Vaccination alone unlikely to end Gorakhpur deaths

Access to medical hubs, better staff and awareness drive must to solve issue

An average of 20 deaths a day in a medical college was “normal”, Gorakhpur District Magistrate Rajeev Rautela told journalists on the night of August 11, after 23 children had died allegedly due to oxygen shortage at the Baba Raghav Das (BRD) Medical College.

Rautela was right, at least in the case of the Gorakhpur-based hospital, where on an average 19 people had died daily in 2015 and 17 had succumbed to diseases in 2016. What Rautela didn’t disclose was the number of deaths in the pediatric department and the neonatal intensive care unit (NICU), where children are treated for acute encephalitis syndrome (AES), which includes Japanese encephalitis (JE) and other water- and vector-borne diseases such as malaria and dengue.

Data accessed by Business Standard suggested no more than eight children had died daily, on an average, in the first seven months of this year at the pediatric and NICU wards. In August, the average remained the same for the first nine days except for August 10, when 23 children died. Oxygen supply disruption, reportedly because of non-payment of dues to the contractor, started the same day.

A committee headed by chief medical officer had blamed the contractor, Pushpa Sales, and senior BRD doctors for failing to ensure adequate oxygen supply. The state government, however, blamed the deaths on AES and pre-natal diseases. Probe reports of the Gorakhpur chief medical officer and a central team, too, fell short of blaming the deaths on lack of oxygen supply.

A report from the Uttar Pradesh chief secretary is likely to be presented to the chief minister on Sunday. But sources said it might not find faults with the state administration for delaying payment to BRD Medical College despite repeated reminders by now-suspended principal Rajeev Mishra. 

“Medical colleges in Uttar Pradesh are run by jugaad by principal. Mishra knows this very well and he should have bargained with the oxygen supplier for more time,” said a senior state government officer involved in an investigation that absolved the state administration of payment delay. “The system is such that payments are always delayed.”

At BRD Medical College, some senior doctors said four to five deaths might have occurred due to oxygen shortage. “But we can’t say conclusively in the absence of post-mortem reports,” added a senior doctor, on condition of anonymity. 

The 950-bed hospital is one of the biggest tertiary care hospital in eastern Uttar Pradesh. About 5,000 patients, including from Bihar and Nepal, visit its out-patient and in-patient departments daily. Every year, BRD Medical College gets 3,500 children with JE or AES from neighbouring districts of Kushinagar, Azamgarh, Siddharth Nagar, Sant Kabir Nagar, Basti, Maharajganj, Deoria and Ballia. 

Some estimates suggest that more than 10,000 encephalitis deaths have occurred here since 1978, when the first case was reported in Uttar Pradesh. In 2005, a major encephalitis outbreak in Gorakhpur and neighbouring areas claimed 1,400 lives.

P N Srivastava, former head of the pediatric department at BRD Medical College, said mortality for JE and AES was between 25 and 30% worldwide. “We have found a cure for JE, but we are still struggling for AES. Lack of awareness is a reason for high deaths. Parents come to us only after exhausting all means of medication at local government and private hospitals. By then, a patient’s condition would have deteriorated,” he added.

JE patients can also be treated at primary and community health centres, said K Srinath Reddy of Public Health Foundation of India. But the state has a 54% shortage in primary health care centres (PHCs), according to the Brookings India Health Monitor. Gorakhpur has around 3,200 villages but only 45% have a sub-centre within a radius of five km. Gorakhpur was also one of the dirtiest cities, the Swachh Bharat Mission had said, with less than 50% of the population having access to toilets.

Critics said the hospital and the state government were equally responsible for the deaths. In its report to health ministry, the Centre’s committee that visited BRD after the recent deaths stated the hospital had filled only four of 12 vacancies for senior residents. Nursing staff was untrained to handle babies and parents were forced to buy medicines from outside. The team also flagged hygiene issues at BRD Medical College. “Nearly 50% deaths are occurring within 48 hours of admission, implying both suboptimal stabilisation at peripheral units and poor care after admission,” the report added.

Uttar Pradesh government 

Mahim Mittal, in-charge of the medicine department at BRD Medical College, said deaths can be reduced if preventive measures, such as vaccinations, are taken before outbreaks of diseases, which usually happen in July-October. 

Chief Minister Yogi Adityanath on Saturday said a vaccination drive had been launched in 38 districts and nine million children have been covered. He did not disclose if the nine million were covered during of his tenure as chief minister or if it included those covered under the previous government, too.

Data from the National Rural Health Mission suggested 50% of children were vaccinated against a target of 6.8 million in 2012-13 and 2013-14, whereas “population at risk is 375 million”. Sustained vaccination drives and more primary health care centres can help.

Experts said the state government would have to supplement its vaccination drive with access to clean drinking water and sanitation facility. Adults survive the virus because of stronger immunity.