The government is supposed to bear all costs, including the cost of surgery, of very poor patients admitted to the hospital in free beds. The costs are to be met from the Poor Fund, but the reality is otherwise.

Most of the poor who are diagnosed for open heart surgery at the National Institute of Cardiovascular Diseases (NICVD) cannot pay for full cost of the surgery that ranges between Tk 70,000 and Tk 1 lakh. Nearly all cases are of defective valves or internal perforation requiring repair.

The NICVD has a seven-member committee to select very poor patients. But the selected ones must pay in advance between Tk 5,000 and Tk 10,000 to enjoy the other benefits free of charge.

This policy has drawn strong criticism from health experts and also the health secretary.

Sources pointed out that due to this policy many of the chronically sick cardiac patients admitted to the hospital have to leave it or remain untreated. An investigation shows only 25 out of 85 applicants between February 23 and May 23 could enjoy the Poor Fund benefits. The rest could not as they were not able to deposit the money and had to go back untreated.

Of the 25 beneficiaries, two received mitral valves, three got aortic valves and the rest oxyginators and other materials for surgery.

The committee's records said between November 23 last year and February 23 this year, 100 applied for the benefits and 81 of them were given 32 mitral valves, five aortic valves and the rest got other things.

"The reality is that many deserving patients drop out just because they cannot pay the deposit money," one source mentioned.

He also said the committee meets only once every three months and that patients requiring emergency intervention cannot wait for such a long time.

An official linked to the committee, refusing to be identified, claimed most applicants ultimately manage to arrange money to get the free benefits and very few drop out.

Meanwhile, the health ministry has declined to increase allocation of life saving devices like valves and pacemakers that are implanted in heart.

The NICVD gets supply of oxyginators, stitching thread, sternal wire and other accessories for open heart surgery of poor patients but they are just not enough, said a senior doctor.

"Even patients who qualify for the Poor Fund benefits, their financial ordeals do not end there. About a week before surgery, doctors prescribe antibiotics, analgesics and other materials required to prepare a patient for the surgery. These are all additional hidden costs, ignored by the committee. A surgery patient also has to keep ready a cash of at least Tk 25,000 for medicines, blood, disposable items and injections," he mentioned.

Another doctor said about 30 per cent of all surgery items including valves and pacemakers are given free of cost from the Prime Minister's Office directly on request but they often do not reach the poor patients. "Many high-ups including ministers, members of parliament and government officials and hospital staff themselves frequently ask for free allotment of the items for their relatives and friends. We cannot avoid this," said an official of the hospital.

Thirteen-year-old Sohel from Laxmiposhar village of Dohar upazila in Dhaka, in Ward -1 of the NICVD, has been waiting for about one month for his turn for surgery to repair aortic valve. But he has to wait till his poor father can manage to pay for the cost of surgery.

" We have already borrowed money from relatives and others to save the life of our ailing son. We have to spend Tk 200 to Tk 300 every two days to buy medicines, which is becoming an increasing financial burden on us. But they (hospital sources) said we have to deposit Tk 10,000 if our son is to be operated here," his mother Nurjahan said sadly.

Scores other poor patients are in similar trouble to meet the financial requirement.

Health Secretary A F M Sarwar Kamal said, "We believe the valves and other expensive life saving devices are not reaching the genuine poor. We want to bring discipline in distribution of the devices. Although they are supposed to be given free of cost, we know they are charging Tk 5,000 to Tk 10,000, which is unethical."