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‘If Oxygen Was the Problem, Others Would Have Suffered as Well,’ Says Uttar Pradesh Health Minister

‘If Oxygen Was the Problem, Others Would Have Suffered as Well,’ Says Uttar Pradesh Health Minister

BRD Medical college, Uttar Pradesh minister for health Siddharth Nath Singh

“One can keep blaming us for things but this is an exercise which has been neglected for the last 20 years in the state of UP, Bihar, Assam,” UP health minister Siddharth Nath Singh said.

BRD Medical college (left), Uttar Pradesh minister for health Siddharth Nath Singh (right). Credit: PTI

Its been four days since news of the Gorakhpur tragedy broke, in which 23 children died in a single day in Gorakhpur’s BRD Medical College. This was a spike from the number of deaths the hospital usually sees. Siddharth Nath Singh, Uttar Pradesh minister for health and state government’s spokesperson, spoke to The Wire on what the cause of deaths were, what responsibility the state government could take, what his government has been working on and whether he considered resigning like his grand father Lal Bahadur Shastri.

Is the official position, after your examination, that no child died due to a lack of oxygen?

There was a disruption. We have taken action. The principal should have avoided this disruption when the payment to the BRD Medical college was in fact made by the director general of medical education on August 10. But fortunately when the disruption happened, no deaths took place in the hospital in the pediatric ward. We went through the log books and other things. But yes, firstly the disruption should not have happened.

As far as the deaths are concerned, there are cases of infection, acute encephalitis syndrome (AES), which come in Gorakhpur in large numbers. We have been working very hard to reduce this kind of inflow into BRD Medical college. It will take time. The only way you can do this is by containing cases at the primary health centers (PHCs) so that if they can get relief within 24 hours it doesn’t escalate, because there is no other medicine for this, its all related to cleanliness.

One can keep blaming us for things but this is an exercise which has been neglected for the last 20 years in the state of UP, Bihar, Assam. Being conscious of this and being sensitive towards deaths of children, we are working hard towards strengthening PHCs.

A source from the Union health ministry tells me that money sent specifically for infrastructure to deal with encephalitis has not been used by Gorakhpur district.

They are absolutely right. Infrastructure needs to be strengthened at the primary level. What you can do is create more community health centers (CHCs), district hospitals and more encephalitis treatment centres (ETCs). We are working on that.

Is it the case that the one in Gorakhpur is not operational at all?

I don’t agree there. Since April we have been working on the existing ETCs and pediatric intensive care units (PICUs) in all 38 districts of UP. But this issue is not just about infrastructure, its also about cleanliness. We need to create infrastructure with the funds coming under National Health Mission (NHM) from the center. Unfortunately, the previous government has not made as much infrastructure, despite the funds they received. Since we came to government, the priority was not to open new centres but to ensure that the existing infrastructure is working. I’m quite satisfied we were able to do that. Statistics seem insensitive but statistics have shown BRD is receiving fewer patients than the past.

For encephalitis or in general?

For AES cases, pediatric cases. But still there are more than 2000-3000 patients who come. So if there’s a drop of 200 or 500 it doesn’t make much of a difference. But that is because the primary and secondary health sectors have been strengthened in the last 3 to 4 months. So the difference is not a big one but there is still a difference. We are realising it and it encourages us to strengthen the PHCs more.

When you say the previous government flipped, can you expand on that? What did they not do? And what have you done differently?

It is not my nature to criticise previous governments, but they haven’t done things. That’s the reason deaths are happening. If they had done something these cases wouldn’t be highlighted in this way at the Gorakhpur hospital.

I take that point but how will your government explain the fact that you have had three years and Yogi Adityanath has had five terms as MP from this very constituency, where we know it is endemic.  He has mentioned this issue many times in parliament, so he has not been blindsided by this. Of course the previous government can be blamed, but where should we fix responsibility on your own government and a five-time MP?

The constitution is very clear on this – health is a state subject.

