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Babies, dead and anonymous
November 8, 2011

West Bengal has a new government, a new chief minister, and a new name — Paschimbanga, but the situation on the ground remains obdurately familiar. The state is again in the news for all the wrong reasons.

In recent days, the media has been awash with stories about a series of infant deaths in various government hospitals in the state. And last week there was an absolute shocker — the case of a woman who was admitted to a hospital in Murshidabad, and allegedly swabbed with carbolic acid instead of antiseptic, causing her burn injuries and death to the newborn. The National Commission for Protection of Child Rights (NCPCR) has demanded an investigation into the incident and submission of an Action Taken Report (ATR) from the state government within 15 days.

What saddens me most are the arguments that are being trotted out to absolve the medical establishment of any wrongdoing as well as the political nature of the debate that has followed the tragedies. The Left and the Trinamul Congress are both busy trashing each other’s record in healthcare in various TV discussions: Chief minister Mamata Banerjee says the Marxists left behind a decrepit system; that enough has not been done to shore up staff strength at government hospitals; that there are not enough well-equipped health facilities, and so on. Then there is the argument of underweight babies being brought to referral hospitals at a critical stage. And, of course, that there are big plans in the pipeline to fix the system — more sick newborn care units are being commissioned across the state. The Left says its healthcare record was not bad and puts the onus of the tragedies down to lack of administrative capability and ineptness of the new regime.

The spat would have shaken Mamata Didi’s government a lot more had the Centre not sprung another fuel price hike at this moment. Now, both Didi and her party are making news for a different reason. The problems on the ground, however, are not going away.

A lot has already been written on the matter. But one basic question strikes me: what would have been the government’s action and reaction if the parents of the babies who died were from Kolkata and from a class that can make noise and be heard? Would the cases still be clubbed under the umbrella term of “infant deaths”?

Within 10 days, close to 40 infants died in the paediatric wards and nurseries of government hospitals in Kolkata and Burdwan. But till date we don’t know the case histories. We know as little about the babies as about their parents: Who are they? What are their names? Where did they come from? Where did the family live? Where did they work? What was the exact chain of circumstances that led to the death of each baby? Were there health clinics next to where they lived? Were they functional? What was the diagnosis? What caused the delay in referring the cases to the hospital? What happened in the hospital? We don’t know. Perhaps, we will never know.

The babies who died have no names and no identities. The only thing we know about them is that they were reportedly of low birth weight and had been brought to the hospital in a critical condition. The odd media report put a name and face to a grieving parent — one Nabokumar Das, father of a dead child, told a reporter: “Early in the morning we were informed about the death of our child. I strongly believe that the treatment was insufficient.”

Now, imagine a scenario where the family is urban, educated and affluent. What happens if such a family loses its baby? Browsing the Net, I came across an incident in Kolkata last August. An infant had died in one of Kolkata’s leading private hospitals. The parents charged the hospital with gross negligence. The family maintained that the mother, a resident of Bengaluru, had been admitted to the hospital and delivered the baby the next day. The baby choked to death when a nurse tried to feed it water. The hospital disputed all the charges. Last heard, the family was taking the case to the Medical Council of India.

Despite some improvements, India continues to be home to a staggeringly high number of neonatal deaths. The neonatal period starts from birth and continues through the first 28 days of life. In India, the mortality rate for newborns stands at 39 per 1,000 live births and contributes to about two-thirds of all deaths in the first year of life. The statistic, however, only tells a partial tale. A very large number of babies who are part of this statistic need not have died — they died because their mothers did not get to a proper health facility in time, or faced negligence. Worse still, such families are unable to fight back.

The West Bengal medical establishment’s official explanations for the recent baby deaths are, in fact, damning indictments of the ground reality in that state. Pregnant women often land at referral hospitals at a critical stage because the primary healthcare system is dysfunctional. A state that gave the world the famous Purulia model of sick newborn care unit (SNCU) has not been able to sustain it. I visited Purulia when the model was launched some years back. It is a good model and can save babies but even then many of the SNCUs being planned had not taken on board staff requirements, factors like power outages and the need for back-up. Without contingency planning, such facilities will not be the life-savers they are meant to be.

Ms Banerjee should also worry a little about why so many babies in her state have low birth weight. Could it be because their mothers are undernourished? To be fair to West Bengal, it is not the only state where the healthcare services are so pitiable and where mothers and children are dying needlessly. But Mamata Didi promised to bring in “paribartan” (change) and blaming her predecessors or pointing to other states will not change anything.

Saving mothers and newborns is not rocket science. What it needs is collective will that can defeat apathy and cynicism. I have seen trained village workers save babies in a tsunami-ravaged village in Car Nicobar, in a mud hut without electricity in Maharashtra, and in West Bengal’s remote, rural interior. Wherever there was success, there was political will, from top to bottom.

