Maternal, Neonatal Deaths In Barwani District Hospital
By Abhay Shukla , Indira Chakravarthi & Rinchin
05 January, 2011
Countercurrents.org
Mass protest against maternal deaths in District Hospital, Barwani
On 28th December 2010 a rally was held in Barwani town, the headquarters of a predominantly adivasi district in south-western Madhya Pradesh (MP). Nearly a thousand people gathered under the banner of Jagrit Adivasi Dalit Sangathan (JADS) , a mass organisation, to protest against extremely negligent treatment of women in pregnancy and labour, particularly the recent death of Vypari bai on the 29th November 2010, a 8-months' pregnant woman admitted in the District Hospital (DH).
The people who had come for the rally on 28th December from far-flung adivasi villages of the district, were seeking to protest against extreme callousness and ill-treatment regularly meted out to women in pregnancy and labour by the public health system, particularly the District Hospital. A quick perusal of the DH records indicated that between April-November 2010 there had been 25 maternal deaths, and 9 maternal deaths have been recorded in this hospital in the month of November 2010 alone . In addition, deaths of 21 neonates (within 24 hours of birth) have been recorded, related to 511 deliveries conducted in the hospital during November 2010. People complained that women with problems during pregnancy and labour were frequently referred to Indore Medical College Hospital , located 150 kms away, despite the DH being supposed to deal with such cases.
The tragic story of Vypari bai – ‘institutional death' instead of ‘institutional delivery'
Vypari bai, a 22 year old woman had travelled over 55 kms from her village Ban since the morning of 27th November 2010 to reach the District Hospital, having been referred from the PHC at Bokrata, and then from the CHC at Pati. She had been carried in a ` jhuli ' (cloth sling) over the first 10 kms from her village to Bokrata, from where the family managed to get the Janani Express ambulance. She had experienced a convulsion that morning, and had high blood pressure and eclampsia at the time of admission in the DH around 1.30 pm on 27 th November.
Following her examination by a gynaecologist at the time of admission in the DH on 27 th Nov., she was visited only once by another doctor during the entire day on 28 th Nov. She had been prescribed medicines after admission to control her BP, but her treatment sheets show only two measurements of BP during the entire stay from 27 th to 29 th Nov. No attempt seems to have been made to deliver the baby, by either induction or cesarean, as is the standard procedure in such cases . An ultrasound scan on 28 th Nov. (for which the woman was taken by auto-rickshaw to a private centre even though the hospital has this facility) showed the presence of live foetus.
It may be noted that the mother and mother-in-law of Vaparibai are both trained health workers who are presently working as ASHAs. The mother-in-law Dunabai in desperation attempted to contact the gynaecologist, who never turned up to see the patient in spite of repeated pleas from the patient's relatives. Moreover the doctor on duty, after checking the patient only once on 28th, was also absent from the hospital premises. After repeated efforts to contact her, at late night at around 11 pm on 28 th Nov., she instructed the on duty Nurse that the relatives could take the patient to Indore , but did not bother to examine the patient or modify the treatment.
Both the block CHC and Barwani DH are CEMONC centres, and the DH is equipped with a Blood Bank. The DH has four gynaecologists and two anaesthetists who could have ensured Vypari bai's delivery, or if they were not available she could have been referred under the ‘Janani Sahayogi yojana' to one of the two local private hospitals. However, the case paper shows that nearly 35 hours after admission, the patient had been referred to the medical college hospital in Indore (150 kms away) at around 11 PM on 28th. Further, the family was asked to sign an undertaking, stating that they were refusing to take her to Indore and they took responsibility for the consequences of this action.
When the family went to the doctor's residence (which is within the hospital premise at a stone's throw from the ward) on 28th night to ask her to attend to the woman as she was in great pain, the doctor refused to go, saying she would phone the instructions to the nurse. The young woman finally breathed her last, without medical attention despite being admitted in the District hospital, at 5 am on 29 th November 2010 .
Demanding Accountability for Negligence
We, the undersigned public health researchers and activists, had read the report of this death and several other cases, and were visiting Barwani to get a first-hand account of the situation there concerning health services, particularly in the District hospital. On 28 th Dec. morning when we tried to meet the CMHO and the concerned lady duty doctor (who happens to be the CMHO's daughter) we were told that they were out of town. The gynaecologist who had admitted Vypari bai on 27 th Nov. said she had anemia and eclampsia and was not in a condition to be operated upon; and that they did not have a ventilator in the hospital. This gynaecologist was not around the day after admission (28 th Nov.) to monitor the progress; she is usually out of the hospital four days of the week performing sterilization operations in FP camps.
