Kurmitola General Hospital committed to serve the people of all walks of life

--Brig Gen A K M Nasir Uddin

1. Director

Bangladesh made ‘enormous’ health advances despite a difficult start after 1971 War of Independence. According to Lancet,” Now Bangladesh has the longest life expectancy, the lowest total fertility rate, and the lowest infant and under-5 mortality rates in south Asia.” Highest-level of political commitment in health helps the country to achieve the health-related Millennium Development Goals. The Government of the People’s Republic of Bangladesh is committed and determined to ensure health care facilities for her 15.5 crore people and to implement health for all.

In this regard, the government has taking different initiatives in health sector. As a part of it, to provide tertiary level health service for the people of the northern part of Dhaka mega city and to provide teaching and training facilities of students and internee doctors of adjacent Armed Forces Medical College, Kurmitola General Hospital was developed. This hospital started its journey since 13th May 2012 after inauguration by Hon’ble Prime Minister Sheikh Hasina, Government of the People’s Republic of Bangladesh.

Background History

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In 1998, Armed Forces Medical College (AFMC) was established and started functioning by using Combined Military Hospital (CMH) Dhaka as the training and teaching hospital for the students of the said college. It was strongly felt that a tertiary level hospital is needed to be established to maintain the standard medical education and at the same time to provide medical treatment facilities to the people of the northern part of Dhaka mega city including Tongi, Savar up to Gazipur.

Considering the above stated facts, in 2001, the then Chief of Army Staff Lieutenant General Harun Ar Rashid initiated a letter to the concerned authority of the government highlighting the necessity of establishing such a hospital and in response, MoH and FW apprised the consent of the government that a 500 bedded Kurmitola General Hospital will be established considering following aspects:

a.        The treatment facilities of this Hospital will be opened for both the civil and military persons of the country.

b.   40% bed will be designated for civil and 60% bed for military with treatment facilities.

c.   This hospital will be under control of MoH and FW and MoH and FW will be made responsible to construct the hospital.

d.   The responsibility of management and administration of the Hospital will be bestowed upon Bangladesh Army.

On June 3, 2004 the then Chief of Army Staff visited the adjacent area of  Armed Forces Medical College  (AFMC) and Central Mechanical and trample department (CMTD) and mentioned that the additional land to construct 500 bedded Kurmitola General Hospital may be taken from CMTD area and there by the present location of the hospital was earmarked and selected. It may be mentioned that the land allotted for construction of this hospital is category A-1 which could only be utilized by the hospital authority keeping the ownership of the land with Bangladesh Army.

On 1 August 2004, a high level inter-ministerial meeting was held at the Ministry of Defense, Chaired by Mr. A K M Ehsanul Haque, Secretary, Ministry of Defense where Mr. A F M Sarower Kamal, Secretary, Ministry of Health & Family Welfare, Major General Muhammad Shahjahan, Principal, Armed Forces Medical College, Brigadier General Ismot Ahmed Chowdhury BP, Joint Secretary, MoD, Mr. Alimushan, Joint Secretary, Brigadier General G M Rabbani, Acting Consultant Physician General, AFD, Md. Abdul Hannan, Joint Secretary (Co-ordination), MoH and FW and other members of the MoH and FW and MoD were present.

In that meeting, Secretary of MoH and FW informed that the proposal of establishment of such a hospital by former Chief of Army Staff was communicated to the Honorable Prime Minister and accordingly she gave her kind consent to that proposal.

3. Director-2

a.         Accordingly, a committee was formed to determine the status of the Hospital, policy for hospital administration, source of income and expenditure, etc., where DGMS, Bangladesh Armed Forces was nominated as the chairman of the committee and other members from MoD, MoH and FW, AHQ, DGHS, AFMC and DGMS.

b.         The Committee was made responsible for following Terms of References:

i.          To determine the status of the hospital,

ii.         To formulate the policy for hospital administration,

iii.        To formulate the rules of employment and TO&E of the hospital,

iv.        To determine the source of revenue expenditure,

v.         To determine the source of recurring expenditure with related policies,

vi.        Whether the system of hospital’s own income source will remain or not,

vii.       Recommendations for authorization of civil-military ratio incase of treatment facilities,

vii.       To formulate the principles of hospital regulation.

