Disease in diagnosis

    Disease in diagnosis

    The quality of medical care in the port city is getting a bad name in recent times, leading to immense patient sufferings. And the diagnostic centres are partly to blame.

    Healthcare is characterised by the treatment of the patient by taking into account the clinical reports, rather than just the symptoms of a disease. Getting the right diagnosis is a key aspect as it helps doctors decide on subsequent steps.

    Bakteyar Hossen Saimon from Noapara village of Raozan upazila in Chittagong thought the worst was behind after his mother's gall bladder removal at Delta Hospital in Chittagong in the first week of June.

    But a few days after the procedure, a diagnostic report showed the presence of malignancy (adenocarcinoma) that had spread and that she would require chemotherapy to heal.

    We were absolutely devastated by the news. Thinking about what to do next, I decided to go to Christian Medical College (CMC) at Vellore, India for a second opinion.

    Zipping through the visa procedure, they flew out the very next week. To our surprise, the medical report of the Department of Hepato Pancreato Biliary Surgery of CMC showed no evidence of cancer.

    Mitu Chakraborty, 42, a resident of Akbar Shah in Chittagong, shares a similar narrative. She had heard of varying blood work results from her acquaintances before and so she gave blood samples at Popular Diagnostic and Nuclear Medicine and Allied Science on September 5.

    Her confusion knew no bounds when she got two diverse results – the report of Nuclear Medicine and Allied Science showed her thyroid-stimulating hormone (TSH) level at 3. 9 and Popular Diagnostic at 12. 72.

    Three days later, she gave a blood sample at Sensive Diagnostic, and the result showed her TSH at 7. 44.

    The head mistress at South Mosjiddha Government Primary School of Sitakunda Upazila is now apprehensive about further tests in the port city and has decided to go abroad for treatment as well.

    In another incident, Farid Ahmed, a resident of Changragona union of Rangunia Upazila, said his wife was diagnosed with a tumour in her gall bladder through assessment at the Centre for Nuclear Medicine and Ultrasound in the first week of March 2016.

    My wife broke down in tears at the doctor's chambers after hearing the test results. However, a second assessment just after three days at Metro Diagnostic Centre showed no tumour.

    We are now even more uncertain of what to do next.

    One of the factors behind misdiagnosis could be the use of expired reagents in carrying out the tests, Chittagong Civil Surgeon Abdul Aziz Siddiqi told The Daily Star. A reagent is a substance or mixture that is used for chemical analysis or other reactions at laboratories.

    RAB frequently conducts drives into these labs and fines them for using expired reagents. But the labs just pay the fines and its business as usual, added Siddiqi.

    We formed a three member probe body to examine into the varying test results of Mitu Chakraborty and will take steps accordingly.

    On why diagnostic reports vary at different centres, Dr Zillur Rahman, head of the pathology department of Chittagong Medical College, said test results may vary depending on the method, quality of reagents, skills of the technicians and the way the reagents are being preserved.

    Hospitals and labs get frequent deliveries of fresh reagents, but some dishonest technicians make do with expired and diluted reagents and sell the new reagents outside, he added.

    Many a labs may even procure low quality materials for diagnosis, as those are cheaper. And lastly, the skills of the technicians in conducting the tests and preserving the reagents is a determining factor as well,” he said.

    What do the diagnostic centres have to say?

    Abu Masud Hanif, assistant manager of Popular Diagnostic Centre, defended their report when Chakraborty returned to confront them about her TSH level, accompanied by journalists. We diagnosed her again and found the same result as before. We can say that our report is one hundred percent right.

    Dr Tapan Poddar, in-charge of the pathology department at Delta Hospital, said a number of patients do not follow the right procedures before going through the medical tests. Sometimes, patients come in after having a meal, while he or she was asked to take the test in a fasted state. This makes it difficult to make the right diagnosis.

    On the case of Mitu Chakraborty, Dr Moinul Islam Mahmud, director of Sensive Diagnostic Centre, said the Civil Surgeon Office formed a committee to look into the reports.

    As the matter is under investigation, I prefer to not make a comment. The findings will reveal everything. But I can say that we use the best equipment and use cutting edge technology to ensure accurate readings.

    The committee found no irregularities while investigating Popular Diagnostic Centre and Sensive Diagnostic Centre, sources said. It was still probing Institute of Nuclear Medicine.

