At Arjhhula village, about 34 km from Shahdol district headquarters in Madhya Pradesh, Mala Kol, 25, mourns her firstborn, Pushpraj.
On November 27, four-month-old Pushpraj was rushed to the district hospital with breathing difficulty and died there — one of the four infants to die at the hospital within 24 hours with suspected pneumonia.
As many as 13 infants are now dead at the hospital in a week, bringing to the fore gaps in the district’s health infrastructure.
At the district hospital, which started its neonatal care department in 2013 with 20 beds in its SNCU and 10 in its Paediatric Intensive Care Unit, there is one doctor and posts for eight others lie vacant.
District Collector Satyendra Singh pointed out that the lone doctor, Dr Sunil Hatgale, was on a 50-day leave after testing positive for Covid-19.
In his absence, three doctors would come for one shift each from Shahdol medical college.
Of the 13 infants who died between November 27 and December 3, five died of pneumonia, two suffered from meningitis, two had Hypoxic Ishemic encephalopathy — a condition where the brain does not receive adequate oxygen –, one is suspected to have had a congenital condition, and another died of cardiogenic shock. Of the remaining two, one died of severe hypothermia and the other was born premature and did not survive as the hospital lacks an incubation unit.
Chief Medical Officer of the district hospital, Dr Rajesh Pandey, said the hospital is facing a shortage of doctors and added that there is no way to ascertain if the five infant deaths due to pneumonia were Covid-19 deaths. “Soon after the deaths due to pneumonia, we tested 21 people, including staff and parents of those admitted to the Special Newborn Care Unit (SNCU). All reports came negative,” said Pandey.
In September 2017, 36 infants died in the SNCU at the hospital. In January this year, six tribal children died at the SNCU within 15 hours. Following this, Chief Medical Officer Pandey was shunted out. He was reinstated in March.
Mala alleged that no doctor attended to her son at the hospital. “When I asked the nurses what had happened to my son, one nurse told me, ‘You can give birth, but can’t take care of your child. Who all should we attend to!’.”
After Puspraj came down with a cold, Mala had rushed him to the block hospital. His condition deteriorated and he was rushed to the district hospital where he died within 24 hours.
Like Mala, Sonu Kol lost her firstborn, Raj. For Sonu, getting her son to hospital from Bodri village, 20 km away, was a struggle. “My child stopped eating and was cold. I called 108 but the ambulance came after five hours. By the time we reached, there was no hope.”
Vijay Mahobiya, who lost his two-month-old son Riyansh, alleged that no doctor visited the SNCU for eight hours after his son was admitted. “If only a doctor could see my child in time, he would be alive.”
On November 27, the SNCU had 33 infants for 20 beds. To accommodate more infants than the capacity, two infants are often placed side by side on a single warmer. While there is one doctor in each shift, most of the work is left to the nurses.
According to the data from the hospital, between April and November, 262 infants out of the 1,516 admitted to the SNCU have died.
Two teams from Rewa and Jabalpur divisions were sent to Shahdol after Chief Minister Shivraj Singh Chouhan ordered a probe into the infant deaths.
In his report, Dr Pawan Ghanghoriya, head of paediatrics department at Jabalpur medical college, has stated that the infants were treated as per National Health Mission (NHM) guidelines, but the hospital lacked doctors and equipment.
Principal Secretary, Health, Suleman Mohammad, said, “The team did not find any deficiency in treatment but made suggestions to provide more doctors and equipment which the government has accepted.”
He said another team is exploring deficiencies in the primary health setup and if the deaths were related to Covid-19. He said another SNCU will be opened at the hospital, doubling the capacity to 40 beds. Also, he said, ASHA workers will be given a 15-day training so that they can identify worrying signs in remote locations, helping villagers reach the hospital in time.
In wake of the deaths, senior doctor Umesh Namdeo, who retired last year and paediatrician Manish Singh, who was transferred, have been temporarily roped in.
Dr Nishikant Prabhakar, who heads the paediatrics department at the hospital in absence of a full-time specialist, said four of the 13 infants were brought to the hospital after they had been taken to ‘Bangali Babas’ — meaning quacks.
“We gave the best treatment we could but medicine takes time to react. Babies are being brought in with body temperature lower than 30 degrees leading to multiple organ failure,” he said, and pointed to the need to strengthen the primary health setup through a network of ASHA workers and block hospitals.
At least 10 of the 13 infants belonged to scheduled tribes of Baiga and Kol living in remote locations and wholly dependent on the primary health setup.
The district administration has started studying the records of ASHA workers to understand if neonatal care was given to these infants.
The hospital has now made it mandatory for infants and their parents to be screened and tested for Covid-19 and block-level primary healthcare centres and fever clinics have been instructed to screen parents of all sick infants.