Field Visit Report

1. Field visit report
(Formal and Informal)
Field Visit Place:
Geriatric Unit of Dhaka Medical College Hospital
Group: E
Group supervisor: Dr. Md .Rabiul Islam
Associate Professor
Institute of Social Welfare and Research
Dhaka University

2. Field Visit Report
History
Dhaka medical college hospital was established as a 250 bedded general hospital in
1946.British major virgin was the first superintendent of Dhaka medical college
hospital. Since then Dhaka medical college hospital is pioneer in the under graduate
medical education and largest service providing hospital in this country. Subsequently it
has been converted into 1800 bedded tertiary level hospital .Now a days it has been
announce 2300 bedded tertiary level hospital ,100 beds is for burn unit. Everyday all

3. types of patients from different corner of Bangladesh are reported to this hospital to get
better management. They have all the specialty/subspecialty of medical science in this
hospital.

Picture 1: Dhaka Medical College Hospital
Organization at a glance
Name of the facility Dhaka Medical College Hospital
Name of Director Brig Gen Md. Mustafizur Rahman
Telephone no. 09677411
Fax no. 08623382

4. Email [email protected]
Dhaka Medical College was established some new ward such as
·Bone marrow transplantation
·New palliative ward
·Geriatric ward
The biggest public hospital, Dhaka Medical College Hospital (DMCH), has opened a
special unit for them called ‘geriatric unit’, in what may be a model for other medical
college hospitals. Geriatric ward was the most important topic on them. It was
established in 14 August, 2014.The announcement came at a seminar in the medicine
department in 2014, 01 October. It was organized to mark the international day for the
old age persons. On that year the slogan of the international day for the old age persons
was “Leaving no one behind, Promoting a society for all”. It was good news for
thousands of poor elderly patients looking for treatment that sometimes mean taking
refuse on the floors of government hospitals. The special ward which is being
supervised by the medicine unit has 28 beds at the second floor of the hospital. Patients
aged above 65 years sufferings from multiple chronic diseases will be admitted in this
ward.

5. Picture 2: Geriatric Unit of Dhaka Medical College Hospital
Picture 3: Inauguration day of geriatric unit in Dhaka Medical College
Hospital.

6. Purpose of geriatric unit
Ageing in Bangladesh is a recent phenomenon. Though internationally accepted cut of
age is 65 years, above which peoples are considered elderly, in Bangladesh, persons
with age of 60 or above are cited as geriatric age group in different literatures.
However, in reality people in this country become older before the age of 60 because of
poverty, physical hard working and, inability and illness due to malnutrition and
geographical condition as well. Every year approximately 80,000 new elderly are
entered into the group of the older persons. The estimates and projections show that the
amount is certain to increase markedly with time.3 This trend is expected to accelerate
and by 2050 the number of persons aged 60+ are projected to be approximately 40.5
million, which is roughly 6 times higher than what it was in the year 2000.4 So it is
worth saying that the burden of old age diseases in our low income country will be
enormous.
The scenario of Bangladesh concerning the old people is quite frustrating. A full blown
geriatric policy in our country yet to be formulated. But this is a matter of hope that a
geriatric medicine unit as a wing of medicine department of Dhaka Medical College
Hospital has been launched in the late 2014.
Associate Professor of Medicine Md Titu Miah is the co-coordinator of the new unit.
He said they came up with
1.The idea of providing “decent care” to the growing number of elderly people.2
2.Citing a study, Titu Miah said a study by their medicine unit on a specific
day found one-quarter of the 332 male patients were above 65years of age.
It was more than one in 10 for female patients.“But many of them do not
even get beds in this very crowded hospital,” he said.

