Indian-administered Kashmir

After a GPJ investigation revealed hundreds of infants died at a government-run hospital, doctors are blaming a lack of equipment, particularly ventilators, as the primary cause. But a new report suggests staff absences and general negligence as additional causes.

SRINAGAR, INDIAN-ADMINISTERED KASHMIR – Mosquitoes, flying ants and houseflies buzz around inside Govind Ballabh Pant Hospital, a government-run pediatric hospital in Srinagar, the summer capital of Kashmir.

Bloodstains dot the floor.

Two babies share a single incubator, and three to four children share a twin-sized bed.

Parents helping out the overburdened staff cover their noses and mouths to block the pungent smell of phenyl, as a shabby cat makes rounds through the hospital rooms.

This is the only pediatric referral hospital where infants and children can obtain specialized health care in Kashmir. While thousands of patients still come from throughout the region in search of treatment, the facility is facing intense scrutiny.

More than 500 infants have died within its walls so far this year.

Farooq Ahmed, from the outskirts of Srinagar, says he is among the hundreds of unlucky families who lost their babies at the hospital this year.

Ahmed says he brought his 7-month-old son, Hudain, to the hospital last month. His friend, who is a doctor in the United States, had told him after hearing the baby’s symptoms that he was likely suffering from hepatic encephalopathy – a loss of brain function as a result of liver failure, which can lead to death if not treated promptly.

But when Ahmed tried to explain the potential diagnosis to a doctor here, he met resistance.

“I tried to explain this with a G.B. Pant doctor,” Ahmed says. “He said that I don’t need to dictate my son’s condition before him with arrogance.”

During his son’s four-day stay in the hospital, the baby received only glucose, not medication or a formal diagnosis.

“The most unfortunate thing is that my son was kept on ventilator without any proper checkup,” he says. “He was suffering, and nobody cared. I lost my son in cold blood.”

Ahmed says that when he tried to seek details about the cause of his son’s death from the hospital doctors, there were only medical interns available. He was told only that his son’s chances of mortality were high to begin with.

While the loss of Hudain has shattered Ahmed and his family, Ahmed is also haunted by the 13 other infants he watched die during his four days at the hospital.

Doctors cite a lack of equipment, particularly ventilators, as the main reason for the death of hundreds of babies at the hospital so far this year. In a new report, the government also recognized staff absences and general negligence as likely causes. Although some hospital staff members acknowledge this lack of care, others say they are overburdened at the only pediatric hospital in the state. The chief minister has announced plans to build another children’s hospital to alleviate the staff and facilities here. In the meantime, the death toll continues to climb.

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Students protest and demand accountability for more than 500 infant deaths here in 2012.

Aliya Bashir, GPJ Indian-administered Kashmir

Some parents must participate in administering medical care because of a lack of staff.

Families crowd into the facility, desperate for care despite the recent rash of infant deaths.

Conditions inside and outside the hospital are filthy. One new report cites unsanitary conditions as a reason for the deaths.

Families blame staff negligence for the death of their babies.

An infant uses one of just three ventilators in the hospital.

A grandmother carries her dead grandchild away from the hospital in May.

A family carries its dead infant away from the hospital.

After news of the 500th infant death here this year, students participate in a candlelit protest.

At a press conference last month, Manoj Kumar Dwivedi, state secretary of health and medical education, confirmed that 480 babies had died in the hospital since January. Dwivedi has submitted a seven-page report to the High Court of Jammu and Kashmir addressing the deaths at the hospital.

In the weeks since the press conference, that figure has already climbed to 512 dead infants, says a hospital official, who declined to be named for fear of being fired.

Dwivedi said his report came in response to a public interest lawsuit filed by civil society activists. The lawsuit urged the High Court to direct the government to investigate the exceptionally high rate of infant deaths in the hospital and also to seek compensation for the victims’ families.

Among other observations, Dwivedi’s report noted the need for infrastructure and equipment upgrades. For example, he found only six ventilators in the hospital, which serves some 30,000 patients per year.

But various hospital employees say the situation is actually worse than the report suggests – alleging that there are only three ventilators available. 

“[The] majority of the death[s] are due to the lack of ventilators,” says a doctor at the hospital, who declined to be named for fear of being fired. “In almost 98 percent of the deaths, asphyxiation has been the prime cause. The premature babies need artificial breathing support over a period of time [until] they get stronger.”

The doctor says requests for more ventilators have been fruitless.

“We have raised the issue of ventilators before the authorities many a times, but of little avail,” the doctor says.

Almost 70 percent [of] baby deaths in the past six months were witnessed in the ICU without supervision of any senior resident doctor posted in the unit.

Even after the report revealed the lack of proper breathing care, Global Press Institute witnessed a hospital employee openly administering oxygen to a newborn through a tube tied to a cylinder with untidy tape and cotton. There was no monitor to regulate the flow of oxygen.

Nearby, a few parents pumped saline vapors into their children’s mouths, while other children waited their turn.

“Due to the lack of paramedics, we have been assigned different tasks, and we are bound to do things [on] our own,” says Gulzar Khan, a parent with a child in the hospital. “We sometimes fear that we might fail to manage things as per requirement, but we are helpless.”

Other reasons cited for the infant deaths include substandard medication, lack of equipment use and even gross negligence by hospital staff.

