A community health centre (CHC) without a specialist and no provision for emergency services; a primary health centre run by a pharmacist unqualified to treat patients; a sub-centre that operates only once in a month — these are some of the places that failed the sick children who later died at the BRD Medical College Hospital here last week.
Beginning with the families of four children who died on August 10 and 11, The Indian Express traced their individual journeys back to their villages — to find how dysfunctional health centres slammed their doors on them.
# Harnahi Community Health Centre (CHC), 35 km from Gorakhpur, should provide, as per government guidelines, “essential services” including “emergency care” in surgery, medicine, obstetrics and gynaecology and pediatrics. But none of these services is available. The Operation Theatre (OT) is closed. Reason: no specialist doctors.
It was here that on July 31, that 29-year-old Vinod and wife Kanchan, nine months pregnant, came knocking. “The nurse called us inside after a while. She looked at the condition of my wife. And then she told us that they did not have the facilities to deliver the baby and asked us to go to a private hospital. When we asked why, she said they don’t have a doctor,” says Vinod.
Vinod, who works as a security guard at a hospital in Gurugram, lost his newborn on August 10 at BRD Medical College Hospital. The newborn was rushed to the government hospital after the private nursing home, where he was delivered, did not have an ICU. “We went to the CHC thinking that they could deliver the baby but they delayed treatment,” says Vinod, showing test reports from a Delhi hospital that showed both mother and foetus were fine.
At the CHC, the staff nurse who saw Kanchan, said on the condition of anonymity, that there is no gynaecologist there since 2014, just three MBBS doctors. “Our specialists were transferred. We have no doctor for emergency cases. Only normal deliveries can take place here,” she said. “We are supposed to provide neonatal services. However, there has been no appointment…we don’t have ventilators so we don’t admit serious cases.” Clearly, Kanchan’s was a serious case.
Asked about the closed OT, a doctor at the CHC said: “I have heard there was an orthopaedic specialist who conducted minor surgeries. But now this OT mostly remains shut.”
# 28-year-old Bahadur, lost his 4-year-old son Deepak on August 10 at BRD Hospital. A day earlier, when his son complained of fever and breathlessness, he went to two clinics — both shut. One, a private clinic in the forested Ekla village; and, two, the government-run sub-centre near his home.
This sub-centre is the first contact point between the primary health care system and the community. It is required to be staffed by an Auxiliary Nurse Midwife (ANM), a female health worker and one male health worker. However, only the ANM visits the centre and that, too, only on the first Monday of every month.
It is locked throughout the month and has no “health worker” at the unit. “The ANM gives polio and vaccine shots. The rest of the time, this is usually shut,” says Mewati who keeps the keys to the centre. Norms say this sub-centre should have one health worker but three years on and there is none.
“There is a bed and a stretcher, we are told that the health worker will be coming. But we have not seen anyone,” says Ramagnya who lives near the clinic. Sanitation services are mandatory at the centre but both the toilets inside are broken.
# For the past three days, 40-year-old Ramesh Yadav and his wife have not stopped crying. The Primary Health Centre at Devarpar is visible from their house but it was of no help when their 12-year-old daughter Vandana needed it. The centre has no doctor and is run merely by a pharmacist.
Ramesh was on his way to Delhi to try his luck at a job of a labourer — his joint family of 20 living in a thatched-roof house have very little means to make their ends meet. But he had to return.
“She has been murdered. There is no doctor at this centre for years now. Doctors cheated us at BRD also. If we were told that there was no oxygen, we would have taken her elsewhere,” says Mani Lal Yadav, the 60-year-old grandfather.
Suffering from high fever, Vandana was taken to BRD hospital on August 10, travelling for two hours. “Nothing could be done at the PHC, she started having convulsions on the way,” says uncle Umesh Yadav, who rushed her to hospital. He said that by the time she reached the hospital, she had difficulty breathing and was admitted to ICU, where he was handed over an Ambu bag to pump oxygen into her.
“We were not the only ones. Others were doing the same for hours. I did not know what it was but was told to pump it. I did so for about three hours,” said Umesh, “Ilaj karana hai to power aur paisa dono hona chahiye aur humare paas dono nahi tha.”
A visit to the PHC revealed that A K Mishra, who was treating patients and giving medicines there and was being referred as “Doctor sahib” was not a doctor. He was a pharmacist and has been running the centre for months. The health centre has an OT, two wards, immunisation room but all these are defunct because there is no doctor. “I give only general medicine. Three days back an AYUSH doctor was posted here but he has gone on leave”, said Mishra.
# 28-year-old Neeraj Tiwari and his 26-year-old wife Reema lost their 12-day-old child Tushar on August 10 at BRD college. They live about 40 km away in Malongaon village. Their baby was born on July 29 at a neighbouring health centre in their village. Two days later, when the child had difficulty breathing, they took him to Kauriram Primary Health Centre hoping to get better facilities. “The doctors there told us to take our child to the medical college for better care. We rushed in an ambulance. There, except for August 9, when Yogi ji was coming and cleaning was done three times, there was no one to listen to us. We were asked to bring medicine from outside. We wanted to speak to the CM but doctors asked all the attendants to go to a ward upstairs saying that it was for security,” says Reema. Her child died on August 10.
Meanwhile, at the Kauriram Centre, the Encephalitis Treatment Centre looks well-equipped — new towels and medicine neatly kept in a tray are on display. Ajay Singh, the doctor on emergency duty, said that about 150-200 patients are seen in the OPD each day by two doctors posted here. He said he was unaware of Neeraj and Reema’s case and added that since this is a PHC, there were no pediatricians there.
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