Not much has changed at BRD Medical College since the August horror. There aren’t enough doctors, ventilators and at least five children bundled up in a single warmer.
Gorakhpur: Back in August 2017, when 31 children died in 48 hours at the paediatric ward named ‘100 AES’ at the BRD Medical College here, allegedly due to a lack of oxygen supply, there was a massive outcry across the country.
But in the eight months since, 247 more children have died in the same ward – an average of almost 31 deaths every month. Outcry? None.
Despite the constant stream of deaths, mostly due to AES – acute encephalitis syndrome – conditions at the hospital remain abysmal, with no infrastructure in place, not enough doctors, and overcrowded, filthy wards, accommodating at least five children on each warmer.
One fateful night, different versions
The hospital administration maintains that the cause of the deaths on 10 and 11 August was mainly brain damage, cerebral palsy, malnutrition, low birth weight, and had nothing to do with lack of oxygen. But of the official number of 50 deaths in the entire month, 31 were reported on just these two days.
The next month, September, witnessed 66 deaths, followed by 77 in October. November and December witnessed 54 and 36 deaths respectively, while in the first four months of 2018 (up to and including 1 May), 14 deaths have been reported.
AES is a vector-borne disease and can be caused by viruses, bacteria, chemicals, or toxins. Most deaths due to AES occur in Uttar Pradesh, Assam, Bihar and West Bengal and in children below 15 years of age. The causative agents of the disease vary with season and geographical region. For instance, in India, most outbreaks occur in the post-monsoon season when the mosquito density increases.
AES results in high fever and vomiting and acute neurological manifestations like delirium, and hallucinations.
“I shudder when I recall that night,” a staff member at the medical college who was on duty on the night of 10 August told ThePrint.
“Doctors were running around trying to save children, but they were dying one after the other. Many had seizures. After the gas got over, we started pumping oxygen manually through pumps. We even called guardians of children to help us operate the pump as we were short-staffed, but children kept dying. A three-year-old succumbed while I was giving her oxygen manually. Her nasal pipe filled with blood.”
Dr Rakesh Saxena, spokesperson for the medical college, however, rubbished the theory of deaths due to lack of oxygen. “It is a sham. The cause of deaths on that night was not lack of oxygen; it was sepsis, brain damage, kidney failures in many children, and not any lack of oxygen. This story is concocted and raises suspicion.”
Dr Kafeel Khan, the doctor hailed as a ‘hero’ who tried to save the children, and later charged and arrested for the deaths before being granted bail late last month, said: “Mostly, children in these cases die due to infections. But it cannot be ignored that mortality rate doubled on 10 August due to lack of oxygen. We were already handling critical cases, but sudden stoppage of oxygen accelerated the problem.”
What has changed since August?
The 100 AES ward was built in 2012, and liquid oxygen was especially procured for its patients. However, later, the facility was extended to the entire hospital, which often led to a shortage where it was needed the most.
“In cases of encephalitis, a brain nerve swells, leading to a lack of oxygen. If oxygen does not reach the brain, it stops functioning. In many cases, the vein even bursts due to pressure, and leading to instant death. Hence, oxygen is the basic requirement in this ward,” said Dr Bhupindra Sharma, nodal officer of the 100 AES ward.
According to hospital staff, there have been incidents where oxygen levels have gone below 4,000 units – enough for just 2-3 days — leading to a crisis situation, but it was always handled by diverting the supply from other departments.
Anil lost his two-month-old son to encephalitis in July, a month before the incident. He was asked to look for another hospital as there wasn’t sufficient oxygen supply. “Doctors told me that I will have to give him oxygen manually through an ambu pump, as there is a shortage of oxygen as well as staff. The doctors also said if something goes wrong, it will be my responsibility,” Anil recalled.
“I got scared and then took him to a private hospital. He was admitted there for a month, and then referred again to BRD as the private hospital did not have the required infrastructure. Just a few days after he was admitted here, the oxygen supply was disrupted and he died.”