The writer, a senior journalist, specialises in development issues in India and emerging economies. She can be reached at patralekha.chatterjee@gmail.com

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The tragic toll tale
Sep 27, 2011

Patralekha Chatterjee

India’s creaky infrastructure is in desperate need of upgradation; Public-private partnerships are the answer; Big-ticket initiatives are in the pipeline. Without better infrastructure, India is unlikely to ever make it to the A-list of the global economy. All this is well-known, and oft-repeated. But recent events show that the infrastructure policy has to take on board new risks and challenges. A key concern is the safety and security of the foot soldiers of the infrastructure industry. They are often among the most vulnerable.
Take toll roads as an example. The toll industry is growing briskly. There is a lot of emphasis on efficient toll collection, an important aspect of managing road projects. The National Highway Authority of India loses almost `300 crore, or 15 per cent of its toll revenue, due to pilferage at manual toll booths every year, according to official estimates. Industry observers say that since toll is mostly collected in cash, it is tough to account for every rupee. Often, lower than expected revenues are attributed to power outages, faulty machines and theft. Private companies involved in road projects are trying hard to plug leakages, by slowly shifting from manually-operated toll booths to those that use smart cards or tags.
But there is another side to this story. Several attacks on toll booths and their attendants over the past year show that building a road and checking for fraud is only part of the job. Making it safe for everyone, including the toll-booth attendant, is the crucial bit that remains. Last week, the picture got grimmer with a murder………………..

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There’s safety in the nitty-gritty
Sep 13, 2011

Patralekha Chatterjee

Eight years ago, while researching a report on awareness about HIV and AIDS in India, I spent an afternoon at the Inland Container Depot at Tughlakabad, on the outskirts of Delhi. A lanky young man working with an NGO was holding “classes” for truck drivers in a shed. He began by asking the young men about their day (and night) on the road. Once rapport had been established, he got into more personal issues, testing his listeners’ knowledge of HIV/AIDS. Eventually, the sensitive issue of condom use popped up. He did not merely say, “Have safe sex.” He took out a wooden demonstration penis and showed his students how to slip on a condom and how to take it off, clarifying doubts about the many things that could go wrong in the process. There were questions from the crowd. Some sought one-to-one time with him later. I remember a remark by a 21-year-old truck driver who was standing next to me that afternoon. “Like everyone else who drives trucks on the highway, I have seen posters about AIDS. I know AIDS kills. I also know that I ought to have safe sex. But no one actually told me what to do next, where to go, how you slip on a condom, till today.”
Talking about AIDS and security in the same breath may seem incongruous. But there is a takeaway message in the anecdote relevant to our current discussions about security. “Have safe sex” messages worked when they were followed by nuts-and-bolts information on what exactly to do and not do, where to go for more information, and who to turn to if one was in doubt. Ditto with security.
There has been a lot of talk about security since last Wednesday’s “briefcase” bomb blast in front of Delhi high court’s gate no. 5. We know there are weaknesses in the current security system and we know that it needs to be strengthened. The focus on the larger issues underpinning security is welcome. But we also urgently need to know more about the specific actions that individuals and institutions need to take in the short, medium term and long term to tone up security preparedness in these times of terror. In short, we need to dwell a lot more on the details. Just as AIDS advocacy achieves little if it is confined to “AIDS kills” and “Have safe sex” posters, security advocacy will also achieve little unless statements are translated into action-points — what to do, what not to do, how to make sure one is doing it right, and what to do when something is not working.
The discussion on security technology provides a telling illustration. There is a widespread belief that in view of repeated terror attacks in the country, better security technology and more specialised equipment are urgently needed. Investing heavily in security technology, however, will not automatically lead to better security unless many other things are done.
It is a bit like safety features in cars. Such features are necessary but not sufficient. Equally important is training the driver to use those features, actions of other people on the roads, the training they’ve had, the decisions they make,
and the milieu they are operating in. The same is true of security.
Investigators of September 7 blast face a serious handicap because there were no CCTV (closed circuit television) cameras at the gate, though there had been an attack near another gate earlier this year. The high-decibel discussion on CCTVs will ensure that Delhi high court soon has CCTVs everywhere. Many other institutions will follow suit. But installation is only the first step. Without proper operation and maintenance, even state-of-the-art equipment is of little use.
Over and beyond security equipment is the question of security consciousness and that, along with the equipment, needs to be monitored. In nuts-and-bolts language, that means tasking specific persons to do specific jobs and holding them accountable for it.
In this context the Comptroller and Auditor General of India’s latest (2011) report on security management in the Indian Railways is revealing. According to the report, a surprise check to gauge the preparedness and alertness of security staff at 15 railway stations deemed to be at “high risk” revealed the following: Out of 470 CCTV cameras/monitors at these stations, 76 were not working. Two of the 15 stations had no CCTV. Out of 96 door-frame or walk-through metal detectors (DFMDs) in the 15 stations, 32 per cent were found to be non-functional. Baggage scanners had been provided at only five of the 15 stations.
Out of 137 authorised gates, 41 had no DFMDs. And of these 41 gates, only 59 per cent were found to be manned by security personnel. In only three stations out of the 15 did passengers have to go through any checks. Disturbingly, there were 106 unauthorised entry points at these 15 stations. No security personnel were deployed at these entrances except at one station. At one major station, Sealdah in Kolkata, nearly 68 per cent of the DFMDs were out of order. At the Jharsuguda station of South Eastern Railway Station, which falls in Maoist-affected terrain, there were several unauthorised entry points
and no door-frame metal detectors. The two that had been installed had gone for repair. There were no baggage scanners or CCTVs either at this station.
Railway stations are by no means the only places where necessary security equipment is either lacking or not working. The broad message when security gizmo talk is at its peak is: installation alone is not action.