    Robiul Haque, director of Institute of Nuclear Medicine, could not be reached over the phone despite several attempts.

    Ride-apps to get govt nod

      Ride-apps to get govt nod

      The road authorities open the door to app-based transport service providers like Uber and Pathao but on two key conditions -- fares cannot be more than that of taxi services and security cannot be compromised.

      The government will fix or re-fix the fares if there is any discontent among passengers over those, according to the proposed guideline for the ride-hailing services.

      The apps used by the service providers must have facilities so that both passengers and drivers can send signal to the police control room in case of emergency, it mentioned.

      Bangladesh Road Transport Authority (BRTA) has prepared a draft of the “Ride-sharing Service Guidelines 2017” and sent it to the Cabinet Division, said ministry sources.

      It is likely to be placed before the cabinet today for approval, they said.

      With 10 sections and 45 sub-sections, the draft has been prepared when around a dozen app-based services, including Uber, Pathao, Cholo, Amarbike, Ezzyr and taxiwala, are already in operation in the capital.

      The app-based service providers have welcomed the government move, saying it would benefit all the stakeholders.

      The services have been well received by the city dwellers largely due to convenience, easy availability and reasonable fares, they said.

      As per the draft, cars cannot charge more than the fare fixed under the Taxicab Service Guidelines 2010.

      At present, the government-fixed fare for taxis is Tk 85 for the first two kilometres and Tk 34 for each subsequent km. Passengers have to pay waiting charge of Tk 8. 50 every two minutes and Tk 20 extra for booking a taxi over the phone.

      The app-based service providers, however, said the fares they charge are already less than that of taxi services.

      Sayeda Nabila Mahbub, marketing manager of Pathao that provides both car and motorbike services, said a car passenger pays Pathao Tk 50 as base fare and Tk 20 for a kilometre with Tk 2. 5 as waiting charge for each minute.

      The minimum fare is Tk 100, she said, adding that it offers 30 to 40 percent discount on fares to its clients every week.

      According to the draft, the apps used by the service providers must have SOS (Save Our Souls) option for ensuring security of passengers and drivers.

      In case of emergency, the SOS option will allow passengers or drivers to send information on their location and other details to a dedicated number.

      The apps must have options for a passenger to know possible fares. It also has to offer facilities to both the passenger and the driver to share their experience of a ride and lodge complaints, if any, with the BRTA and the service provider, it said.

      Service providers will preserve details of the trips, including fare, distance and time for three months, but they must not share those with others.

      However, if necessary, law enforcers, the BRTA and other authorities may be given access to those, the draft said.

      The apps must be approved by the BRTA or the other authorities concerned.

      Besides, all service providers must have a system to allow the police control room, if necessary, to keep watch on a trip, the draft mentioned.

      Private motorbikes, cars, sport utility vehicles, microbuses and ambulances can be included under the services, and both the company and the driver have to obtain certificates from the BRTA.

      A company must have 100 vehicles for providing services in the capital, 50 in Chittagong and 20 in any other area.

      Documents on the vehicles must be up-to-date and drivers will not be allowed to wait at places, other than the designated ones, to pick up passengers.

      A person can register only one vehicle under the service and that can be done a year after the vehicle's registration with the BRTA, it said.

      A company has to pay Tk 1 lakh and submit other relevant documents, including trade licence, to get “enlistment certificate”.

      A car driver has to pay Tk 1,000 and a biker Tk 500 as yearly enlistment fee and renew the “enlistment certificates” after three years.

      The draft noted that cars, motorbikes, sport utility vehicles and microbuses used by individuals or families are on the rise, leading to traffic jam. Through the ride-hailing services, an individual will be able to rent out his private vehicle after meeting the requirements.

      Once the ride-sharing service is introduced, it will help ease traffic jam, improve transport service and above all, owners of private vehicles will be benefited economically, mentioned the draft.

      In May 2015, the USA-based Datavoxel Ltd launched the first app-based motorbike service -- Share a Motorcycle (SAM) -- in Dhaka city.

      Later, the BRTA issued a notice saying that such services were illegal as motorbikes were registered privately, and that there was no scope for using those for commercial purposes.

      When Uber, a popular app-based ride-hailing service, launched operation in Dhaka city in November, 2015, the BRTA said the service was run in violation of the country's motor vehicle regulations.

