At around 10:30am on September 22, a noisy crowd of people were seen standing in queues in front of the ticket counter of the National Institute of Cardiovascular Disease (NICVD), eagerly awaiting an appointment with one of 12 physicians at its outdoor department.

The crowd only got bigger as time went by, making it difficult for the three staffers manning the booth to handle such an onrush.

They were issuing an average of three tickets per minute with the price of each ticket set at Tk 10, as witnessed by this correspondent.

Within just half-an-hour, the number of treatment seekers had risen to 88.

"Most of these people came here complaining about chest pain and the number of people with heart problems is increasing day by day," one of the staffers said.

The situation was similar at the nearby emergency ward, where critical patients with heart diseases are referred by different hospitals across the country.

Officials of the NICVD said an average of 800 patients come to the outdoor department every day, which is comparatively higher than the daily turnout during pre-pandemic times.

At the indoor wards, an average 1,200 patients are treated every day against its capacity to treat 400 patients only.

Physicians said such a huge number of referred patients indicates that the number of people with cardiac diseases is rising across the country.

Cardiovascular disease is an increasing cause of concern for Bangladesh as those suffering from such ailments top the list of people with non-communicable diseases.

"The number of patients has hit an all-time high in the past couple of months," said Prof Dr Mir Jamal Uddin, director of the NICVD,

"Our observation is that the number of heart patients has increased notably in the country, but we have no quantitative data in this regard," he told The Daily Star.

According to cardiologists, most cardiac patients suffer from ischemic heart disease or coronary heart disease, which are mainly caused by an unhealthy lifestyle and food habits.

Of all heart related issues, ischemic heart disease was the second leading cause of deaths each year between 2009 and 2019 in Bangladesh, as per a systematic analysis for the Global Burden of Disease Study, published in The Lancet journal on October 17 last year.

According to the non-communicable disease risk factor survey 2018, some 15.5 per cent of Bangladeshis aged between 40 and 69 years are at risk of cardiovascular diseases.

TREATMENT FACILITY DHAKA-CENTRIC

Specialized treatment facilities for cardiovascular diseases are mostly located inside Dhaka and other metropolitan areas. As a result, people with heart ailments crowd the city hospitals.

Mia Md Alamin is one of them.

The 42-year-old experienced cardiac arrest on September 19 and after receiving initial treatment at the Narsingdi Sadar Hospital, he was referred to the NICVD.

"We had to bring my husband here as we did not get proper treatment in our district," Soma Nasrin, Alamin's wife, told this correspondent.

"Thankfully though, he is slowly improving," she said while sitting by her husband who was laid on the corridor along with five other patients in front of the NICVD cardiology ward.

The first cardiac surgery in Bangladesh was conducted in 1981. However, the number of well-equipped facilities that provide such treatments has not increased in proportion to the country's population size since then.

According to the Cardiac Surgeons Society of Bangladesh (CSSB), the country has 42 cardiac care units in both public and private facilities, of which 28 hospitals are equipped to conduct cardiovascular surgery.

The number of hospitals in Dhaka that provide such services currently stands at 20 while there are four in Chattogram, two in Khulna, and one each in Sylhet and Sirajganj.

In Dhaka, 16 of these facilities are privately owned and four are public while the number stands at three and one respectively in Chattogram.

One of these hospitals, the Zia Heart Foundation in Dinajpur, has not been functional since 2016 due to a shortage of surgeons and funding.

There are around 175 cardiac surgeons in Bangladesh, of which only 45 are capable of conducting surgeries independently, CSSB data shows.

Of these independent surgeons, 32 work in Dhaka.

Around 12,000 cardiac surgeries are done in those 28 hospitals round the year.

In government facilities, the fees for cardiac surgery begin at Tk 1.10 lakh while the lowest fee that private hospitals take is around Tk 3.5 lakh.

Aside from surgery facilities, there are six public medical colleges in Rangpur, Rajshahi, Khulna, Sylhet, Mymensingh and Barisal which have coronary care units.

However, only angiograms and other related diagnostic facilities are available at these colleges. Besides, these services often remain unavailable due to a shortage of doctors, various sources said.

This newspaper spoke with a number of cardiac doctors and surgeons working in different government facilities who said that although there are primary care facilities for heart disease at the district level, they are not up to the mark.

So, referred patients rush to the capital city for treatment, they added.

Dr Monzur Hossain, an assistant registrar of the cardiac surgery unit-5 at NICVD, started his career as a junior consultant at Bhangura Upazila Health Complex in Pabna in 2012.

"The cause behind this scenario lies in weak planning. The infrastructures and equipment supply in public hospitals are poor. Additionally, there is a huge shortage of necessary manpower to run the available devices," he said.

To run a three-bed intensive care unit (ICU) for bypass or equivalent surgeries requires at least 35 staffers, including three to four surgeons.

"It is a matter of teamwork. In the absence of any one of these human resources, you cannot serve a heart surgery patient," Hossain added.

Last year, the government approved the development of eight full-fledged cancer hospitals complete with well-equipped cardiac units in as many divisional cities.

"This is a good development but without ensuring skilled human resources, you cannot serve the people," Hossain said.