On 26 October 2004, Director Works Brigadier General Md. Abdul Quadir, Army Headquarters (presently Major General) was nominated as first Project Director (PD) of 500 bedded Kurmitola General Hospital by AHQ, E in C’s branch. Later, November 23, 2004, Vice- Principal, AFMC Brigadier General Shah E Alam (Retd) was nominated as PD of this hospital by AHQ, E in C’s branch. On 29 November 2004, Lieutenant Colonel A N M Shahidul Alam (Retd) AMC of CMH Dhaka was attached to AFMC as PD of Kurmitola General Hospital by AHQ, MS branch. Finally, on 29 July 2009 present Project Director Lt. Colonel (presently Brig Gen) Md. Abdul Karim Khan, Professor of Pharmacology, AFMC was given additional duty as PD of Kurmitola General Hospital by AHQ, MS branch, Dhaka cantonment.

On 18 December 2004, the First Co-ordination meeting was held which was presided by Major General Abdul Moyeed Siddique, DGMS of Bangladesh Armed Forces.

4. Primeminister

The committee was entrusted with the responsibilities for formulation of different policies of the hospital management as mentioned below:

a.   The hospital will be constructed under the supervision and control of Military Engineering Service (MES) instead of PWD and CMMU and will be handed over to the MoH and FW after completion of the construction.

b.   Formation of committee to formulate the policy for hospital management and administration where DGMS was nominated as the chairmen of that committee.

c.   The proposed hospital will be utilized as the teaching hospital for the cadets of AFMC.

d.   The Professors, Associate and Assistant Professors of AFMC will take part in the        treatment of admitted patients of Kurmitola General Hospital and will ensure the training of AFMC cadets and internee doctors.

e.   The key appointment for hospital administration and patient management will be deputed from Army Medical Corps and accordingly a proposed TO&E was prepared and as per the proposed TO&E the total manpower was determined 951 where 52 persons (AMC) were military and 899 from MoH and FW.

f.    All 3rd class employees will be appointed by MoH & FW and 4th class employees will be appointed on contract basis, by outsourcing.

g.   All necessary medicine and electro medical equipments will be purchased by Hospital Director following the PPR – 2003 like other government hospitals of the country.

On 12 January 2005 Second Co-ordination meeting was held and presided over by DGMS, Bangladesh Armed Forces. In that meeting, the proposed TO&E was revised and total 955 manpower was proposed where 78 from military (AMC) and 877 from MoH & FW. Major changes were inclusion of 18 assistant registers (Major rank and specialist) and 20 senior staff nurses from AFNS (Armed Forces Nursing Services) with few other changes in appointment and rank.

On 5 December 2010, the Third Co-ordination meeting was held and chaired by DGMS Major General A K M Zafarullah Siddique. The major changes in decisions were as follows:

a.   The proposed manpower was 1026, out of which 77 were from military (SMC) and 949 from MoH and FW.

b.   Policy for hospital management-

i.    The hospital will be operated under MoH & FW instead of MoD.

ii.   The hospital will provide treatment facilities for all citizens of Bangladesh including members of Bangladesh Armed Forces where in earlier it was 40% bed for civil and 60% bed for military.

iii.  To operate the hospital, necessary revenue and recurring budget will be provided by MoH & FW directly to hospital authority like other government hospitals.

iv.  All the income of the hospital like patient registration fee, diagnostic fee, cabin fee etc. will be deposited to the government treasury.

v.   The policy for hospital administration will be formulated and controlled by MoH & FW, earlier it was bestowed upon MoD.

c.   Authority to formulate policy for Hospital Regulation. This policy will be controlled by Ministry of Health & Family welfare.

Hospital Management Committee

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This hospital will run by a management committee-DGMS will be the president of this management committee. Following are the compositions of this management committee.

Finally, on 6 July 2011, the Ministry of Public Administration approved a TO&E of 966 manpower. On 7 March 2012, the Ministry of Finance approved 396 manpower (1st phase). Out of this 396 manpower, 194 (few 3rd and all 4th class employees) will be employed by outsourcing.  On 20 September 2012, present Director Brigadier General A K M Nasir Uddin joined this hospital as the first Director. Where Lieutenant Colonel Sheikh Shahidul Islam and Colonel Md. Jalal Uddin joined as first Assistant Director and Deputy Director on 25 September 2012 and 20 December 2012 respectively.

A high level meeting was held on 15 May 2013 at conference hall of MoH & FW chaired by former Hon’ble Health Minister, Ministry of Health & Family Welfare where Chief of Army Staff General Iqbal Karim Bhuyan, psc along with other senior Army Medical Corps officer and secretary and other senior officials from MoH & FW were present. In that meeting decision was taken out of 966 manpower, 04 (Director, Assistant Director, Senior Store Officer and Ward Master) will be deputed from Bangladesh Army while the rest all the manpower of this hospital will be from MoH & FW (including 194 out sourced manpower).

