OPINION
BEYOND RAGE
The Gorakhpur Dead Speak to Punjab
- Awagyakrit Singh
The Gorakhpur Dead Speak to Punjab



BETWEEN AUGUST 7 and August 11, 60 children died in Gorakhpur's BRD Hospital. On the single night of August 10, 23 children died. This is the night when the oxygen supply allegedly dried up. On two days of Aug 29 and 30, 42 kids died in same hospital. At BRD Gorakhpur, the month of August saw 290 children dead— 213 in NICU, 77 in the encephalitis ward. 
 
A few days later, it emerged that 49 children died in the same one month at Ram Manohar Lohia (Mahila) Hospital in Farrukhabad, allegedly for the same reason. As a leading sociologist and public intellectual has asked, have we become a "nation without common decency, common practicality and basic compassion?”
 
Why else will a TV anchor shriek that we should not speak about the Gorakhpur dead and instead speak about "real issues” like Vande Matram?
 
The point, however, is to speak not just about the Gorakhpur dead, but to go beyond it. The worst sin that we can commit is to limit our rage to Gorakhpur.
 
The fact is that a Gorakhpur is waiting to happen any day in some hospital in Punjab.
 
I vividly remember the day when five infants were burnt alive at Patiala's Neonatalogy Unit of the Government Rajindra Hospital in 2009. It was attributed to an electric short circuit. The fact is that 10 newborn babies in incubators had no one watching over them on that 31st day of January. I distinctly remember the calm unruffled demeanour of the then superintendent of hospital Dr Surinder Singh telling scribes that "it was an accident and nothing more should be read into it," and the journalists dutifully reporting his statement in next day's newspapers. Readers are welcome to google it.
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We need to not only speak about the Gorakhpur dead, but to go beyond it. The worst sin that we can commit is to limit our rage to Gorakhpur or Farukhabad. The fact is that a Gorakhpur is waiting to happen any day in some hospital in Punjab.
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That is exactly what happens. A tragedy happens at Gorakhpur. We bemoan it, are even sad about it, at times full of rage, sending each other messages, spreading awareness. And all this while, conditions in the medical facility in our neighbourhood could be even worse. 
 
In endless government hospitals and lesser facilities, you can still see electrical fittings almost designed to invite disaster. The sorry state of affairs in medical domain, of course, goes much, much beyond poor electrical cables to scarcity of oxygen cylinders. Stories of loot by private hospitals abound, people invariably believe, and with good reason, that hospitals often do not even inform relatives about the death of an in-patient and treatment continues for a couple of extra days just for some pecuniary gains. The glass gates barring patients' relatives from seeing their sick loved ones make little sense to those who watch medical dramas like ER or Grey's Anatomy. "Would Shonda Rhimes not have known about such glass barriers?" they wonder. 
 
Look carefully at this picture of Bahadur Nishad, holding his son Divaker, 2, and his wife Nandini cradling, instead of their 4-yr-old son Deepak, just his picture. Deepak died in the Intensive Care Unit of the Baba Raghav Das hospital in Gorakhpur district 48 hours before Prime Minister Narendra Modi laid out his plan for re-imagining a New India. 
 
Read the picture: It is a family that official India does not consider poor. Study their possessions, one by one. That big drum: it has grains, the survival lifeline. See that cot, its condition much like much of India's though sarkaari ads on I-Day paint a different picture. Unplastered walls, untiled floor, all worldly possessions hanging from the nails hammered into walls. You can see their world because there is electricity - that solitary bulb. When floods come, the scene changes a little, but why disturb you further? If you have a heart, it should be broken by now.
 
If we had a heart, we would have shouted and shrieked ourselves hoarse about the state of medical care in Punjab. We would have do so much, much before those children were burnt alive. We would have been doing so much after those deaths in Gorakhpur. More than that, we would have engaged with national health policies in a manner befitting of people who care about small kids in Gorakhpur, or anywhere.
 
