Standing in the hospital corridors with other parents too anxious for news of their children to sleep or sit down, Abdul Rajjak’s face crumples with relief when he finds out his son has survived life-saving but high-risk open heart surgery.
Rajjak tells a story all too familiar in Bangladesh, where congenital heart disease is common. Even in the capital, Dhaka, there is a shortage of doctors for paediatric surgical cases.
He and his wife, Shelina, discovered that their baby had a hole in his heart, but had to live with the guilt of their inability to afford the $2,500 (£1,689) surgery required and the anxiety of seeing him struggle to breathe, feed and play.
“This baby is so precious to us, he’s so valuable,” Rajjak says of two-year-old Siam.
The couple spent eight years trying for a baby and exhausted all their savings on fertility treatment. When his son was finally born, Rajjak said it was “like holding the moon”.
But Siam was often in hospital and it became difficult for Rajjak, who works in a Dhaka textile factory, to pay the resulting medical bills.
Doing overtime, which meant working 17 hours a day, earned him 8,400 taka (about £72) a month. Half was used to pay the rent on their one-room home. Rajjak had started taking out loans when he heard that a surgical team was coming from Saudi Arabia to do free operations.
Siam was one of 400 children brought from all over Bangladesh – a country with a population of 160 million – to Dhaka’s combined military hospital (CMH). He was among 250 children chosen for surgery, and survived the six weeks between selection and operation.
“Fifteen patients died when we were calling them, as they were very serious and they could not wait,” says Dr Nurun Fatema, who opened Bangladesh’s first paediatric cardiology unit in 1998.
Equipped with a “cath lab”, Fatema can do heart operations using a probe, balloons and stents passed up a catheter to widen valves and increase the flow of oxygenated blood.
She refers her private patients to the CMH, meant for military families, and operates on some patients for free through a local charity.
But in Bangladesh, where many poor mothers don’t receive scans, nor sufficient food and care during pregnancy, the need is too great for Fatema and the handful of other paediatric specialists to fulfil.
“We did a study in this hospital and we found 25 per 1,000 live births are suffering from congenital heart disease. It is about eight to 10 live births in advanced countries,” she says.
“Eighty percent of [the patients’ families] are below the poverty line. They can’t afford it by themselves and most of them die due to a lack of money and facilities.”
The surgery is so complex and the patients so fragile – months-old but newborn-sized babies and frail children – that few surgeons risk operating.
“It has to be a winning game, our business. We can’t be killing babies,” says Dr Jameel al-Ata, who has come from Saudi Arabia with 23 medics to operate on children as part of the British NGO Muntada Aid’s Little Hearts programme.
In Bangladesh, many poor parents post adverts appealing for money to send their babies for treatment in India. The only alternative is to watch them perish.
When he knows a foreign team is coming, CMH’s cardiac surgeon, Dr Mohammed Abdul Hannan, contacts families, as “if they can’t go abroad to get treatment, then these babies are dying, definitely”.
In Rayer Bazaar, one of Dhaka’s many suburbs, three-year-old Shohan is fighting fit, six months after having open heart surgery.
“My baby got a new life,” says his mother Nasima, who begged the women whose houses she cleaned for money to send Shohan abroad after her husband was hit by a truck as he pulled a rickshaw.
“He’s grown so much, as he eats now, and he doesn’t cry. His favourite thing is running around,” she says.
The latest of three visits to Bangladesh for Little Hearts has been a record breaker for the charity, with 94 operations in a week. Muntada Aid has raised £1.6m and worked in Sudan, Mauritania, Yemen and Tanzania over the past three years.
It now has paediatric specialists lining up to donate their time and skills to operate in some of the world’s harshest places. “We’ve got about 80 or 90 doctors on board and we are organising these missions on a much larger scale,” says spokesman Kabir Miah.
A key element of the missions is to train local staff to take over. In Bangladesh, “there are two surgeons that [do] complex paediatric cases, and that’s not enough to cover one city, let alone the entire country,” says surgeon Mohammad Shihata.
Siam’s heart has been mended, but Rajjak is maintaining a bedside vigil. It’s only been a day since surgeons operated, but his son is now out of intensive care. “I’m just so grateful. I’ll do everything to keep him alive”, says Rajjak, as he tenderly feeds Siam sips of milk.