The state of Bangladesh's health care

Additional image:: 

THE FIRST patient of the day at M A Muttalib's clinic in Dhaka is a 6-year-old boy. After asking the boy's mother a few questions, Muttalib prescribes medicine for a parasitic and then comments, "The child goes back into the same unsanitary environment and becomes re-infected. Within six months, he'll be back with another worm and I'll prescribe another tablet. And so it goes on."

The next patient is a healthy baby girl brought in for a measles vaccination. The third visitor is a sales representative offering three new antibiotic treatments for diarrhoea in infants. Muttalib listens to the sales pitch and skims through the sales literature. Then, he hands them back with a query, "These studies are seven-eight years old. Don't you have anything recent?"

The sales representative's perfect patter suddenly falters. He mutters nothing recent has been published yet. Muttalib send him away after pointing out that antibiotics are seldom required for diarrhoea in children.

Says Muttalib, "What we need are simple treatments and basic health education. Our doctors should be able to deal with this. It's a tragedy that we can easily prevent many of the problems of infant health and don't do so."

The telephone rings. A mother who gave birth the previous day is calling to report she and the baby are fine. She thanks Muttalib for the counselling he and the clinic staff gave her on breast-feeding. The doctor puts down the phone and smiles. Another child has been started successfully on the road to health.

The events in Muttalib's clinic in the space of less than 30 minutes, encapsulate some of the major problems of health care in a developing country. They also dramatically highlight the benefits and failings of drugs. For example, anti-worm tablets are effective, but they cannot treat the root cause of ill-health: poverty, lack of sanitation and clean water, low levels of education and poor understanding of the causes of disease.

Some drugs, such as the measles vaccine, are both effective and essential in preventing illnesses, but are in short supply in many countries. Others, such as anti-diarrhoeal antibiotics are not necessarily effective and may even be unnecessary and harmful. Yet, they are often the most promoted products.Non-drug therapies for health problems should also be encouraged.