In the wake of over 70 encephalitis-afflicted children dying after the oxygen supply at Gorakhpur’s Baba Raghav Das Hospital was cut off following a payment dispute, the stage has been set for a rigorous debate on criminal negligence and public health spending. Initiatives such as Swachh Bharat and Mission Indradhanush, though commendable, advance the notion that India’s public health landscape is positively transforming. However, it is too soon to celebrate.
Tragedies such as the mass deaths in Gorakhpur, or more recently in Farrukhabad which claimed 49 newborns, remind us of the reality of India’s abysmal public health situation and raise deeply troubling questions on India’s priorities in its run-up to becoming a superpower.
An outstanding debt of Rs 70 lakh on a prominent state-run institution served an instant death sentence to children. The government’s claims that it hadn’t known of the oxygen shortage until August 4 have been contradicted by a recent newspaper report, according to which UP ministers had been made aware of the debt and the subsequent punitive cutting off of oxygen supply in March. This continued until August 9, when chief minister Yogi Adityanath visited the hospital and was informed of the situation. However, no urgent action followed.
The same evening, the oxygen supply was cut. Thousands of children have died since 1978 when the pestilence first broke out, and the hospital management was as abysmal then as it remains today. It is time to accept that a major overhaul in India’s public health landscape will only be achieved with adequate budget allocations – a move only possible when we confront our own apathy and move beyond empty rhetoric.
Since 1978, right around monsoons when encephalitis strikes, people from in and around Gorakhpur, other neighbouring districts, and even Bihar and Nepal, teem outside the hospital as it is the only institution providing treatment for the disease. However, the hospital does not have enough trained doctors, beds, or ventilators, and it hasn’t had these for a while now. Despite the dire circumstances BRD spent Rs 426.13 crore out of its total fund of Rs 452.35 crore and was still 27% short of clinical equipment, according to a CAG report.
Since many people (mostly rural poor) have to travel miles to reach the hospital – often critical cases requiring an immediate response – many patients succumb to the disease on their way to the hospital. In 2013, on the recommendations of an independent research team, several treatment facilities were set up near villages to provide immediate care to critical patients, but were unable to function as anticipated. As a result, 40 years and numerous deaths later, BRD remains the only facility catering to patients of the deadly disease, even as it is severely under-staffed and ill-equipped to tackle one of India’s deadliest public health challenges.
According to rural health statistics for 2015, there was a 37.7% shortfall of doctors in UP. Doctors at BRD knew oxygen would ultimately run out 10 days in advance when the supply was cut off, and no steps to arrange for backup were taken. This can only be described as criminal negligence of the highest order.
The disease is commonly referred to in India as Japanese encephalitis. However, the term only represents select cases of encephalitis caused by the JE pathogen. WHO has coined the broader term acute encephalitis syndrome (AES) to refer to a cluster of illnesses with similar symptoms.
Many cases in the Gorakhpur belt have displayed symptoms common with JE albeit without the presence of the JE virus. The other pathogens could be the West Nile virus, dengue virus, Chandipura virus and chikungunya virus – all known to cause AES. However, over the years, India’s focus has been on the eradication of JE while other forms of encephalitis remain comparatively neglected.
As a result, while the number of JE cases have reduced, the havoc of undiagnosed encephalitis continues. In 2015, the Indian Council of Medical Research found that from over 10,000 cases of encephalitis, only 8.4% were of the JE strain. While several independent research teams have carried out research to understand the disease in its entirety and presented often conflicting findings, no concrete diagnosis for the “other aetiology” encephalitis has been found.
Without diagnosis, it is impossible to devise any practical preventive strategies. Forty years down the line, it is high time for a more stringent, research-driven focus on the other causes of AES.
With no significant allocation of funds towards public health, and the poor state of health infrastructure in the country, economically disenfranchised people are forced to turn to private healthcare which leaves them penniless and in debt. There is a need to spend a significantly higher proportion of our GDP on public health, make public health more accessible to the poor by investing in more facilities, improve the quality of healthcare by increasing human resource and training them well and regularly, monitor the public and private health sectors to ensure quality health services for all.
When we thump our chests and speak of development for progress of the nation, do we forget that people make the nation and not the other way round? If by development we mean skyscrapers, wealth, health and privilege for some (but certainly not all), what kind of nationalism are we buying into? So long as our medical facilities continue to languish, and our people continue to perish due to sheer negligence, our patriotism rings hollow.
(Credit: This Article is published on The Time of India Dated 05/09/2017)
The Author is former Union Minister and Member of Parliament from Rajya Sabha
DISCLAIMER : Views expressed above are the author’s own.