Patients deprived of healthcare
The government is yet to decide when to re-open Praava Health after temporarily suspending its operation about two weeks ago due to "minor" violations of rules, leaving the private health service provider in limbo at a time when hospitals in the capital are overwhelmed with Covid patients.
Health directorate officials said they received two applications from Praava early this month for a temporary stay on the suspension to allow it to provide healthcare services. But no decision has been made yet in this regard.
The Directorate General of Health Services (DGHS) on August 2 suspended all healthcare activities of Praava Health, well-known for providing quality medical services to the city dwellers at their homes.
Talking to The Daily Star, Dr Farid Hossain Miah, director (hospitals and clinics) at the DGHS, said Praava recently submitted two applications to the health directorate.
"It sought a stay on the suspension of its operation. But we are yet to make any decision in this regard."
Earlier this week, Prof Nasima Sultana, additional director general (Administration) at the (DGHS), told this newspaper that they would take into consideration all the aspects before making any decision on Praava.
Seeking anonymity, a DGHS official said Praava submitted two applications to the DGHS -- the first on August 3 and the second on August 9.
The official, however, refused to give details.
Contacted, Praava officials declined to comment in this regard.
Last month, a DGHS inspection team visited Praava after Dr Mahfuz Shafique, son of ex-law minister Shafique Ahmed, complained of "non-cooperation" from the facility following false positive results of RT-PCR Covid tests conducted there on July 7.
The team found violations of four rules by Praava Health, according to the suspension order issued by the DGHS.
Those are -- failure to maintain separate areas for donning and doffing of personal protective equipment (PPE), charging an extra Tk 150 for registration, absence of signature of a registered MBBS physician in test reports and listing the World Health Organization as a "partner" instead of a "corporate client".
The suspension order, however, did not say anything about Praava's services related to clinical quality or question its laboratory test results.
According to Praava website, its laboratory equipment is state-of-the-art and equivalent to that used by some of the best labs in the world. Its PCR equipment is manufactured by Roche and Thermofisher.
It uses only the reagents recommended and approved by the government for Covid-19 testing.
For external validation of testing, Praava participates in RIQAS (Randox International Quality Assessment Scheme), the world's largest international external quality assessment scheme. It has been participating in RIQAS every month since its inception -- to date, it has received a 99.9% average monthly accuracy score.
Praava's Senior Laboratory Director Dr Zaheed Husain is a renowned molecular biologist and former faculty member of Harvard University, added Praava.
Section 11.3.b of the Medical Practice and Private Clinics and Laboratories (Regulation) Ordinance, 1982, says a clinic's licence cannot be cancelled unless the owner of the clinic has been given an opportunity of showing causes against such cancellation.
Asked, Prof Ridwanur Rahman, a medicine and infectious disease specialist, said, "The suspension for such minor flaws was not logical. In terms of quality, Praava's services were much better than that of many others. On the contrary, there are questions about the quality of services of many government and private healthcare organisations.
"Praava could have been given space for addressing the issues."
The suspension of Praava's services dealt a blow to the service seekers as many city dwellers turned to the facility for Covid-19 tests amid scarcity of testing facilities.
According to the DGHS, before the suspension of services, Praava had conducted 152,904 RT-PCR tests -- about three percent of the total Covid tests conducted so far in the country.
Besides, more than 230,000 patients received healthcare services from the facility which started its journey on August 25, 2017.
"I am a regular client of Praava health. Their service is good. The suspension has created problems for me," one of the healthcare service seekers in the capital's Dhanmondi area told this newspaper, wishing anonymity.
WHAT DID THE COMPLAINANT SAY?
Talking to this newspaper, the complainant, Dr Mahfuz Shafique, said Praava Health staffers collected samples of his wife and their two daughters from his house for Covid tests on July 7 afternoon.
"By around 11:00pm, we received the test results that came out to be positive for Covid-19," he said, adding that he had requested the officials of Praava Health twice for retests as none of the family members had any symptoms.
"Instead, they sent us their service packages for Covid-19 positive patients.
"Being a doctor, I know false positive was not impossible," said Shafique.
To be sure, he gave his sample to Green Life Hospital for Covid test that night. His test result came out to be negative.
Later, samples from all his family members and others, including domestichelp, were collected and tested at the Institute of Epidemiology, Disease Control and Research (IEDCR) on July 8.
"The results of all the tests conducted at the IEDCR lab came out to be negative the following day," he said.
Asked what prompted him to lodge the complaint, Shafique said, "Praava officials did not acknowledge that there might be something wrong. Due to their over-confidence and non-cooperation, we had to reschedule a flight abroad. For me, it was a loss, but I was able to endure it. For many, it is not endurable."
FALSE POSITIVE
The RT-PCR test is considered as "gold standard" for detecting Covid-19.
But even though the test is highly specific, there is a chance of "false positive" results for someone not infected with the virus.
According to a pre-print study published in medrxiv.com, the false positive rates in rt-PCR tests is 0-16.7 percent.
"The most common causes for false positive results we observe are clerical error, testing the wrong sample, cross-contamination from someone else's positive sample, or problems with the reagents used," said Dr Arifa Akram, assistant professor of virology at the National Institute of Laboratory Medicine and Referral Centre in Dhaka.
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