Can politicisation of the unfortunate deaths of more than 60 children at Gorakhpur’s Baba Raghav Das Medical College since August 7 really help in the future prevention of such a monumental tragedy?
Can the explanation by the ruling Bharatiya Janata Party that the deaths should be treated as an accident, which, in a vast country like India is a natural phenomenon, be condoned so lightly?
Can the medical fraternity in general and those in the Raghav Das Medical College in particular, be absolved its part in the tragedy from the viewpoints of both ethics and competence?
Unfortunately, the answer to each of the three questions is a big “NO”.
Take the case of the politicisation. Politicisation of a tragedy is usually done by the opposition parties to put the ruling party in a poor light; it is rarely attempted at finding out a solution to the problem. And since the whole process of politicisation is terribly partisan, whose principal goal is to attract maximum publicity for the participants in the process, there are no uniform criteria or yardsticks to judge the efficacy of the very process. The whole exercise is often terribly partisan.
Take the present case. Opposition leaders are landing at Gorakhpur since it happens to be the city of Chief Minister Yogi Adityanath. That the ruling party happens to be the BJP, the tragedy provides a grand opportunity to the opposition parties to lambast Prime Minister Narendra Modi and his brand of good governance. But then, had the same opposition leaders cared to visit the Shishu Bhawan or Children’s Hospital in Odisha’s Cuttack where as many as 61 children had died in two weeks’ time in August-September, 2015? None of these leaders had called it a mass murder by Naveen Patnaik government then. Nor for that matter it was a big issue for the national media and civil-rights activists. Are children of Cuttack less important than the children of Gorakhpur?
Secondly, the problem with politicisation is such that no premier political party in India is a paragon of virtues. And it so happens that in most of the tragedies, there are always direct or indirect roles of the opposition parties of the day too. If the present tragedy is due to the stoppage of the supply of oxygen by the vendor for the non-payment of his dues, something that has been alleged, then going by the Indian Express newspaper, the payment was due since November 2016. And if that is the case, it is the then Samajwadi party-led government in the state that is as much responsible for the present tragedy as the Yogi-government is.
Similarly, the Bahujan Samaj Party supremo Mayawati may be at the forefront today in demanding the ouster of the Yogi government for its omission and commission that led to the present mishap. But what was her record in the health-care when she was the Chief Minister (2007-12)? It may be noted that it was during her regime that top politicians and bureaucrats had siphoned off a massive sum of Rs. 10000 crore from the National Rural Health Mission, a central government programme meant to improve health care delivery in rural areas. In order to cover up the scam, five people, including two Chief Medical Officers, were also murdered. Senior ministers of Mayawati were alleged to have been involved in the case.
Now let us see the role of the BJP. I think it is sheer lack of compassion that marked the statement of BJP President Amit Shah when he said that “in such a big country tragedies have happened before and have happened during Congress rule as well.” Because, the tragedy in Gorakhpur is essentially man-made and it was expected that of all the governments the one led by BJP should have taken maximum care, particularly when Gorakhpur happens to be the nerve-centre of Chief Minister Yogi’s political base. Some cruel facts will prove the point.
Gorakhpur and its adjoining areas constitute the bulk of India’s encephalitis belt, which, in turn, risks the lives of as many as 375 million people. According to Dr. R. N. Singh, who taught at Baba Raghav Das Medical College in the Seventies and began running a campaign for encephalitis eradication after he retired, “ Baba Raghav Das hospital has an average of over 200 deaths per bed since the outbreaks began in 1977. Gorakhpur is the capital of the world for encephalitis. There is nowhere else in the world which would have witnessed more than 200 deaths per bed. It is a very sorry figure.” In a sense, the BJP is right that such deaths every year during the rainy season are very normal and that there should be no role of politics in aggravating the crisis. But then, the question is what is the solution that the BJP in general and Yogi in particular has been offering.
It is a common knowledge that this particular disease (encephalitis pathogens) among the children is seen among those sections of the populace that are poor with poor hygiene, poor nutrition and poor clothing. And when children get sick, the local health care facilities and doctors are not up to the task of quick treatments that the disease requires. It is because of this that in 2013, the Uttar Pradesh government, following the recommendations of an expert group on encephalitis, set up 104 treatment centres in the Gorakhpur region so that there would be the required ventilators( for continuous supply of oxygen to the brain) and trained doctors near the homes of the patients. The idea was to discourage the patients to cover long distance to reach large hospitals such as Baba Raghav Das in the city. Because, it was felt that the longer journey to the city was killing more patients as by the time patient is taken to the hospital, the brain was damaged beyond repair. Obviously, these centres are non-functional with no qualified doctors and facilities and the rush to Raghav Das hospital continues. More than anyone else, being the unchallengeable people’s representative of the region so far, the Chief Minister has a lot to explain for this pathetic state of affairs.
Now, let us see the role of the doctors. More than the legalities and rules, it is grossly unethical that during the critical rainy season that witnesses deaths of the children every year because of encephalitis, the head of the hospital takes a long leave to go out of the town and most of the doctors at the Raghav Das hospital spend more time in their private clinics to earn much more money than their monthly salaries (in Uttar Pradesh, the government-doctors are allowed to have private practices).
The medical profession can never be equated with a normal corporate or business career. A doctor’s fundamental duty is to save lives, prevent or relieve suffering, cure disease and disability, and ameliorate the consequences of disease when it cannot be prevented or cured. A true doctor can never be morally comfortable with the idea that some people should be denied access to health care that might relieve their suffering or save their lives because they cannot pay for it.
Unfortunately, of late, the medical fraternity in India has been confronted with scam after scam because of bogus degrees, illegal medical colleges, organs-trading (killing unsuspecting poor to extract organs and then selling), and dubious nexus with drugs-manufacturers. In fact, the national organisation that deals with the fraternity, the Medical Council of India, has been a den of corruption, with a former head landing in jail. In 2012, the Parliamentary Standing Committee on Health and Family Welfare found how leading doctors from different parts of the country sent identical letters on certain drugs — as if the letters have been written by a common entity while the doctors just signed them – to promote some companies’ interests.
It is of course true that in the rapidly changing scope of the health-care, the moral responsibility of a physician to a patient is not enough. Medical ethics must involve other stake holders – medical devices companies, pharmaceutical companies, diagnostic clinics, insurance companies, clinical trial organisations, and other service providers entering the field. In a developing country like India that needs quality, accessible and affordable health, there is all the more reason to expand the scope of the definition of ethics within the field of medicine.
In sum, if the tragedy of Gorakhpur is to be prevented in future, then one must rise above the blame-game. The need of the hour is to ensure how the health system– government funded and private– acquires minimal functionality, particularly in rural and semi-urban areas. It requires political will, administrative efficiency and the sense of service of the medical community.
By Prakash Nanda