We were stunned on hearing the news of 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 (CM) of the state, Yogi Adityanath.
Some said that it was the lack of oxygen cylinders (due to unpaid bills) that caused these deaths. Others noted that children dying was not extraordinary and that deaths due to diseases like encephalitis have been common in the past few decades. The press and the media worked overtime in exposing the various shortcomings of the place and the system, which are 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 the health sector. The amount allocated to the Ministry of Health and Family Welfare for this year is ₹47,352.51 crores. This is a mere 2.2% of the overall expenditure (as mentioned in the Budget) of our country for this year. Of this, the amount allocated for Swachhata Action Plan is ₹155 crores, divided among the numerous states and union territories. 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 talk to one of my friends, who is a doctor in a government hospital. When I asked him about the specific incident in Gorakhpur, he said 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 this 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 they lacked, which necessitates the transfer.
On prodding further, it came to light that the funds allocated to buy equipment and medicines are not used for the purpose. They get gobbled up by the rampant corruption in the hierarchy, which leads to substandard equipment being bought, that conks off at the earliest instance. The doctors hesitate to refer, fearing their superiors and their power.
He also mentioned that maintaining cleanliness is as much the duty of the people accompanying the patients, as it is for the hospital’s staff. “Nurses and ward boys 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 they are asked to transfer the patient to a better hospital. They are more concerned about the whys and the hows than actually saving time, and consequently, the patient,” he said.
The allegations of sitting on the bills, which led to the delay in their payment, also seem to be 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 till the dean of the college/hospital. Every single representative will tell you that they supply surgical instruments at a markup price of 30% or 40% of the actual cost because of these bribes that have to be factored in.”
When asked if it was legal for an agency that supplies life-saving drugs and equipment to suspend its sales due to non-payment of bills, 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 somehow restored. 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 a point to having a stock of supplies which can act as a buffer when things do not go as planned. It is a mystery 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 practise with half-assed instruments way beyond their expiry dates. For example, my surgical kit has instruments exclusively from my clinic. I don’t want to use 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 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 said.
Lack of qualified technical staff also adds up to the woes of the hospitals in India. Corruption reigns there as well – so much so that one staff is substituted with another, based on whoever is ready to pay a higher amount as bribe. The surgeon agreed to this and helplessly stated, “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 referred to Stanley Hospital or the Government 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.”
The surgeon also expressed his disgust and helplessness at the situation. “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.
These can be eye-opening for us – but in the meantime, these issues have already killed 72 children and don’t seem to be ending anytime soon. The government’s inaction in addressing the deaths and in taking punitive action against all involved is baffling and unbelievable. Suspending officers does not quite solve the problem. Everyone, starting from the health minister, is equally responsible for this sorry state of affairs in government hospitals.
A version of this article first appeared on the author’s blog.
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Featured image used for representative purposes only.