Infant deaths - a preventable human tragedy

Dr. Sanjiv​ Kumar​, director at IIHMR Delhi speaks about the human tragedy that could have been prevented.

The recent media attention to unfortunate preventable deaths in Baba Raghav Das (BRD) Medical College, Gorakhpur, UP is another symptom of the deep rooted problems in health system in the country. There has been similar media coverage recently to a poor man with his daughter carrying his wife’s dead body from an Odisha hospital and babies getting incinerated in baby warmer in West Bengal.

These events are only a tip of the iceberg of the ill-health of public health system in the country. These unfortunate incidents highlight the need of fixing the health system rather than the knee jerk reaction of subjecting health care providers to punishment as scapegoats rather than addressing the underlying problems. A typical reaction is for a media house to claim the “Breaking News” and “first to expose a story” and put the service providers to media trial. The immediate action by authorities is to terminate a senior doctor or a number of doctors, politicians from both the centre and state descend at these facility and “informally” investigate and capture media bytes blame the ruling party while bureaucrats and technocrats from the ministry and state to give a quick report to government at centre or state. The authorities “under political and media pressure” announce a “formal” investigation under chief secretary of the state or a judge.

The recent deaths in BRD Medical Collegefrom what was reported in print and electronic media tried to capture what went wrong. The author has looked at these reports through a public health lens.

The BRD Medical College Hospital with 950 beds has been functioning since 1972 in an underserved region of UP. It also caters to the marginalised population in the neighbouring regions of Bihar and Nepal. A large number of serious patients arrive in the hospital in the evening via train from Bihar.

Due to constant supply of patients from rural hinterland the hospital is always overcrowded with hardly any space even on the floor. The doctors and other staff are overworked and as quoted by one newspaper a staff member at hospital said that “in the past 40 hours we have not gone home to sleep”. Another reported that “the ward ploughed into darkness as the reporters 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 last year) still BRD hospital lacks the basic amenities like water and electricity.

As Media reported 60 deaths in the hospital between 7 and 11 August 2017; Out of these 12 deaths were due to Japanese Encephalitis. The Oxygen supply in the hospital was interrupted for two hours on Thursday night. This received media attention and the media attributed these deaths due to interrupted Oxygen supply.

The State Minister of Health stated that there were no deaths during those two hours. As a doctor, one will say that the deaths may not occur during these two hours but will follow soon after or leave lifelong sequelae due to irreversible brain damage caused by lack of oxygen.

Even a single death is not acceptable and calls for all possible preventive and curative actions. A public health-trained professional will compare the number of deaths with same period in previous years. In the previous three years, average numbers of deaths in the hospital in August were 567 (2014), 668 (2015) and 587 (2016); which comes to 19 to 22 deaths per day. The reported deaths of 60 from 7 to 11 August come to an average of 12 per day which is not above the average for the same period in last three years. Statistically data does not show a higher trend and the reasons for the death should be revealed in coming days by the fact finding committee headed by chief secretary of the state of Uttar Pradesh.

As far as the underlying causes of excess deaths in BRD Hospital concerned there are some actions which should be taken immediately and others in Medium and Long term to stop such tragedies in future. Immediate Action: a) Eliminate the 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) Investigation to look at the system related issues and individuals responsible for the current crisis. The individuals responsible for deaths and who delayed essential medical supplies within and outside the hospital should be given exemplary punishment and d) Address system related issues at the earliest.

Medium and Long Term Actions:

  Educating the media on responsible reporting.

 Address corruption leading to interrupted Oxygen and other supplies: Unfortunately corruptions runs through the whole fibre of the society from politicians down to the service providers in various government sectors. The private sector becomes an essential part of it to get what they want. In this particular case, the Pushpa Sales Private Ltd had stopped supplying Oxygen as their bills worth Rs 63 lakh had not been cleared since 23 November 2016. The company had written more than 12 reminder letters, many copied to District collector and state authorities. The media reports allege that a higher commission (12% against earlier 10%) was asked to clear the bill. The root cause is corruption not confined to health system alone that resulted in interruption of Oxygen supply.

Overcrowding due to lack of facilities in PHCs, CHCs and district hospitals. These facilities need to be equipped with essential supplies and manpower.

Expedite action to accelerate progress in prevention of Japanese Encephalitis which is stagnating despite availability of technologies to prevent mosquito breeding and vaccine for JE. e) Heavy workload on healthcare providers needs to be looked into.

Lack of basic amenities like electricity and water even in tertiary care hospitals must be addressed.