Human Rights Law Network

In Uttar Pradesh, infants die in a tangled web of medical apathy, neglect and corruption

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“Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease,” says the World Health Organisation, having expanded the scope of public health policy beyond an outdated pathology-based point of view to stress on the overall ‘well-being’ of persons.

Right to health is also protected as the fundamental Right to Life in the Constitution of India and the rationale for this is simple: the development of any country depends on the health of its population, and thus, it is the duty of the state to provide sturdy mechanisms for the welfare of the public.

However, ground realities differ vastly from what is promised. According to the medical journal ‘Lancet’, India is ranked 154 out of 195 countries in terms of health care access -- far behind countries such as Bangladesh, Nepal, Ghana and Liberia. India spends only a little over 1% of its GDP on public healthcare, compared to China which spends 10.4% of its budget on healthcare. India is even superseded by Uzbekistan (10.7%), Tanzania (12.3%) Kenya (12.8%) by Uzbekistan (10.7%), Tanzania (12.3%), Kenya (12.8%) and Nicaragua (24%).

Uttar Pradesh, the largest Indian state by population, also has its second-highest maternal mortality ratio (MMR), with 258 deaths recorded per 100,000 live births. The state also has the country’s highest infant mortality rate (IMR) -- 64 deaths per 1,000 births.

In August 2017, over a 100 newborns died in the span of a week in Gorakhpur district, allegedly due to medical negligence in the treatment of a potentially fatal disease, Acute Encephalitis, and the lack of oxygen supply. The company that sold oxygen to the hospital, Pushpa Sales, apparently stopped its supply due to non-payment of bills when the outstanding amount touched nearly Rs 50 lakh. Reportedly, the company had been forced to cut off supply last year as well.

Encephalitis is an infection caused by viruses, bacteria or other pathogens that triggers brain inflammation. As the brain swells, it gets crushed against the skull, causing seizures and strokes, and sometimes, death. Last year, Uttar Pradesh reported 621 deaths out of 3,919 cases of Acute Encephalitis Syndrome.

Gorakhpur district, in particular, is notorious for having some of the worst standards of hygiene and cleanliness in the whole country, and this is not without its repercussions on public health. Indeed, health department data shows that 62 out of 1,000 children born in Gorakhpur die before turning one. NFHS 4 data further shows that 35% children in Gorakhpur are underweight, while 42% are stunted. One in three children do not complete the mandatory immunization cycle. Only 35% of its households have a toilet, which suggests a high rate of open defecation, which results in 25% of children suffering from diarrhoea.

“As mosquitoes breed in rice paddy fields and pigs gorge on garbage piles near human dwellings, conditions are ripe for animal to human transmissions of viruses through insect vectors. Bacteria, too, abound in unhygienic surroundings easily invade the ill-nourished bodies of poor children… Early marriage and motherhood of an undernourished adolescent, leading to a low-birth weight baby that suffers further malnutrition and falls prey to infections – this is the tale that plays out as the backdrop for sick children in hospitals in Gorakhpur and neighboring districts,” said one Dr K Srinath Reddy, as quoted in a report in the Indian Express.

After news of the infant deaths spread nationally, Gorakhpur’s Baba Raghav Das (BRD) Medical College and Hospital came under intense scrutiny – an exercise that unearthed cycles of gross apathy and neglect.

A report in The Economic Times said that it found two AES patients having to share the same bed, demonstrating a clear shortage of facilities. It was also revealed that the hospitals faces an acute shortage of active doctors -- 8 out of 12 senior resident posts were vacant, and only 3 out of 31 nurses were trained to handle newborns. The hospital also had no functional air conditioners and its wards were overcrowded. The same newspaper feature noted that BRD hospital’s paediatric wing had some of the highest mortality rates in the country.

In response to the ‘massacre’ of infants, a petition was filed in the Allahabad high court which sought a CBI investigation into the deaths. It also asked for the provision of all necessary facilities and infrastructure in the Encephalitis ward in the BRD Medical College and the installation of a nonstop oxygen production unit there. However, any actual action on the ground still remains to be seen. 

Shortly after this, news of the death of 49 infants emerged from another district in the state, Farrukhabad. Media reports said that the babies had died of a lack of oxygen supply and of easily treatable issues such as premature delivery and breathing complications. 19 of the 49 infants reportedly died right after birth. The Chief Medical Officer and the Chief Medical Superintendent of Farrukhabad went on record, reporting that the children had died due to prenatal asphyxia.

Farrukhabad has a staggering Infant Mortality Rate of 78 (per 1,000 live births, and under-5 mortality rate of 54. Most of these deaths are reportedly caused by diarrhea, anemia, and respiratory infections. As suggested by these figures, we also found that child health facilities in Farrukhabad are exceptionally pathetic. Less than 6.9% of children in the district receive adequate nutrition. 38.7% of children are diagnosed with anemia, 31.4% are underweight, while a staggering 49.10% have stunted growth.

