At Gorakhpur’s BRD hospital, dogs roam the corridors, cows amble about
A visit to the medical college that’s been in the news, following 80 child deaths in a week, reveals chaos and disorder.health Updated: Sep 03, 2017 12:15 IST
Dogs run around or laze in the dimly lit corridors. Cows roam near the emergency section. Grass is untrimmed and peppered with litter.
The stench of urine is over-powering; it doesn’t leave you even inside the wards.
This is the scene at the Gorakhpur hospital that made news after more than 80 children died there in a single week. It’s no wonder that desperate parents have more faith in the healing powers of a tree.
A peepal just outside Ward Number 100 at the Baba Raghav Das (BRD) hospital and medical college has its trunk smeared with bright vermilion. Ward 100 is where the encephalitis patients are treated.
During the monsoon, when the disease is most widespread, parents can be spotted praying at the tree. Their children lie a few feet away, in a dirty, overcrowded, poorly equipped and understaffed hospital where child deaths run into the hundreds every month.
On average, about 10 to 20 children die at BRD every day during the monsoon, when viral and other infections spread faster.
In the paediatric ward, most admissions and deaths occur between July and October.
Between January 1 and August 22, a total of 6,247 children were admitted to the paediatric care ward; 625 suffered from Acute Encephalitis Syndrome. Of these, 158 died.
Encephalitis is the swelling in the brain that leads to sudden high fever, headache, neck stiffness, disorientation, coma, seizures, spastic paralysis, and leads to death in up to 30% of cases.
At BRD, other causes of child deaths include septicemia (blood infection), pneumonia and respiratory distress syndrome in preterm babies.
The rains are particularly unwelcome for other reasons. Parts of the hospital flood with every heavy shower.
A row of bricks peek out of the floodwater and offer the only land route to the out-patient department (OPD).
And yet this 950-bed facility is one of the most prominent medical colleges of India, the only facility of its kind available to a population of about 5 crore people from eastern Uttar Pradesh and north Bihar.
Close to 300 doctors treat between 3,000 and 5,000 patients every day. Across the region it serves, AES is rampant, particularly in the monsoon.
Over-crowding is an obvious problem, with two to three children sharing each bed and even some incubators, raising cross-infection risk.
There are only 22 intensive care unit (ICU) beds for encephalitis-affected children; about three times as many are needed.
After spending about five hours with her 16-day-old son, Kiran Devi, 24, rests on the empty cement sacks cluttering the long corridor that leads to the encephalitis ward. She and her husband take turns to pump the ambu bag— a respiratory device used for manual ventilation – to help their baby breathe.
“He had high fever, he was vomiting and his lips had gone dry, so we brought him here,” said Kiran, who works as a daily-wage earner with her husband in Gorakhpur’s Kushmi village.
“These are the kind of patients we treat here — the poorest of the poor,” says a doctor passing by, refusing to identify himself. “They don’t understand or follow even the most basic instructions.”
If we are treating far more people than what we are equipped to handle, we would need better resources, which means more oxygen supply, more IV drips, more medicine stock, more beds, he adds.
A Comptroller and Auditor report in June pointed to gaping holes in the BRD infrastructure. It found 27.21% of the required clinical equipment missing, against the minimum requirements prescribed by the Medical Council of India, even though the hospital had adequate funds.
The overcrowding is not limited to the wards. Most sick children are accompanied by at least three family members, who crowd the paediatric ICU corridor despite a board warning that too many people, and any footwear, raises infection risk.
“No one follows visiting hours, they enter anytime. If we try to stop them, they become aggressive,” says a guard.
No one seems to be using the toilets either; the hospital walls bear testimony to this.
In a makeshift washroom close to Ward 100, families bathe and wash utensils and clothes, which are then hung out to dry on the staircase.
Dirty water collects and mixes with garbage from an overfull bin and disposable masks, soiled cotton and gauze.
With barely enough space for all the relatives to sit, some share the patient’s bed — if it’s not being shared by another patient already.
In the past, the hospital introduced a token system that allowed a single person to accompany a patient inside the hospital. “It failed miserably as relatives of patients almost attacked our staff trying to restrict entry,” says Dr PK Singh, the new principal of BRD. “There are issues and the hospital needs improvement. I have just taken over and I will see to it that things improve.”
One of the most recent improvements is a new National Institute of Virology (NIV) lab at the hospital, which has helped speed up diagnosis since 2009.
“Before the lab, we sent samples to NIV Pune, which resulted in a huge backlog,” said a BRD doctor, requesting anonymity.
“It is obvious that the hospital is severely overcrowded, treating patients way beyond its capacity,” said Union health secretary CK Mishra, who visited the hospital on August 12, a day after 23 children died within 24 hours.
“The deaths are not about oxygen supply or negligence. It’s about the failure of the primary health delivery services. We are planning a blueprint with experts to see how a permanent solution can be found.”