Accordingly, Government Order (GO) of 396 manpower (1st phase) was published on 26th June 2013. Out of this 396 manpower, 10 were Junior Consultants, 02 Residential Surgeons, 4 residential physician (RP), 3 Registers, Assistant Register 5, 35 Medical Officers, 77 nurses and 194 outsourced manpower of 4th class employees. Approval of 2nd phase of TO&E having 570 manpower is under process. The highest level of physician authorized in this hospital is Junior Consultant. Senior physicians like Professor, Associate Professor and Assistant Professor of different specialties will come from adjacent Armed Forces Medical College in future.

Objectives of the Hospital

The objectives of the hospital are as follows:

q          To provide modern medical treatment for all citizens of Bangladesh, especially the people residing at northern area of Mega city Dhaka including Tongi, Savar and Gazipur area.

q          To provide emergency and life saving treatment to the road traffic accident            victims of the near by area.

q          To operate as the teaching and training hospital for Armed Forces Medical College.

q          To provide on-job training to the internee doctors and practical training to the cadets of Armed Forces Medical College.

q          To create employment opportunity for the unemployed doctors, nurses, paramedics and supporting staff.

q          Standard clinical and general waste management (sewerage treatment plant and medical waste management system) will be introduced in the hospital.

Phase of Constructions and Development

The 10-storied hospital including 2 basements will be constructed in 2 phases. The 1st phase of construction was estimated to be completed by 2008 but it was revised and it was scheduled to be completed by June 2013. Initially, it was decided to construct the hospital with 10-storied building having 2 basements. But in 2008 it was decided by concerned authority of MoH & FW to develop this hospital as a 12-storied building including 2 basements. In the 8th meeting of Project Implementation Committee (PIC) chaired by the then Additional Secretary, MoH & FW on 28 November 2008 following important decisions were taken:

i.          The hospital will be built up to 9th floor, where 8th and 9th floor only structure will be constructed.

ii.         Kitchen, Laundry, CSSD etc. must be finished in stipulated time which is designed to be constructed in 9th floor.

iii.        Instead of central AC for whole hospital it was decided to keep such provision for OT, ICU/CCU, labour room, Radiology department, post operative ward. Pathology Department Medical store will have split type of air conditioning system.

iv.        Instead of 10 OT, 6 OT will be made.

v.         Only infrastructure of Liner Accelerator will be made.

vi.        To prepare a Revised Scheme Summary additional 25 crore taka was proposed.

Budget Allocated for Construction

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On 29 June 2005, the project summary scheme of establishment of 500 bedded Kurmitola General Hospital under HNPSP (Health, Nutrition & Population Sector Programme- 2003-2006) was approved by planning section of MoH & FW. In this scheme summary total of Tk. 196.66 crore was approved where Tk. 125.73 crore from GOB and Tk. 70.93 crore from project aid.

On 7 February 2010, the revised scheme summary was approved by MoH and FW under HNPSP in OP of original scheme summary. In that revised scheme summary the estimated completion cost was Tk 226.16 crore where Tk. 155.23 crore from GOB and Tk. 70.93 crore from project aid.

Source of Revenue and Recurring expenditure

The revenue and recurring expenditure will be met up by obtaining budget from Ministry of Health & Family Welfare.

Disposal of Revenue/Income by this Hospital

All the revenue earned by the hospital from the patients’ registration fees, diagnostic fees, cabin and paying bed fees bed etc. will be deposited to government treasury.

Manpower State

As it was mentioned earlier that on 7 March 2012, Ministry of Finance approved 396 manpower as 1st phase of TO&E of this hospital. On 26 June 2013 Government Order (GO) was published in regard to 396 manpower as below:

Hospital Facilities

This is a tertiary level general hospital having different wards/departments, including sophisticated medical equipment/instruments and modern investigation facilities. This hospital will capable to handle more then 500 indoor patients having expansion capacity of 200-300 more indoor patients. Following departments/wards will also be available:

Outdoor Facilities

Since 10 November 2012, outdoor facilities of Medicine, Surgery, Gynae & Obs, Orthopedic, Eye, ENT, Dental, Pediatrics, Dermatology and Psychiatry had started. Other OPD service will start soon. Month wise patient reported in OPDs are shown below:

Indoor Facilities

Total hospital bed is 500. At present 350 beds are functional.

