“These deaths are not unusual at all…Sometimes the influx of patients is so high that three, four, five can die. Sometimes 15 can die.” – M.K Chatterjee, Superintendent, BC Roy Memorial Hospital for Children, Kolkata, West Bengal, India.
There is a proverb in Bangla – “kings fight it out with other kings while irrelevant commoners lose their lives.” At the premier tertiary healthcare hospital in one of India’s major cities, babies are dying every day. In response, the media, general public, government, and healthcare establishment are reacting precisely as they have in the past. You can pick up newspapers from previous decades and genuinely think that the events are current. The names of the dead have changed. But no one other than family members remember the names of the dead.
We’ve seen it happen before many times. When the Left Front ruled the state, we excoriated erstwhile Health Minister, Dr. Suryakanta Mishra for saying, “there is nothing abnormal in the number of deaths that have taken place,” immediately after 14 children died within the span of two days in 2002 at the BC Roy Memorial Hospital for Children in Kolkata. At that time, the leader of the Opposition, Ms. Mamata Banerjee took to the streets to protest the callousness of the government. Reams were written in daily newspapers. Experts waxed eloquently on what needed to be done on televised talk-shows. We seethed and gheraoed those who we could find. And then we moved on to other matters.
The children were still dying every day.
In May of this year, the Trinamool Congress swept into power at the state on the promise of changing the policies of decades of Left Front rule. Over the short span of two days in June, 22 children died at BC Roy Memorial Hospital. This time, Dr. Mishra, who was now a leader of the Opposition, wasted no time in blaming Ms. Banerjee for failing to provide adequate healthcare in the state. Ms. Banerjee ordered an inquiry after which she, (and excuse the pun), issued a clean bill of health to the hospital.
Scores of children are dying again. There is national and international coverage focusing on the hospital. And again, the reaction, this time from the Union Minister of State for Health and Family Welfare, Mr. Sudip Bandopadhyay, representing the Trinamool Congress is predictable. “Such child deaths in large numbers is quite normal. I don’t know why so much uproar is created on child deaths in the state.”
After a few days, the newspapers will move on to other stories. The children will continue to die.
Let us step back for a minute to focus on the broader state of healthcare in India, and in West Bengal in particular. The Organization for Economic Cooperation and Development notes that India currently spends around 1% of its gross domestic product on healthcare, which confers on it the dubious distinction of ranking eighth from the bottom.
When we consider how we treat our most vulnerable citizens, the situation is even bleaker. One universally-accepted healthcare metric is the infant mortality rate which denotes how many babies under the age of one-year die every year for every 1,000 live births. Most advanced nations have an infant mortality rate which is less than 10. India’s current infant mortality rate is estimated to be around 57. The infant mortality rate in West Bengal, which is 35, is actually lower than the average for India, and has decreased by approximately 40% over the last decade. The progress that has been made is admirable, but beating the average is no reason to gloat, especially when the average is abysmal.
More than 400,000 babies die within 24 hours of birth in India – the highest for any country in the world. 5,000 children under the age of five die every day. Malnutrition among prospective mothers leads to underweight newborns, who are especially susceptible to infection. The most tragic aspect of this vicious cycle is our children are dying not from incurable diseases but primarily from infectious diseases for which treatments have been available for decades; they are dying from gastroenteritis, encephalitis, diarrhea, and pneumonia.
I did a back-of-the-envelope calculation of the number of infants who will die this year in West Bengal based on the reported data – the infant mortality rate for the state and the population increase though live births – and came up a range of 50,000-60,000. Incidentally, this number is higher than the number mentioned by the Chief Minister, Ms. Banerjee (40,000). If we consider the entire range of these numbers then we can predict that currently at least 110-140 infants under the age of one are dying in West Bengal every day! And this number is almost certainly an underestimate. In addition, it does not include many of the children who are dying after surviving for a year.
I then decided to examine the unfortunate statement of the superintendent of BC Roy Memorial Hospital, Dr. Chatterjee that “the influx of patients is so high that three, four, five can die.” It was difficult gauging an accurate number of outpatients and admitted children who are being treated by the hospital every day. One news-story claims that one pediatrician examined 500 patients in one day. If we take this to be an anomaly, we can consider the more conservative number of patients as roughly 1500 treated every day from a recent report. The data then suggests that one sick infant for every 300 who is treated, dies at the hospital every day.
The data also suggests that the children will continue to die at the hospital every day, even after our short attentions move on to other topics. BC Roy Memorial Hospital is a tertiary healthcare center. Usually, the sickest of children are referred by physicians from primary and secondary healthcare institutions after they’ve given up hope. I’ve lived in a district town in West Bengal for many years to know how it plays out with an air of finality as the attending physician rudely absolves himself or herself from all blame – “Why did you wait so long? Nothing can be done here. Immediately, shift the patient to Kolkata.”
And so while the current deaths at BC Roy Hospital worry me, I know they will continue unless the healthcare system is overhauled across the state.
I request the media to consider the following questions. Why does the state website report that there are only 924 filled positions in primary health centres and 1069 are lying vacant? Why is there a continuous stream of patients who feel that they need to go to Vellore, a small Christian medical college hospital in South India, to get proper treatment because they get none in their own? Why are instruments unused and beds lying vacant while seriously sick patients lie in corridors with dogs and pigs? Why are physicians employed by hospitals spending more time for their private practice at nursing homes? These are the stories which every person who grew up in West Bengal can narrate. Tell these stories. Focus on the deaths every day until we are shaken out of our stupor. Don’t move on.
