Baba Raghav Das Medical College

Baba Raghav Das Medical College
BRD Medical College in 2014
Type State-run Medical College
Undergraduates 100 (MBBS) students every year[1]
Postgraduates 54(MD & MS) students every yearr[2]
Location Gorakhpur, Uttar Pradesh, India
26°48′49″N 83°24′00″E / 26.813584°N 83.3999654°E / 26.813584; 83.3999654
Acronym BRD Medical College
Affiliations Deen Dayal Upadhyay Gorakhpur University & Medical Council of India (MCI)
Website brdmc.ac.in,brdmc.org
Location in India
Baba Raghav Das Medical College (Uttar Pradesh)

Baba Raghav Das Medical College is a medical college in Gorakhpur, India. It is run by the Government of Uttar Pradesh.

The hospital affiliated to the College is the only tertiary care centre in a 300 km2 region around Gorakhpur. This region has seen severe annual encephalitis outbreaks, and the hospital attracts a large number of poor patients from Uttar Pradesh, Bihar, and Nepal. During 1978-2011, over 30,000 patients died of encephalitis at the hospital, many of them children. The trend continued during 2012-2017, when over 3,000 children died of encephalitis at the hospital. A number of child deaths in August 2017 attracted international media attention, although there has actually been a sharp decline in child deaths compared to the previous years.

History

The BRD Medical College was established in 1969, and is affiliated to Gorakhpur University. It was initially developed as a centre for treating mosquito-borne diseases.[3] The Nehru Hospital is affiliated with the college. It has 700 beds, with an additional 108 beds in Epidemic Ward.

The college in run by the state government.[4] In August 2014, the Union Health Ministry led by Harsh Vardhan announced a plan to modernise the institute's infrastructure, and to transform into a "super-speciality facility" on par with the All India Institute of Medical Sciences.[5]

It was at the Government Regional Public Analyst Laboratory on the College campus that the Maggi noodles were first found to contain too much monosodium glutamate (MSG).[6]

Encephalitis cases

The BRD Medical College is the only tertiary referral hospital in a 300 km2 area around Gorakhpur, and serves patients from 15 surrounding districts.[7] It is a major centre for treating encephalitis,[8] a disease that has seen regular outbreaks during the monsoon season in the Gorakhpur region.[4] Patients from several neighbouring districts, as well as Bihar and the neighbouring country of Nepal, come to the hospital for treatment. According to a 2017 estimate, the BRD Medical College treats over 60% of the encephalitis cases in India, and receives 2500-3000 encephalitis patients every year. Most of the encephalitis cases arrive during August–October, when the number of patients in the hospital ranges from 400-700.[8]

Deaths

Encephalitis-related child deaths at BRD hospital[3]
Year Number of child deaths
2012
557
2013
650
2014
525
2015
491
2016
641
2017 (till 11 Aug)
163
Trend of child deaths at BRD Medical College Hospital[9][10]
YearChildren admittedTotal child deaths
201451,0185,850
201561,2956,917
201660,8916,121
2017 (Till Sep 2)Not available1,317

The first encephalitis epidemic broke out in the Gorkhapur region in 1978.[11] During 1978-2011, more than 30,000 encephalitis deaths were recorded at the BRD medical college.[12] This included the deaths of 1,500 patients, 90% of them children, in 2005.[8] The 2005 outbreak was the worst since 1978.[4] The tragedy became a political issue, and several ministers visited the place. The number of cases went down after vaccinations were administered to children in the area.[8]

According to official records, during 2012-2017, more than 3,000 children died at the BRD hospital. Most of the deaths were attributed to acute encephalitis syndrome (AES) caused by the Japanese encephalitis. According to the institution's former principal and head of pediatrics department KP Kushwaha, these officials numbers are actually understated. In 2017, he alleged that the doctors at the institution play down the number of deaths to avoid action against them, and to get promotions. Other medical practitioners have blamed the hospital's negligence as a major factor behind the high number of child deaths. Over these years, several politicians visited the hospital after each incident of mass child deaths. They made promises to upgrade the hospital facilities, but no such upgrades were done.[3]

In 2017, 175 children died of encephalitis (out of a total 1,256 deaths at the hospital). The deaths attracted media attention and generated political controversy in August 2017, when 296 children died (including 77 of encephalitis).[13] However, the total number of child deaths (including encephalitis-related child deaths) has actually dropped in 2017.[9][10]

Alleged causes of deaths

Mismanagement

The organization's management has been accused of corruption. In December 2010, the commissioner of Gorakhpur zone P.K. Mahanti accused the College principal Dr R.K. Singh of impeding the normal functioning of the institute by frequently going on leave. In August 2011, Mahanti's successor K. Ravindra Nayak made serious allegations against Singh, including improper award of maintenance contracts, purchase of hospital supplies at inflated rates, misappropriation of funds from various government schemes, irregularities in job appointments, and non-payments or delayed payments to other parties despite the availability of sanctioned funds.[14]

In August 2010, Dr K.P. Kushwaha, who held the charge of the pediatrics department and the encephalitis ward, complained about the malfunctioning ventilators installed by the contractor GT Enterprises during 2008-2009. He recommended blacklisting the company, but subsequently, GT Enterprises was award another contract for installing a gas and oxygen pipeline in the hospital. This was despite GT Enterprises quoting a price of ₹ 242,000, when another bidder had quoted a lower price of ₹ 148,000.[14]

A report found dogs roaming around the hospital chambers and beds being shared by multiple patients in the pediatric ward.[15]

