HOW TO PREVENT ANOTHER GORAKHPUR

When India woke up to the deaths of children at a hospital in Uttar Pradesh’s Gorakhpur district last week, I remembered what an academic, who was then writing a paper on the uprising in Egypt’s Tahrir Square in 2011, told me: “The signs of political ferment were all there in the years preceding the uprising … they were in newspaper reports and government documents. But nobody joined the dots … read the signs.”

This — not reading the signs — holds true for the public health system in Gorakhpur. The immediate cause of the deaths could have been the oxygen shortage at the ward of the Baba Raghav Das Medical College (BRDMC) that had children suffering from encephalitis but the signs of a coming catastrophe were always there. According to the National Family Health Survey, in August 2014, 567 children died in this hospital, in August 2015, 668 children died and in 2016, the toll was 587.

Isn’t it then surprising that no one raised an alarm despite so many deaths? However, the malaise in the public health structure is much deeper than what meets the eye is evident from fact that nine more deaths have been reported from BRDMC, taking the toll to 105 since the August 10 tragedy.

You may call me a pessimist, but this tragedy will soon vanish from public memory. The investigative reports by the health department and medical associations that came out after the first round of deaths will be lost in the mountain of files in government offices. The children will again be remembered when the next tragedy strikes.

Revamping the health sector is never an easy task, but it isn’t impossible. I am not a public health expert but my friends who are in know of such things tell me that three steps are needed if UP — or for that matter any other state — want to improve the healthcare system and avoid such deaths. Over the years, BRDMC has been creaking under tremendous pressure; it has been taking in more patients than it is supposed to. This is because it caters not just to patients from Gorakhpur and its neighbouring districts but also from Bihar and Nepal. On any given day, reports said, about 200 to 250 encephalitis patients are treated at the hospital, and the mortality rate is 7% to 8%. Many of these children could not be saved because they were critical. What does this show? The public health system in the surrounding areas is so badly equipped and poorly staffed that there is no scope for early detection.

While setting up proper, well-equipped brick and mortar hospitals in the surrounding areas is an ongoing process, we must look at other possibilities. One such possibility could be to invest in telemedicine so that people don’t have to travel long distances for detection. A telemedicine system can provide the rural population access to basic, specialty and super specialty consultations. It can turn out to be economical since people in rural areas lose wages when they have to travel to bigger hospitals in cities for diagnosis.

In 2015, the Centre had launched a pan-India health initiative called Sehat (Social Endeavour for Health and Telemedicine) in line with its Digital India vision. The initiative aims to connect 60,000 common service centres across the country and provide health care access to citizens irrespective of their geographical location. The roll-out has proved to be difficult due to absence of infrastructure, Internet connectivity and lack of sufficient medical personnel. But these problems — if there is the political will — are not insurmountable, especially since now the same party rules in Lucknow and New Delhi.

Then there is Big Data. Considering that the basics health care requirements are not in place, this may sound too ambitious. But wouldn’t it be stupidity to re-haul the system without leveraging the advantages that modern science and technology provide us? These days, I am told, Big Data is being used to predict epidemics, cure disease, improve quality of life and avoid preventable deaths. I was bit skeptical when I heard this considering the on-ground problems we have, but it seems India had started working on this in 2013.

At the Institute of Genomics and Integrative Biology, part of the Council of Scientific and Industrial Research, Anurag Agrawal, a 2014 Shanti Swarup Bhatnagar Prize awardee, has been working on a project that streams health data from different areas to a central server in Delhi. Such data is gold, Agrawal told MINT in an interview. “More than public health, it is about creating massive data sets that will give us a sense of what’s going to happen in terms of recognising diseases in their early stages”.

Last but not the least, governments have to invest in nursing colleges and medical schools to ensure that adequate number of health personnel enter the system every year and fill the gaps. Uttar Pradesh has only 25 medical colleges —10 government and 15 private. The situation is worse in nursing colleges, which are mostly private.

Thanks to unavailability of trained staff in State-run hospitals, people tend to throng to quacks: A Hindustan Times reporter found out that for residents of Ramnagar village, located 10 km north of Gorakhpur’s BRDMC, quacks are the first port of call for many.

There are as many as 200 unregistered medical practitioners, commonly known as quacks or ‘jhola chhap’ doctors, who are running thriving ‘clinics’ in localities and villages near BRDMC. The presence of such ‘jhola chhap’ doctors is indication enough that the system has collapsed, but it seems no one is reading the signs.