Gorakhpur hospital deaths: Critical care, including undisrupted oxygen supply, is extremely important for AES treatment, say Experts

Gorakhpur hospital deaths: Disruption in oxygen supply in the encephalitis ward of Gorakhpur’s BRD Medical College Hospital is said to have proven fatal for several infants. Uttar Pradesh CM Yogi Adityanath, however, insisted that oxygen shortage did not lead to the deaths.

Written by Abantika Ghosh | New Delhi | Published:August 13, 2017 4:03 am
Gorakhpur, gorakhpur deaths, gorakhpur hospital deaths, Yogi Adityanath, gorakhpur hospital tragedy, oxygen, gorakhpur encephalitis Gorakhpur hospital deaths: A child being treated at the hospital. (Source: Express photo by Vishal Srivastav)

Two of the authors of a seminal study in The Lancet (published in April, 2017) on Acute Encephalitis Syndrome (AES) say oxygen is a critical element needed in AES care. In fact, paediatric ICUs are public health requirement for AES-prone districts.

Disruption in oxygen supply in the encephalitis ward of Gorakhpur’s BRD Medical College Hospital is said to have proven fatal for several infants.

Uttar Pradesh Chief Minister Yogi Adityanath, however, insisted that oxygen shortage did not lead to the deaths.

Dr A C Dhariwal of the National Vector Borne Disease Control Programme, who is one of the authors of a study in The Lancet linking AES in Muzaffarpur to excessive litchi consumption, said: “Critical care is a crucial element of AES. Clinical set-up, availability of paediatricians, laboratory facilities, etc are important to ascertain the causal agent; it can be anything — virus, bacteria, protozoa. But critical care, which means monitoring of heart rate, respiratory rate, blood pressure, oxygen saturation, blood electrolytes, etc, and undisrupted oxygen supply is extremely important for AES care.”

Gorakhpur, gorakhpur deaths, gorakhpur hospital deaths, Yogi Adityanath, gorakhpur hospital tragedy, oxygen, gorakhpur encephalitis Gorakhpur hospital deaths: Hospital staff ready oxygen cylinders for use early Saturday. (Source: Express photo by Vishal Srivastav)

All of these, Dr Dhariwal said, have been provided in the 60 paediatric ICUs set up in AES-prone districts of the country, including Gorakhpur.

Respiratory distress depends on the stage and severity of the disease, said Dr L S Chauhan, who retired from the National Centre for Disease Control and is one of Dr Dhariwal’s co-authors in The Lancet study. “Respiratory distress is a function of chest infection. It usually appears late in the disease but depends on the severity,” Dr Chauhan said.

“AES is basically not one disease but a syndrome with multiple manifestations, (and) the prognosis is different for different patients.”

The importance of oxygen in AES care — right from the primary health centre-level — is reflected in the operational guidelines for the National Programme for Prevention and Control of JE/AES, released in 2014.

The guidelines talk of oxygen and use of ambu-bags — handheld resuscitation device that can be used when a ventilator is not available — at the level of primary health centres (PHC), the first level of healthcare in India. The guidelines say: “All centres should be equipped with ambu bag and oxygen, in addition to other medicines and I/V (intravenous) cannula.”

One of the essential components of a paediatric ICU for JE/AES is “central gas pipeline (Oxygen, compressed air, vacuum) (2 pts. For O2 and 1 for vacuum and compressed air)”, the guidelines state. Oxygen is listed as an “essential equipment” even at the PHC level.

The BRD Hospital is a tertiary care centre (third level of health system, providing specialised care) in one of the most AES-prone districts of the country.

Gorakhpur is one of the 60 districts where the Centre has sanctioned paediatric ICUs for tackling AES, and oxygen supply is a crucial element of any ICU.

Gorakhpur, gorakhpur deaths, gorakhpur hospital deaths, Yogi Adityanath, gorakhpur hospital tragedy, oxygen, gorakhpur encephalitis Gorakhpur hospital deaths: Uttar Pradesh Chief Minister Yogi Adityanath, however, insisted that oxygen shortage did not lead to the deaths. (Source: Express photo by Vishal Srivastav)

Yet, BRD Hospital, which has treated AES outbreaks in Gorakhpur since 1978, chose to ignore red flags about possible disruption in oxygen supply and even sat on the suppliers’ payment.

