Do we let our newborns die over Rs200?

Words are dual-use weapons. They reveal as much as they conceal. They can be used to obfuscate or illuminate. Last week, a four-day-old girl died in the Jalandhar civil hospital, Punjab. She was born prematurely, showed symptoms of jaundice, and was put on phototherapy, typically used to deal with neonatal jaundice.

The hospital staff demanded that the parents cough up Rs200, ostensibly as running cost of the equipment. The family did not have the money. The newborn was taken off the life-support system. Soon after, she died.

The news sparked revulsion across the country. The grieving parents, and many people who read about the incident, wondered if removing the life-support system had caused the baby’s death.

As I write, the preliminary report into the death of the newborn is in. The probe panel has come down heavily on the hospital staff, but the report rules out any link between the baby’s death and her being taken out of the phototherapy unit.

That settles one thing. Now, we know what the baby did not die of. However, many questions remain. Why did the baby die? We are no wiser. Could the baby have been saved? Were there critical delays which led to the death? Was the death merely ‘unfortunate’ as Punjab’s health and family welfare minister Madan Mohan Mittal put it?  Does the word ‘unfortunate’ dilute culpability by seeking to define the incident as a tragedy that is regrettable but something where the fault lines of responsibility are blurred? Do words and phrases matter when there is a tragedy?

A baby is dead. We need to know why. In all such deaths, there is clinical reason. But equally important are other factors — acts of omission and commission — which cumulatively can lead to a fatality. Both are equally important.

From what we know, while the baby was in a critical condition, a staff nurse was busy harassing the parents about paying money for use of the phototherapy unit. The nurse has now been suspended. As we know, all too often, suspension achieves little unless systems are put in place, and monitored regularly to ensure that there is no repeat of such sordid behaviour.

Back to questions. Who took the decision to discontinue phototherapy and why was it done when it had earlier been considered medically necessary for the baby? How is it that no one in a government hospital in a city like Jalandhar appears to have even been aware of the existence of the central government sponsored Janani Shishu Suraksha Karyakram, which provides for all such services to be given free of cost in public hospitals.

What does this say about the level of awareness of central schemes, and about coordination between the states and the centre?

India leads the world in newborn deaths. The harsh truth is that, despite all the platitudes and policies, the risk of dying continues to be unequal in this country. Imagine, for an instant, what would have happened if the dead baby had been the child or the grandchild of a minister, a senior bureaucrat, someone rich and well-connected, or people like us? Given exactly similar medical conditions, would the hospital staff have dared to behave the way they did?

Last December, during a visit to the Bharawan primary health centre in Hardoi district in Uttar Pradesh, I saw a dog foraging in the trash can in the maternity ward. A few feet away, a young woman swathed in a blue shawl sat on a cot, staring impassively at the wall. The worn-out blanket that draped her legs and the crumpled bed sheet on her cot were her own. The young woman had delivered a baby girl the night before. It should have been a joyous occasion for the young mother and the family. But the baby died in the early hours of the morning. Was it hypothermia? What went wrong? Was it callousness or criminal neglect? There too, the family was too poor, too powerless to wrest an answer from the medical staff.

There are schemes. There are statements. Every time something goes wrong, there will be expressions of regret. But till we start using the right words and asking the right questions to throw light on a problem instead of covering up, little will change.
Whose baby is it any way? It matters to know.

The author is a Delhi-based writer