legs and abdomens. Many were brought to the hospital by their friends. Many others died before reaching the hospital.

Doctors, nurses and employees were also deeply emotional at the time. But as doctors, our responsibility was to continue providing treatment. We fulfilled that responsibility properly.
What advice would you give to your successor?

Asaduzzaman: The most important task is to move forward with the 4,000-bed DPP. Five proposals worth around Tk 200 crore have also been submitted for purchasing medical equipment.
If these are implemented, many of Dhaka Medical’s problems will be addressed. I hope the next director will take these initiatives forward.