Kota infant deaths a grim reminder of 2018 Gorakhpur tragedy; staff, equipment shortage behind poor healthcare system in Rajasthan and UP

The deaths of eight infants on 30 and 31 December took the toll at Kota’s JK Lon Hospital to 100 for December. Lack of hygiene and leaking roofs were said to be the reason behind the spread of infection,  India Today reported. Of 500 medical devices, only 200 were functional. There were only 20 nurses against the sanctioned posts of 42 in the neonatal intensive care unit (NICU). In the paediatric ICU, there were only eight nurses against the requirement of 21. In the NICU, of the 71 warmers, only 24 were functional. The hospital has 20 ventilators but only six are working, the hospital records accessed by  Hindustan Times showed. Meanwhile, apex child rights body National Commission for Protection of Child Rights (NCPCR) inspected the hospital, where 940 children died in 2019, and found broken windows and gates, pigs roaming on hospital campus and an acute shortage of staff. “It is evident that there was no glass in windows panes, gates were broken and as a result the admitted children were suffering with extreme weather condition [sic],” NCPCR chairperson Priyank Kanoongo said. A high-level committee of expert doctors and experts, commissioned by Rajasthan chief minister Ashok Gehlot to examine the case, lay the blame at the feet of management. It found that though the infants were administered the right treatment, the problem lay in factors such as shortage of beds, the hospital functioning at 150 percent of its capacity and equipment lying unused due to the lack of an annual maintenance contract. While bureaucratic processes, lack of staff and maintenance of medical equipment are major impediments to the smooth running of hospitals, the serious fund crunch at government hospitals is a major concern. As per a report in  The Wire, India spent only 1.1 percent of its GDP on healthcare. Another Gorakhpur?  The incident is a grim reminder of what occurred in August 2017 at Gorakhpur’s BRD Medical College — which saw  1,000 child deaths that year — where 72 children died over five days allegedly due to lack of oxygen. [caption id=“attachment_5096251” align=“alignleft” width=“380”]  Representational image. Reuters[/caption] The deaths should also be a reminder of the immense pressure on major hospitals in districts in the absence of adequate facilities at primary healthcare centres. A report by the Centre for Policy Research, New Delhi showed that in 15 states, not a single primary healthcare centre met the national public health standards set by the Ministry of Health and Family Welfare.   Dr Kafeel Khan, who was arrested after the deaths in 2017, on Tuesday called the Gorakhpur events a “massacre” that took place for “10 percent commission”. Khan, then a paediatrician at the state-run hospital, was accused of negligence, suspended and later arrested. “The massacre happened for just 10 percent commission. It is not a tragedy, it is a man-made massacre,” he told PTI. He added that the contractor supplying oxygen to the hospital at the time had written 14 letters, including to the Chief Minister Yogi Adityanath, for the release of pending payments, but nothing happened. The state government, on the other hand, pinned the reason for the deaths on encephalitis, a viral outbreak that is witnessed in Uttar Pradesh every year. Adityanath ordered an inquiry by a principal secretary rank official into the deaths and said that they had not occurred due to lack of oxygen. The report, however, did not fix any responsibility for the deaths. In fact, of the first 30 deaths that occurred on 10 and 11 August, 2017, only six deaths were related to encephalitis, LiveMint reported. Additionally, when Indian Council of Medical Research prepared a report under National Japanese Encephalitis Control Programme in Uttar Pradesh, especially in Gorakhpur, only 5 to 10 percent of cases were of Japanese Encephalitis. “With high death rate of infants, it is apparent that intensive care units are poorly managed and they don’t have trained staff,” Soumya Swaminathan, secretary, Department of Health R and director general at ICMR, said. Gorakhpur’s BRD Hospital caters to patients from 15 districts of eastern Uttar Pradesh and also from a few districts in Bihar. At any given point in time, the paediatric department is treating 300 children, but there are only 210 beds. The hospital is not only overcrowded, but it also faces a resource and financial crunch.  Down To Earth quoted a Comptroller and Auditor General report released in June 2017 that warned that there was a 27.21 percent shortage of clinical equipment and 56.33 percent shortage of non-clinical equipment, which includes oxygen supply, in this hospital. Infant deaths in UP According to a  The Times of India report, 75 percent infant mortality cases in Uttar Pradesh are reported within 28 days of birth, with neonatal infections from labour rooms or due to lack of hygiene of health staff and parents accounting for 20 percent of these deaths. While a recent government report blamed the medical staff for 49 infant deaths at Farrukhabad’s Ram Manohar Lohia Hospital, PTI reported that the deaths occurred due to the apparent lack of oxygen in the ICU. Another 19 infants, who did not survive childbirth, were not part of the government report. All 49 deaths occurred between 21 July and 20 August, 2017. Police said that in the Farrukhabad case, the hospital “did not insert oxygen pipes (into infants’ windpipes) after birth”, BBC reported. In June, another  infant in Bareilly, who was having trouble breathing, lost her life when her parents were reportedly made to visit one department after another for three hours, Politicos play blame game The deaths have already triggered a political slugfest, with Rajasthan health minister Raghu Sharma attacking the BJP’s “ politics over death” in the absence of “anything else to cover up over the anti-CAA protests”, questioning why the BJP had not sanctioned funds sought by the hospital in 2015, 2016 and 2017 when the saffron party was in power. He later added that the state government will provide additional funds to improve facilities at the hospital. Aiming a salvo at the Congress-led government in Rajasthan, Adityanath on Thursday criticised the ruling party for “acting with apathy towards the families who have lost their children”.  “It is upsetting that Sonia Gandhi and Priyanka Gandhi Vadra cannot understand the families’ suffering despite being mothers. Instead of staging a drama in UP, if Vadra should have met the grieving mothers, who lost their babies solely due to the government’s carelessness. They do not worry or sympathise with the people, they only want to indulge in politics,” Adityanath said. With inputs from agencies