We observed the rally that was being organised outside the DH on 28 th Dec. About 500 people (nearly half of them women) had gathered at the entrance of the DH at around 12 noon , by which time the OPD was almost over. The 2-3 doctors present there left when they heard the rally approaching. The police tried to snatch away from the rallyists their microphone and the cart on which it was placed; however the rallyists managed to convince them that they would leave very soon. About fifteen minutes later the people moved away from the hospital premises and continued their dharna on the road in front of the Collectorate office, well away from the DH. Several activists and ordinary village women, including the mother-in-law of the deceased woman spoke of their travails at the DH. A set of 22 issues concerning the District hospital, which were mentioned in the set of demands, were read out to the assembled people. The Civil Surgeon was asked for, but he refused to come out to receive the petition; finally the ADM came and just gave a brief assurance that the issues would be responded to in writing in 15 days time. By around 4 PM the rally had dispersed.
It needs to be mentioned that the pilot phase of Community-based monitoring in MP under NRHM had been implemented in Barwani during 2007-08. Even prior to this the mass organisation JADS had been actively addressing the health problems in the area in several ways. In May 2008 a three-day programme of monitoring of services at the CHC Pati and dialogue with health officials was followed up with a rally at Barwani town on the dismal state of health services in the District hospital. So the area has a history of peaceful rallying for improvement of rural health services. However, there seems to have been hardly any concerted response from the administration to address the problems raised by the people regarding the District hospital.
Response by the administration – ‘ignore the message,
crack down on the messenger'
We met the Collector on 28 th Dec. evening after the rally and apprised him of the state of affairs in the DH. It emerged that the process of carrying out maternal death reviews since April 2010, as stipulated by the Union health ministry in February 2010, had not been carried out in case of any of the 25 maternal deaths. During our meeting with the Collector, the CMHO and CS came when they were summoned. According to the CMHO such maternal deaths keep occurring, that women here were very anaemic, and it was ‘not possible to bring them down to zero'. When pointed out that the DH was a CEMONC centre, that there were 4 serving gynaecologists and 2 anaesthetists, and it was enquired why such institutional deaths were still taking place, there was no satisfactory response. The Collector appreciated our bringing things to his notice, and said he would initiate the task of Maternal Death Reviews. At the same time, he also hinted at linkages of the mass organisation with ‘Bastar' and ‘Andhra Pradesh', thereby seeking to taint the people's organisation as being associated with ‘Naxalites'.
We are now extremely shocked and dismayed that two days after this rally (on 30 th Dec.) as per local press reports, the police has foisted several charges on the leaders of JADS and 200 people participating in the protest. They have been charged with Sec 146 of IPC (unlawful assembly, rioting, armed with deadly weapon which when used is likely to cause death), Sec 186 IPC (obstructing public servant in discharge of public functions), and Sec 16(3) of MP Kolahal Rules. Yesterday (31 st Dec.) one of the activists of the organisation, Bachhiya bhai, has been arrested and has been sent to jail on charges that were slapped on him and others in 2008. It may be noted that Bachhiya bhai and other JADS activists had at that time protested against a case of denial of services in PHC Menimata, where the PHC expelled a woman in labour apparently since she did not pay the illegal ‘charges' demanded, and she had been forced to deliver on the road in front of the PHC.
We wish to draw attention to the grave situation that seems to be building up in places like Barwani. It is now more than a decade of RCH and five years since NRHM, RCH-II, JSY etc, were launched as flagship programmes. On one hand the government is spending several hundreds of crores of rupees annually, is vigorously promoting institutional deliveries and talks of safe and guaranteed health services; and through processes such as community monitoring is promoting the idea of demanding accountability from the public health machinery. On the other hand, the ground reality in places like Barwani seems to show little change. And when people get organized to demand accountability through peaceful actions, attempts are made to discredit and ‘brand' their leaders, to intimidate and repress them, and to shield the responsible officials who seem to be completely indifferent to the situation of the patients.
While they are involved in the most basic human process of bringing new life into the world, women continue to die in large numbers. These deaths are avoidable and completely unacceptable; we need to pay heed and support the voices being raised against such deaths, deaths, which we must all work together to prevent.
Abhay Shukla – Medical Doctor and Health Activist, Pune; Indira Chakravarthi – Public Health Researcher, Delhi; Rinchin, Activist – Bhopal.
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