Why Gorakhpur Is A Lesson To Be Remembered For A Lifetime

We were left stunned on hearing the news about the death of children in a Government hospital in Gorakhpur, Uttar Pradesh. We had too many people to blame, especially since it was the constituency of the Chief Minister of the state, Shri.Yogi Adityanath. Some said it was due to the lack of Oxygen cylinders caused due to unpaid bills that caused these deaths. Somebody else noted that children dying were not something out of the ordinary and that deaths due to Encephalitis are very common phenomenon out there for many years now. The Press worked overtime in exposing the various visible shortcomings of the place and of the system, which is alleged to have led to the fiasco. Sad indeed.

A cursory reading of the Union Budget for the year 2017–18 gives us an idea about the importance given to health spending. The amount allocated to the Ministry of Health and Family Welfare for the year 2017–18 is Rs.47,352.51 crores. This is a mere 2.2% of the overall expenditure budget of our country for this year. Of this amount, the allocation for Swachchta Action Plan is Rs.133 crores, which is about Rs.4.58 crores for each state ( which has numerous government hospitals based on the size of the state) per year. Having done audits of companies and banks in India, I know how less an amount this is, especially for a hospital.

Keeping this in mind, I happened to engage one of my friends, who is a doctor in a Government Hospital. I asked him about the specific incident in Gorakhpur and he opined that the children should have been referred to other places when the authorities knew that shit was going to hit the fan. He also added that it is easier said than done because more often than not, the doctors are required to record the reason for the transfer of any case to another hospital. They are supposed to specify what lacked causing such transfer. On prodding further, it came to light that the funds that were allocated to buy equipment and medicines are not used for it. They get gobbled up by the rampant corruption in the hierarchy, leading to buying of sub-standard equipments, which conk off at the earliest instance. So doctors hesitate to refer fearing their superiors and their power.

He also mentions that cleanliness, apart from being the duty of the hospital, is equally the duty of the people accompanying the patient. “Nurses and Wardboys don’t spit in the corridors nor do they spill food items on the floor inside the hospital building”, he said. Many a time, it is also the relatives of the patient in a critical care unit, who create issues when asked to transfer the patient to another better hospital. “They are more concerned about the why’s and the how’s than actually saving time and in consequence the patient”, he said.

The allegations of sitting on the bills, delaying the payment also seem authentic. A surgeon working in the Rajiv Gandhi Government general hospital said,” Even life-saving instruments and drugs are not available because the company knows that after supplying them they have to pay to move their bill from table to table. It is a long line of people from the Junior clerk, senior clerk, section officer, administrative officer, vice principal up until the Dean of the medical college hospital. Every single representative of surgical instruments will tell you that they supply at a markup price of 30% to 40% of the actual cost because of these bribes having to be factored in,” strengthening the possibilities of such incidents happening. When enquired if it was legally allowed for an agency that supplies life-saving drugs and equipment to suspend its sales due to non-payment, he replied, “Absolutely. If they are giving repeated legal notices about unpaid bills, it’s the duty of the person-in-charge to make sure that the supply is restored somehow. Even the vendor would have known the consequences of the action they have taken. Despite that, if they still did it, it means something is rotten somewhere and it’s not all cut and dry as the story has come out in the public”. Also, there is this point of having a stock of supplies so that they could act as a buffer when things do not go as planned. It is a mystery as to how things went unnoticed till the very end, especially when the buffer stock is being used as the regular stock.

“We have excellent doctors in government hospitals, but our hands are tied with all this red-tapism, multiple levels of documentation and second guessing after emergency decisions are made. Most of the times we practice with half-assed instruments way beyond expiry date.For example, my surgical kit is almost exclusively of instruments from my clinic. I don’t want to use the government supplied instruments either because they are not sharp enough and will slow me down or they are not small enough for fine work. So I bring all my own instruments (which are expensive) for doing free surgeries in the government hospital and I am not alone in doing this. Almost every other surgeon does this as they can’t depend on the quality of the instruments supplied by the government. Ultimately if anything goes wrong, it is the doctors’ responsibility,” he says.

Lack of qualified technical staff also adds up to the woes of the hospitals in India. Corruption reigns there as well, so much that one staff is substituted with another, based on whoever is ready to pay a higher amount as bribe. The surgeon agrees to it and adds, “In our hospital, there are two posts for anaesthetists, but because of the bribes, two pathologists were appointed to the anaesthetists’ posts. We only have a single anaesthetist available and if he is not on duty, all surgeries have to be postponed or sent away to Stanley hospital or Govt Royapettah hospital, even if the Patient is in a very critical condition. We can’t do anything because as surgeons we can’t give anaesthetics and anaesthetists are not there to do it either,” thereby conveying the helplessness of the doctors in this regard.

The surgeon also expressed his disgust and helplessness in equal measures. “If you have multiple levels of redundancy at one stage or the other, you are bound to hit a deficiency. How did everyone miss everything?” he exclaimed.

This could be eye-opening to us, but it has killed almost a hundred children and is not ending anytime soon. The inaction by the government in addressing this murder and also in taking punitive action against all those involved is baffling and unbelievable. Suspending the officers does not quite solve the problem. Everyone from the Health Minister is equally responsible for this sorry state of affairs that plague the Government hospitals. The day when people in power are forced to share hospital beds with the common man will help in resolving this. But, will that ever happen?

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