There will always be MPs from parties which are different from the state government. They have (members of parliament local area development division) MPLADS funds and other tools to use.

Things don’t work like that. MPLADS cannot feed ETCs, PHCs and PICUs.

So what about the three years the central government has had?  

The centre can only provide the money. They can’t physically come and create a PHC on state government land. The center has done many things. I’ll give you a classic example- Life support ambulances. For two and half years it had been pending with the Akhilesh Yadav government. He didn’t want to take money for advanced life support ambulances because he was insistent that the Samajwadi Party name should come on it. The NHM scheme does not allow that. When our government came and I came as minister, within month and a half I used that money.

You are making a larger constitutional point. Are you saying a five term MP is powerless because there was a different party in power at the state?

Today the media and others are talking about AES and Japanese encephalitis (JE) in different states because of Yogi Adityanath. This is the structure of things. An MP does not build hospitals, pediatric intensive care unit (PICUs) or buy medicines.

In that case, what was within the chief minister’s power? At a press conference on this, he said the hospital’s surroundings are very dirty. Could this have been attended to?  

I can speak for what we are doing and what I am doing. The only way you can control this illness which plagues the 38 districts of UP and other states like Bihar, Assam, Bengal and also Nepal, is children are taken to the hospital within 24 hours of their fever and they start treatment. The treatment is not rocket science either – its simple medication and antibiotics. We need to create a better infrastructure with NHM money of CHCs, PICUs, ETCs. Thirdly, we need better training of doctors. This is being conducted by various NGOs which are under WHO. In the last four months we have focused on ensuring that trained doctors for these illnesses are posted in the 38 districts, especially the seven main districts like Gorakhpur. We have cancelled all their holidays within this period. We have ensured in these PICUs and ETCs that the ventilators are working. We have also done a massive programme on vaccination, because JE can be prevented at least. We vaccinated 93 lakh children in May and that has been a record – last year the rate of vaccination was only 55%. These are the positive steps we have taken.

As per the government’s statistics for UP, in 2016 UP experienced a big jump in deaths from AES and JE. But this year, as of August 8, there has been a big drop and this is fabulous – JE has only had three deaths all year so far, for example.

Going back to our earlier discussion. You mentioned that during the period of disruptions with oxygen, there were no deaths. So three days since, what is the cause of death then?

We came to the conclusion with the help of doctors. If there were deaths during the disruption, obviously we need to look in that direction. But there were no deaths in this time. What had happened was like this – on August 10 by 7:30 pm, there was a dip in the pressure of liquid oxygen. We are examining this. The system of replacing with oxygen cylinders happened immediately. This continued till 11.30 pm and when this got depleted, they went back to liquid supply although it was at low pressure. Manual supply was also being used by doctors, sisters and relatives. By 1.30 pm, cylinders came into stock and the supply chain was maintained. No deaths occurred in the period from 11.30 pm to 1.30 am. The last death was at 10.05 pm on August 10 and the next death happened on August 11 at 5.30 am. Therefore there was no indication that deaths took place because of low oxygen.

That’s a pretty clear statement.  

Secondly, there are more than 100-150 pediatric patients in the same ward. If oxygen was the problem, others would have suffered as well.

So between 7.30 pm on August 10 and 1.30 am on August 11 when oxygen regularised, how many children died?

Between 7.30 pm and 10 pm on 10 August, seven children died.

So if they were not related to oxygen, what was the cause?

Some deaths were due to natal problems, some due to liver failure, some AES.

Lastly, comparisons are being made to your grandfather, Lal Bahdur Shastri, who resigned after a railway accident on his watch. Are you considering resigning? What are your reasons?

My grandfather was the railway minister when the incident happened. I’m not the minister for medical education here. I don’t see any reason for him to resign either.

Is it the responsibility of the minister concerned to resign?

The fault is not of his department. There are deaths which are taking place regularly and the cause of the death is unfortunate but has been there for many decades. We are working towards eliminating and at least reducing these deaths.

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