7. 3. This type of special ward is new in government general hospitals including
medical colleges. The military hospital CMH has a separate unit for elderly care.
4.The number of elderly is growing by the day in Bangladesh as the
average life expectancy nears 70.As they grow old, they suffer from
multiple chronic diseases like hypertension, diabetes, heart conditions,
dementia, infections and joint pains that need special care.
“It has to be well-equipped,” Titu Miah said, adding they were seeking government’s
support to develop this unit. 65 years sufferings from multiple chronic diseases will be
admitted in this ward.
Patients aged above 65 years sufferings from multiple chronic diseases will be admitted
in this ward. The special ward which is being supervised by the medicine unit has 28
beds at the second floor of the hospital. The DMCH special unit for them will take this
special attention with proper nursing.
Committee
The biggest public hospital, Dhaka Medical College Hospital (DMCH), has opened a
special unit for them called ‘geriatric unit’, in what may be a model for other medical
college hospitals. The special ward which is being supervised by the medicine unit.
All member of the Medicine department are the committee member of geriatric unit.
The Department is divided into
1.11 units headed by five Professors and six Associate Professors.
2.There are 10 Assistant Professors alongside to second each unit. The Units are
also armed with Registrar and Assistant Registrars along with a number of Indoor
Medical Officers and Honorary Medical Officers. The Registrars maintain the

8. academic activities of the unit while the Assistant Registrars are responsible for
the clinical side.
3.Proff Titu Miah is the co-coordinator of the new unit.
4.There are 5 senior staff nurse in this department. They are specially for here.They
are well trained and In charge name is Selina pervin. They do roaster duty in
three shift, those times are morning, evening and night shift. They said all time
doctors are available.
The Department of Medicine of Dhaka Medical College is one of the core disciplines of
the institution. Since its establishment in 1946 this Department has earned a reputation
that only others can envy of. Not only does it handle the bulk of non surgical
emergencies of DMCH, the Department also has a very strong teaching and research
activity. The Department is also complimented by a strong group of Allied Discipline
which brings out the strength of the Department and is considered as the auxiliary
power. They are Neurology, Cardiology, Nephrology, Hematology, Hematology,
Gastroenterology, Endocrinology, Pulmonology, Dermatology and Psychiatry
Departments.
Services of geriatric unit
From the era of ancient medicine, physicians tried their best to alleviate the sufferings
of elderly but only a few people reached their maximum due to early death by diseases
and war. When modern medicine evolved the average life span of human increased with
time. This demographic transition started slowly but got it’s pace very soon. Now 11%
of the world population is of 65 years of age or over. Sometime around the year 2020,
For the first time ever, the number of people aged 65 and older in the world is expected
to exceed that of children under the age of 5.

9. 1.Prof Titu Miah the coordinator of geriatric unit said they came up with the idea of
providing “decent care” to the growing number of elderly people.
2.Quality Assurance Scheme (QAS) activities ran very smoothly.
3.All activities of different phases worked satisfactorily.
4.All time doctors and sister are available.
5.They care for them with special nursing care.
6.As per patient’s requirement and by doctors referred all specialized doctors are
available for them.
7. ICU and CCU services are also present.
8.They have some chair with special toileting system for bed ridden older person.
9. Management strategy adopted in geriatric unit is also quite similar comparing the
developed countries.
Geriatric medicine unit as a wing of medicine department of Dhaka Medical College
Hospital has been launched in the late 2014. Now it is the time to flourish this small
initiative to a complete geriatric medicine department which will be a great
achievement and milestone in the history of medicine in Bangladesh.
How it is fruitful for patient
“The problem of old age is not merely medical; it is physical, mental, economical
and socio-cultural. A cumulative approach is needed to combat the problem which

10. should involve the medical professionals, social workers, political leaders, NGOs
and media personals. The western society has become successful to blend the above
sectors together. As a result, life expectancy and quality of living of aged people
have been improved. The most notable contribution is from medical sector. To
overcome this new situation they have established geriatric medicine department in
the hospitals targeting the aged people”, Proff Titu Miah said.
After the establishment of geriatric medicine unit in DMCH in 2014, total 561
patients have been admitted till 10 May, 2016. 300 of them are male and the rest
261 are female. Multi morbidity is common.Till 10 may, 2016 total death was
53. Mortality rate was 5.70%. Patients were treated by supportive care only due to
lack of emergency medical facilities. Patients with diseases from every
subspecialties of medicine e.g. cardiology, nephrology, neurology, endocrinology,
respiratory medicine, gastroenterology, were admitted and treated accordingly. In
male patients, the mostly encountered diseases were CVD, HTN, COPD, DM and
bronchial carcinoma. Female patients were predominantly suffering from DM with
its complications and UTI. The mean age of admission was 67.4 years & the patient
with highest age was a 108 years male. Some of them are so happy because
government took a step for them. Treatment facilities are so much expensive in
private hospital.
Satisfaction Statement of Patient
When we visited the geriatric unit there was 5 patients. They came from the outside
of Dhaka for better treatment. Most of the people don’t know about this special

