BORN TO BE DEAD

Inefficient treatment. Inadequate infrastructure. Babies are at great risk in government hospitals

Pooja Kashyap | TNN 

    Last week — between July 8 and 10 — 24 infants died in the space of 72 hours in two government hospitals of Murshidabad in West Bengal. Ten days earlier, 18 newborns perished in Kolkata's B C Roy Hospital, and in January, 21 babies died in yet another government hospital in Kolkata. A string of incubator deaths, too, has been reported from hospitals across the country — in Nagpur, Patiala, Ahmedabad and other towns — over the last few years. 
    Why are India’s babies dying in the very places they should be getting a new life? Is it because our government hospitals are ill-equipped and overburdened? Is 
it because of a lack of sensitivity needed to deal with cases that demand delicate handling? Not that ignorance on the part of society doesn't further imperil young lives — like the age-old practice of administering oil into the nostrils of newborns, or applying cowdung on an umbilical stump. It’s hardly surprising, therefore, that India accounts for 30% of neonatal deaths (out of 3.9 million worldwide). 
    Dr Satish Saluja, senior consultant, neonatology, Sir Ganga Ram Hospital, believes public sector healthcare facilities are “seriously overstretched with paucity of trained medical staff and inadequate availability of beds.” Medical facilities like incubators are not of “optimal standards" and childcare facilities are neither “well organised nor universally available”. 
    Every year, nearly 1.2 million newborns die in India, most of them within the first few days after birth. “A vast majority of these deaths are a result of totally preventable causes,” says Dr V K Paul, head of pediatrics department, All India Institute of Medical Sciences (AIIMS). “Scientific evidence shows that in India alone more than one million lives could be saved by scaling up known and proven cost-effective interventions.” 
    What are the key “interventions”? Doctors say simple measures like exclusive breastfeeding for six months can reduce child deaths by as much as 16%. Other lifesavers are keeping the baby sufficiently warm, neonatal resuscitation, micronutrient supplements and antibiotics for sepsis, pneumonia and dysentery. Oral rehydration solutions and basic vaccinations can bring down the deaths by two-thirds, says ‘Child Health Now’, a study by World Vision, an NGO. 
    The difference is evident from state to state. Kerala and Tamil Nadu have lower infant mortality rates than Orissa, Uttar Pradesh and Bihar primarily because of the southern states’ initiatives in childcare and maternal health services. A 2006 study conducted in rural Uttar Pradesh came up with a shocking finding: as many as 71 % neo-natal deaths occurred during the first week itself. 
    The buck, though, stops with the hospitals which don’t make it any easier for either mother or infant, putting both at considerable risk. In Chennai’s Government Hospital for Women and Children, for instance, stray dogs can be seen sniffing dangerously at newborns. Sometimes they chase pregnant women and lunge at anything that resembles food. There are endless sources of infection, but authorities couldn’t be bothered as they have “more important things to handle”. 
    The sheer callousness and nonchalance on the part of the nursing staff is both symbolic and symptomatic of the larger malaise: a few years ago in a Chandigarh government hospital, nurses forced a woman who had just delivered a child to “clean up the mess.” Though the incident caused some furore, nothing much really changed after that. 
    Patna-based paediatrician Dr Akhilanand Thakur says that even “betterknown” government hospitals in Bihar are not well-equipped to deal with emergency cases involving newborns. This, in turn, has a different spiral. With round-the-clock medical facilities a distant dream in rural areas, many children are born at home. It is no surprise then that the single largest contributor to neo-natal deaths is the high numbers of births in home settings, under the supervision of untrained attendants. “It’s probably easier and cheaper to have another child than to save the one who needs medical intervention,” Thakur says with a touch of irony. 
    So, what does the future hold for India’s babies? Thomas Chandy, CEO, Save the Children, says the country has a long way to go before it achieves the safety standards that are a norm in most of the developed nations. “With the latest data showing only a one-point decline in neonatal mortality (accounting for 57% of IMR), India is likely to miss the Millennium Development Goal on reducing under-five deaths,” he says. 
    According to the NGO, over four lakh newborns die annually in India within the first 24 hours of birth — the highest in the world. Chandy says it's a silent epidemic and “now is the time when we must shed our complacency.” At least, as one doctor put it, “The incubator deaths have to be stopped immediately.” 
HOSPITAL OR HELL? 
July 8-10 | 26 infants die in two government hospitals of Murshidabad in West Bengal 
June 29 | 18 newborns die in Kolkata's BC Roy Hospital 
January, 2011 | 21 infants die at a government hospital in Kolkata 
2010 | Infant dies of heater burns at a Nagpur government hospital 
2009 | 6 newborns charred to death in their incubators at Government Rajindra Hospital in Patiala 
December 2008 | Three-day-old killed after incubators catch fire in a hospital in Ahmedabad. Incubator deaths also reported from government hospitals in Allahabad, Meerut and Delhi