Day Visit Report

Visit No.

: 04

Date of Visit

: 02.09.10

Name of the organization

: Bangladesh Institute of Research and Rehabilitation

in Diabetes, Endocrine & Metabolic Disorder
(BIRDEM)

Location of the Organization

: 122, Kazi Nazrul Islam Avenue, Shahbag, Dhaka1000

Date of establishment

: 1956

Type of the Organization

: Non-Government Organization (NGO)

Objectives of the Organization:

1. To provide comprehensive (promotive, curative, preventive & rehabilitative) health
care, free of charges to all the diabetic patients irrespective of economic and social
status so that he/she can lead socially and economically productive life.
2. To ensure prevention and control of diabetes and rehabilitation of poor and
unemployed diabetics.
3. To incorporate diabetic health care in the primary health care level for early and
prompt diagnosis and appropriate management at an early stage.

Existing Resources:
a.

Manpower: Total staffs-2200

There are 400 doctors.

In the nursing division, 550 skilled nurses are providing skilled care.

b. Financial Resources: Sources of funds of BIRDEM include

Self-income generation- Running expenditure is DAB (Diabetic Association

of Bangladesh) generated. In 2005-06, own collection was 6229.29-lac taka.

Foreign aids- These are received through the Govt.

Govt. funding- Ministry of Social welfare provides 7-10% of the annual

budget. In 2005-06, it received 1440.00-lac taka as Govt. grant.
However, 3739.39-lac taka was taken as loan.

Fund generating
Cross financing

Specialized tertiary care to Diabetic

and Non Diabetic patients:
1. OPD- Non Diabetics
2. Hospital services
3. Diagnostic services
4. Specialized services (Cardiac
care, Dialysis etc.)

Free Diabetes Care:

1. OPD services for all
2. Comprehensive services for
poor diabetics Drugs
Hospitalization
Diagnosis &
Rehabilitation

c. Others:

BIRDEM hospital is a 600 bed multidisciplinary hospital.

Floor space of the hospital: 2, 54, 000 sq. ft.

Total number of ward beds/cabins-593

Total beds-600(20% non paying)

Total number of cabins-117

Paying beds: for males-163 & for females-170

Non paying male beds-46 + female beds-38

Special units: ICU-10(Intensive Care Unit)

CCU-7(Coronary Care Unit)
SCABU-22(Special Care Baby Unit)

GHPD-5(Gastro intestinal Hepato-Pancreato Disorder)

Haemodialysis-16

Total number of wards is 71 out of which 15 are allotted for the children.
Observation beds: for males-6 & for females-4 (emergency) which is
excess to total bed capacity-593

Total number of Operation Theatres-10

Diagnostic facilities: General Laboratory of BIRDEM provides diagnostic

services to in and out patients of BIRDEM Hospital and acts as a referral Laboratory
for Dhaka City as well as the entire country. This Laboratory extends regular
services to Ibrahim Cardiac Centre and National Health Care Network (NHN) Centre
as and when necessary.

Well-developed laboratory services division with the facilities of

Biochemical,

Pathological,

Haematological,

Endocrinological,

Microbiological, and Immunological Investigations with Histopathological

and Cytological facilities.

Provision of molecular diagnosis (PCR, RIA, Karyotyping)

Facilities for liver and kidney transplant.

Facilities for Haemodialysis with a separate Haemodialysis unit equipped

with Haemodialysis machine, CRRT (Continuous Renal Replacement
Therapy) machine, Cardiac monitor and Ventilator.

Facilities for intensive care through department of critical care medicine

equipped

with

Medical

ventilators,

Emergency

cardiopulmonary

resuscitation trolley equipped with Defibrillator, total parenteral nutrition,

continuous Cardiac & Respiratory monitoring, Central venous pressure
monitoring

Well equipped SCABU ( special care baby unit)

Library facilities: It has a highly enriched Library with books, monograms,

journals and internet facilities.

 Transport Facilities: It has 10 transports used for providing its medical services.

Activities of the Organization:

1.

Specialized tertiary care to Diabetic and Non-diabetic patients:

a.

OPD-non diabetics

b.

Hospital services

c.

Diagnostic services

d.

Specialized services (Cardiac care, Dialysis) etc.

e.

Successful management of Diabetic pregnancy

f.

Special care Baby Unit provides care to babies less than one month of age
and the paediatric ward cares for the group aged 1 month to 18 yrs.

2.

Free Diabetes Care:

a. Blood sugar level is tested free of cost for all.
b. OPD services for all.
c. Comprehensive services for poor diabetics include-

3.

Drugs

Hospitalization

Diagnostics &

Rehabilitation

Emergency Services: It provides a 24-hour emergency service able to handle both

diabetic and non-diabetic emergencies.

