There has been a hue and cry over the deaths at GB Pant Hospital.  The deaths have shaken the administration, politicians have stepped in to engage in blames and counter blames and the separatists too have pressed the alarm button!  Critics have questioned the role of doctors, the number of ventilators, the infrastructure of the hospital and the availability of beds at GB Pant has been debated.  GB Pant and the deaths it has witnessed represents just the tip of the iceberg, the core issues related to the health especially health of infants have neither been addressed nor are they under any consideration for redressal.
380 infants dying in a single hospital in a span of few months is an alarming figure.  We need to ponder as to why the deaths have taken place – the reasons cited by the critics are too inadequate to explain the deaths, these all factors might have enhanced the fatalities but the problem lies elsewhere, and, if, corrective measures are not applied, all hospitals of the valley will go GB Pant way.
The infants who died must have come from different Zillas, Tehsils or Districts; what about the availability of services to these poor people in their native places?  380 deaths at GB Pant means a failure of 380 peripheries.  Why have these peripheral nodal points failed in discharging their duties?  Why is there a malfunction at our peripheries?  Nobody cared to know whether these neonates were seen by any specialists in their own areas and with what diagnosis were they referred to GB Pant?
Widely publicized programmes exist within the State which focus on the healthcare issues related to mother and the newborn.  The goal of these programmes is to have a healthy mother and a healthy baby.  To achieve this goal, mother and child are considered a single unit and monitored under a single blanket.  A neonate is never seen in isolation – mother’s health, her immune status and her nutrition has a bearing on the health of a neonate.  What do we know about the health of the mothers of all those neonates who died?  Were the mothers of these neonates under a regular antenatal check up, if not why not?  Childbirth is a normal physiological process which in the background of careful monitoring should go ahead uncomplicated.  Peripheral health centres, district and sub-district hospitals should be optimally capable of looking after uncomplicated pregnancies, thereby ensuring sound health of mothers and neonates.  The question we should ask ourselves is – why should all pregnant ladies be directed to Lala Ded hospital and never monitored in their native places?  The maddening rush at LD has affected the quality of services it provides to women who deliver there, resulting in health issues related to women and children – has anybody thought about it? A crash landing of pregnant ladies at the time of delivery without any antenatal monitoring is proving fatal both for mother and the child.  Our maternal mortality rates are not encouraging either - have we failed in the implementation of programmes which are successfully running in other states? Had peripheries worked well, LD and GB Pant would not have been flooded.
So, the key lies in strengthening the peripheries, providing adequate staff and facilities for antenatal monitoring, smooth conduct of deliveries in hygienic conditions there, and the care of the newborn.  It takes quite a bit of effort to see that all schemes and programmes related to maternal and child health are implemented in letter and spirit.  Same accountability mind you, needs to be demanded from the doctors working in peripheries ,as is being done nowadays for the doctors working at GB Panth.  However strong our services at GB Panth be, they will be deficient if peripheries are collapsing….
There are issues related to hospital infrastructure which should be addressed at the earliest.  Neonatal monitoring has to be done adjacent to maternity care services.  Why in our case is the crib separated from the mother – with neonatal care facilities located at one end and maternity services at the other end of the city?  How will the maternal and child health unit function when the two are physically so much separated?
Most infants succumb to infections acquired in hospitals where they are born or where they are treated.  With a huge rush at our maternity hospital and pediatric hospital, we cannot escape infections.  While strengthening the peripheries is the key to reducing rush, it will also improve the quality of services offered by the specialists. There will be adequate time for the specialists to concentrate on more serious cases while common non serious ailments are taken care of by the peripheries. Besides this, no compromise on basic sanitation-it has to improve in both hospitals!  Outsourcing the sanitation is perhaps one measure that can be applied to take care of dirt and filth which by conventional methods seems unmanageable.  SKIMS has a successful experience with outsourcing, why can’t SKIMS model be applied to GB Panth?
Manpower deficiency at GP Pant is a consequence of time consuming methodologies employed by the Health and Medical Education Department in recruitment.  Adhocism should be replaced by fast track regular appointments.  I remember the times when there were only two permanent faculty members manning the entire hospital – even now, the hospital does not have adequate faculty strength.  Adhocism will not be effective where results are desired.
GB Pant requires a prompt and effective laboratory support.  Investigations should be available round the clock so that sick are treated scientifically.  Blood bank facilities for exchange transfusion and an in-house drug counter providing all life saving medicines should function round the clock
Srinagar requires a ‘State of art’ pediatric hospital and so do other districts.  Young pediatricians are helplessly looking for jobs in our State – it is in the interest of the State to provide ideal working places for them. 
While we blame doctors working at GB Pant for negligence , not acknowledging the fact that these poor beings are just the victims of the system; their efforts are not showing results because the system is faulty.  But, if negligence is found on their part, they should be brought to book – for doctors are no saints….. The drug mafia will not work when authorities don’t want it to work!
While doctors working at GB Pant are the servants of the system, what about the role of those pediatricians who are doing private practice?  Is their work being monitored by some authority?  Are the facilities in their clinics optimal?  Do they adhere to asepsis and healthy medical practices in their clinics?  Are they using the drugs rationally on patients?  Nobody cares to put a limit on the number of patients that these doctors can see per day?  The dingy ,dark and over-crowded clinics of pediatricians working in private are contributing a good number of patients to GB Pant after their own trials of treatment fail – accountability from private clinics is the need of the hour too!
Before I close, I am reminded of a programme started by one of the prime institutions of the State i.e. an M.D. in Maternal and Child Health.  The course was innovative and would have created squads of doctors who would look after mother and child.  The course started by visionaries was abandoned unfortunately, and a novel idea got aborted before it could take off…. we need those visionaries again, we need that will again to save our children – any takers, please come forward!
The authorities should not forget SKIMS neonatology which takes specialized care of neonates-that Department too needs upgradation and a keen interest from administration.
Probing death of 380 kids is OK but go a little beyond and formulate a policy to save other kids.

(Feedback at rumanahamid@rediffmail.com)

Lastupdate on : Thu, 31 May 2012 21:30:00 Makkah time
Lastupdate on : Thu, 31 May 2012 18:30:00 GMT
Lastupdate on : Fri, 1 Jun 2012 00:00:00 IST