11. unit. When we talked with them about they told us some issues about their health
and care and family, these are
1.Most of them were come from lower middle class and middle class family. For
this reason they had so much tension about cost of money.
2.Some of them had long term disease and they were taking medicine for them
such as every patients had Diabetes Mellitus, High pressure, Chronic
Obstructive Pulmonary Disease, Chronic Liver disease,Cancer,Arthritis,Urinary
tract Infection, Stroke and it is so much expensive for them.
3.They told some complain about nursing care.
4.They said that they have to purchase most of the drug. (When we asked the duty
nurse about this they told us that some medicine is not available because
government don’t supply them).
5.Most of them were telling that they had one common problem and that is
“PAIN”
6.But they tell one thing that if government did not take any step they have to
spend so much money in any private hospital and for this they are very thankful
to this hospital and government.
Doctors Statement
When we asked a question to Prof Md. Azizul Kahhar ,he share of his view with us and
these are
After few months of observation in our geriatric medicine unit, certain difference has
been noted between the global geriatric trends and that of Bangladesh.
1. The disease pattern is more or less same but infectious disease is more prevalent here.
2. The management strategy adopted in our unit is also quite similar comparing the
developed countries

12. 3. But the most notable difference is economical rather than medical. In the western
society, there is a social security service for old and health insurance policy run by
government. They bear all the treatment and rehabilitation cost.
4. In our country, as old people are mostly dependant, they cannot cope with expensive
investigations or treatment.
5. So they often fail to maintain the follow up schedule. As a result they come with
more serious complications later on.

6.Though the victory over communicable diseases has been achieved, other non
communicable diseases like CVD, IHD, DM, malignancy and neuro-degenerative
disorders have become more prevalent in developed countries.
Limitations
1. The management strategy is not so much strong
2. They have no one stop service system, all the patient have to run from one
area from another area.
3. Some time they spend so much in hand of bad people for treatment
purpose.
4. Due to the majority of population belonging to the lower economical
group, our dependency on the Government Health Care system is very high.
But there is widespread public perception about the low quality of health
service delivery, be it provided by government, private or other non-state
actors in Bangladesh. Several studies and surveys published has proven that
the quality of healthcare has declined in Bangladesh with increasing cost
backed by the non-availability of certain treatments, more waiting time, lack

13. of cordial and caring doctors, scarcity of professional nursing staff, poor
reliability on pathological and diagnostic tests etc.
5. Absence of human touch and care from the hospital staff.
6. Absence of sense from government because this is a special unit and there
is no assisted living device.
7. Physiotherapy center is so much far from geriatric unit.
Regardless of several limitations, the geriatric medicine unit is running
successfully since its initiation. We hope that positive steps from the
government and donor organizations towards a geriatric friendly health care
system will soon be on the cards. Increase in allocation and change in policy
will see a rapidly flourishing discipline. The elderly are the people who have
fought for this nation it is time we repay them and should not forget that
pretty soon we will also be joining them.
Recommendations’
1. Most of the people don’t know about this unit so awareness should spread
among people.
2. Physiotherapy unit should be available for them for removing their pain
and gait
3. Treatment should be easily accessible for older person.
4. Nurse and doctor’s ratio for all older people should be increase.
5. Ward boy and aya should be increase for them.

