My column in The Asian Age and Deccan Chronicle
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 firstname.lastname@example.org