4.

Health Education:

It provides education and training program for diabetics and their family
members.

Three important days are observed every year in regards of providing health
education. They are28th February--BADAS foundation--Diabetes Awareness day
6th September--Death of Professor M.Ibrahim--Diabetes Service Day
14th November--World Diabetes Day -- (since 2007-United Nations
Day)

On these days, press conference, rally, health camp, interaction with patients,
distribution of leaflets on diabetes, roadside blood glucose level measurement, art
exhibition of Diabetic children etc are held with the aim to create awareness
among the people.

Health related information is disseminated through publication of journals and

bulletins, thereby creating health awareness among the masses.

5.

Social Welfare Services: It provides social welfare services, which take care of
social, economic and other problems of patients to uphold and improve their lifelevel, especially to help them to lead a normal self-dependent and useful socioeconomic life.

6.

Rehabilitation Services: It also provides rehabilitation services, particularly to the

poor juvenile diabetic patients and widows without families to help them get
employment after getting trained in different trades through Rehabilitation and
vocational Training centre (RVTC) of BIRDEM. In addition, a diabetic welfare
society pays for the poor diabetics.

7.

Academic and Training Courses:

It conducts Post Graduate Courses including-PhD, MD, MS, M.Phil and

Diploma, in Endocrinology and Metabolism (EM), Radiology & Imaging,
Gastroenterology, Internal Medicine, Neonatology, Gynaecology and Obstetrics,
General Surgery, Ophthalmology, Biochemistry and Dermatology under the
Research & Academy Division.

They have established Distance Learning Program (DLP), which is a project of

the Diabetic Association of Bangladesh to run distance-learning course with a
view to developing workers in the field of diabetes throughout the country. The
course was introduced in collaboration with the Open University; UK in
2004.The Duration of these courses is six months (January-June & JulyDecember Session).DAB also offers other short courses.

It also conducts selective intensive training courses for officials of primary health
care.

8.

Specialized Medical Services: Transplantation of kidneys is carried out.

9.

Diagnostic Services: General laboratory of BIRDEM provides diagnostic services

in and out patients of BIRDEM hospital including free check up of DAB registered
diabetic patients.

10. Research Works: BIRDEM conducts basic and applied research works and runs
several projects in collaboration with national and international universities and
donor agencies. The current major research projects include:
a.

Plant materials as a source of drugs.

b.

Aetiopathogenesis of Diabetes and its complications in the Bangladeshi

population.

c.

Nutritional evaluation of food materials.

11. Conferences and Seminars: It conducts conferences, seminars and workshops in

collaboration with international universities and organizations.
12. Self-Sustainability: It carries out income generating activities through which it
funds its free diabetes care.
13. Others: BIRDEM, through its printing and publication department publishes,
Diabetic Guidebook for the Diabetic patients, which is the lifetime document for
a diabetic patient.

Achievements of the Organization:

1956 : Established and started its activity

1959: Membership of International Diabetic Federation (IDF)

1979:- Elected in the executive committee of IDF.

- Chairpersonship of the South-east Asia region.

Expanding diabetic services----In 1956 it started with 39 registered patients.

Throughout the years, its efficient services attracted a larger number of people
resulting in registration of approximately 3, 57,418 patients in 2006. The clinical
services division of BIRDEM attends approximately 35oo patients in the outpatient
department daily.

In 1982, BIRDEM was designated as the WHO Collaborating Centre for developing
Community Oriented Programs for Diabetes Control and Prevention.

In 1997, the institute was redesigned as WHO Collaborating Centre for Research
and Training for Prevention and Control of Diabetes Mellitus.

Primary prevention of Diabetes mellitus (PPDM) ----BIRDEM is one of the most

well recognized institutes for management of diabetes and other endocrine
disorders.

It is the second largest health association next to Ministry of Health and Family
welfare.

Manpower development by academic courses and other programs----BIRDEM

plays a pivotal role in the field of medical education by conducting a number of
postgraduate medical courses and thereby contributing to the build up of skilled
manpower in the country. They have spread their activities in abroad also. In
association with IDF (International Diabetic federation), Southeast Asia region,
BIRDEM has taken initiative to provide technical assistance in Nepal, Myanmar,
Maldives and Pakistan. Fellows are coming from various neighboring countries as
well as from Africa for research & training under various international fellowship
programs.

