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Anuradha Varanasi
Anuradha Varanasi

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Baby blues

24-The-special-newborn Cry for help: The special newborn care unit at the Nashik civil hospital, where 55 infants died in August | Ajaj Shaikh

Infant deaths at the Nashik civil hospital paint a bleak picture of the public health care system

In the ten days after her son was born, Rohini Khetade, 22, could hold him in her arms only twice. The child, born at roughly 32 weeks, was kept in the special newborn care unit (SNCU) of the Nashik civil hospital, and was brought out only for tests—first an X-ray and later a sonography.

At birth, the baby weighed only 1.6kg. “To make matters worse, the doctors and nurses informed us that he was not drinking milk,” said Dattu Khetade, the father, a police constable in Titwala. “The entire time he was admitted at the SNCU, we didn’t get to see him even once, except for when he needed to undergo tests.”

The parents, who had come from Dahyane, about 80km from Nashik, were compelled to leave on September 17, soon after the delivery. “I made the decision to shift him to a private hospital in Sinnar, which is one hour from Nashik, after a doctor at the civil hospital said they were unable to treat him and that he might need surgery,” said Khetade. “After he was admitted to a private hospital, the paediatricians told us that, had we not discharged him on time, he would have died. He had developed an infection in that hospital and, as the saline IV drip injection was not given properly, his left hand was swollen for days.”

After being put on ventilator support for two days in a private hospital in Sinnar, where the bills amounted to Rs 10,000, the parents said the infant had started drinking milk and that they hoped he would steadily gain weight.

Many other infants, however, were not so lucky. In August, 55 infants died at the hospital’s SNCU. They, too, were underweight and born prematurely.

“Other than the fact that most of the babies admitted to the SNCU have extremely low birthweight, this is a secondary health care centre, where we are not equipped to take care of babies below 2kg,” said a paediatrician at the hospital, on condition of anonymity. “However, the problem in Nashik is that we don’t have any referral care centre. We have only one medical college that caters to these extremely low-birthweight babies. [The medical college] has ventilators and it reserves most of them for babies delivered at its own hospital.”

In fact, doctors and nurses at the hospital said that, in the past three years, they had repeatedly approached authorities regarding the poor infrastructure and manpower crunch at the hospital, but their proposals fell on deaf ears. It took the death of 55 infants for the Directorate of Health Services (DHS) to place orders for 18 incubators and four CPAP (continuous positive airway pressure) machines.

27-Sonu Mother, load: Sonu (right) has not seen her baby girl, who weighed less than a kilo at birth, since the latter was admitted to the special newborn care unit of the civil hospital.

Dr Pankaj Gajare, chief paediatrician at the SNCU, told THE WEEK that, despite overcrowding and being forced to keep two to three infants in one incubator, they couldn't, as a government hospital, turn away patients who travel hundreds of kilometers from tribal villages around Nashik. “The sad truth is, our facility was not made to treat babies who are less than 1.5kg and, as per government guidelines, level two hospitals don’t have ventilators,” he said. “In fact, around 50 per cent of the infants who died in our SNCU were below 1.5kg and they can only be handled in tertiary care hospitals. Of the total admissions, a 10 per cent death rate is considered normal. However, ours was 15 per cent in August. We are trying to do our best with the limited options we have, but with two to three babies in one incubator, there is also a high risk of cross infection.”

Gajare said that, since April, 1,492 infants were treated in the SNCU, of which 187 had died and, since 2013, when the SNCU was inaugurated, 2,885 of 13,885 babies treated there had died.

“These babies travel long distances. And, if severely underweight infants don’t get treatment within two hours, they develop hypoglycaemia or low blood sugar,” he said. Once the blood sugar level drops below 40mg/dL, the infant also develops breathing problems and, though the baby needs to be fed every one or two hours, doctors can’t give her anything because of the risk of pulmonary aspiration, he said.

“For patients from these rural areas, even arranging for a vehicle to travel all the way to Nashik can take more than two hours,” said Gajare.

For instance, after she gave birth to a premature baby girl, Sonu Sakrushet, 20, travelled 366km from Mudegaon to Nashik civil hospital. Her daughter, who weighs less than a kilo, is currently kept in an incubator at the SNCU. Sonu herself weighs only 35kg and admits that she worked on her husband’s farm well into her pregnancy. “I was never informed about what kind of food I should eat during pregnancy or the fact that I shouldn’t have exerted myself so much physically. Since my baby was admitted to the SNCU, I have not had the chance to see her,” said Sonu, who is also severely anaemic. A resident medical officer at the hospital said most of the mothers of low-weight babies weigh 30kg to 35kg at the time of birth.

Moreover, given the severe manpower crunch at the hospital, the nurses at the SNCU have to handle 42 to 67 infants at the same time. Ideally, the patient to nurse ratio should be 1:1 and there should be one paediatrician for 11 incubators. Of the three paediatrician posts sanctioned in the hospital, two are only MBBS doctors who lack the training or expertise to use ventilators or CPAP machines, said a doctor.

Malini Deshmukh, the matron-in-charge, said, “We have 18 sanctioned posts for nurses and all of them are occupied. However, the workload on us is immense. We have only four on-duty nurses during the day and three during the night. These three or four nurses have to take care of 42 babies. I have repeatedly asked the authorities to increase the number of sanctioned posts for nurses, but all my requests fell on deaf ears. We have finally been assured by DHS deputy director Dr Archana Patil that another 18 posts of nurses will be sanctioned.” Recently, 17 new nurses joined the hospital and have been working in shifts at the SNCU.

The hospital has added eight more incubators since September (10 more are to be added) in a ward of the hospital to reduce the risk of cross-infection, but space is an issue. While the government had sanctioned 021 crore to set up a four-storey building for mother and child health care on the hospital’s campus last year, the project is tied up in red tape.

Dr Suresh Jagdale, Nashik district civil surgeon, said the hospital had not yet received permission to cut down four trees on the hospital premises. “We have submitted our permit application to the High Court, and the maternal and child health care building will take at least one more year to come up,” he said. “The work order, however, was completed last December itself. As of now, we will get 16 additional warmers in the next one week and, to reduce the burden of patients on one hospital, four corporation hospitals will get 23 additional warmers.” Currently, there are only 17 incubators in the four corporation hospitals in Nashik and none of them has ventilators or CPAP machines.

Health activists, meanwhile, said the solution did not simply lie in increasing the number of incubators or CPAP machines. Dr Abhijit More, convener of Jan Arogya Abhiyan, said 60 per cent of specialist posts in primary health centres lie vacant. “Due to this, institutional deliveries are still low and, to make matters worse, the mothers from rural and tribal areas are themselves underweight and anaemic. The 3-tier health care structure should be rigorously followed, which means primary health centres should first be strengthened,” he said. “Rural hospitals are the weakest link as there are no gynaecologists, paediatricians or physicians. The only way to fill this lacuna is improved coordination between the medical education department and public health department. These departments are headed by the BJP and Shiv Sena, respectively, which is causing poor coordination. Doctors don't follow the mandatory rural postings and, because of this, poor patients in rural areas continue to suffer.”

Activist Anup Laddha of Jan Arogya Manch said government hospitals needed to be strictly monitored to curb negligence. “One can find the same loopholes in the deaths of infants at the Nashik civil hospital and in the Gorakhpur tragedy. This is all related to public health funding, which is neglected by the government year after year,” said Laddha. “From 4 per cent of the GDP, the health budget has now been slashed to 1.2 per cent, and this is nothing but a bureaucracy problem.”

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