Gorakhpur Hospital Tragedy: insufficient oxygen supply not the sole reason

Context:

• The death of over 30 children within a span of 48 hours at the government-run Baba Raghav Das (BRD) Medical College hospital in Gorakhpur, Uttar pradesh, isn’t merely about oxygen cylinders and unpaid bills but it is a consequence of many deeper problems.

The tragedy:

• 60 deaths have been reported in the children’s department of the Baba Raghav Das (BRD) Medical College hospital in Gorakhpur from August 7^th to 11^th, 2017.
• Infections and possible disruption of oxygen supply in the paediatrics ward are being blamed for the death
• Reports says that the company that supplied the oxygen had previously issued notice to the hospital on large unpaid bills but only a high-level judicial inquiry will have credibility.
• However, the hospital and district administration have rejected the contention that inadequate oxygen supply led to the tragedy.
• Among ailments, Japanese encephalitis is claimed to be the major reason for the tragedy.

Present medical care in Uttar Pradesh:

1. The Centre has a vaccination programme in place and a stated commitment to build paediatric intensive care units in priority districts.
2. The Uttar Pradesh state government runs government medical colleges at Agra, Allahabad, Gorakhpur, Jhansi, Kanpur and Meerut besides a medical university as well as a super-specialty hospital at Lucknow; plans are afoot to develop four more super-specialty hospitals in various locations.
3. The Department of Medical, Health and Family Welfare of the state government was set up in 1921 and through its ‘Provincial Medical and Health Services’ it has been responsible for provided related services to even the remotest rural areas in the densely populated state.

• Almost half of the districts in Uttar Pradesh are covered by Public-Private Partnership (PPP) programs implemented by non-profit organizations supported ably by state agencies and The United States Agency for International Development (USAID).
• These projects are based on the social franchisee method, the aim being to create sustainable PPP models that can reach out to the marginalized populations through a network of franchised hospitals that offer quality medical services across all areas.

4. Effective medical care in meeting emergency needs and requirements of the people, including maternal healthcare and child care services are at the core of many programs run in government hospitals in the state.

The deeper problems:

Despite the existing medical facilities and healthcare infrastructure what proved to be largely inadequate to prevent the death of he children? The reasons are as follows:

1. Gorkhapur is the worst-affected region in the state due to encephalitis. Although vaccines are available, there is no such vaccine for checking Acute Encephalitis Syndrome.

• Since 2012, 3,000 children suffering from Japanese Encephalitis have reportedly died at BRD Hospital.
• Encephalitis is correlated with expansion of irrigation and construction of dams four decades ago, resulting in an increase in disease-transmitting mosquitoes.

1. India’s abysmally low public spending on healthcare also tops the list of drawbacks.

• The infant mortality rate in India in 2015 was 38, according to the World Bank—far better than the 165 in 1960 but lagging comparable countries such as Bangladesh (31), Indonesia (23) and Sri Lanka (08).
• And the situation in even worse in some large states such as Uttar Pradesh, where around 50 out of every 1,000 children die before they reach the age of five.

3. Another problem with India’s healthcare system is acute manpower shortage.

• The country has only about one doctor for every 1,700 patients whereas the World Health Organization (WHO) prescribes at least one for every 1,000 patients.
• In other words, there is a shortage of about 500,000 doctors.

4. The fourth problem is that a vast majority of people do not have health insurance in a country.

• India’s inability to find a workable model for taxation or insurance has left its poor particularly vulnerable.

Suggestions:

• The Medical Council of India (MCI) will have to reform the entire medical education system if these gaps of medical facilities have to be filled.
• In the meantime, more healthcare providers need to be brought into the system, including nurses, optometrists, anaesthetists and AYUSH (ayurveda, yoga and naturopathy, unani, siddha and homoeopathy) workers.
• Nurses especially can and should be empowered so that they can take off some of the load from physicians.
• The Indian Council of Medical Research needs to launch a special commission for U.P., treating it as a public health emergency.
• Such a system should be non-commercial and regulated to contain costs, giving everyone affordable access to doctors, diagnostics and treatment.