It is a tragic coincidence that in the same week the Madras High Court passed a judgment going easy on the accused in the Kumbakonam fire accident case of 2004, about 72 children have died at the BRD Medical College at Gorakhpur due to disruption of oxygen supply. Three different inquiry committees have been set up to investigate the deaths. The probe team instituted by Union Government has noted that the shortage of oxygen is not the cause of death, further adding that the number of deaths has gone down (in terms of number), compared to the previous year. The District Magistrate's report squarely blames the medical college authorities, hinting at serious financial anomalies on the part of the doctors responsible for record maintenance. This report castigates the oxygen supply vendor, M/s. Pushpa Sales Private Limited, which stopped the supplies due to lack of payment by the hospital, as they are primarily engaged in providing emergency service. The third report is from an independent inquiry conducted by Indian Medical Association which held the medical college principal and the doctors responsible for the graveness of the situation. Fingers have been pointed at all directions, blames exchanged, yet the truth remains hazy.
Ground reality
The Indian Journal of Medical Research in January 2017 published a detailed survey paper specific to the Gorakhpur division of Uttar Pradesh known for the seasonal, frequent outbreaks of acute encephalitis syndrome (AES) with a high percentage of fatality and disability.
The Indian Journal of Medical Research in January 2017 published a detailed survey paper specific to the Gorakhpur division of Uttar Pradesh known for the seasonal, frequent outbreaks of acute encephalitis syndrome (AES) with a high percentage of fatality and disability.
Only 42.3% of Gorakhpur division's eligible children had been administered the two recommended doses of Japanese Encephalitis (JE) vaccination. Reasons for not achieving the immunization targets include both systemic and economic factors.
Failure to co-administer JE vaccines, (JE-1 and JE-2) along with other vaccines of Universal Immunization Programme, is considered as the main reason for missed opportunities for vaccination for JE. There seems a misconception among health workers that simultaneous administration of multiple vaccines can overload the child's immune system and increase the risk of side effects. This system related factor should be considered as a case of administrative negligence and steps should be taken to sensitize the auxiliary nurse midwives (ANMs) about vaccinating children with all the eligible vaccines.
On the part of the parents of the infants, their utter poverty and lack of awareness acts as an impediment in immunizing themselves as well as their children. The time and money spent in approaching health centers for the purpose of vaccination is a deterrent to the economically backward parents.
On the part of the parents of the infants, their utter poverty and lack of awareness acts as an impediment in immunizing themselves as well as their children. The time and money spent in approaching health centers for the purpose of vaccination is a deterrent to the economically backward parents.
When prevention fails
The national vector borne disease control program under the Health Ministry recognizes Uttar Pradesh as a highly endemic state and has established 15 sentinel sites for diagnosis in Uttar Pradesh.
The BRD Medical College at Gorakhpur has been allotted Rs. 5.58 crores under NRHM for establishing AES/JE facilities. It is an irony that this very encephalitis ward specially constituted to address the AES/JE has ended up snuffing the lives of the children.
Over flowing beds, lack of resources, poor maintenance, bad sanitation facilities have been repeatedly noted at the ward. Serious among the problems is the lack of diagnostic facilities due to maladministration which two of the three reports in connection with the deaths of children clearly mention. The ventilator vendor's allegation that the hospital did not renew deals and skipped payments further confirms the lackadaisical attitude exhibited. But these are symptomatic causes which have piled up over a period of time to culminate into a gory consequence. Given that Mint has reported that apart from AES/JE affected babies, even pre-term babies, babies affected by sepsis, swine flu –all of whom would have needed continuous supply of ventilation – also died on a fateful day calls for serious and incisive judicial investigation as opposed to hasty inquiries.
On the close heels of Gorakhpur, 3 children were reported dead in Chhattisgarh due to alleged lack of oxygen. The officials had ruled out disruption of oxygen supply and had admitted a possible drop in oxygen for some duration. Did something similar happen at Gorakhpur? What really is the immediate cause of death then? Common sense would mean one would immediately refer to autopsy/postmortem reports. Shockingly, no post-mortem has been conducted citing sentimental reasons and the dead children have been carried via back doors of the hospital by the grieving parents, with a warning to avoid the raging media. That the local Member of Parliament is the present Chief Minister of Uttar Pradesh raises hard and unavoidable questions. The state government wants us to believe that there are factors beyond the human capability, but the hard reality that stares us is medical negligence, corruption, and state apathy. Instead of finding ways to exonerate itself of the crime, the Government should focus on being sensitive to the nature of the incident and doing justice to the innocent toddlers, the grief-stricken parents and the citizens of India who are stupefied by the mysterious deaths and the callous attitude of the administration in dealing with the mishap.
On the close heels of Gorakhpur, 3 children were reported dead in Chhattisgarh due to alleged lack of oxygen. The officials had ruled out disruption of oxygen supply and had admitted a possible drop in oxygen for some duration. Did something similar happen at Gorakhpur? What really is the immediate cause of death then? Common sense would mean one would immediately refer to autopsy/postmortem reports. Shockingly, no post-mortem has been conducted citing sentimental reasons and the dead children have been carried via back doors of the hospital by the grieving parents, with a warning to avoid the raging media. That the local Member of Parliament is the present Chief Minister of Uttar Pradesh raises hard and unavoidable questions. The state government wants us to believe that there are factors beyond the human capability, but the hard reality that stares us is medical negligence, corruption, and state apathy. Instead of finding ways to exonerate itself of the crime, the Government should focus on being sensitive to the nature of the incident and doing justice to the innocent toddlers, the grief-stricken parents and the citizens of India who are stupefied by the mysterious deaths and the callous attitude of the administration in dealing with the mishap.
Justice A.Arumughaswamy of the Madras High Court (Madurai Bench) had compared the scenes of the infamous fire accident at Kumbakonam of 2004 to that of Jallianwallah Bagh massacre of 1919. I wonder what he would have to say at the hushed up deaths of children at Gorakhpur.
Bhargavi Chandrasekharan is a Chennai-based lawyer, She is the Lead Editor for Legal Affairs at The Lantern.
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