The hospital is designed to facilitate the indoor patients is as follows:

a.        Medicine ward including Gastroenterology, Hepatology, etc.

b.         Pediatric and Pediatric surgery ward.

c.         Dermatology ward.

d.         Surgery ward.

e.         Gynae & Obs ward.

f.          Orthopedic ward.

g.         Eye ward.

h.         ENT ward.

i.          Psychiatry ward

j.          Dental and Maxillofacial surgery ward.

k.         Oncology ward.

l.   TB & Infectious disease ward.

Since the start of operative management following the number of operation in different specialties were carried out:

Burn and Trauma Centre

It is a unique hospital which is equipped with burn, trauma, reconstructive surgery and casualty centre which is capable of being independently operated. This centre has three emergency OTs, three bedded ICU, 17 bedded HDU and 10 bedded post- operative ward which will act as one-stop mall. Necessary steps are under way to make this center totally functional especially burn centre.

Special Facilities of the Hospital

a.         19x OT (6 are Functioning)

b.         60x ICU beds (3 beds are Functioning)

c.         32x CCU beds

d.         82x Post Operative beds (25 beds Functioning)

e.         17x HDU beds 7

f.          66x Modern Cabins

Other Ancillary Facilities

a.         Modern Laundry and modern Kitchen facilities

b.         2000 KV Generator, 1, 00,000 Gallon capacity water reservoir

c.         National grid supported uninterrupted electric supply.

d.         Sewerage treatment plant (STP). (Proposed)

e.         6 storied internee hostel and 6 storied nurse’s dormitory having capacity to build up to 10 storied.

f.          Bank facilities (underway)

g.         Canteen and Gift Shop.

At present male and female Medicine, Surgery, Orthopedic, ENT, Eye, Dermatology, Child, Gynae and Obs wards are functioning. Steps are under process to start other important wards.  The Pathology Department has the ability to undergo all relevant hematological and biochemical investigations by its semi and automated equipment. Besides, Radiology and Imaging Department have the capacity to undergo 128 slice CT scan, 500MA digital X-ray, Fluoroscope, ultrasound, dopler, laser surgery in dermatology etc. are also functioning. MRI and other heavy medical equipment are under process to be installed. Laproscopic surgery, ETT, Echo and Angiogram is also in the process of implementation.

Floor wise different wards/departments are shown here below:

9th Floor- Kitchen, laundry and CSSD.

8th Floor- Cabins (General & VIP)

7th Floor- Female Wards.

6th Floor- Female wards Gyanae and Obs, Natal, Post natal ward, Cabin etc.

5th Floor- Male wards.

4th Floor- Male wards.

3rd Floor- OT complex, ICU, CCU, Post operative ward.

2nd Floor- Day surgery, Cath lab, Endoscope, OPDS and Pathology Department.

1st Floor- OPD and Pathology department, Blood Bank and Administrative Block.

Ground Floor- Casualty and mergency, Reception, Pharmacy, Canteen, bank etc.

Basement 1- X-ray, CT scan, MRI, Liner Accelerator, Car parking.

Basement 2 – Liner Accelerator, Mortuary and car parking.

Annual revenue budget FY 2013-2014

For the first time annual revenue budget of Tk 127,29,75,557/ in the FY 2013-2014 was demanded. Accordingly, MoH & FW allocated Taka 4,57,93,970/. Besides, from DGHS under operational plan, Tk  47.44 lacs and Tk 61.13 lacs (fy 2013-14) were also received by this hospital for its expenditure. The annual revenue budget of FY 2013-2014 is shown below:

Hospital Activities

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a.         The hospital authorities start its OPD services since 10 November 2012 having 35 Physicians, 2 Nurses, 25 Military Paramedics and 28 outsourced 4th class employees. Gradually, on 16 June 2013 male indoor, 18 August 2013 female and child indoor and 24-hour emergency services were started having only 9 nurses and 4 paramedics with 45 doctors. On 01 September 2013, finally operation facilities were introduced by receiving one anaesthesiologist. Now differant types of complicated operation in the field of General Surgery, Orthopedics, Gynae & Obs, ENT, Eye and Dermatological case are regularly performed by a set of young, energetic and devoted physician and nurses.

b.         The hospital authorities ensure that all of its admitted patients will get totally free treatment while they stay at this hospital including operation with investigations. This is very much unique in contest of other government hospitals of the country.

c.         All outdoor patients are getting different types of required medicine free of cost.

d.         A high quality and required quantities of food are provided to all admitted patients.

e.         A high standard of clean and hygienic environment in all around the hospital is ensured.

f.          Quality of pathological and radiological investigations are maintained by careful monitoring.

g.         A congenial environment is Prevailing inside the hospital where all doctors and other employees are working in a well discipline and responsible manner. This ensure to reduce patient waiting time and timely disposal of patients other needs.

h.         By careful and continuous monitoring all medical equipment, instrument, furniture and other the government properties are well maintained and functioning.

i.          Gradually and slowly the increasing patients load indicate the confidence and satisfaction of them which properties are well maintained and functioning.

j.          Modern cook house and modern laundry ensure better food and clean cloth to all admitted patients.

