Hospital Social Services in Bangladesh (Fieldwork: Part-01)

Hospital social work is a specialized field of social work. Hospital social work is also known as Medical social work. As a sub-discipline of social work hospital social work aims to assist people with illness to deal with psychological, social and economic crisis which are threatening to them.

Rapid and radical social changes are characteristics of post-industrial urbanized society. Industrial revolution as an unmixed blessing brought rapid and radical social changes. These changes result into changed role of individual and family. It has loosened social and family ties. Due to attraction to luxurious life or in search of job people become interested to live in urban area. Living in urban area was costly. Urban facilities were not available for the people of low income group. Maintaining a large family in urban area is always difficult. So, people started to migrate in urban area alone or with only wife and children. As a result large joint families broke into small/nuclear families. The children, elder and dependent persons became insecure.

In pre-industrial period problems were unilateral. After industrial revolutions these problems turned into multilateral problems due to affect of complex socio-cultural factors. In many cases, these problems cannot be solved only through individual attempts and Outside assistance becomes essential. Social work has emerged to help people so that they can solve their problems effectively with their own resources.

Social work includes all aspects of human life to ensure comprehensive welfare. Medical setting is one of the fields of social work. Hospital social work deals with psychological, social and economic problems of patient contributing to their illness. Medical social work was first introduced at Massachusetts Hospital, Boston, USA in the 1905. At present it is well established in most of the hospitals of developed countries. Medical social work is also practiced in developing countries such as Bangladesh, India, Pakistan, etc. Medical Social Worker works in a medical setting with a group of doctors, nurses and hospital staffs. Doctors only deal with physical problems, Medial social worker deals with psychosocial aspect of a patient and help the physician in treatment and discharge planning.

In Bangladesh medical/hospital social service was introduced during the 1958. From then till now it is continuing and expanding its activity throughout the country. But the matter of our concern is that no comprehensive study has been done on it after 1969. So, it has been decided to conduct a study titled “Medical social work in Bangladesh” to know the present status of hospital social service in Bangladesh, its limitations and necessary recommendations for improvement.

Objectives of the Study:
The general objective of the study is to know about the available hospital social services in Bangladesh and its present situation.
Specific Objectives of the include-
  1. to know the personal information of the service recipients;
  2. to review the historical perspective of hospital social service in Bangladesh;
  3. to get to know the present situation of hospital social service in Bangladesh;
  4. to get acquainted with the odd situations confronted by the hospital social workers;
  5. to gather recommendations from service recipient and Medical Social Worker to enhance the quality of Hospital Social Service.
Rationale of the Studies:
Bangladesh is a developing country. It is a populous country having a burden of 151.6 million people. It is not possible for her to ensure basic human needs (e.g. food, clothing, accommodation, education, medicine and recreation) of all her citizens with limited resources. Medical services in Bangladesh are not adequate. The ratio of population and medical bed is 1: 3508 and for per registered Doctor is 1: 2773(Economic Review of Bangladesh-2012).

Inadequate number of hospitals and low quality of health services are leading sick people to death specially the poor. Department of Social Services (DSS) of Bangladesh introduced Hospital Social Services for the welfare of poor patient in 1958. From then Department of Social Services (DSS) is expanding Hospital Social Services all over the country. After 1969 no comprehensive study has been done on Hospital Social Services Program of Bangladesh. To gather proper information about the present programs of hospital social work, to evaluate its efficacy with the passage of time, to identify the existing hindrance in the way of development of professional hospital social work practice in Bangladesh and to identify necessary steps for modifying and enhancing existing services the present study is considered to be proved as a prominent initiative. 
In Bangladesh, there are limited source of indigenous literature on Hospital Social Work. This research paper is wished to supplement the scarcity of literature to a substantial extent. It will also serve the purpose of literature review for the future researchers as a relevant source of literature.