Earlier this year when authorities made a surprise visit to the hospital, at least 65 employees were absent from duty throughout the hospital. The authorities recommended docking their pay for the day.

“Almost 70 percent [of] baby deaths in the past six months were witnessed in the ICU without supervision of any senior resident doctor posted in the unit,” says a junior doctor at the hospital, who declined to be named.

He also cites substandard medication from nonreputable companies and lack of equipment use as reasons for the infant deaths.

Irtifa Qureshi, a children’s rights activist, calls the infant deaths a human rights violation.

“The collapse of the public health system is to blame,” Qureshi says. “These shocking figures [are] reflective of how precious lives are being wasted. Government need[s] to strengthen infrastructure for providing quality health care to everyone.”

Qureshi says that lower-income families often suffer the most.

“Private sector has grown significantly, but that is inaccessible to a large population,” she says.

The 140-bed hospital receives 300,000 infants and children annually, admitting 30,000 of them last year and providing outpatient services to others, says an employee at the registration desk, who declined to be named because of a lack of permission to speak to the media. Many patients admitted in the hospital are from remote areas of the state.

The collapse of the public health system is to blame. These shocking figures [are] reflective of how precious lives are being wasted.

But knowing just how many patients come from rural areas is difficult. Hospital records are in shambles, according to a report conducted by Dr. Showkat Ali Zargar, director of Sher-i-Kashmir Institute of Medical Sciences. The government chose Zargar to investigate the infant deaths.

His findings were presented at a press conference earlier this month. His report documented the patient mortality rate in the neonatal intensive care unit at more than 20 percent – double the normal average.

Zargar’s report blamed high-level hospital personnel for the deaths, namely Dr. Javed Choudhary, former hospital superintendent. Choudhary has since been removed from his post, while other high-level specialists have been moved to another local hospital.

One renowned child specialist and two senior pediatricians at the hospital were moved to Lal Ded maternal hospital earlier this year. Some say this unprecedented move is to shield them from blame.

“It is just a conspiracy to save their skin so that until the issue will boil down, they’ll again rejoin,” says a senior doctor at G.B. Pant Hospital, who declined to be named for fear of being fired.

Others say that regardless of the motive behind the move, it has rendered the three hospital units that they headed almost defunct.

Dr. Muneer Masoodi, the newly appointed medical superintendent of G.B. Pant Hospital, told reporters at the May press conference that one person could not be blamed for the surge in the infant mortality rate.

“It is a Herculean task to attend [to] every patient,” he said. “We receive almost 95 percent of infants from remote villages like Ramban, Uri, Banihal, etc. Most of them are in the various stages of infection and malnutrition. They have to travel long distance[s] to reach here as they don’t have specialists in their villages. Most of the cases usually come here with various complications with minute chances of survival.”

But Masoodi’s explanation has not pacified the outcry here. Advocates and families say they want more accountability.

“[Until] now, no infant death was reviewed for rectification of grounds,” says a hospital administrator, on the condition of anonymity. “Only some of the medico-legal cases in the hospital, which is registered in police stations or courts, gets some limelight.”

Sumeer Kaul, a renowned oncologist who was in the Kashmir Valley to hold a camp to treat women with cancer and is also the national spokesman for the People’s Democratic Party, says he was shocked to learn of the newborn deaths.

“The deaths are [the] equivalent of genocide,” he said in a phone interview. “Unhygienic conditions in the hospital were responsible for many of these deaths. Lot[s] of government hospitals have been buying huge amounts of equipment and not on developing any kind of accountability.”

A lack of neonatal care at district hospitals leads to an overburdening of G.B. Pant Hospital, where pediatricians are unavailable after 4 p.m., according to the Doctors Association Kashmir, an organization of doctors in Jammu and Kashmir.

“The government forces the doctors to do the deliveries at district and subdistrict hospitals without having any neonatal facilities,” said Mir Mushtaq, spokesman for the organization, during a phone interview. “They are referred to the hospital at most of the times in critical conditions, thus resulting in increased mortality.”

Others blame the budget.

Staff salaries account for nearly 70 percent of the annual hospital budget, which totals 130 million rupees ($2.3 million), according to hospital records. The remaining budget is divided among medicine and equipment, utilities and building maintenance.

“Due to the poor budget, the patients do not get the expected care,” says another hospital official, who declined to be named for fear of being fired. “But most of this expenditure is being spent on the salaries of thousands of employees and other wages.”

Others say the budget is fine, but administrators misspend the funds.  

“The funds are sufficient at the hospital, but they are not properly utilized,” says Manzoor Bhat, who works in the hospital’s laboratory. “There is no quality training provided to the staff, as they lack any proper education. Most of the doctors are busy with their private practice.”

R.S. Chib, the state minister for medical education, announced during a high-level review meeting a slew of measures to streamline the functioning of the hospital.

“I have directed for adequate security, renovation of toilets and lifts,” he said. “There will be strict procedure for attendants as well. I have also released funds for buying more ventilators, trolleys and beds.”

By press time, no new equipment had been purchased.

Chib said the hospital had already shown a tremendous improvement, despite the additional 32 infants who have died here this month.

As public outrage continues to mount, Omar Abdullah, chief minister of Jammu and Kashmir, who visited the hospital in May, says the government will soon set up a new children’s hospital with a 200-bed maternity wing in Srinagar. Abdullah says the establishment of two additional hospitals will resolve the distance problem that was hampering immediate care for infants.