‘We need to tell hospital management to do job well’: Dr O N Bhakoo

Childhood mortality is the major cause of mortality, out of which infant mortality forms a major part with almost two or three of them dying in the first month. Unless we improve the neonatal healthcare, we cannot reduce the childhood and infant mortality rate.

What would happen if proper attention is not given to neonatal healthcare?

There will be diseases and several problems. Brain damage can also occur during the newborn period.

Where does Chandigarh stand in terms of infant mortality rate?
We are in the middle, neither among the highest nor the lowest.

Do you think that the Indian government is giving some special attention now to neonatal healthcare?
Neonatal healthcare is the thrust area for the Indian government at present. Two years ago, WHO had said by 2025, the world mortality rate will be in single digit, that is less than 10. The Indian government had then pledged to achieve the target by 2030. At present, the mortality rate in India is 27-28, which means we have to bring it down to 1/3rd.

Do you think the government has done enough so far to improve the neonatal healthcare?
The government has already made some investment in the sector. Now, it has also invested in SNCU (sick newborn care unit) and set up 500 units. Neonatal healthcare is increasing in the government sector.

What about the private sector?
It has also increased in the private sector. Over the past 15 years, there has been expansion in the private sector.

Do we have sufficient neonatal healthcare facilities in the Tricity?
We have four neonatal units in the government sector. In the private sector, we have eight such units. The population of the Tricity is 20 lakh and the facilities available here for the public are sufficient.

Is there any new trend of disease among the infants?
Long time ago, neonatal tetanus was the common one and now it has been eliminated. At present, neonatal infection is perhaps a difficult challenge to us. It is the major area of concern in the primary, secondary and tertiary care. Studies have found that almost 50 per cent of the infection in newborns are resistant to almost all antibiotics. Therefore, a lot of work needs to be done towards prevention and not only towards treatment. Also, in cases of premature babies, the quality of management needs to be improved. However, a sizable number of premature babies, who are not managed well, are developing ROP (retinophathy of prematurity), which leads to blindness. This is a major issue that has come up over the last 10-20 years.

What is the reason for developing ROPs?
There are multiple reasons, the major one being the uncontrolled use of oxygen. The quality of neonatal healthcare is important.

Who is responsible for such cases?
The responsibility lies with the management. All those who are involved are responsible. It is important to maintain the appropriate oxygen level in the first few days after birth. A lot of work is required in this area. The PGI is doing a national campaign for retinophathy of prematurity. We need to aware the management to do their jobs well.

What about the brain damage and polio cases among the children?
The number of brain damage cases is coming down and polio has also gone down drastically. No case has been reported. If there are some cases, they are because of oral polio vaccination. In the private sector as well, the vaccination is available. Earlier this year, PGI witnessed a fresh case of neonatal tetanus even after the Union government claims that it has been eliminated. Neonatal cases are also coming down. There are cases where childbirth is not done in dirty condition. I will be happy, though a little surprised, if there are no cases of neonatal tetanus in the country.
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What can be done to improve the healthcare?
When we talk of health, we have expertise available in the country. But the link between the expertise and the resource is missing. We are not utilising the best as we can. It is happening in both the government and private sector. The coordination between the primary, secondary and tertiary care is missing. A patient who can be treated at a primary healthcare, is coming to PGI. We need to provide adequate infrastructure at the health facilities. There has to be an audit of facilities. We need to develop leadership at the district-level to improve coordination between the primary, secondary and tertiary healthcare. You have also served as the chairman of PGI’s ethics committee. How was the experience and why there are cases of plagiarism?
It is not a common thing. The cases are rare and maximum punishment is being awarded to those who are found guilty.

In PGI, four doctors are accused of plagiarism. How do you see it?
If it is proven, then punishment should be a deterrent. If someone can get away with it, it will be a worse thing, which you are projecting to the younger generation. Morality is important in the research.