“We have essentially been running two separate healthcare setups in our hospital since the emergence of COVID-19”

Considering the COVID-19 crisis, how would you analyse the current situation of people who are suffering from cardiovascular diseases (CVD) in Bangladesh?

Currently, people with deteriorating symptoms of CVD are often delaying going to the hospital out of fear of contracting COVID-19, thereby worsening their situation. We need to mitigate this fear of hospital visits and consultations. Additionally, I would request everyone to refer to experts while taking healthcare decisions instead of believing information from unreliable sources.

At this stage, it is difficult to comment on whether there is any direct impact of COVID-19 on CVD patients. However, what COVID-19 does is accelerate the health deterioration of CVD patients. As we know, COVID-19 damages the lungs severely, so when it comes to COVID-19 positive CVD patients, there is a chance of an additional complication arising during cardiac surgery and other cardiovascular treatment procedures. This is why we try to treat COVID-19 before moving forward with definitive treatment of underlying cardiovascular problems.

Many people are staying home for months on end. These people need to stay active, eat nutritionally balanced food at regular intervals, and take care of their mental health. People will have no control over hypertension, diabetes, obesity and other cardiac issues if they do not lead a disciplined life. If all of these are maintained, not only the heart, but the entire body will stay healthy. The most important part is still, of course, maintaining social distancing and proper handwash hygiene and wearing masks.

What types of challenges are you facing regarding cardiac patients and their management during this time?

Patients of heart failure quite often exhibit symptoms similar to COVID-19 patients, such as difficulty in breathing. This leaves cardiovascular patients confused about whether they have COVID-19 or not. This is why we always prioritise screening all patients for COVID-19 first.

If a CVD patient is found to be COVID-19 negative, we follow the usual cardiovascular treatment protocol. However, if a patient is found to be COVID-19 positive, physicians deliberate on which treatment procedure would be best for them and whether medical management is required or not, depending on individual patients' situations. Since a lot of analysis is needed to come to clinical decisions, management of COVID-19 positive CVD patients can be difficult.

What facilities has United Hospital introduced to tackle this pandemic?

We have designed a new protocol for the entire hospital. Our patients are all screened regularly to check whether they have COVID-19. Any patient who enters the emergency unit must first go through various clinical assessments.

We have essentially been running two separate healthcare setups under the same roof of our hospital since the emergence of COVID-19. There are two floors dedicated to the management of COVID-19 patients. We prepared custom-made infrastructure for these patients with extra facilities such as ICUs with ventilators and high flow nasal cannula, central oxygen line support, dedicated dialysis facilities and coronary care. We have opened a new dedicated ICU for COVID-19 patients and earmarked separate beds for CCU and for dialysis. Our Cath labs and Operation Theatres (OTs) are also marked separately for COVID-19 patients, in case they need those facilities. We are also trying to provide separate consultant care for COVID and non-COVID patients, so, young consultants are receiving more work opportunities here now. We provide separate healthcare staff, including doctors, nurses, patient care attendants, housekeeping staff for COVID and non-COVID areas.

How are you ensuring awareness, hygiene and other safety measures?

We have many senior consultants who are involved with international forums. They receive and share constant updates from around the world. Furthermore, we have held many workshops, symposia and conferences regarding COVID-19 treatment and awareness. We have engaged with the government, UN agencies like WHO and UNDP to raise awareness among our staff.  

We have especially focused on awareness-building. Communicating COVID-19 prevention measures to the patients and staff is crucial and therefore, we are facilitating these conversations very actively. Our doctors are involved in regular Zoom sessions where we provide advice to CVD patients about lifestyle changes, nutrition, etc. Flyers, emails, and SMS are also used for knowledge dissemination.

As a protocol, all staff are tested for COVID-19 whenever appropriate. Safety measures for the health workers treating COVID-19 patients are in place and we are ensuring they all have right PPEs for right occasions. Health workers are often infected when they take off PPE, which is why we constantly raise awareness on the relevant guidelines for PPE donning and doffing.

We have a home care package for COVID-19 patients where we include all the essentials such as disposable plates, glasses, spoons, gloves, masks, sanitisers, surface cleaners, medicines, notepads, pulse oximeters, and thermometers. For each of the 14 days of isolation, our doctors, dieticians, rehab specialists, and counsellors provide the patient with video consultations. We also have a two-week post-COVID rehab programme where COVID patients are given treatment advice and rehab exercise with relevant investigations to regain a normal functional life.

What are your long-term plans for United Hospital in the post-COVID era?

In terms of patient management, we have adapted very fast in this crisis and we feel confident as we are already managing two parallel healthcare setups in our hospital.

Unfortunately, there is no COVID vaccine in sight. Our plans depend a lot on when the vaccine will arrive. The United Group is committed to people's healthcare, both through our commercial ventures and through United Trust, which works heavily in healthcare. We have extensive plans for network expansion with a commitment to set up 1,700 beds with existing 500 beds of United Hospital, upcoming 500 beds each in United Medical College Hospital in Satarkool area of the capital and United Chattogram Hospital under PPP with Ministry of Railway, and the 200-bed state-of-the-art MA Rashid Hospital in Jamalpur to be launched in January. With the arrival of COVID-19 vaccine, our network expansion strategy will be aligned accordingly. 

Many patients from Bangladesh usually go abroad for treatment but they are unable to do so now due to this pandemic. This is an opportunity for us to create confidence among these patients that we are equally able to provide them with same quality treatment that they obtain overseas. This current situation is also an eye-opener for the healthcare industry since all infrastructures and facilities need to fill up existing gaps as per the demands of the pandemic.

Do you have any recommendations for the government during this transitionary period?

We have probably around 90,000 doctors in the country. However, I believe, to ensure proper healthcare for the entire country, we need much more than that. We have approximately 70,000 nurses, but again, we require an amount which is a multiple of what we have now. Therefore, only developing hospitals is not enough; developing trained and skilled healthcare staff is crucial as well. The private sector has a significant role to play here. They must actively find opportunities to present their ideas to the government and gain permission to build centres. The government can also help them with policy support to establish hospitals and other relevant centres, especially because investment in new healthcare centres leads to significant employment generation.