Where newborns go from cradle to grave

A mother holding her baby inside the general ward of the paediatrics department at the J K Lon Hospital in Kota, Rajasthan. The kin of patients wait outside the hospital, which is being renovated. (Credit: DH Photo)

For Sanjay Rawal and Padma Rawal, who reside in the Chattarpur area of Kota, visits from politicians and media have become a routine affair since the fateful night of December 23, when the couple lost their five-month-old son, Tejash. 

Tejash died of severe pneumonia at J K Lon Hospital, a day after he was brought to the single largest facility in the state’s Hadoti region. Kota is a major city in the region. The Rawals suspect that if not for the laxity and mismanagement at the hospital, their son’s death was preventable. 

“We came here as we couldn’t afford treatment at the private hospital. But now I’m cursing myself as our two-night stay at the hospital was a nightmare. Water leaked over our bed and the hospital staff refused to change it, initially. The washrooms were in a bad state, and there were flies swarming inside,” said Padma.

READ: Over 10,000 newborns die every year in Karnataka

“We were also forced to share one bed with three other mothers in the emergency ward. Later when my son was moved to intensive care unit, there was hardly anyone to fix the oxygen pipes. Moreover, there were no warmers provided for us. During the night hours, only one medical assistant (compounder) was available. No doctor or nurse would ever come to see the patient,” complained Padma, who had lost her firstborn in 2013. 

The story of the Rawals was highlighted as Tejash was among the 10 kids who died within 48 hours between December 23 and 24.

This spate of infant deaths at the hospital was firmly put under the scanner of the national media four days later when Kota MP and Lok Sabha Speaker, Om Birla, tweeted and highlighted the issue and even tagged the Rajasthan government while seeking serious action in the matter.

In response, the Ashok Gehlot-led government in Rajasthan swung into action and sent Health Secretary Vaibhav Galriya to survey the situation, found several flaws in the hospital during the initial investigation.

ALSO READ: India accounts for 14% of global newborn deaths

It soon emerged that over 100 children had lost their lives in the same hospital in December. Over 950 babies out of the 16,892 babies admitted died in the hospital over the year, marking a 5.7% rate of fatality. 

Infant deaths in the past month have propelled the country’s coaching capital to infamy over alleged medical negligence.

However, according to data from Kota district collector Omprakash Kasera and the hospital superintendent, the number of infant deaths at J K Lon Hospital has witnessed a constant decline since 2014, when 1,198 deaths were recorded, which was 7.6% of the 15,719 admitted, The percentage declined to 7.2% in 2015, 6.6% in 2016, 5.9% in 2017, 6.1% in 2018 and 5.7 %, the lowest, in 2019.

In Bikaner, 162 infants died in the PBM Hospital in December. The hospital recorded 1,681 deaths of the 25,876 kids that had been admitted in the hospital in 2019.

In the light of casualties in J K Lon Hospital, a report prepared by S N Medical College over infant deaths in Jodhpur also assumed significance as it revealed that 146 infants died in Umaid and MDM hospitals in Jodhpur in December; 102 deaths were reported in the neonatal intensive care unit itself. These hospitals maintain that the deaths were due to natural causes. Official reports on the infant fatalities in these hospitals are pending.

But the initial reaction by the Chief Minister failed to douse the political firestorm and invited more backlash as his comments were instead seen as an attempt to normalise the situation.  

“Death of even one child is unfortunate but there were 1,400-1,500 deaths in a year in the past; this time the figure is 900. There are a few deaths [every day] in every hospital in the state and in the country. Action is being taken,” he said. The response betrays the experience of other patients like the Rawals who also complained about the lack of equipment, staff and infrastructure in the hospital. 

Interestingly, a visit to the J K Lon Hospital revealed it to be under a sudden makeover. Painters, masons and repairmen are giving the hospital a facelift. Authorities are busy directing the revamp — clearing electrician’s dues, instructing toilet repair, and taking stock of ongoing repairs from the staff over the phone. All this hustle-bustle in the hospital materialised only IN the past 10 days.

Caregivers in disarray
According to insiders, the condition of the hospital worsened after the head of the paediatrics department and the superintendent were changed in 2017. A tussle between the newly appointed head of the paediatrics Amrit Lal Bairwa and the superintendent H L Meena is said to have affected its maintenance, especially that of equipment installed in the hospital’s
critical care units. According to Dr Suresh Dulara, the hospital’s new superintendent, a dip in the weather aggravated the condition of pneumonia patients. “Most of the cases in the hospital are referral cases.

They come in a critical situation. However, there is a shortage of staff. The cold weather has also been a huge cause,” he said, adding that patients come
fromBaran, Bundi and Jhalawar(100-150 km away) to the hospital for treatment. In its initial report on the deaths, dated December27, the paediatrics department wrote that most of the equipment were functional and none of the patients died due to the lack of resources. However, the same report mentions that there was a lack of warmers and equipment, shortage of
oxygen lines, which ended up at risk of infection after patients were provided cylinders inside the neonatal intensive care unit. The report also pointed out that of the 533 equipment, 320 were not functional for want of annual maintenance contract.

ALSO READ: Infant deaths - Malnutrition, late diagnosis major causes

The facility-based newborn care guidelines recommend each special neonatal care unit maintain four beds for every 1,000 deliveries per year. The J K Lon Hospital administers about 9,000 deliveries a year but has only 12 beds. Taking cognizance of the reports published in the media, the government Medical College in Kota is now planning to double J K Lon’s bed capacity from existing 157 to 313. Principal and controller Vijay Sardana confirmed that the hospital is preparing a proposal of adding another 156 beds, which include 90 general ward beds,36 in NICU,and30 in paediatric ICU.

Dr Suresh Dulara said an audit committee, comprising the heads of paediatrics and gynaecology departments, had been formed to give the report to Kota Medical College principal on cases of all infant deaths. Damage control The Congress government has been under steady fire from BJP leaders, BSP leader Mayawati and celebrities over alleged negligence and mismanagement. Two days after Ashok Gehlot’s comments regarding a marked decline in infant deaths, Deputy CM Sachin Pilot said that the government should tackle the situation instead of blaming the previous government.

He also said that the leadership in the state had to“face responsibility and consequence However, none has been taken to task so far. Congress president Sonia Gandhi has also sought a report from the government. Meanwhile, the state health minister Raghu Sharma blamed the previous BJP government for the sad state of the hospitals. “In 2017, the medical administration had sent a requirement of 300 beds to the then government. But no approval was granted. In 2015, Rs 8 crore was sought to make this hospital well-equipped, but again no approval was given. In 2016, this hospital had asked for Rs 9.25 crore, but it didn’t get a single penny. In 2017, Rs 20 crore was asked, but approval for that, too, was not granted,” rued Sharma.

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