This study aims to uphold the present situation of Hospital social service program in Bangladesh including its problems and prospects. The output of the study is hoped to attract the attention of the Government of The Peoples’ Republic of Bangladesh as well as the Policy Makers, Social Workers, Economists, Physicians and the civil Society to take necessary initiatives for improvement of hospital social services in Bangladesh to ensure Good health facilities for all citizens like that is in the developed countries of the world.

Universe of the Study
The universe of the study covers two different segments including all the patients receiving services from hospital social service programs and all the hospital social service officers who are directly engaged in providing hospital social services to the patients.

Sampling Method
In this study non probability random sampling has been used for the convenient of research work. All the hospitals of Bangladesh have been considered as clusters. 30 hospital social service officers and 35 patients receiving hospital social services have been taken as sample of the study through purposive sampling.

Variable under Consideration
As two groups are included in the universe of the study two different sets of variables has been taken under consideration during conducting the research work.
Variable in relation to the patients-
  1. Family composition
  2. Economic status
  3. Marital status
  4. Educational status
  5. Income and occupation
  6. Knowledge about hospital social services
  7. Expectation and satisfaction level
  8. Behavior and response of hospital social serve officers towards 
  9. them 
  10. Opinion about necessity of hospital social services.
Variable in relation to the social service officers-
  1. Age and sex
  2. Educational background
  3. Length of service
  4. Satisfaction in this profession
  5. Problems in this profession
  6. Recommendation for solving problems and improvement of hospital social services
Techniques of Data Collection:
In the study the following techniques have been used for data collection:
  • A structured interview schedule has been used in this study after pretesting prior to field investigation to ensure significant level of reliability and validity.
  • Necessary data have been collected from the selected patients by interview method. In many cases assistance was sought from the attendance of patients’ (parents, offspring, siblings and others) as the patients were unable to speak on to provide me with required data.
  • As this study is part of educational curriculum the researcher did not appoint any data collector and collected all the data herself.
  • Observation method has been used as a supportive method of data collection to testify the collected data.
After completing field investigation the collected data have been edited carefully to screen out errors and mistakes. The data were put into order to make it meaningful. Editing was done to ensure completeness, accuracy and uniformity of the collected data on the day on which the interview has taken place.

Before processing data almost every variable has defined by a unique number called code. This technique is called coding which makes data processing easier. After collecting data answers were cod into code sheet.

After editing, coding, verifying and checking internal consistency tabulation of data was done with combinations of variables.

Analysis of Data
After tabulation data have been analyzed using in the form of percentage rate, etc. pie diagram, bar diagram has been used to present data

Organization and Presentation of Data:
The presentation of analyzed data has been organized under to broad heads and some sub-heads:

1. Data collected from service recipient (Patients)
  • Demographic information
  • Service related information 
2. Data collected from service provider (Hospital Social Service Officers)
  • Demographic information
  • Service related information
  • Profession related information 
Problems Confronted during Field Investigation:
Collecting data is a complex task. It depends upon the convincing and rapport building ability of the field investigator. As a student of MSS second semester I have I have conducted the study for my thesis. I could not collect information from all the Hospital Social Service Departments existing in seven districts of Bangladesh. My field operation was limited to the hospitals of bangabundo shekh mojibur rahman medical university Hospital. I have collected data from two groups- service recipients (patient) and service providers (Hospital Social Service Officers). I have faced few difficulties during collecting data from the Service Recipient comparing to the Social Service Officers. Although the Social Service Officers are well educated but sometimes I have experienced lack of cooperation from them. In some cases they were so reluctant that after explaining the objectives of the study I have failed to collect data from them. But most of the social service officers helped me to collect necessary data.