Other Special Features of the Hospital

1.         A congenial environment is prevailing inside the hospital where all doctors and other employees are working in a well disciplined and responsible manner. This ensures in reduce patient waiting time and timely disposal of patients other needs.

2.         By careful and continuous monitoring all medical equipment, instrument, furniture and other government properties are well maintained and functioning.

3.         Gradually and slowly the increasing patients load indicate the confidence and satisfaction of them which encourage the hospital staff to do more.

4.         Modern cook house and modern laundry ensure better food and clean clothes to all admitted patients.

5.         A high standing and security and discipline inside the hospital is also maintained.

Centre for MRCS Part-B Examination

8.

The Royal College of Surgeons (RCS) of England had selected Kurmitola General Hospital as the first Bangladesh Centre for MRCS Part-B examination. In this regard, a MoU was signed between DGHS and Royal College of Surgeons, England in the year 2012. A pilot examination was carried out at Kurmitola General Hospital on 18 September 2013 by RCS England team where 22 Bangladeshi students were participated. Later, on 18-19 January 2014 first MRCS Part-B exam was held at Kurmitola General Hospital successfully. It was also decided by RCS England council to take one or two such exams at Kurmitola General Hospital every year.

Introduction of Diploma and Graduate Nursing Course

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This hospital had a capacity to accommodate 200 nursing students in its nursing dormatory. Necessary steps are underway to start 3-Year Diploma in nursing course at this hospital. The will definitely help to fulfil the nursing support to admitted patient in Kurmitola General Hospital.

Green Hospital Concept

Government has selected this hospital as a pilot project of Green Hospital in Bangladesh. This hospital is designed to dispose all kinds of hospital waste in hygienic and scientific way where environmental pollution in all regards will be prevented. Green hospital concept is very new in Bangladesh but in developed countries it is being practiced since more than a decade.

In green hospital concept, importance is given to utilize natural light, air at highest level. Besides, to reduce sound pollution, less electric consummation, safe disposal of both hospital and general waste, minimum use of chemical items and to develop more green area by plantation etc. are given due importance. Ministry of Environment and WHO are jointly conducted this pilot project. This hospital authority has given due importance to make this pilot project a successful one.

Institutional shortages and limitations

10.

1.         This hospital is designed to accommodate 500 Indoor patients of different nature with other operational and investigational facilities. Medical instrument and equipment are being installed and maximum of them are in functioning state. To achieve its total ability 2nd phase of organogram having 570 manpower of different categories need to be materialized. Otherwise its full ability could not be achieved.

2.         Necessary budget will also be needed for its smooth functioning.

3.         Residential accommodation in and around the hospital primes for doctors, nurses, paramedics and other important employees are badly needed.

4.         Hospital repain and maintenance cell is required to be established.

Future strategies and development plan

a)         Important department like Neurology, Neuro Surgery, Urology, Nephrology, Cardiac Surgery etc. will be opened gradually.

b)         ICU, CCU, Dialysis, Cath lab, MRI, Advanced lab test etc. will also be introduced soon for better investigation and critical patient management.

c)         Provisioning of teaching and practical training of students and internee doctors of Armed Forces Medical College will be introduced soon. Besides, necessary steps will also be taken to consider this hospital as training hospital for post graduate trainees.

d)         A burn and plastic surgery unit will be established soon to provide the medical support of burn cases. For establishment of Burn and Plastic Surgery Unit the infra structured facilities are available. Necessary steps are underway  for obtaining budget and manpower to sart this unit.

Conclusion

The government has given utmost priority for functioning of this hospital in full capacity. Arrangement of necessary manpower, budget and other requirements are in the process of implementation. Hopefully, within a couple of month a significant capability building of this hospital will be possible by the active support of all concerned.

I do consider this hospital as a new generation government level hospital which will able to satisfy our patients’ requirement and accpectation and acceptation as citizens of an independent country. Provision of total free quality hospital care will be ensured for all helpless, poor and under privileged community in and around the hospital area. This will be such kind of tertiary level health care centre where every individual doctor, nurse including paramedics and other employees will be answerable to its clients for their actions and services. Relentless efforts are given by all concern of this hospital to ensure quality treatment within available resources. I welcome all citizens of the country to visit this hospital for treatment and encourage others to do so.