Protests after the fall of the Awami League government have forced heads and top officials of many government healthcare facilities and institutes to resign or remain absent, leaving the entire sector in disarray, and ultimately causing patient suffering.

Even the new head of the Directorate General of Health Services (DGHS), appointed last month after the fall of the Awami League government, has been unable to enter his office in the face of protests.

Meanwhile, a string of sudden promotions of pro-BNP doctors who were "deprived" during the AL government at Bangabandhu Sheikh Mujib Medical University (BSMMU) has shed light on the direct effects of politics on the sector.

Although the influence of politics was not directly linked to the recent doctors' protests over the assault on a colleague at Dhaka Medical College Hospital (DMCH), the absence of top officials was clear as the new administration grappled with the situation. Amid the doctors' strike for two days earlier this month, many patients were turned away.

Dulal Hossain, 60, a patient with chest pain from Munshiganj, was taken to the DMCH by his family on Sept 1 amid the strike. They had to leave without getting any treatment. "What could be more unfortunate than something like this? The patients and their families suffer ultimately," Dulal's son-in-law Md Mohsin told The Daily Star.

This reporter's repeated attempts to reach Health Adviser Nurjahan Begum for comments on the current state of the country's health sector after the political changeover via mobile phone calls and messages failed. After the doctors launched the strike, she visited DMCH and promised stern action against those involved in the attack.

At the DGHS, Professor Robed Amin replaced Prof ABM Khurshid Alam, appointed by the previous regime at the height of the coronavirus pandemic amid allegations of widespread corruption in the sector, as acting director general on August 18.

Officials and employees, however, have been demonstrating in front of the DGHS offices in Dhaka's Mohakhali almost every day demanding his removal.

During a visit to the DGHS last week, three banners were seen hanging at the main gate, each reading, "We want the removal of all corrupt officials, including new DG."

On the first floor, seven rooms of top officials were locked. They have been absent since the ouster of the AL government on August 5, said two staffers who were playing ludo on a mobile phone.

"I haven't been able to get into my office yet. I'm doing some work from home. However, not everything can be done from home. Activities of the DGHS are being severely disrupted. We can't do all the hospital-related work," Prof Amin told The Daily Star.

"I'm barred from office even amid the flood situation. I've tried several times but a section of the officers and employees are obstructing me. I'm a victim of injustice."

More than 60 percent of the officials are unable to go to the DGHS, which is hampering services at the hospitals and medical institutions, he said. "This is unfortunate."

Following protests at the National Institute of Preventive and Social Medicine (NIPSOM), the interim government on August 22 replaced its director Dr Md Shamiul Islam with Prof Meerjady Sabrina Flora, a DGHS additional director who became a household name in the early days of the pandemic with her daily briefings.

Prof Sabrina, too, has been unable to perform her duties at NIPSOM and DGHS since protesting officials and employees declared her persona non grata, accusing her of collaborating with the previous government.

She did not respond to our calls and text messages for comments.

Prof Ahmedul Kabir, additional director general of DGHS, has not been able to enter the Institute of Public Health since becoming its director on August 22.

Prof MA Mannan said he resigned as executive director of the Institute of Child & Mother Hospital at Matuail as he could not enter his office.

Abdul Kader resigned as the principal of Mymensingh Medical College on August 20 amid protests by students and staffers. Prof Md Abdul Khalek was forced to resign as the principal of Rajshahi Medical College on August 12.

Such removals and voluntary and forced resignations of health officials one after another are hampering the healthcare and medical education sector, reducing the activities of hospitals and government health offices by 50 percent, said Bayezid Khurshid Riaz, who was himself forced to resign as the additional DG of medical education.

Public health expert Abu Jamil Faisal said protests and resignations will not solve the problems in the sector.

The protesters should find an alternative method of demonstration and qualified people for replacements.

"Otherwise, these institutions will not be functional in the absence of guardians," he said and suggested forming a search committee to find suitable people for the sector.

At Dhaka Medical College, principal Md Shafiqul Alam Chowdhury and vice-principal Debesh Chandra Talukdar resigned on August 22 after two-and-a-hour confinement by protesting students to their offices.

The protesters also demanded the removal of pro-AL teachers and officials but later withdrew the demand. Three professors confirmed the matter to this correspondent. Ex-principal Shafiqul, without giving details, said he was forced to resign that day.

Seeking anonymity, an administrative official of DMCH told The Daily Star that they saw the facility being occupied by groups that had been inactive for the last 15 years. "'Mostly officials and employees with less political involvement are now at risk."

DAB REPLACING SWACHIP?

The pro-AL doctors' organisation Swadhinata Chikitsak Parishad (Swachip) controlled the health sector with great force over the past 15 years. Swachip leaders used to influence recruitments and transfers, apart from doing health-related businesses.

Previously, during the BNP government's tenure, the Doctors Association of Bangladesh (DAB), backed by the party, had similar control over the sector.

On August 8, BSMMU promoted 173 medical officers known as BNP-Jamaat loyalists to assistant professors after their promotion had been held up for years during the previous government's tenure. They are among 213 recently promoted assistant professors. In addition, 31 have become professors and 23 have been appointed and promoted to other posts.

"The Awami League deprived the pro-BNP physicians of promotion. They have been promoted now without any interview and syndicate approval," said a doctor at BSMMU who sought anonymity.

"This deprivation will not go away. This process is not right. Questions will arise again," he added.

The then BSMMU registrar Prof ABM Abdul Hannan signed the orders on the promotions on behalf of former vice-chancellor Deen Md Noorul Huq. Both were forced to resign, along with pro-VCs Mohammed Atiqur Rahman and Md Moniruzzaman Khan, on August 18.

Asked how the promotions took place without any interview and syndicate approval, Prof Hannan said, "We had to do it under a situation. It had the consent of the VC and pro-VC."

Public health expert Jamil told The Daily Star that partisan politics was prevalent in medical institutions under the guise of professional politics for a long time.

''It won't be possible to reform the sector by keeping Swachip and DAB active,'' said Jamil, president of the Public Health Association of Bangladesh.

DAB, however, has tried to distance itself from the incidents in the aftermath of the AL government's ouster. The association suspended its BSMMU unit on August 27 "to prevent chaos".

DAB President Prof Harun-Al-Rashid told The Daily Star that discrimination had prevailed at BSMMU for a long time. "It has been unfair to those deprived for so many years. Reforms are now underway there," he said.

"A new VC has been appointed at BSMMU. New officers and employees will be appointed too. The DAB committee at the university has been suspended so that no one can create any chaos at this time," he said.

"Politicisation and partisanship are never good. But the previous government did these openly and secretly," said the DAB president.