05/19/2011, 00.00
BANGLADESH
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Healthcare in Bangladesh: only sterilization and vasectomies are free

by Nozrul Islam
The government does not provide any type of health care and all medical treatments are at the expense of the patient. But the arrival of Western medicine has raised the costs and the vast majority of people struggle to buy even an aspirin.

Dhaka (AsiaNews) - In Bangladesh the only form of free health care at all (or almost) is provided by reproductive health centres, funded by the countries from northern Europe and the United States. Vasectomies and tubal ligament are part of government birth control policy: until a few years ago the state paid people who accompanied women to undergo surgery. And often, when a girl has to undergo an intestinal operation, doctors take this opportunity to sterilize them without their knowledge.

This practice led to a social outcry, but similar structures still exist and the birth rate is declining (1.6% in 2010). Bangladesh is one of the most populous countries in the world (162.2 million people), but is paying a high price for the impressive economic progress and modernization that have exploded over the last decade.

The sudden and massive introduction of Western medicine (allopathic), expensive by Bangladeshi standards, has seriously undermined a health system that provides no government assistance and is based only on traditional medicine. Given the apparent effectiveness of "modern" medicines the use of herbs, ointments and kobiraj (magic practices) have declined, causing an increase in demand and, consequently, costs.

Few people have full health care coverage, mostly government employees, and they go to private hospitals or abroad (usually India, Thailand and Singapore). For the remainder, state hospitals that exist in theory should provide free treatment: instead, as well as being insufficient in number, except for a general visit the patient must pay for prescriptions, food, medical and clinical examinations.

People’s awareness has changed - "this medicine is better and it cures me" - but the earning capacity of the population, very poor on average, has not changed. The rich have access to health care and medicine, while the poorest now know that treatment is available, but they can not do anything, because there is no public health care.

There are increasingly frequent and painful cases: people who suffer very minor injuries or illnesses which in itself would not be nothing, bronchial or intestinal forms that become chronic, wounds that degenerate from a minor infection. Especially in the villages, the poorest first attempt to treat themselves with traditional methods, when these prove ineffective, when it is almost too late they turn to the doctor or hospital.

The missions, the Church and the "sick shelters" provide a minimum form of assistance, covering the medical expenses. However, hospitals have discovered the "package" system; for a certain type of operation they ask a certain sum, but then the total balloons because of additional costs (food, blood transfusions, additional days of hospitalization). These end up doubling the price, forcing the missionaries to make painful choices because they are unable to pay for treatment for all.

The state goes someway in supporting leprosy sufferers, occasional vaccinations against rabies and tetanus, awareness campaigns on nutrition and reproductive health centres.

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