BANGLADESH

The ICDDR,B has shaved meat, egg and fish off the diet for patients, who are the 'lifeline' of the international health and population research and training institute, raising eyebrows.

The well-funded International Centre for Diarrhoeal Disease Research, Bangladesh that enjoys immunity from local taxes and duties has made the decision citing a 'cost containment' plan.

Bangladesh owns and largely funds the institute that gets over Tk 50 million in each fiscal year from the government for patients care. It treats more than 100,000 patients a year at its Mohakhali hospital filled with hundreds of brightly coloured diarrhoea cots with holes in the middle opening to clear buckets beneath.

The medical director of the hospital Dr Mark Pietroni in a Sept 6 letter to all hospital staff said the decision would be 'effective from Sep 11 till further notice.'

'no fish, chicken, mutton and egg will be given in the patient and staff diet unless prescribed by a doctor as part of a therapeutic diet for the patient.'

however, could not gather immediately why the institute braced for cost-cutting measures despite increasing funding from donors and the Bangladesh government.

The sudden penny-pinching has caused deep resentment among ICDDR, B's scientists and employees. Unnamed staff have circulated bulletins among the ICDDR, B staff, a copy of which is also with bdnews24.com.

The bulletin suggests prohibitive salaries for a few of its foreign officials and corruption in the last three years put the centre into a financial tailspin.

A government investigation is underway on the alleged misuse of Tk 1 billion funds allocated for the vertical expansion of the centre's three-storey Mohakhali.

In an email response, Dr Pietroni, however, did not make it clear to whether and why they stopped serving meat, poultry and eggs in the diet.

He only said the patients were given the diet that "their doctors feel is best for them."

Dietician with the ICDDR, B hospital Anowara Begum told  that they got a notice from the hospital authorities to stop serving fish, chickens, mutton and eggs.

"We used to serve any of those items along with vegetables, daal (lentil) and rice," she said, adding that the decision might be revised. "Senior scientists (at the centre) are trying to convince hospital administrators to revise the decision," she said.

A patient, Kamrul Hassan, 26, On Monday that he was given 'vegetables, daal and bhat (rice)' for lunch.

A senior nutritionist in Bangladesh, Akhtarun Nahar said she never heard of such decision at any hospital in her lifetime. "For the first time I heard it from you," the principal nutrition officer of BIRDEM told  when asked.

She said unless a few specific cases like liver cirrhosis and kidney diseases put them on a diet, hospital patients should be served 'improved' diet.

"Even a mother of a breastfed child needs protein-rich food so that she can continue breastfeeding her ailing child.

"I cannot agree with their (ICDDR, B's) decision," she said, adding if they suffer from fund crunch 'they could at least serve eggs for the patients.'

"Its (eggs) cheaper protein," she said.

Health Rights Movement's president Prof Rashid-e-Mahbub termed the ICDDR, B measure 'inhumane'.

"It's a research institute. Patients are their study subjects. It's their (patients) right to get proper services and diet," he said.

The hospital runs a diarrhoeal diseases surveillance for which they draw blood and urine samples from patients.

Health secretary Mohammad Humayun Kabir would not comment on issue since it involves the ICDDR, B's management.

But the secretary, who is also a member of the centre's board of trustees, said he would discuss it in the next board meeting.

The meeting will be held in mid-November. The 16-strong board meets twice a year and endorses the centre's activities.

The only centre of its kind in developing countries, the ICDDR, B was set up through an ordinance in 1978 that also offers a wide range of privileges for its foreign employees including exemption from income tax and privilege of duty-free import of all personal and household items.

The centre is legally mandated to move biological materials in and out of the country.

Leading health professionals of Bangladesh and India have urged their prime ministers to keep public health collaboration high on their agenda in Dhaka summit, as they believe prioritisation on health 'can spur human development' and ensure health for all.

Five Indian and six Bangladeshi professionals and public health experts made the request in a letter handed over to the prime ministers offices in Dhaka and New Delhi, just before Manmohan Singh's two-day Dhaka visit on Tuesday.
  obtained a copy of the letter signed by Prof. K Srinath Reddy, president, Public Health Foundation of India on behalf of others.

The letter addressed to the both prime ministers sought 'considered' support for a strong bilateral initiative for strengthening public health in both countries through 'collaboration in education, learning and research.'

Prof Reddy handed over the letter to the Indian prime minister's office on Sunday while Bangabandhu Sheikh Mujib Medical University (BSMMU)'s vice-chancellor Prof Pran Gopal Datta handed over the letter to the Bangladesh prime minster's office on Monday.

The Indian professionals are Prof Reddy, Dr A K Shiva Kumar, UNICEF adviser and member of National Advisory Council; Dr Mirai Chatterjee, Social Security Self Employed Women's Association director; Prof Rama V Varu, Centre of Social Medicine & Community Health, Jawaharlal Nehru University; and Dr Abhay Bang, director, Society for Education, Action & Research in Community Health.

The Bangladeshi professionals were: National Professor Shahla Khatun; BRAC founder and chairman Sir Fazle Hasan Abed; Bangladesh Diabetic Association president Prof A K Azad Khan; Obstetrician Prof. Samina Chowdhury; ICDDR'B deputy executive director Dr Abbas Bhuiya; and Prof Datta.

"Our (letter) focus is on bilateral cooperation in public health issues," the vice-chancellor Prof Datta said while confirming  about handing over the letter.

They identified some common gaps that still remain in both countries, despite progress and initiatives to improve the health sector and reduce health inequities.

According to the letter, the gaps are in the availability and quality of health services, health information systems based on which policy and programmes are designed, and the size and skills of the multi-layered health workforce required to meet the health system's requirements.

The letter suggested 'collaboration in capacity building for public health in all of the above dimensions' to strengthen health systems in both countries.
"We have much to gain by learning from each other and even more by learning together," it said.

The letter outlined that collaboration should involve shared educational resources, joint academic programmes, joint research projects for the design and evaluation of innovations in health service delivery, and studies of different models of health financing for Universal Health Coverage.

The doctors extolled Bangladesh's progress in recent years with different health indicators and the role of women has been seen as catalysts for community action in health.

India's launch of the National Rural Health Mission was commended for transforming access to health care and improving maternal and child health across the country.

 health experts earlier suggested a joint infectious diseases contingency plan between the neighbours to control the 'emerging' viruses as Bangladesh shares most of its border with India.

Long-disputed border issues, sharing of river water, trade, power and transit would dominate Manmohan's visit.