Limitations of the Study:
The study titled “Hospital Social services in Bangladesh” is a part of curriculum of MSS Second Semester of Institute of Social Welfare and Research, University of Dhaka. As it is carried out by a student of MSS, several limitations can be identified due to her limited knowledge, limited skill and experience.
  1. This dissertation is needed to be submitted within a fixed date, Due to limited time the researcher could not include sample form all the hospitals of Bangladesh which provide hospital social services.
  2. Due to limited time all the service recipients could not be interviewed. Finding out patients is a time consuming task. Difficulties have been faced to search the service recipients by going ward to ward and bed to bed in large hospitals.
  3. For verifying the findings of research, it needs to be compared with secondary source of date using high level of statistical measurement such as ratio test, hypothetical test, correlation etc. Due to absence of related secondary source of data these statistical methods could not be applied. This is the most important limitation of the study.
  4. As a young researcher it was difficult for the researcher to conduct a study without having proper training.
Despite of these limitations, as a young researcher the researcher has tried to accomplish the study with great care and sincerity according to the guidance of the skilled supervisor.

Review of Literature:
In the book ‘Medical Social Work’ E. M. R. Clarkson has stated her experience as a teacher of social work and an actual worker in the field in several continents.

In this book, she has stated the inception of medical social work in UK and USA. She has also highlighted the necessary of medical social work knowledge to deal with sick or disable persons and their families. She has defined Medical Social Work as a specialized branch of social work practice which deals with temporarily or permanently sick people in hospital settings.

According to Miss E. M. R Clarkson considerable aspects of medical social work along with all the rules and principles of social work practice are referrals, relationships in medical social work, interviewing emotional support and practical help case recording, attitude of patient and their relatives towards illness etc. Besides, she has also discussed about areas of practicing medical social work, necessity of cooperation among medical social worker and other hospital personnel, role of medical social worker as health education, administration of a medical social work department, training for medical social work, importance and relevancy of research in medical social work, application of medical social work to deal with psychosomatic illness and social aspects of various illness e.g. cancer, epilepsy, orthopedic, disabilities, deaf, blind and physically handicapped children, tuberculosis etc.

She has also mentioned some important aspects of practicing medical social work in developing countries with reference to Bangladesh. According to her – The main point to consider in the training and practice of medical social work in developing countries is that it should meet the need of the country. Hours spent with individual patients, though desirable may be quiet impractical, thus the medical social worker has to consider how to be of the best help to the greatest number of patients and what methods of social work to use.

She has concluded the book describing a case history, comments and suggestions to the case history, problems she has faced when she was placed in a hospital and the ways she overcame the problems (Elizabeth M.R. Clarkson, 1974).

An Article titled is Practice of Hospital Social Services in Dhaka City. Empirical study authored by Mohammad Hafiz Uddin Bhuiyan the main objective of the study was to find out the real feature of hospital social service practices in Dhaka City. The specific objectives were to know about demographic conditions. Expectations and satisfactions of the service receivers, existing programs and nature of services provided by the social service officers, existing problems of hospital social services department and bringing out necessary recommendations.

In this study case method has been used as principle method of data collection. Bangabondhu Sheikh Mujib Medical University, Dhaka Medical College and Hospital were selected as cases through purposive sampling. Information has been collected through interview and observation. Secondary source of data has been used for collecting more information.

Findings of the study have revealed that most of the hospital social service receivers belong to very poor families. According to the study existing hospital social service programs are –
  • Helping patient to adjust with hospital environment;
  • Analyzing economic, social and psychological causes liable for illness;
  • Providing necessary financial assistance, medicine and nutritious food, etc.
  • Making regular correspondence and consultation with patients and their families to eradicated their anxiety;
  • Rehabilitating the destitute and unknown patients;
  • Building awareness among the patients and their relatives about nutrition; child health family planning and personal hygiene.
This study also highlights existing problems of hospital social service department of these three hospitals including lack of trained medical social workers, insufficient government allocations, lack of cooperation and coordination between the hospital administration and hospital social service department, etc. Besides, this study highlights some recommendation to solve these above mentioned problems.