      Later, Uber and other firms urged the government to formulate a guideline for app-based services.

      Kamrul Hasan Emon, a director of the recently-launched transport service provider Ezzyr, welcomed the government move.

      We want to give service to people in line with all the rules and the law of the land,” he said.

      Hussain Md Elius, chief executive officer of Pathao, said, “It is very good that there will be a guideline. It will give legitimacy to our service.

      On the security measures to be taken by the service providers, he said, “It will be helpful for all. We are often asked about the security measures. Now those will be laid down in the guideline. We will comply with those.

      In reply to an email from The Daily Star, Uber's Dhaka office said, “We are working with the government and the policymakers to help bring innovation to our cities through constructive dialogue and engagement. We are thankful for all the cooperation and support that we have received from the government of Bangladesh.

      We admire the government's intent and vision for redefining the urban mobility landscape in Dhaka [city] and beyond. We are hoping to see something beneficial for our riders, driver partners and the industry at large,” it mentioned.

      Talking to The Daily Star, Sajal Ahmed, who works at a private company in the city's Karwan Bazar area, said he has been using app-based transport services for the last one year.

      These services are hassle-free and cheaper than taxi services,” he added.

      Four questions for the tri-series

        Four questions for the tri-series

        With their most recent outing being the disastrous tour of South Africa in September-October 2017, when they handsomely lost all seven matches across formats, there will be more than a few flaws to correct for the home team when they kick off their tri-series campaign today by taking on Zimbabwe in the opener at the Sher-e-Bangla National Stadium in Mirpur from 12:00pm today. The following are a few things to watch out for during the series.

        Can Fizz lead the pacers out of the doldrums?

        The Bangladesh team conceded 1,004 runs in three ODIs in South Africa while taking just 12 wickets -- an average of 84 runs per wicket at just over seven runs an over. Needless to say, a repeat of such toothless and profligate bowling will not bode well for Bangladesh. To that end the coaching staff and technical director have been working hard with the bowlers in the training camp that began on December 27.

        They have one big hope in the returning Mustafizur Rahman, who was ruled out on the eve of the South Africa ODI series with a twisted ankle. That is not to say that Mustafizur's presence would have made a big difference in South Africa as he averages a none-too-impressive 30. 55 in away conditions, but the numbers strongly indicate that his presence at home is a substantial one.

        Back in 2015, he was the spark that ignited Bangladesh's ODI rise and his home record is a fantastic 26 wickets from nine matches at an astonishing average of 12. 34. His brand of beguiling cutters are especially suited to the grip offered by the Mirpur wicket, and how he starts today will be integral to Bangladesh's search for their first triangular trophy.

        Will the number three puzzle finally be solved?

        Since the start of 2015, there have been seven batsmen tried at the pivotal number three position in ODIs and the best average among them was the discarded Soumya Sarkar and vice-captain Shakib Al Hasan's 29, the latter playing just one match in the position in the first ODI against South Africa in Kimberley last year. Technical director Khaled Mahmud yesterday informed that Shakib will be the one tried in that spot today and, judging by his statement that the team management wants a regular number three, for the rest of this series.

        Shakib is as good a choice as any, given his ability to read the game and take it by the scruff of the neck. With a rich 2017 with the bat, Shakib is well placed to solve the puzzle for the time being, but it will be important for him to hit the ground running today.

        Will Riyad get the time his talent warrants?

        Mahmudullah Riyad is the man for every position. He has batted as low as number eight in the order and as high as number three, where he hit his two successive World Cup tons in the 2015 event in Australia-New Zealand. In South Africa, he batted at number five in the first match, but was demoted to number six for the next two. Mahmud has recently said that the batsman has been underutilised lower down the order and said that he will likely bat at number five today. Like Shakib, if Mahmudullah can make this spot his own it will make for a more stable batting lineup.

        Can Anamul step up?

        Having hit a rich vein of form in domestic cricket, Anamul Haque has been recalled to the national squad at what could be the perfect time for the right-handed opener to make a comeback. Soumya Sarkar seems to have been deemed a failed experiment for the time being, and with Imrul Kayes yet to recover from a thumb injury, Anamul will now open with Tamim Iqbal. With the two left-handed openers named above not really making the number two position their own despite repeated chances, a left-right opening partnership with Tamim-Anamul may not be the worst thing.

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