Research works-----The development of research activities in BIRDEM is worth

noting. As a recognition of its excellence in the research arena the World Diabetes
Foundation (WDF) has awarded a 3-year project to BMRG (Biomedical Research
Group) of Research & Academy Division of BIRDEM on Improving nutrition of
Bangladeshi population: from research to practice. Besides, in collaboration with
the Chemistry Department of Dhaka University, researchers of BIRDEM have now
developed an anti-diabetic agent from a plant source, which is almost at the stage of
marketing. Such an innovative research is a praiseworthy achievement of the
institute.

Rehabilitation----- Vocational and training centre of BIRDEM helps Diabetic

patients to lead meaningful and respectful lives by income generation that also helps
to the control their diabetes and lead a life close to normal.

The model of cross financing proposed by late Professor M. Ibrahim, founder of the
institute, has gained worldwide appreciation.

BIRDEM is credited to perform the first CT scan in Bangladesh. It is also the

pioneer of Karyotyping in Bangladesh.

BIRDEM has successfully performed Living donor Liver transplantation (LDLT)

under KALTU (Kidney and Liver Transplant Unit).

They have been successful in the management of Diabetic pregnancy through their
Perinatal Care Project (PCP).

Ibrahim cardiac hospital and research centre (better known as DAB cardiac centre)
has become an international standard for patients with cardiac problems and has
been providing an effective service to people in need of sophisticated cardiac care.

As a whole, all the diabetics, countrywide have recognized this institution as a

medical sanctuary for them.

Problems and constraints:

1.

According to recent data, total no of established patients at BIRDEM up to May

2009---Diabetes Mellitus-3, 83.000 and IGT-35,400.Now

is taking care of only

15%-20% of estimated diabetic patients in the country, which is not enough. The
current facilities available at BIRDEM are not sufficient to cope up with the
increasing number of patients. Therefore, steps should be taken to decentralize the
out patient load through National Health care Network (NHN) centers and Affiliated
Association.
2.

Awareness about Primary Prevention of Diabetes is not adequate.

3.

There is lack of enough trained and skilled manpower and adequate fund. It is far
away from achieving economic balance to maintain fore front of health care
technology and education. That is why it needs greater amount of investment each
year for rapid and constant modernization of its facilities.

4.

There is no facility for Neurosurgery and Paediatric surgery.

5.

There is less scope of providing services to the diabetic patients with complications
likerenal failure, retinopathy.

Personal observation:
As per the reputation, BIRDEM is an ideal example of a modern specialized health care
providing institution. Thanks to its sincere & kind-hearted staff, it has managed to run
smoothly within its imitations. Some of the initiatives like cross financing & providing costfree services to the poor have made it a patient-friendly institution in true sense. It has to
manage such a heavy load of patient that a very few health institutions in our country can
afford. Nevertheless it has been successful to keep its services up to the standard.

Conclusion:
Diabetes mellitus is one of the most prevalent debilitating diseases in the whole world
including Bangladesh. BIRDEM was the first organization in our country to notice the
seriousness of this problem & still remains the only reliable institution in this context. It has
been a milestone in the history of health services not only in our country but also in the
whole subcontinent. But a single institution cannot single-handedly solve this problem in a
country like Bangladesh. So it is high time the government took initiatives to set up new
hospitals taking BIRDEM as a role model & extend the services to the rural level.

_____________________

_______________________

Signature of the teacher

Signature of the student

Date:

Date:
Roll: 33

ORGANOGRAM
National council of DAB
President
DAB secretariat

Secretary General

DAB project office

BIRDEM

Clinical Services
Division

Out-Patients
Department

Diet and
Nutrition
Dentistry
Dermatology

Physical
Medicine &
Rehabilitation
Social welfare

Public
Relation

NHN

Finance and
Accounts Division

In-Patients
Department

Internal medicine
Critical care
medicine-ICU
Cardiology

IMC

ICHRI

Administrative
Division

Logistic Services
Division

Nursing Department
Equipment
maintenance
department
Building
maintenance
department
Kitchen Section

Pediatrics and
neonatology

Laundry-linen and
Apparel Section

Gynecology and
obstetrics

Material
management
Department (store)

General surgery
Urology
ENT & Head
&Neck Surgery

Procurement
Printing and
Publication
Department

Treasurer

RVTC

HCDP

Division of
Lab Services

Clinical
Biochemistry,
Clinical
pathology,
hematology

Endocrinology
Microbiology
Histopathology
& Cytology
Immunology

DLP

Research and
Academy Division

BIRDEM
Academy
Library
Radiology &
Imaging
Biochemistry &
Cell Biology

Pharmacology
Physiology &
Molecular
Biology
Epidemiology &
Biostatistics

Health
Education

Orthopedics and
Traumatology
Ophthalmology
Anesthesiology
Transfusion
medicine
Emergency Unit
Hemodialysis Unit

Signature of the Teacher

Date: