Chronicle of a tragedy

A sick child is a mere statistic in a grotesque graph of deaths in these dark, disease-ridden parts of eastern Uttar Pradesh, Bihar and Nepal. The horror of the tiny body’s death throes, as a deadly disease claims yet another victim, is routinely adjusted for political expedience every year.

And so it has been in the monsoon months this year, when viral and bacterial strains — Japanese Encephalitis and Scrub Typhus respectively — that cause Acute Encephalitis Syndrome (AES) are at their most noxious.

The spiral of deaths caught headlines on August 10-11 when 34 children and 18 adults died within 48 hours, allegedly due to the disruption of oxygen supply at Gorakhpur’s government-run Nehru Hospital, which is associated with the Baba Raghubar Das (BRD) Medical College there.

Since then, political expediency has demanded that the abnormally high rate of 40 per cent infant deaths here is attributed to “normal” factors — systemic corruption linked to previous governments, UP’s high infant mortality rate, and the like — and any link between oxygen supply disruption and infant deaths is disproved.

Indeed, in these parts, the sight of anaemic, under-age mothers with their malnourished infants is routine and their inability to access even basic treatment and care apparent to explain sudden infant deaths fairly easily.

The 950-bedded, much maligned Nehru Hospital is the only facility available for about six crore people from 14 districts in eastern UP, including Gorakhpur, Kushinagar, Basti, Gonda, Bahraich and Ghazipur and at least five districts in Bihar, including West Champaran, Siwan, Gopalgunj, East Champaran and Chhapra, besides the adjoining terai areas of Nepal. It has beds for 228 children, but on an average, it accommodates at least 350 of them: many of the beds house two children increasing secondary infections.

Harried, overworked doctors who work 18-hour shifts, nursing staff and lowly bureaucrats have all been asked to explain that the death count has in fact been low this year, since the MP who has represented the area for over 25 years is current Chief Minister Yogi Adityanath.

Officials in the Health Department told BusinessLine that in 2014, a total of 5,850 deaths were recorded — roughly 16 infant deaths a day. In 2015, the deaths numbered 6,917 — or an average daily count of 19 infants. The 6,121 deaths last year translate into 17 babies dying every day. This year, 1,317 deaths were recorded till September 2. The stress is in underlining that there has been a sharp drop in deaths per day – 6.5 babies a day!

Health Minister Siddharth Nath Singh says he has worked overtime and is scornful of the illiteracy of the media for “sensationalising” infant deaths. He says the death count in August this year — 325 babies dead in 31 days — vindicates his stand.

“In the month of August, 2017, there were 325 deaths. It is unfortunate but, last year and in 2015, there were over 600-plus deaths in the same period. The reason it has come down is because we have focused on this issue because of Chief Minister Yogi Adityanath,” Siddharth Nath Singh says.

Government machinery has also been quick to deny that the children did not die because a local company that supplies oxygen cylinders had not been paid for months. The Health Minister says it was indeed true that the hospital had not been paying the company; but the children did not die because they did not get oxygen.

“Yes, there was an administrative problem. But the deaths did not happen because of that. There are two issues here. Yes, there was corruption and they (the officials responsible) are being punished. But fortunately, the deaths did not happen because of lack of oxygen or disruption. It becomes clear from the timeline. The first death happened at 10.05 on August 10 and next death at 5.30 am on August 11. If it was due to lack of oxygen, other children would have died as well. That did not happen,” Siddharth Nath Singh says.

The sequence of events at Nehru Hospital on the intervening night of August 10-11 provides a contrary picture. At 11.20 am on August 10, central oxygen pipeline operators noted down the reading at the hospital’s Medical Liquid Oxygen Plant. It stood at 900 kg in the 20,000-kg capacity plant. All four operators then dashed off a hand-written note to the Head of the Department of Paediatrics, a copy of which was forwarded to the Principal of the BRD College as well as Chief Medical Officer, Head of Anaesthesia and Nodal Officer, National Rural Health Mission.

“Officers of Pushpa Sales (the company that supplied liquid oxygen to the hospital) have refused to send supplies despite repeated requests, citing pending dues. If oxygen supply is not immediately restored, there is danger to the lives of patients admitted here,” said the operators in a letter, a copy of which is in BusinessLine ’s possession. According to the report, at 7.30 pm on August 10, liquid oxygen pressure was so low that the hospital had to employ the 52 jumbo cylinders in stock. These could only last a maximum of 8-9 hours.

The emergency supply of jumbo cylinders requisitioned from Faizabad reached the hospital only at 1.30 pm on August 11.

During the intervening period, 34 children and 18 adults died in the hospital.

This is high even by the routine number of high infant fatalities in the hospital. Data collected by BusinessLine for the first week of September showed the death count at 13 infants for September 1; 10 on September 2; 15 on September 3; 10 on September 4; 16 on September 5; 13 on September 6; and 12 on September 7.

There’s more. The district hospital at Gorakhpur has no staff to man its neo-natal ICU so the incubators lying there have been requisitioned for use in the BRD hospital. Primary Health Centres (PHCs) around Gorakhpur are barely functional and even so-called operational Community Health Centres (CHCs) BusinessLine visited faced an acute shortage of doctors and support staff.

None of the ICUs, especially those dedicated to encephalitis patients, were fully functional in either PHCs or CHCs.

So it is the BRD hospital that remains the only hope for the thousands who flock here daily.

Twenty-five-year-old Dhruva Sahni and his wife Sunita, barely an adult herself, travelled 150 km from Tumkoi Raj village in Ghazipur just a day after they had a baby. The bleeding, anxious Sunita Sahni lay outside the neo-natal ICU while her husband tried to ascertain if their baby would survive. “No one tells us anything,” says Sunita, lying alone on the filthy floor, less than a week after she gave birth.

Mohan Varma, grandfather to a 27-day-old baby boy, has not named his grandson yet. His daughter-in-law and son rushed the boy from Karoda village in Chhapra, Bihar to Gorakhpur when the baby developed fever and shortness of breath. On September 7, Varma was pacing helplessly around a community centre in BRD Hospital for anxious young parents and families of sick infants. He had a written complaint which he refused to share.

“They are still treating him. But if my grandson dies, I will not spare them,” he whispers. “After a day in ICU, my grandson became alright. But the nurses took off for the Teej festival and no one looked after these really sick babies. He had to be readmitted to the ICU. But what has happened since then is even worse. A nurse was cutting the plaster on his wrist and she sliced into his arm. I thought it was only a superficial wound but they have now taken him in for surgery — she had cut a vein. If he dies, I will not spare them.”

But these are voices that remain buried in official statistics. It will require yet another catastrophe before human stories of life, death and helplessness will have any impact again.

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