Pratap Bhanu Mehta has asked if India at 70 is too late to recover its own humanity. A clue to the answer to that will be in another query - how much is India talking about the health of its citizens?
 
Economists Jean Dreze and Amartya Sen have underlined that health occupies an insignificant part of democratic reasoning and discussion in India. This despite the fact that India does poorly even in South Asia on health-related parametres, and even falls behind Bangladesh.
 
In their 2014 book, An Uncertain Glory, they reported after monitoring the opinion pages of India’s largest English dailies in the second half of 2012, that only 1% of the articles – yes 1% – were about health. 
 
Even when health reporting increases in quantum, it is either episodic, as in case of Gorakhpur or Farukhabad, or about insurance scams or drug prices or life-style diseases like obesity. 
 
Why is there is so little interest among journalists and activists in the region about aspects of the new National Health Policy? Public interactions like the one organised by Jan Swasthaya Abhiyan and other groups recently in Chandigarh are exceptions that merely underline the lacuna.
 
As for the politicians, they have successfully inoculated us of any humane response. Kids burnt to death in Patiala? Badal government chor hai. Infants died dead in Gorakhpur? Yogi Adityanath ka kasoor hai. You opt for some expert-talk and watch TV debates but find that officials and ministers are busy chastising opposition leaders for seeking to politicize the issue. 
 
Make no mistake – they are ensuring that more will die next time around, and that our anger will be subdued because the novelty of this kind of pain is gone. Remember when farmer suicides made it to headlines initially? Watch the same headlines now, and you notice the normalisation. A few days of media headlines turns the unspeakable into the expected, and even acceptable.
 
Where is the debate about why India@70 can afford to have encephalitis claiming hundreds of lives every year without losing its standing globally? 
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Remember when farmer suicides made it to headlines initially? Watch the same headlines now, and you notice the normalisation. A few days of media headlines turns the unspeakable into the expected, and even acceptable. No wonder, India can afford to have encephalitis claiming hundreds of lives every year without losing its standing globally.
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Gorakhpur's dead children want you to go back to the drawing board. 

* India spends about 1.4 % of its GDP on public health, among the lowest in the world. The world level norms are 5-8 %. The target India has set for 2025 is to spend a mere 2.5% of GDP.
 
* Punjab's health spend on salaries is far more than on healthcare

* The recent reports on health and healthcare in Punjab, released by Tata Memorial Centre (TMC), Mumbai and PGI, Chandigarh have pointed to people dying due to late diagnosis of diseases like cancer.
 
* PGIMER and Public Health Foundation of India have said 77% of expenditure on health was being borne by households and individuals, with government’s contribution a mere 20%. 
 
* People are dying not because treatment is not available, but because they cannot afford it. 
 
* People are being pushed into poverty because of high health related expenditure. A total of 63 million people are pushed into poverty every year because of excessive out-of-pocket expenditure.
 
* If people in Chandigarh can visit government hospitals, why do people in Punjab avoid them? 
 
Even a little active interest evinced by a minister triggers action. Punjab's Health Minister Brahm Mohindra recently ordered a probe into Rs 6.28-crore purchase of Iron Folic Acid (IFA) tablets. The minister was candid enough to admit that the stock was clearly purchased for the sake of commission.
 
Brahm Mohindra's recent admonition to officials of 11 government departments for their "non-serious” approach in fighting dengue, chikungunya and other water and vector-borne diseases should have made is sit up and take note. This is when deaths are prevented, an epidemic is stopped.
 
It is time for us to seriously engage with National Health Policy 2017, the third such policy since India became Independent. It does little to regulate drug pricing, hospitalisation charges and frivolous charges. It acknowledges corruption in the health sector but explains little what is being done to regulate it. It advocates involving the private sector to meet public health goals, and devolves the government of its duty to provide health to all. The policy's intent is to promote private health industry for closing critical gaps in health care.
There are serious questions of regulation of clinical establishments or medical councils.
 
The dead kids in Gorakhpur cannot talk. We can. The Gorakhpur dead would want us to. Silence will be collaborative.

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