MSS and TI: Dhaka is the capital of Bangladesh (figure 1) and the fifth largest city by population in the world. It is home to more than 14 million people and to the National Institute of Neurosciences & Hospital (NINS), a government-run neurological centre of excellence, recognised with the health minister’s best performance award for the past 3 consecutive years, since inauguration in 2012. Patients with neurological disorders from all over the country access the hospital resulting in ever-increasing caseloads. There were more than 268 000 outpatient visits and 36 000 emergency visits last year to a hospital with 450 beds, staffed by 13 professors, 19 associate professors, 34 assistant professors, 11 registrars and medical officers.

Specialised outpatient clinics are run by senior neurologists. Patient registration costs 10 taka (approximately 9 pence). Experienced neurologists may see more than a hundred patients in each clinic per day, meaning that consultations are extremely focused, each lasting only a few minutes, and require a high level of clinical acumen. Waiting times can be long. Outpatient services run from 8:30 until 14:30 6 days a week and emergency services are open 24/7.

NINS has both paying and non-paying beds. Paying bed costs are 275 taka per day including food (£2.50). Most medication is free …