COVER STORY
Vandana ’ s treatment started at 9 pm . The night passed fitfully as her condition worsened . She was moved to another ward in the wee hours with breathing difficulty . At around 3 am , she lost her vision . Ramesh had been given an Ambu bag — a handheld device used to resuscitate patients during emergencies when ventilators are out of order or unavailable . “ There was no oxygen in the hospital . So I operated the device all night ,” says Ramesh . “ It gave her a lot of relief .”
At 5 am , Ramesh left for the blood bank . A doctor asked him to let a nurse operate the Ambu bag , as his brother wouldn ’ t be allowed into the ward . When he returned an hour later , Vandana was lying alone , very still , with nosebleed . The device lay beside her . “ The nurse had abandoned her . Many children had already died , though the doctors weren ’ t admitting it ,” he says .
Hospital staff soon evicted Ramesh and other parents from the children ’ s ward . Minutes later , they saw paediatrician Dr Kafeel Khan rush in . “ Dr Kafeel was drenched in sweat . Soon after he arrived , doctors re-inserted pipes into patients and got busy again ,” Ramesh says . Dr Kafeel is credited with arranging scores of oxygen cylinders on August 9 , 10 and 11 , to make up for the disruption in supplies . Inexplicably , he was among the nine jailed BRD employees — currently he ’ s out on bail and spoke to us ( see interview ).
Vandana could not be saved . An anguished Ramesh let a doctor take most of her medical records and , though he tried , never got them back .
In 2017 , UP had one allopathic doctor per 3,467 persons . The norm is 1:1,000 . Less than five per cent of the PHCs are functioning , according to a study .
Hospital staff made bereaved families leave quickly and quietly through a rear exit , an act that has not been probed although it reeks of how inequality besets rural care-seekers . Outlook saw the record that stated Vandana died of “ acute meningo encephalopathy ( sic )”— one of many forms of AES .
KUMAR , the principal , is keen to deflect the focus away from oxygen supply disruption . “ The media added up all deaths and blamed oxygen shortage , although it was there only for one night . The last five year ’ s data shows there has been no real change in casualties ,” he says . Morbid business , this comparison . Deaths were indeed very high for years , but those hours last year were lethal : hospital records themselves show a sharp spike . On August 7 , 8 and 9 , there were 9 , 12 and 9 deaths respectively . But on August 10 , suddenly , 23 children died . By August 11 , as oxygen supplies normalised , they fell to 11 . But Kumar echoes a number of official reports and submissions in court , seen by Outlook , which say lack of oxygen did not lead to casualties . “ There were more deaths on one day as there were more admissions that day . But there was always enough oxygen — we had cylinder backup ,” Kumar says .
If so , it ’ s unclear why BRD overhauled oxygen purchases later and initiated steps to buy it directly from a manufacturer , sidestepping middlemen . BRD also ramped up oxygen in stores to 300-400 cylinders from last August ’ s 52 . “ If there was no problem with oxygen , why are seven people , including my parents , in jail for the last eight months , charged with
T a m i l
BREAKING THE RURAL NO-G0 JINX
Tamil Nadu has tried to provide for healthcare where it ’ s needed most
by G . C . Shekhar in Chennai
T
N a d u
HREE-year-old Manivannan ( not his real name ) swallowed a handful of iron tablets that his grandmother had left unattended . As iron toxicity coursed through his veins , his family rushed him to Thanjavur Medical College Hospital , 24 km from his home in Orathnaadu . The doctors met with limited success , so an ambulance sped him off to the best destination for childcare in the state , the Institute of Child Health ( ICH ) in Chennai .
Slowly , Manivannan ’ s breathing and pulse improved . He was shifted from the emergency room to a stepped-down facility where he could lie on his mother ’ s lap , who helped him breathe from an oxygen mask . “ We let mothers handle children unless they are seriously ill . Children feel secure with their mothers and that helps recovery ,” says Dr Indumathy Santhanam , emergency care expert at ICH . Manivannan will be under observation for 48 hours . Already , he wants to play with the toys strewn about the colourful ward .
Elsewhere in the hospital , ICH director Dr A . T . Arasar Seervalar , a senior paediatrician , pores over eight-month-old Marikannu ’ s test results . The bright-eyed , emaciated baby girl from Pudukottai district has two holes in her heart . He assures the little one ’ s mother , a woodcutter ’ s wife , the problem can be set right with surgery at the hospital .
“ We will improve her nutritional intake and conduct tests in preparation for surgery . She may have to be here for a week ,” he says . Of course , everything is free of cost . This is why the hospital is much in demand , for cardiac care , neurology , nephrology , pulmonology and gastroenterology — name the specialisation and it seems to exist at ICH . “ Sometimes we draft experts from private hospitals to treat complicated cases ,” Seervalar says .
ICH started out as an extension of the paediatrics department of the Madras Medical College . It is recognised as the best government-run hospital for children in the South . Some 3,000 outpatients stream in daily to the hospital , from Andhra Pradesh and Karnataka as well . It has 837 beds , 64 paediatricians , 54 postgraduate students and even a 30-bed children ’ s
20 OUTLOOK 2 July 2018