Patralekha Chatterjee writes on development issues in India and emerging economies
and can be reached at patralekha.chatterjee@gmail.com

Patralekha Chatterjee
They were playing “Lose Control”, that peppy, foot-tapping track from the mega hit Rang de Basanti when we arrived at India Gate early Sunday evening.
The music turned to more sedate, patriotic songs as we got closer to the scene of action — joyous throngs waving the tricolour, ice-cream sellers, channa vendors, hawkers of Anna Hazare memorabilia and dozens of TV crews and OB (outdoor broadcasting) vans which had taken up position to capture the “victory march”. Just hours earlier, the 74-year-old Anna Hazare had sipped coconut water and honey, breaking his 12-day fast after members of Parliament had finally agreed to consider his main demands to make a strong Lokpal law in the fight against corruption.
Mr Hazare’s anti-corruption stir over the last fortnight changed many things on the ground, and in our minds. Corruption is not new. Talking about corruption is not new. What is new is the active engagement of so many more people with the subject. That was what had brought us to India Gate on Sunday evening — to see for ourselves the festival of “people power”.
At the end, will anything change? Many friends and colleagues are cynical. They argue that every man or woman who was there at Ramlila Maidan or India Gate or any of the other places to cheer Team Anna is not a saint, and has perhaps paid or taken a bribe or two at some stage of his or her life. That is entirely possible. But looking around the excited young faces at India Gate and talking to ordinary families who had gathered, something else was equally evident — the word “possible” had acquired a new meaning.
“Anna is a flawed hero. But he inspires me. Everybody in this crowd will not follow Anna at every step. Even if a small percentage pays heed to his broad message, it is progress. He has made us feel that ‘everything is possible’. An ordinary person can achieve extraordinary things if he or she has conviction and resolve. That means a lot. Every time I go to a government office and someone asks me for a bribe, the memories of this evening will come back. I think I won’t do what I might have done earlier,” said a man who worked for an investment firm. “I don’t know about others. But I have decided I will not pay a bribe again,” said another man who had come to the festival with wife and small children. He was busy buying “Main Hoon Anna” caps for his children. They may come in handy if anyone acts on the suggestion to whip out a cap and stick it on the head the moment one is confronted with a demand for a bribe, he quipped.
Do these personal resolutions mean anything? Does the experience of a few people count? Maybe, maybe not.
Mr Hazare is neither India, nor a messiah. Neither does one have to agree with every clause of his proposed Lokpal Bill. But there is no denying one thing: whatever be one’s views on Mr Hazare, credit the old man with forcing the different Indias to talk to each other. Young boys and girls who had never seen a big political rally or had associated the national flag only with stage-managed formal events were happy waving the tricolour as their friends sang and danced at India Gate that evening. Yes, they were not as erudite about the law or the Constitution as some of the experts who spoke in panel discussions on television. But they had stepped out of their comfort zone, and shown willingness to engage with one of the most important issues of the day.
The young people I met at India Gate and earlier at the Ramlila Maidan said such engagement had been a transformational experience. A part of them had changed. Perhaps, their first response in such unfamiliar terrain is “simplistic” or “naive” as some call it. India inspired, however, is not necessarily India committed, nor India responsible. “Victory marches” over, the real battle begins. In the coming weeks, the debate about the various Lokpal bills will continue. An apathetic public has been awakened, and many among them will be vigilant. Team Anna and its thousands of supporters across the country, who are pushing for a strong Lokpal law, will be held accountable to the same high standards of probity as they advocate for the political class and others. A single slip-up can dent the momentum of their mass movement.
This is no time for triumphalism either. One hungerstrike, no matter how influential, does not make for “victory” when the battle is against such entrenched interests. But as so many people said to one another at India Gate, “Should we not make a start?”
Mr Hazare has made us think. We can use what we have learnt in other areas too. After the trip to India Gate, my 13-year-old daughter said, “Imagine, what would happen if we could have a mass movement against female foeticide and dowry. Imagine, tens of thousands hitting the streets, and saying they will not give or take dowry, and actually sticking to it.”
Patralekha Chatterjee writes on development issues in India and emerging economies and can be reached at patralekha.
chatterjee@gmail.com