Lack of funds

The College management has cited lack of funds for poor facilities at the institution.[8] In 2009, the state government granted the College several millions of rupees from a federal health programme. The College spent a part of this money to hire 135 researchers, doctors and paramedics focused on encephalitis treatment. However, by August 2009, most of the money had been spent, and only 36 of the hired staff were being paid regular salaries.[4]

In August 2017, it was reported that an average of 300 child patients were being admitted to the 50-bed pediatric Intensive Care Unit (ICU) every month. One infant warmer was being used for 3-4 babies simultaneously. The families of newborn babies were asked to sign consent forms stating that the College would not be held responsible if their baby died because of infections caught from other babies in the same warmer. In August 2016, when the Union Health Minister Anupriya Patel visited the institution, it was reported that the BRD College did not have budget for stocking up on the medicines: the patients were forced to buy the medicines from outside. In February 2016, the principal of the College sought a budget of around ₹ 379.9 million from the government for the treatment of encephalitis cases. The College also asked for ₹ 100 million to set up a Level 3 ICU with a staff strength of 149. These proposals were not approved by the state government as of August 2017.

In March 2017, the institution's oxygen supplier had discontinued its services for lack of payments.[8] In August, 2017, the oxygen supply to the hospital was cut over non-payment of dues. This led to a large number of deaths, which came to widespread media attention. It emerged that the dues were not paid despite several letters by the supplier to various officials of the UP state administration, including the Chief Minister, Adityanath.[16]

Misdiagnosis

In the past, the encephalitis epidemics in the Gorakhpur region have been attributed to the typical viruses, such as the Japanese encephalitis virus. Since the epidemic first broke out in 1978, several organizations including the National Institute of Virology and the National Centre for Disease Control visited the BRD Medical College to determine the cause of the encephalitis outbreaks. They ran lab tests for the malaria parasite, and the various viruses that are known to cause encephalitis, including enteroviruses, the Chikungunya virus, the Herpes simplex virus, and the dengue virus.[11]

In 2007, the Government of India started a Japanese encephalitis vaccination programme with drugs imported from China. The initiative was successful in several states, but the Gorkahpur region continued to see a high number of encephalitis cases.[11][17] After research, other viruses, such as the enteroviruses were also ruled out as a major cause.[11] In 2009, the scientists from the United States Centers for Disease Control and Prevention visited the area to take samples to identify the virus.[4]

A 2016 study by a group of 10 doctors concluded that a high number of the children admitted to BRD Medical College had encephalitis triggered by the scrub typhus,[18] a bacterium that was previously not known to be responsible for encephalitis outbreaks.[11] According to Govindakarnavar Arunkumar of the Manipal Institute of Virus Research, in Gorakhpur, the scrub typhus was not diagnosed and treated during the early stages, ultimately triggering difficult-to-cure brain inflammation.[11]

References

  1. ↑ "List of Colleges Teaching MBBS. -Medical Council of India (MCI)". Medical Council of India (MCI). Archived from the original on 7 June 2013.
  2. ↑ "PG capacity of BRD Medical College". BRD Medical College. Retrieved 3 September 2017.
  3. 1 2 3 Rajesh Kumar Singh (12 August 2017). "Gorakhpur hospital tragedy: BRD Medical College has seen more than 3,000 child deaths in six years". Hindustan Times.
  4. 1 2 3 4 5 Soutik Biswas (12 October 2011). "India encephalitis outbreak kills 400, mainly children". BBC News.
  5. ↑ "Six medical college hospitals in UP will be upgraded: Harsh Vardhan". 25 August 2014.
  6. ↑ Khan, Hamza (7 June 2015). "Maggi Row: It started from six overworked men and a Gorakhpur lab". The Indian Express. Retrieved 8 June 2015.
  7. ↑ "When Children Die". Economic & Political Weekly. 52 (33). 19 August 2017.
  8. 1 2 3 4 5 6 Manoj Singh (13 August 2017). "How Gorakhpur's BRD Medical College Struggled With Money and Manpower for Years". The Wire.
  9. 1 2 "Sharp drop in BRD hospital deaths this year: Govt data". The Times of India. 3 September 2017.
  10. 1 2 "Sharp drop in BRD hospital deaths this year: Govt data". Indian Express. 3 September 2017.
  11. 1 2 3 4 5 6 Priyanka Pulla (14 August 2017). "Ignoring the science behind encephalitis deaths". The Hindu.
  12. ↑ "33 years later encephalitis still an issue of concern for voters in UP". Firstpost. 7 February 2012.
  13. ↑ "36 children die in last 48 hours at Gorakhpur's BRD medical college". DNA. 29 August 2017.
  14. 1 2 Amir Haq; Gajendra Tripathi (16 November 2011). "Encephalitis patients suffer due to corruption in Gorakhpur hospital". India Today.
  15. ↑ "Photo Story: How a Medical College in Gorakhpur Turned Into a Funeral Factory". The Wire. Retrieved 2018-08-13.
  16. ↑ "Gorakhpur Deaths: Adityanath Government Ignored SOS on Oxygen Payments for Months". The Wire. Retrieved 2018-08-15.
  17. ↑ Prabhash K Dutta (12 August 2017). "Gorakhpur has a history of children's deaths, 25,000 kids have lost lives to encephalitis". India Today.
  18. ↑ "Gorakhpur hospital tragedy: Scrub typhus a major cause of encephalitis, reveals 2016 study". Firstpost. 14 August 2017.
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