Patients at the National Institute of Cardiovascular Diseases and Hospital (NICVD), Bangladesh’s only government specialised cardiac-care institution, are waiting months for heart surgery because of a shortage of functioning operation theatres. Children with congenital heart disease face particularly long delays, while extended hospital stays are increasing treatment costs and psychological pressure on patients and families.
Adult patients requiring cardiac surgery are also waiting for one month or longer after admission. Prolonged stays add to medical and daily expenses for patients and relatives, while causing additional mental stress.
Health Directorate data show that NICVD has 1,250 beds. More than 225,000 patients sought outpatient consultations at the hospital last year, while nearly 200,000 received emergency treatment and 112,000 were admitted. A total of 5,909 patients died at the hospital during the year.
NICVD performed 1,972 major surgeries and 16,269 minor surgeries last year. The patient admission rate stood at 120 per cent of bed capacity.
Established in 1978 in Sher-e-Bangla Nagar, Dhaka, NICVD provides treatment for adult and paediatric heart diseases. The hospital has 11 departments, including cardiac surgery, paediatric cardiology, vascular surgery, anaesthesiology, radiology and imaging, pathology, blood bank, physical medicine and rehabilitation.
The institute also provides diagnostic tests, emergency treatment, angiograms, catheterisation laboratory-based interventions, cardiac surgery and treatment and surgery for congenital heart disease in children. It also offers higher education and training, including MD in Cardiology, MS in Cardiovascular and Thoracic Surgery, and Diploma in Cardiology.
Hospital authorities said NICVD has 10 operation theatres: seven for cardiac surgery and three for vascular surgery. Two of the seven cardiac surgery theatres can no longer be used because their designated service life has expired.
Only five cardiac operation theatres are therefore effectively functioning. One is allocated for paediatric cardiac surgery, three for adult cardiac surgery and one for infection control and prevention.
Surgical procedures are carried out on a rotating basis by different units. NICVD has 10 cardiac surgery units, two paediatric cardiac surgery units and four vascular surgery units, each headed by a professor or associate professor.
A man from Chandpur brought his two-year-old daughter to NICVD for treatment. The child was admitted to the paediatric cardiac surgery department in Ward 21 on October 5 and requires open-heart surgery.
Doctors told the family that the child may have to wait more than two months for the procedure. The father first came to NICVD in early August but could not secure admission because no bed was available. The child was admitted after a prolonged wait.
A seven-year-old child from Gosai village in Dashmina upazila of Patuakhali has been admitted to the same ward since August 31. The child has congenital heart disease, including a hole in the wall between the heart’s two upper chambers, known as sinus venosus atrial septal defect (SVASD).
The child also has partial anomalous pulmonary venous connection (PAPVC), an abnormal connection involving blood vessels that return blood from the lungs to the heart. A blood vessel from the right lung is connected in an abnormal location, while the child also has mild pulmonary hypertension.
Doctors said the child requires surgery urgently, but no specific surgery date has been set because of the high number of patients. Family members believe the child may have to wait another month.
The paediatric cardiac surgery department has 44 beds and one dedicated operation theatre, where one surgery is performed daily. Excluding Fridays, the department can conduct between 20 and 24 surgeries a month.
The separate paediatric intensive care unit has 10 beds, including four with ventilators.
Dr Md Zahidul Islam, head of paediatric cardiac surgery, told Ajker Patrika: “With the surgeons and manpower we have, we can operate another operation theatre.”
A large proportion of paediatric cardiac surgeries are performed to correct congenital heart defects. Major procedures include repairs for atrial septal defect, ventricular septal defect and tetralogy of Fallot, as well as arterial switch surgery and Glenn and Fontan procedures for complex heart disease.
Doctors said catheter-based treatment is also provided in some cases, depending on the type and complexity of the condition.
NICVD faces shortages of perfusionists, critical-care medicine specialists and anaesthesiology specialists, according to doctors. Although the hospital has six approved perfusionist posts, none is currently filled.
Perfusionists operate heart-lung machines during cardiac surgery to maintain blood and oxygen circulation in the body. Heart-lung technicians are currently carrying out those duties.
The cardiac surgery department has 150 beds under its 10 units, with each unit having between 14 and 17 beds. Admitted patients often wait a long time to receive surgery dates, with delays increasing for those with more complex physical conditions.
Three operation theatres are allocated for adult cardiac surgery, where 10 units perform procedures on a rotation basis. The hospital can perform about 70 surgeries a month, excluding Fridays.
Another operation theatre has been designated for infection control and prevention. Of the department’s 38 intensive care beds, 24 are operational and 11 have ventilators.
Mechanical faults in old infrastructure and equipment occasionally force the hospital to suspend surgical activities. Such disruptions reduce the effective capacity of operation theatres and increase pressure on waiting patients.
The vascular surgery department has three operation theatres, including one for emergency procedures and two for scheduled surgeries. The department treats diseases of arteries, veins and other blood vessels, including narrowed or blocked vessels, blood clots, reduced blood circulation in the legs, aneurysms and vascular injuries.
At least five NICVD doctors, speaking on condition of anonymity, said the hospital cannot perform surgeries in line with demand because of limited operation theatre capacity. The doctors said delays in treatment can worsen complications, particularly for patients who require urgent surgery.
Doctors said inactive operation theatres should be restored quickly, older facilities modernised and surgical capacity expanded. Intensive care units, high-dependency units, manpower and equipment capacity must also be increased, they said.
NICVD Director Professor Dr Abdul Wadud Chowdhury acknowledged that extended hospital stays increase treatment costs and create risks of infection. Relatives also face additional pressure because they lose working time, he said.
Asked why the number of operation theatres was not being increased, Chowdhury told Ajker Patrika: “The service life of those operation theatres has expired. We are preparing a Development Project Proposal for the installation of three new operation theatres. A Development Project Proposal is also being prepared for the development of vascular surgery.”
The director said the hospital’s most severe staffing shortages involve fourth-class employees, cleaners and the anaesthesiology department.
“A hospital has to remain operational 24 hours a day and work in three shifts,” Chowdhury said. “It becomes difficult to run hospital activities without the necessary number of cleaners and security personnel.”