The media screamed blue murder when 60 children died at the Baba Raghav Das (BRD) Medical College Hospital, Gorakhpur, because of a lack of oxygen supplies; and promptly dropped the issue off their radar a few days later. The supplier cut off supplies because a payment of Rs 68 lakhs was pending for nearly a year, in spite of three dozen reminders and funds being sanctioned by the state health department. Story goes that a 10% commission was demanded, but not forthcoming; that the payment was made but not cleared by the bank, etc. With the Modi government constantly drumbeating a cashless economy, it is difficult to understand why payment was not made by direct transfer to the supplier, eliminating the middle man and the associated corruption. After all this is the trumpeted objective of cashless transactions.
An enquiry was conducted, and concluded that the children did not die because of lack of oxygen, but because of Acute Encephalitis Syndrome (AES) and other causes such as malnutrition and pneumonia. If that was the case, why were nine people charged and arrested, the principal Dr. Mishra, and the Asst. Professor, Dept. of Pediatrics, Dr. Khan suspended? A shortfall in the supply of oxygen in a tertiary center even if not directly responsible for deaths, amounts to criminal administrative negligence and not medical negligence. The responsibility for this negligence should have been laid directly at the doorstep of those bureaucrats responsible, rather than making the staff the fall guys. This is a repetition of 2013, when the 100 bedded AES unit at the BRD College was inaugurated with 25 new ventilators which remained non-functional because the oxygen pipelines had not been installed.
More to the point, when the oxygen supply was restored, did the children stop dying? Certainly not; they have been dying since 1978 when Japanese Encephalitis (JE) was first reported with over 20,000 deaths since then. In the first ten days of September alone this year, there have been 110 deaths and 415 in the month of August.
The term AES loosely encompasses a symptom complex that arises from inflamed cerebral tissue, manifesting with fever, and seizures Survivors are often left with severe mental and physical handicaps. The symptoms are common to a number of conditions, the leading ones being, 1) JE or the “japani bookhar” as the locals call it, caused by a virus transmitted by mosquitoes 2) encephalitis due to scrub typhus transmitted by a mite3) an enterovirus (EV) transmitted through dirty contaminated drinking water, and 4) a peculiar spike in cases during the litchi harvesting season.
Of these, JE is preventable by vaccination repeated every 3 years, and improved sanitation to prevent mosquitoes breeding. The follow-up of the extensive vaccination campaign has been questionable. Sanitation has been badly neglected in rural UP in general and AES caused by scrub typhus and EV continue unabated. Since 2005, scientists’ at the National Institute of Virology have been trying to draw attention to EV as a cause of encephalitis and its link to lack of clean drinking water.
In 2012, the NIV identified EV in 100 out of 1000 samples of cerebrospinal (CSF) fluid; epidemiologically a significant strike rate of 10% for CSF testing. The link with the litchi harvesting season has two theories. The fruit contains a substance that produces a sharp drop in blood sugar and results in neurological symptoms rather than inflammation. The second theory is that the symptoms are caused by the pesticide used just before the harvesting season. The rural poor not having much else to eat, gorge on the fruit, and suffer the consequences.
Yogi Adityanath has been the Gorakhpur MLA since 1998, and has raised the issue in Parliament around 20 times over the years; with no outcome. One can’t help wondering how much of his MPLADS funds he devoted to sanitation and safe drinking water. He was probably pre-occupied by his Hindu Yuva Vahini, gau rakshaks, cow sanctuaries, anti-Romeo squads and patriotism tests for madrassas. A common denominator with these deaths is that most of the patients do not require tertiary care and could easily be treated at PHCs with basic support. But with PHCs non-existent or non-functional in rural UP, the patients are looked after at home often by quacks and brought to the BRD hospital when the clinical situation deteriorates to irreversible; often travelling distances of 300 k. with minimal transport facilities. With 529 PHCs, Gorakhpur has less than half the number needed for the 4.5 million people; and most of these are non-operational due to lack of doctors or nurses, with 7328 posts lying vacant for years.
A central team that inspected the BRD hospital found gross inadequacies in health care standards. Of the 31 nurses in the neo-natal unit, only 3 were appropriately trained. There were four senior residents working and 12 vacancies.
In March 2016, the budget allocation for the National Vector Borne Disease Control Programme, which includes six different diseases, was reduced by 3%. And JE cases rose by 210% with a mortality of 181%. Infant mortality rate in Gorakhpur is 64 per 1000 live births as compared to the national figure of 37. Gorakhpur ranks 314 in a list of 434 cities for cleanliness National Health Policy promises to increase spending from the present pathetic 1% to 2.5% by 2025; by which time, with an annual birth rate 26 million, the allocation will remain equally pathetic.
The crude reactions of politicians leave no doubt that this is an abject failure of policy summed up by the arguments of the Attorney General against the right to privacy at the SC hearings. He maintained the privacy does not matter to the rural poor. It seems that our politicians appear to work on the assumption that health also does not matter to our rural population. We just do not care.
(The writer is a founder member of the Voluntary health Association of Goa).
