How a toxic system led to sudden deaths in UP

Shahira Naim in Gorakhpur (UP)

In the times of tragedies, governments are prone to lies, and are extremely fond of setting up committees. The tragedy involving death of children and adults (the toll could be as high as 80 in just a week) in Uttar Pradesh’s Gorakhpur is demonstrative of such an egregious lapse by a government hospital that anybody would hang one's head in shame and wonder if we do have a government. The sequence is even more shocking: 

August 9: A day before BRD Medical College Hospital that reported horrendous deaths hosted a meeting presided over by chief minister Yogi Adityanath, a consecutive five-time local MP. He led a team that included state minister for medical education, five principal secretaries, divisional commissioners of Gorakhpur and Basti and seven chief medical officers. None among the attendees is on record having spoken about the impending crisis of near-dry liquid oxygen cylinder supply that is blamed for the deaths of around two dozen infants the very next day.

August 7: From all accounts the money to be paid to the oxygen supplier was in the hospital account. Reportedly, it was ‘commission’ that could not be settled.

July 31: Pushpa Sales Pvt Ltd which supplies liquid oxygen to the medical college, sent a legal notice. No response. The pending payments since November last year had reached Rs 72 lakh by March this year. From February to August this year the company had sent at least seven reminders asking for its dues to be settled. “As per the agreement, the company's payment was to be made within 15 days and the arrears were not to exceed Rs 10 lakh,” says the company's Gorakhpur sales manager Deepankar Sharma.

Fast-forward to August 10: Around 7.30 pm, the supply of liquid oxygen was disrupted. The college had all of 52 jumbo cylinders in its stock through which it somehow managed till 1.30 pm till the next day when 60 more cylinders arrived in two lots. This is the time when in the AES ward, neo natal ward and ward number 14 for adults saw the maximum deaths. This was unprecedented: On no previous occasion had the medical college recorded deaths of 36 children and 18 adults within 24 hours.

There is another far grimmer fact: Gorakhpur over the years has become synonymous with Japanese Encephalitis — a deadly fever mostly affecting infants and children — and Acute Encephalitis Syndrome (AES). Each year the fevers take dozens of lives in the district, parts of Bihar and Nepal. The BRD Medical College Hospital is one of the 60 paediatric ICUs set up in Gorakhpur to cater to nearly 50 million people in eastern Uttar Pradesh, Bihar and neighbouring Nepal.

The tragedy has stretched to yet another level: Both the state and Central representatives have already let it be known - even before two separate investigations could conclude — that the shortage of oxygen was not the cause of the deaths, and that such deaths were an annual feature in August. 

There are many studies to substantiate how undisrupted oxygen supply is critical for treatment of AES. Dr AC Dhariwal of the National Vector Borne Disease Control Programme is a co-author of a seminal study appearing in the Lancet of April, 2017. It said: “... critical care, which means monitoring of heart rate, respiratory rate, blood pressure, oxygen saturation, blood electrolytes and undisrupted oxygen supply is extremely important for AES care.”

Just how serious the state administration has been is clear from the fact that on August 11, Gorakhpur district magistrate Rajeev Rautela had ordered a magisterial enquiry which was to present the facts within 24 hours. It was to ascertain if oxygen supply had been disrupted and if the deaths were directly related to it. Six days later the report has not been made public, only portions of it have been leaked, and you are right, there is no clear word about oxygen supply! And Dr Purnima Shukla, the wife of the suspended principal RK Misra, is under investigation by another three-member committee examining her role in the whole tragedy.