14. 6. Some assisted living device should bring for their daily living
7. Government has to take some initiative to flourish this special unit.
Ageing is a natural phenomenon which cannot be stopped or altered. From
the dawn of civilization man is feared of being old. There is a German
proverb, ‘Old age is a disease that you die from’. In fact elderly suffer from
variety of diseases which make them feeble, dependant and even bed bound.
This is why, every human being wants to get rid of old age but this is
inevitable. Population trends in Bangladesh show that Bangladesh is well
into third phase of demographic transition, having shifted from a high
mortality-high fertility regime to a low mortality-low fertility one. Every
year approximately 80,000 new elderly are entered into the group of the
older persons. The estimates and projections show that the amount is certain
to increase markedly with time. This trend is expected to accelerate and by
2050 the number of persons aged 60+ are projected to be approximately 40.5
million, which is roughly 6 times higher than what it was in the year 2000.4
So it is worth saying that the burden of old age diseases in our low income
country will be enormous. The scenario of Bangladesh concerning the old
People are quite frustrating. So we should take more steps for older person
because in some days we will join them. More specialized geriatric unit
should be open in every tertiary level hospital, because sometimes it’s so
much painful for older person to travel from outside of Dhaka.

15. Findings of Informal case study
All of the respondents were in the young old and middle old age area
variation. Among all respondents 4 of them were women and 6 of them were
man.
In their sociodemographic situation we find varieties findings. One
respondent was poor, rest of them were in middle class higher class and well
established in society. They are Muslim by their religion and their
educational background is good. All of the respondents are living with their
children and grandchildren except one. He and his wife lives alone in a
house. He spends a very successful life .He makes all children well educated
and well established in society. Now he and his wife feels very helpless,
hopeless and lonliness.One of them is so much poor ,she lives with her
younger daughter who works in Qatar and she looks after her grandchildren.
Four women respondents were widower and 2 of them lives with their
daughter and 2 of them lives with their son. Among them 2 respondents
getting pension because their husband was government job holder. After a
long winding struggle of one and a half year through the authority they
finally got the pension fund from the government. They use this money for
their daily needs.

16. Six men respondents, they are happy with their wife and children and
grandchildren. Among them 2 men respondents was government job holder
and they are getting pension.
If we look on their findings about health, we will find one common thing
that is PAIN. If we categorize their physical disease then it will be easy for
us:
1. Bronchial asthma
2. Diabetes mellitus
3. Hypertension
4. Arthritis
5. Joint pain
6. Cataract
7. Gallbladder stone (operated)
8. Tumor (operated)
9. Cough
10. Urethral stone
11. Urethral stricture
12. Lung infection
13. Constipation
These are long term diseases we find among respondents and most of the
respondents are suffering from 2 or 3 diseases. All of them are taking
medicine for long time under doctors’ supervison.The respondents who have
diabetes all of them are in strict diet chart and some of them take insulin

17. after checking glucometer. They maintain a good health by morning walk
and doctors advice.Their diseases cost much money of their family and for
this reason sometimes they feels tension.
We get one important findings about their mental health and these are
1. Insomnia
2. Anxiety
3. Stress
4. Depression
Specially the persons whose children aren’t living with them. They feels
lonlely,helpless,hopeless.They wants stay happy and secure with all family
member, but there sons and daughters are too busy to talk with them and
hear them.
All of them a good relation with their family, friends and neighbor. They
have good contact with relatives and family member those lives in Dhaka or
outside of Dhaka. Some older persons are the head member of the cultural
committee of society. Some older person is the main decision maker of the
family and members respect the decision. In their leisure time, they do many
things.
1. Fishing
2. Gardening
3. Spend time with grandchildren

18. 4. Paper reading
5. Gossip with friends and peer groups
6. Some helps their daughter in laws in kitchen.
They have no idea about National policy for older person and parents act law
2013.Some person heard about old allowance but they don’t know how they
can get it and some don’t want to take it. When told them about parents act
law they hear it very deeply. We told that if their sons, daughter or daughter-
in-law don’t care them they can case a file against their children then they
told us that parents can’t case file against their children.
All of them do their prayers every day. They all-time think about their death
and dying process. In everyday prayers they want some limited things from
ALLAH, her/his children happiness, and they want to die in fronts of
children and family. Some widower and single older person all time thinks
about their daughter that how they will manage when they will die. They
think who will look after them. They want to see her married in their lifetime
and want to ensure a good life for them. They want to die with respect and
dignity. They don’t want die alone.