“Medical Social Work in Hospital in Dacca City” is first of its kind conducted by Selima Begum and Syed Ahmed Khan in 1969 during Pakistan period. According to the study medical social work in East Pakistan (present Bangladesh) was introduced with some specific aims and objectives. This study was conducted with the purpose to know how far these objectives had been achieved in reality, to know usefulness of such programs in medical setting and to find out new approaches for improvement and indigenization of the program according to the socio-culture characteristics of the people.

This study was conducted on three hospitals of Dhaka City; Dhaka Medical College and Hospital, Post-Graduate Medical Institute (present Bangabondhu Sheikh Mujib Medical University) and Salimullah Medical College Hospital. Interview schedule was used as main method and observation as auxiliary method of data collection. Patients referred by the doctors were directly interviewed and medical social workers were indirectly interviewed.

Findings of the study shows that most of the patients who received hospital social services were the head of the family and belong to low income group. About 50.8% patients are dependent on family members while 27.7% is self employed. Half of the respondent (51.7%) mentioned that they had received psychological support, 26.7% mentioned about financial support and 22.6% could not mention any particular assistance they had received from the medical social workers (Begum & Ahmed, 1969).

This study briefly described the relationship between the theoretical objectives of medical social work and its real practice in the hospitals in Dhaka city. Available services were limited to providing financial assistance, providing psychological support, providing necessary knowledge about diseases, helping to adjust with family members, case recording, etc. It also pointed some medical social work services which were necessary but unavailable in these hospitals such as –
  1. Convalescent home for the after care of the recovered patients;
  2. Training facilities for the disabled patients;
  3. Alternative provision to take care of the children and dependent family members of the patient during hospitalization.
This study also provides some guidelines for further study. It was felt by the researcher that an extensive study of the needs of the patient should be done to improve existing medical social work programs.

In conclusion, the study has pointed out some suggestions for medial social workers e.g. emphasizing on aftercare of home poor patient, supervising medial and other facilities provided by different social welfare institution, helping hospital personnel to focus on socio-economic aspects of the patient developing cooperation and working relationship with hospital personnel, receiving specialized training to meet the need of medical treatment, etc. (Begum & Ahmed, 1969).

A brief but clear definition of Medical Social Work has given The Social Work Year Book (19640. According to the Social Work Year Book: “Medical Social Work is Social Work practiced in a responsible relationship to medicine and public health within the structure of health and medical care.”(cockerill, 1960)

The author has identified key functions of medical social worker. These include directing social casework services to individual within their family, social group work with the groups of patients and relatives, consultation to other members of the clinic or health team and to community social and health workers, supervision of junior social work staff members, administration of the social unit or department, education of social work students, interdisciplinary teaching (medical, nursing and other students) and finally participation in research effort and in community health planning (Cockerill, 1960).

He mentioned that medical social work was first introduced in 1905 at the Massachusetts Hospital in Boston, UK. After that it was introduced at Bellevue Hospital in New York City. He has also clarified the roles of medical social worker as consultant and teacher. He has concluded the article describing educational background of medical social worker. 

W. A. Friedlander in his book titled “Introduction to Social Welfare” stated that social work practice in medical setting has been developed to deal with various social and psychological aspects of sickness and disability. According to him physicians consider hospital social work as an allied discipline of Health and Medicine (Friedlander,1982).

He stated that as an integral part of the medical team social workers collaborate with doctors, nurses and other therapists in the study, diagnosis treatment planning process of patients. The aim of medical social worker is to help the patient to regain his/her lost capacity for social functioning through solving their psychosocial problems that restrain him from achieving a satisfactory level of adjustment or recovery from the illness.

He has mentioned four major predecessors of medical social workers e.g. friendly visitors, lady almoners, visiting nurses and medical students trained in social agencies. He defined the key role of medical social worker as a case worker is to understand psychological stresses the patient is undergoing the resources available to him or her during and after treatment. Social worker can closely help the medical team in understanding and treating the body, the mind and the environment of the patient (Friedlander, 1982).
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