Vinod Kumar Yadav, whose 12-day-old son died on 9 August, recalled that the oxygen levels were dipping on 9 August itself, but nothing was done because the hospital was busy welcoming CM Yogi Adityanath, who inaugurated a ward for critical children afflicted by Japanese encephalitis and AES.
“No treatment was given to the children on 9 August. All doctors and staff members were busy making arrangements. In fact, I was told that the oxygen supply is limited so I should give my child oxygen through ambu pump,” Yadav said.
“When I was giving him oxygen, they asked me to leave the ward as Yogi ji was making the rounds. When I asked them who would give oxygen to my child, they said they would take care. The next day he died.”
The hospital now claims to have “fixed” the problem. Instead of buying liquid oxygen through M/s Pushpa Sales agency, for which it paid Rs 16.39 per litre, it now procures it directly from Innox. It now pays Rs 19.29 per litre.
“The rates have changed. But we are now getting regular supply and are making sure that payments are made without any delay,” BRD spokesperson Dr Saxena said.
Massive number of patients, hardly any experts
BRD hospital not only caters to patients from Gorakhpur, but also from the nearby districts of Deoria, Kushinagar, Azamgarh, Faizabad, Barabanki, Ballia, the state of Bihar, as well as the neighbouring country of Nepal. In the rainy season, when mosquito breeding is at its peak and encephalitis is widespread across these parts, the hospital has around 1,600 suspected cases at any given time, about 400-500 of which eventually test positive for the dreaded disease.
But the total number of doctors to treat these cases, as well as every other aspect of paediatric care, is just 11 at present — nine consultants (five on contract, four from the UP Public Service Commission) and two senior residents. This is after three doctors resigned and one took voluntary retirement after the August incident.
What’s worse, few of these experts are trained to diagnose encephalitis. In most cases, doctors do not carry out the necessary tests and treat it as normal fever, which then leads to complications. Once a child is found to have encephalitis, expert attention is even more of a necessity.
“When a child is being treated for encephalitis, the liquid given through the drip depends upon his or her weight. The liquid has to be measured drop by drop, which only an expert can do. If a medical student is given the job that only a senior doctor can perform, it will lead to complications and fatality,” Dr Kafeel explained. “In case excess liquid is given, the already swollen brain will swell further, leading to the child’s death.”
Since August, the UP government has advertised to fill 7,000 vacant government doctor posts across the state. It hopes to fill these through walk-in-interviews, extensions to retired doctors, and more recruitments through the UPPSC; however, no fresh recruitments have been made in the last seven months.
“Though the UP government has promised a good salary, no one is willing to take the jobs. They are scared after the arrests of doctors for performing their duties,” Dr Kafeel said. “With the number of patients being treated at BRD, at least 16 senior doctors are required but there is no staff to deal with so many cases.”
Utter squalor
The intensive care unit within the AES ward accounts for half of its 100 beds. But how can ‘intensive care’ be provided without any cleanliness or precautions to isolate patients within from infections?
Walk through the corridor of the ICU ward and a strong stench of urine overpowers the senses. Water lies in pools on the floor without being swept away, mosquitoes and flies have a free reign over food leftovers, plastic bags are stacked on one side, and no one cares to put on a mask or remove shoes before entering the ward.
Newborn children are bundled up on warmers, nasal pipes criss-cross their faces, as one nurse on duty shuttles between beds.
The situation will change by June, the hospital claims, when a new ward that’s currently under construction will be completed, adding 470 new beds to the existing 100, according to AES ward nodal officer Dr Bhupendra. But there’s hardly enough staff to take care of the existing numbers, let alone 470 new beds.
The condition of the neo-natal care ward is also appalling. Despite proposals given by doctors to purchase equipment, nothing has been done. It’s commonplace to see five children on a single warmer.
“There are only 16 warmers for thousands of children. Under normal circumstances, every child born prematurely needs one warmer each. But when we ask for infrastructure, we are told that we have to manage with what is available,” a doctor said on the condition of anonymity.