“Mortality in such children is quite high. Often, we get children who weigh less than a kilo or two kilos. At times, the children are born with complications or there is a delay in being referred to the hospital from primary health centres,” said Dr Kailash Kumar, the Special Newborn Care Unitin-charge at the district’s Ram Manohar Lohia (RML) Hospital.

In early September, Human Rights Law Network (HRLN) conducted a fact-finding session in the district, also visiting the RML hospital – the scene of most of the infant deaths.

The most striking thing we found was the lack of patients in the otherwise huge hospital. This is highly unusual given the general state of affairs in Uttar Pradesh’s government hospitals, where overcrowding is rife. The doctors and nurses at the hospital categorically refused to entertain our questions, and denied permission to see the Neonatal Intensive Care Unit (NICU) ward. We then spoke to some families who lost their babies in the hospital.

One Akhilesh Kumar told us that his wife gave birth in a private hospital, but he had to take the infant to RML because of a cardiac complication. There, nurses charged money twice to administer oxygen before declaring the baby dead merely two hours later.

Investigation also revealed that brokers were soliciting almost every single patient that came through the hospitals doors – and that, often, these brokers were none other than RML nurses. Akhilesh Kumar’s story was echoed by several others who reported going to RML and being turned away, then being taken by nurses to one of the several private hospitals that have sprung up in the vicinity. After delivery, the babies were brought back to RML because, more often than not, they suffered from breathing or heart complications. At RML, these families were asked for money ranging from a few hundred Rupees to several thousand – in some cases, going up to Rs 25,000 – at the end of which, the families lost the babies anyway.

Under national government schemes such as the National Maternity Benefit Scheme, Janani Suraksha Yojana, and Janani Shishu Suraksha Karyakram, pregnant women are entitled to provisions including free (and cashless) delivery, drugs, provision of blood, food and ambulance transportation, but families we spoke to said that RML denied them all aid.

They further reported that their newborns weighed less than 2.5 kgs (healthy babies weigh between 2.5 and 4 kgs) – an alarming fact that reflects on the poor health of both the mothers and infants. Since the babies are underweight, they become highly susceptible to conditions and diseases such as diarrhea, malnutrition, and anemia.

All families also recalled having horrific encounters with medical personnel at the hospital. According to one family, when they went to RML for delivery, a nurse carelessly said, “Ja ja leja, yaha kya marne ke liye layi hai?” (‘Take her back, have you brought her here to die?’).

After the deaths in Farrukhabad, the Chief Judicial Magistrate himself filed an FIR against the Chief Medical Officer (CMO) and Chief Medical Superintendent (CMS) and a senior child specialist of the Ram Manohar Lohia (RML) district hospital and took the case suo moto, ordering a probe into the matter.

HRLN too filed a writ petition in the Allahabad HC, seeking compensation to the families of the deceased children and the constitution of a committee to inquire into the deaths. The petition also prayed for the state’s Health and Family Welfare department to provide all necessary equipment, oxygen, medicine and other infrastructural facilities in the hospital and for them to take disciplinary action against persons responsible for the deaths.

Enacting long-term solutions are the only way the government can prevent such massacres in the future. The public healthcare infrastructure in India is ailing and needs urgent repair. 70% of Indians pay for medical expenses from their own pockets. At a time of intensive privatization of the medical system, most of the country’s population thus relies on government institutions for affordable treatment. However, the administration has repeatedly fallen short of providing a respectable degree of health care to its own people. For instance, according to the WHO, there should be one doctor per 1,000 people, but in reality, Uttar Pradesh has one doctor for over 6,600 people.

Merely providing monetary compensation to the families of the affected is akin to putting out flames without attempting to find the cause of a rapidly spreading forest fire, because human lives cannot be measured by money. Moving forward, states must implement stringent measures and bring about far-reaching policy changes, appoint more healthcare professionals and ensure adequate infrastructure.

Farrukhabad Field Report

Gorakhpur Field Report

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Human Rights Law Network (HRLN) is a division of the Socio-Legal Information Centre (SLIC). SLIC is a non-profit legal aid and educational organization, registered under the Registration of Societies Act, 1860, Indian Public Trust Act, 1950 and the Foreign Contributions (Regulation) Act, 1976.

HRLN is a division of the Socio-Legal Information Centre (SLIC). SLIC is a non-profit legal aid and educational organization, registered under the Registration of Societies Act, 1860, Indian Public Trust Act, 1950 and the Foreign Contributions (Regulation) Act, 1976.