The stench tells you that you have arrived at Sardar Vallabhbhai Post Graduate Institute of Paediatrics, Cuttack, popularly known as Sishu Bhawan. It is the same familiar stench that greets you at any government hospital across the country. But this hospital in the one-time capital city of Odisha, and one of its major commercial centres, is known as a premier facility for children’s diseases. The paint peeling off the walls, the wards flooded with people, infants lying in the incubator and their parents, helpless and distraught, hanging on in desperation, waiting for their child’s agonies to end: familiar scenes of neglect and horror provide the visuals to accompany the shouting, the wailing — and the stench.
It was here that 69 infants died in just the last two weeks of August, leading to protests demanding an investigation into why the children had to lose their lives. It was, after all, scary stats even for a state that ranks second in India in infant mortality, better off only in comparison with Madhya Pradesh. Interestingly, the Economic Survey 2013-14 mentions that Odisha along with Madhya Pradesh have the highest percentage of rural poor in the country.
When TEHELKA visited the hospital, it came across some disturbing figures that show how the prominent government hospital is coping with the appalling infant mortality rate without even any computerised medical records of the infants admitted. Documents accessed by TEHELKA , though, reveal that the infant casualty in the Intensive Care Unit (ICU) increased from 16.17 percent in 2013-14 to 25.84 percent in 2014-15. Strikingly, the spike in the number of deaths does not reflect the number of infants admitted, which has seen no dramatic increase in the same period.
Critically ill newborns are referred to Sishu Bhawan, Cuttack. It is one of the better-known paediatric hospitals in the state, catering to infants and children below 14 years. The 416-bed hospital has 21 ICUs.
Most of the dead infants are said to have succumbed to birth asphyxia (the medical condition resulting from deprivation of oxygen to a newborn infant that lasts long enough while being born to cause physical harm, usually to the brain), prematurity, sepsis and meningitis. The authorities, however, claim that most of the infants were already in a critical condition when they were brought here following referrals from other hospitals, so their chances of survival were slim.
The claim seems to be little more than the hospital and government’s way to evade responsibility for the infant deaths. To understand how it is so, you have to ask why the children landed up in Sishu Bhawan in the first place. For that is proof of the failure of the government to provide adequate and effective healthcare facilities across the state and near-total absence of critical care in the hinterland forces. Babies suffering from multiple diseases and in critical condition are brought to Sishu Bhawan by parents in the hope of proper treatment.
How the district hospitals fail to provide timely treatment becomes clear when you look at the case of Manoj Kumar Sahu. Sahu, who works as plumber in Pune, recalls how he came all the way from Koraput district in the south Odisha to Sishu Bhawan with his nearly dead daughter.
“She had fever on the sixth day after her birth,” he says. “We admitted her in the district hospital but her condition did not improve. The doctors referred us to Sishu Bhawan. We had to pay Rs 1,000 to hire an ambulance for taking our baby to the hospital. It took almost an entire day to reach Cuttack. By then, my baby was almost dead. There was no movement. The doctors immediately admitted her in the ICU. Had there been a good hospital in our district, she would not have died.”
The poorer and more remote a household, the greater the tragedy it confronts. Distances apart, the sheer cost of treatment (did you think government hospitals are cheap?) can break the back of any family that barely makes ends meet and push it into an endless cycle of indebtedness. Sample this: parents have to shell out Rs 250 a day as ICU charges for the first five days, after which the rate goes up to Rs 500. They also have to pay an extra Rs 500 as ventilator charges. Even for intravenous drips of electrolyte, glucose and lactate, they have to pay Rs 300-400 more. This, in a state where the government increased the minimum wages for unskilled labour (including agricultural labour, on which most of the population depends) from Rs 150 per day to Rs 200 on International Labour Day (1 May) this year, from Rs 170 to Rs 220 for semi-skilled labour and Rs 190 to Rs 240 for skilled labour.
The medical expenses look even more deadly when you learn that more than one-third of the rural population in Odisha (35.79 percent) lives on less than Rs 32 a day (the official poverty line in India). The monthly per capita expenditure figure of Rs 1,003 shows that rural Odisha has the lowest spending among the states, with 57.2 percent of the total expenditure of households being on food.
Pradip Pradhan, an activist with the Right to Food Campaign, in his report submitted to the governor of Odisha recently, had clearly stated how BPL (Below Poverty Line) cardholders face trouble in seeking treatment from Sishu Bhawan. Take this for instance: “A BPL card holder from Jeypore in Koraput district came for the treatment of his threeyear- old baby. The staff at the counter demanded that he must pay the fees for the blood test. When he showed his BPL Card and said that he was entitled to free treatment, the staff abused him and asked him either pay up or leave.” He was eventually forced to pay Rs 190.
According to the report, the hospital authorities are unaware that people covered under the Rashtriya Swasthya Bima Yojana (national health insurance scheme) and the Biju Krushak Kalyan Yojana (a health insurance scheme for farmers in Odisha named after former chief minister Biju Patnaik, father of the current CM Naveen Patnaik) are also entitled to free treatment. The authorities’ ignorance, therefore, ends up denying a large number of the poor their right to free treatment.
The state government, nevertheless, claims it has sufficient resources to deal with the deaths. What’s worse, the hospital authorities take pride in supposedly being in a better position than Madhya Pradesh. As per the government’s guideline, the death rate at a Sick Newborn Care Unit should not exceed 15 percent. Sishu Bhawan in Cuttack has a 13 percent death rate while the figure is 24 percent at Jabalpur Medical College and Hospital, 19 percent in Bhopal and 13 percent in Dibrugarh, Assam.