Text: © 2011-2013, Anirban
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It is a tight vicious cycle- population stresses resources, poverty enables malnutrition among other things, finally inattentive medical care and fake drugs. A child’s immune system needs maturation, the window is simply not afforded to the poorest group, most vulnerable and helpless.
Private practice by physicians seems unregulated. A very famous physician, I’ve heard from family, arrives around 10:30PM!! So many things wrong with this.
If those in power really cared, they can make a difference. Small steps do add up in the long run. Even helping with nutritional supplemental help for young children can make a small difference.
Death of infants like this speaks loudly of the society’s health overall.
I agree with you completely. Miners used to put canaries in mines. If the canaries died, the mine was deemed unsafe. As you point out, our children are a barometer of health of society at large.
I was thinking more about this. Actually in the larger picture, it is not just the children, but some more groups that depend on the kindness of the able majority and the law of the land: children, old people, disabled people. The quality of life available at a society level for this population shows the health of it. Especially within the have-not sections.
In a story by one of your famous fellowmen, a child tragically dies due to cholera. Written a few decades ago, it is so stark and brings to life all the factors in a village that led to the death. Each child that now dies has a similar story, just the people and placement are different. Nothing has changed very much.
But we all do care, just the extent varies. In the same story, Sarat Chandra, who was perhaps newly exploring social justice in his stories, has Pandit Moshai say “If only each educated person can care for the education of one another, just one another person”. I’m no activist but thought when I read it and still think it is a great idea.
Disparity of rich and poor has always been a factor in developing societies but the extent and the size of it in India is unprecedented. Personal responsibility even in a small and affordable scale from those who “have” can go a long way.
Bull’s Eye. We are more obsessed with sensationalist numbers than trying to get to the bottom of the problem. “Terror attack – 200 died.” – WOW! Rant about this. STOP PRESS! Fill the headlines!! “Terror attack – 10 injured.” – Whatever. Also, we have very less liability for criminal negligence – applying both to doctors as well as politicians.
Also, I had had the misfortune to get a friend admitted to a sarkari hospital here in Kolkata a couple of months back. One of the nursing staff demanded 500 bucks to let an actual doctor see the patient. Beds, equipment, food, proper medication had extra charges. My question is, why is only the media responsible for tackling this? Why shouldn’t the police and the political authorities be equally responsible too?
I am very sorry to hear about your friend’s experience. I am even more sorry to note that this is probably not an exceptional case. It must be happening quite often.
I am fine if West Bengal does not become an industrialized sensation overnight if we can improve our educational system and our healthcare facilities. Those should be the top two priorities (after the necessary law-and-order of course).
It’s all about integrity. There is a complete lack of moral and personal integrity in india today in all sections of society. It’s not very difficult to provide a good primary health care system which will reduce infant mortality by half.but this needs all concerned to have integrity and do their jobs honestly.right from the politicians to the ias officers to the doctors to nurses and also the class 4 hospital staff,the police,water supply staff, and the press.
And that is the crux of the problem in our country.the west has progressed because where it concerns their own citizens they do work honestly.
And this problem is country wide.and it wont be solved by getting a lokpal.
Atul, those are all important points. Many Western countries also have an efficient means for redress. People in the United States joke around about how litigious their society has become, but someone has to be held accountable. Medical malpractice is real, but unfortunately due to the nexus that you allude to and our faltering judicial system, the malignant elements of society can get away with negligence and wrongdoing.
Your analysis is probing and accurate but আঁতুর ঘরে সুতিকা জ্বর is a very old malady that had taken terrible tolls on mothers and infants without mercy from time immemorial, at least in this part of the world.
Joseph Lister had once observed that there were more fatal infections (in 19th century England) when babies were delivered by qualified doctors/organised hospitals than under the care of traditional midwives. That was because the latter invariably washed their hands oftener than doctors who had to treat scores of patients. His point was that doctors then didn’t understand the need for disinfection while midwives abhorred the thought of not washing before and after each delivery.
In our land there was no dearth of শুচিবায়ুগ্রস্ত elderly women in the family but the local ধাইমাs, invariably from the lower stratum of the society, had neither soap nor running water. The concept of hygiene has still not fully evolved and, the doctor:patient ratio being what it is and class four staff being who they are, we have high infant mortality especially in the busier hospitals where obstetric cases are admitted alongside patients with serious infections.
The difference between Bengal and the rest of India is that more such cases in Bengal are picked up by the press. The only recourse is a massive drive for education with special focus on education of the fairer sex. That would not only bring down the infant mortality but will also lower the birth rate to compensate for it.
Thank you for your lengthy comment.
Your comment has prompted me to think more about the goddess Sitala and small-pox, which I may write about some day.
With respect to your comment about the difference between Bengal and the rest of India, there is definitely some validity. I think the fact that it happened in an apex institution in Kolkata made it more newsworthy than if the deaths had happened elsewhere.
Hi Anirban! Visiting after a long time (and I’m really sorry about that!). Thanks for bringing up this topic. B.C. ROy is and always has been a deathtrap, not just in the pediatric ward. And, as you rightly point out, none of us are doing anything about it!
Thanks for visiting Roshni, and for commenting. 🙂