A review of AES cases in BRD Hospital — “AES: Clinical Presentation and Dilemmas in Critical Care Management”, published in 2014 in the Journal of Communicable Diseases titled — noted: “Nehru Hospital of Baba Raghav Das Medical College is the most approachable tertiary care hospital for a population of 50 million of eastern UP, parts of Bihar and adjoining Nepal, and has witnessed all epidemics right from 1978… The annual admission rate for AES is approximately 2,000-2,500 patients/year.”

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    Ashutosh Mahajan
    Aug 13, 2017 at 9:28 pm
    Bacteria, Virus and other Parasites can cross 'Blood Brain Barrier' in case of Children and Older people very easily. It depends on the host's immunity also. In world surprisingly approximately 40 people are suffering from some sort of Meninges Inflammation caused by Autoimmune diseases, Bacteria, Virus and other Parasites. Our brain has its own immune system to fight these infections, in the form of Head Lymphatic System. But due to the emergence of drug resistant superbugs allopathic treatment fails in many cases. Applying Antimicrobial oil like Neem Oil, Chalmungra Oil, Nirgundi oil, Eucalyptus Oil, etc on bald scalp and Backbone skin can cure these diseases successfully. Vitamin-C plays a very important role in the immunity of brain and fighting the germs.
    Reply
    1. R
      Ravi
      Aug 13, 2017 at 3:06 pm
      The BJP government can happily spend crores of money on gau-shala, awarding gau-rakshaks, cow-id-cards etc, but cannot spend money to purchase cylinders... Very wrong priority set by these BJP govts which value cows' lives more than human lives.
      Reply
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        Ash
        Aug 13, 2017 at 1:40 pm
        Yogi knows best.Who will tell him to listen to experts ?He is now issuing statement which reach an educated audience who are swayed by his illogical commentary.I find it very strange that a magistrate with no medical knowledge is able to say in such a short time that deaths were not caused by lack of oxygen.Even the common person understands that oxygen is a lifeline in critical care.But this is the new India where science is being relegated and gurus are peddling potions for cancer.Supplier had warned about stopping supply but still no action was taken by local govt time prin l will say funds were not released?Where blind lead,don't expect progress,only chaos.
        Reply
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          AlsoIndian
          Aug 13, 2017 at 1:13 pm
          The PM tweets immediately after the death of people in Belgium, Myanmar, Turkey....... When Indians die, it takes him 36 hours (yes this is true) to break his Maun (Remember: MaunMaunSingh). Anyway, children die in India every day so what is the big fuss about it? One BJP Minister said "children die during the month of August", so why all this hue and cry? After people voted BJP for Gau Raksha and not for Baby Raksha so just celebrate that cows are safe in India. Every wonder if not 72 but just 2 calves would have died, what would have been PM's reaction?
          Reply
          1. A
            AlsoIndian
            Aug 13, 2017 at 1:04 pm
            India needs food for all. India needs health care. India needs education. India needs jobs. India needs safety of women. India needs basic infrastructure. BJP OFFERS LOVE JIHAD. BJP OFFERS ANTI ROMEO SQUADS. BJP OFFERS RAM MANDIR. BJP OFFERS GAU RAKSHA. BJP OFFERS RESEARCH IN GAU MUTRA AND DUNG. BJP OFFERS HATE FOR ALL. BJP OFFERS SHAMSAN VS. QABRASTAN. BJP OFFERS HATE FOR ALL. BJP OFFERS TRIPLE TALAQ.
            Reply
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              Al S
              Aug 13, 2017 at 12:30 pm
              Yogi has gone to say that lack of oxygen is not cause for death of angels. However, if we go with this IE story, then it means that Yogi is denying. Even in the death of innocent children, the government is lying.
              Reply
              1. A
                author
                Aug 13, 2017 at 10:32 am
                Book all involved for Murder and get them convicted and hanged.
                Reply
                1. P
                  P.C.Kulkarni
                  Aug 13, 2017 at 9:47 am
                  It is high time BJP govts start concentrating on healthcare and education rather than monitoring who is nationalist and who is not
                  Reply
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