Treatment on hold

Thousands of critical cancer, heart, kidney and liver patients have their treatments on hold  as medical tests they require have been off for lack of radioactive isotope for the last two months.

Jahangir Shahabuddin, a retired government officer, suffering from kidney disease and prostate cancer, also has anaemia which may indicate that cancer has spread to the bone. He was prescribed a bone scan more than a month ago but he hasn't been able to avail an appointment.

"All the hospitals said they do not know when they will be able to conduct bone scans again. I am really afraid that by the time I shall be able to conduct the test, it might be too late and my disease may get out of control," said Jahangir.

No one can get these tests, at the moment, putting their treatments at stake.

Sharmin Sultana, who recently underwent a mastectomy (surgical removal of one or both breasts to treat breast cancer), was also prescribed a bone scan by her doctor to diagnose whether her cancer has progressed to the bone -- necessary in determining further treatment for her.

Following her surgery two weeks before Eid, Sharmin has been unsuccessfully trying to get a bone scan appointment.

The radioactive isotope, called Technetium-99m or Tc-99m, is an essential component in over 80 percent of nuclear medicine procedures.

These includes bone scans as well as other medical imaging tests such as immunoscintigraphy and sentinel node biopsy to identify cancer patients, myocardial perfusion imaging and cardiac ventriculography for cardiac patients, functional brain imaging, blood pool labelling and several other tests needed by kidney and liver patients.

According to a 2019 World Health Organization (WHO) report, there are more than 15 lakh cancer patients in Bangladesh.

These tests are done at 14 centres under Institute of Nuclear Medicine and Allied Sciences (INMAS), which are attached to government hospitals across the country.

Besides, the National Institute of Nuclear Medicine and Allied Sciences (NINMAS),  housed at Bangabandhu Sheikh Mujib Medical University (BSMMU), also conducts the tests.

All the 15 centres are managed by the Bangladesh Atomic Energy Commission (BAEC), which is under the Ministry of Science and Technology.

Additionally, a few private hospitals and diagnostic centres with a department of nuclear medicine, can also perform these tests.

However, at present, all these public and private facilities are refusing patients waiting to be tested as there is no supply of Tc-99m.

Since the suspension of international commercial flights in mid-March, particularly flights with Turkey, Bangladesh has not been importing Tc-99m.

The radioactive isotope is imported from Turkey via special cargo flights, as many regular cargo flights cannot carry radioactive materials, said Dr Md Sanowar Hossain, chairman of BAEC, last week.

"These flights are suspended at present. We cannot also import this isotope from neighbouring countries because they cannot produce enough for themselves."

The isotope can only be stored for 10-14 days, said experts; as a result, tests conducted with this isotope have been on hold since the beginning of April.

BAEC's research reactor, located at its facility in Savar, is not capable of producing the required isotope, said Dr Sanowar. "The reactor can only process the isotope to make it useable for medical purposes."

"We have to wait two to three weeks at least to resume the test in the government hospitals," he added.

BAEC was talking to importers, to figure out how to get the much-needed supplies; the commission supplies the isotope to all public and private nuclear medicine departments in the country.

Contacted again on June 2, Dr Sanowar said resuming the tests would still take two to three weeks.

There was no  development as of yesterday.

Meanwhile, patients remain in limbo, frustrated and uncertain about their treatments and diagnoses.

Neither the INMAS Dhaka nor BAEC websites have an announcement that these crucial medical tests are unavailable at this time.

The NINMAS at BSMMU previously conducted bone scans three days a week.

There are long queues of patients at the department seeking to book appointments for tests or of those who have booked and paid for an appointment asking for the tests to be resumed, said Dr Nurunnahar, director of the nuclear medicine department at BSMMU.

The NINMAS website too makes no mention of the tests being unavailable though many patients use it to book their appointments online.

"We are struggling to make our patients understand the current situation. In this situation, we cannot tell them anything but to wait," said Dr Nurunnahar on May 27.

She estimates it will not be possible to restart tests using Tc-99m before the end of June.

Once the isotope is finally imported, it needs to be processed before being distributed to hospitals.

"The reality is that we haven't even started to import these yet. It will take time and there is no alternative to waiting patiently for it," she added.