The recent media attention on the unfortunate and altogether preventable deaths in the Baba Raghav Das (BRD) Medical College, Gorakhpur, is another symptom of the deep-rooted malaise in national healthcare. There was similar high-voltage media coverage in April 2016 when a poor man in Odisha, Dana Majhi, ran for several kilometres with his wife’s dead body because no one would provide him a hearse, while in West Bengal several babies got incinerated in a baby warmer.
These unfortunate incidents highlight the need to fix the system rather than scapegoat healthcare providers and demand that they be “punished”. Typically, TV channels have resorted to “Breaking News” and claims that they were the “first to expose a story”, even as they subject these health service providers to a media trial. In response, the immediate reaction by the authorities is to terminate a senior doctor or several doctors, while politicians descend upon the hospital to “informally” investigate the matter. Under pressure from the selfsame media and politicians, the authorities announce a “formal” investigation under the aegis of the state chief secretary or a judge.
But let me focus on the recent deaths in the BRD Medical College Hospital through a public health lens.
With 950 beds, the BRD Medical College Hospital has been functioning since 1972 in an underserved region of Uttar Pradesh. It also caters to the marginalised population in the neighbouring regions of Bihar and Nepal. A large number of seriously ill patients arrive in the hospital by the evening train everyday. A constant stream of patients from the rural hinterland means that the hospital is overcrowded already. There’s hardly any space even on the floor. Doctors and staff are severely overworked. One staff member was quoted saying, “in the past 40 hours we have not gone home to sleep,” while another report said “the ward ploughed into darkness as journalists were talking to a doctor” for 12 minutes before a generator brought lights back.
The hospital is located in the heart of the endemic area of mosquito-spread Japanese Encephalitis (JE) which peaks in July to October every year (417 deaths took place last year). But the BRD hospital lacks basic amenities like water and electricity.
The situation has hardly changed these last several years. As many as 60 deaths were reported from August 7-11, 2017, a figure which has caught the national imagination, but here are some statistics for deaths in August in the last three years. In 2014, 567 deaths took place, in 2015, 668 babies died and in 2016, 587 children lost their lives. The statistical horror which we must deal with is that there were 19 to 22 deaths per day in the month of August from 2014-2017.
This clearly indicates that the problem, compounded by apathy and severe negligence, has existed across governments, whether it was the Samajwadi Party government until February 2017, or the BJP government ever since. It has been business as usual for so long in Uttar Pradesh that citizens, who transform into voters at the time of elections, remain at the bottom of the pyramid, their voices unheard and unaccounted for. Perhaps these poor people may have had better luck if they had access to the media.
As India celebrates its 70th year of independence, death is a constant presence in Gorakhpur, a constituency that has returned UP chief minister Yogi Adityanath five times to the Parliament.
Statistically, at least therefore, the number of children who died from August 7-11 (60 deaths were reported) is not higher than the numbers in the previous years.
The horror continues outside the statistics. The UP health minister has denied that the deaths occurred due to interrupted oxygen supply. As a doctor, I will say that the deaths may not occur during those two hours on Thursday when the oxygen was reportedly shut off, but will follow soon after or leave lifelong sequelae due to irreversible brain damage caused by lack of oxygen.
While the hospital has instituted an inquiry into the cause of the deaths, it is time that state governments – since health is a state subject – begin to look at overhauling the health care systems so that they are able to deal with crises on an everyday basis.
The hospital can take the following immediate action :
a) Eliminate bottlenecks in availability of essential medical supplies such as oxygen and other lifesaving drugs. b) Minimize media visits and political visits for hospital staff to focus on providing health care. c) Investigate system-related issues and individuals responsible for the current crisis. For instance, all those individuals who abdicated responsibility and delayed essential medical supplies within and outside the hospital should be given exemplary punishment.
Among the most important medium-term actions is to crack down on corruption in hospital-related supplies. In this particular case, a company called Pushpa Sales Private Ltd had stopped supplying oxygen cylinders as their bills worth Rs 63 lakh had not been cleared since 23 November 2016. According to some reports, hospital authorities allegedly asked for a 12 per cent commission, as against the 10 per cent earlier given, to clear the bill.
Overcrowding is another fatal problem. As for the prevention of Japanese encephalitis, much progress has been made in the availability of technologies to prevent mosquito breeding as well as JE vaccines, but they don’t seem to have gotten very far in Gorakhpur. Lack of basic amenities like electricity and water even in tertiary care hospitals only add to the problems on the ground.
As doctors we know that JE especially preys upon the weak and malnourished. Who better than small children who havent been able to build their immunity yet?
