Nolzim Uddin is a man with a dream. Equipped with a radiant white smile and kind eyes, his handsome features are befitting of his job as an actor for Bengali television dramas. But the struggles of a rising actor are not unique to the streets of Hollywood or New York City. If anything, the effects of unsteady offers and competition in the industry are only exacerbated in a country with already limited opportunity. In order to make sure the needs of his wife and one-year-old son are met, Uddin must supplement his income by working at a local restaurant six days a week, only taking small breaks in his schedule when a part comes through.

Although his priorities are first and foremost to ensure the security of his family, Uddin hopes to one day assist his countrymen in their own endeavors of attaining happy and stable lives. His plan of action is to eventually build a hospital in his hometown of Khulna; a hospital where “all people—poor man and rich man—can come when they are sick.”

According to Uddin, healthcare in Bangladesh is currently corrupted by profit-driven motives, both on part of the hospitals and, more importantly, the doctors themselves. Government support to provide access to healthcare has been severely minimal in an already resource-poor country. This has not only perpetuated a cycle of poverty and sickness that threatens the state of the nation, but has also created a market for the privatization of medical centers and services. As a result, the number of hospitals and health care workers in Bangladesh has increased over the last ten years, most notably in the capital, Dhaka. However, with the introduction of private state-of-the-art hospitals, such as Apollo Hospital Dhaka, comes a significant price to pay, as funders tend to have their own agendas at work.

Dr. Dewan Alam of the Chronic Disease Unit at ICDDR, B has noted the progression of public-private partnerships and is disheartened by the outcome. “Health has become a commercial commodity,” he stated, “even a mother and her newborn infant are billed separately on hospital invoices now.” The combination of exceedingly overcrowded public hospitals where it is impossible to get treatment, and private for-profit facilities run by capitalistic mechanics, has made it so that basic health interventions and procedures are not widely available to the people, just under half of which are living below the poverty line.

Rising prices of maternal healthcare services attests to this fact. According to a 2010 report by the Ministry of Family Health and Welfare, expenditures for normal delivery methods in a private facility range up to 3,750 Taka, over triple the amount one incurs at federal hospitals. Moreover, if complications should arise, prompting the need for a C-section delivery, costs can range up to nearly 14,000 TK, which equates to 1-8 times the monthly salary for nearly half the population. These strains are devastating to communities that already struggle for basic necessities.

At the very least, one would hope that the physicians themselves would be moved to revolutionize the system, after witnessing their country’s destitution on the most intimate of levels, but this does not seem to be the dominant case. In fact, as far as Uddin is concerned, “90% of the doctors in Bangladesh are business men…they do not listen, they do not nurse the poor; they just secure money for themselves.” The numbers of patients seen in a day at private clinics far outnumber those that are manageable to provide quality treatment. According to his testimonies, Uddin and his family have never received a health consultation that has lasted longer than 15 minutes, no matter the case. “They just take the maximum number of patients for maximum income.”

It is understandable that in one the most densely populated countries in the world, physicians will be hard-pressed for time during patient consolations, especially if motivated to help as many individuals as possible. However, what is lost in minutes must be made up in attention to detail and effective treatment prognosis, both of which seem to be lacking in Bangladesh.

Due to the conditions previously outlined, many times it is not even possible for people to visit a qualified physician, especially in the rural areas. As a result, nearly 50% of the people in Bangladesh are first diagnosed and treated by Unqualified Allopathic Professionals (UAPs), namely “village doctors”. Although they lack formal medical qualifications, these village doctors still prescribe and practice medical treatment, most of the time with detrimental results. Previously observed issues have included misdiagnosis and harmful or unnecessary prescription guidance, which can easily endanger the lives of patients. But despite these trials, institutions such as ICDDR, B recognize the key role these individuals play in the country’s healthcare system, and have created initiatives to train the village doctors in proper medical treatment, rather than eradicate their practice.

Still, this has proved to be quite a challenge, as unnecessary prescription writing continues to be a reoccurring problem. Village doctors have high incentives to recommend various drug treatments, whether they are needed or not, as pharmaceutical industries offer them a percentage of the money paid towards medication; their income is being directly bolstered by such authorizations.

Furthermore, the same conditions are offered to qualified MBBS and MD practitioners, who also get a percentage of the payments made towards biomedical tests and drug costs. This has led locals, such as Uddin, to grow skeptical towards the healthcare industry, questioning whose interests they truly have at heart.

But of course, not everyone has remained passive to these circumstances. Dr. Sufian Sheikh MBBS has been equally outraged by these systems that continually ostracize those most in need of care. Deeply moved to make change in anyway possible, he has set up a private clinic in Khulna, his own place of birth. In his clinic, Dr. Sheikh charges bare minimums for his services—just enough to keep it running—so as to not deter anyone from seeking the medical treatment they need.

Like Uddin, Dr. Sheikh views the disorderly healthcare structure as fault of the physicians who fail to put people before profit; however, he puts blame on the government, and their failure to address poverty in Bangladesh, for the results of a profit-driven system. “People have five needs: food, clothes, education, health, and shelter—all of which the government is not working to provide,” he states. With these five elements in place, Dr. Sheikh believes the people will not only be able to build up their own success, but in their stability they will also be willing to extend help to others that are struggling to survive.

Research done by Bangladesh Development Research Center would seem to support Dr. Sheikh’s theories. The study refers to Abraham Maslow, an American Psychologist, and his proposed ‘Hierarchy of Needs’ (depicted below), which was used to assess motivational factors in Bangladesh. Outcomes showed that a majority of the respondents, regardless of class, stated that “physiological needs are the prime needs of most Bangladeshis…they will be happy if they are able to get the basic needs.”

Although there was slight mention of needs for safety and security, others beyond these first two tiers of the pyramid were virtually non-existent. Furthermore, respondents went so far as to discount emotional needs, such as love and a sense of belonging, as “worthless”, when most are just simply trying to make ends meet. This may serve as an explanation as to why there is not more active collaboration among communities intra-nationally within Bangladesh.

Yet what is lacking in resources is made up in the sheer number of people living in the country; if the government can start mobilizing communities out of destitution through welfare programs, perhaps it will be possible for a pattern to bloom outwards, as groups work together to reclaim their rights, such as access to healthcare.

Physician-anthropologist Paul Farmer warns that recurrent concepts in public health, such as “cost-effectiveness” and “sustainability”—also relevant to the discussed public-private health ventures—are dangerous because “they are likely to be perverted unless social justice remains central to public health and medicine.” In the case of Bangladesh, concerns of financial stability have overshadowed the primary role of hospitals and healthcare professionals: to serve and treat the afflicted, regardless of socio-economic status.

As it stands now, the healthcare sector leaves much to be desired, and whether or not reforms are made in the near future will have a major impact on status of the nation. However, there remain pockets of hope that carry the promise of one day promoting changes to revolutionize the delivery of medical services. Until that time, it will be up to these few to continue in their efforts of promoting equality—no man left behind.