“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