 Hello and welcome to NewsClick. Just days before India celebrated its 70th Independence Day, a terrible tragedy occurred in the Gorakhpur district of Uttar Pradesh, resulting in over 60 deaths of children. Today we have with us Dr. Amit Sen Gupta to discuss the events at Gorakhpur and to talk about the public health system of India. Dr. Sen Gupta is the convener of the People's Health Movement in India. What are some of the problems in the Gorakhpur hospital and in Gorakhpur in general which led to this incident? The Gorakhpur hospital in a sense epitomizes all that is wrong with India's public health care system. The hospital itself is under resourced. It has huge shortages of both supplies and personnel and it is under financed. Now the hospital is one that caters to something like 15 districts in eastern UP and it gets patients from Bihar and Nepal as well. It is the only tertiary centre and speciality centre for treating children who are at high risk. So the fact that even a tertiary hospital is so under resourced is the root of the problem in the first place. It was reported that a lot of deaths were caused due to encephalitis and encephalitis has been a major problem in Gorakhpur in general. A lot of cases emerge from that area of UP and in UP. How can this disease be dealt with and the other problems as well in this hospital? Encephalitis itself is not one disease. It means swelling of the brain. So one of the major causes of encephalitis is due to viral infections. Now again the ones that have been documented the most are what is called Japanese encephalitis. So Japanese encephalitis the spread of the disease is related to one living condition. So mosquito breeding sites it is also related to households tightly packed and sitting next to where pigs and other animals are being bred which are the reservoir of the disease. You also have encephalitis infective that is caused by another group of viruses which are enteroviruses. These are spread through drinking water when you have fecal matter mixed with drinking water. Again in the monsoons you have a rise in drinking water becoming mixed with sewage and again linked to living conditions. It is also been reported in this region and probably the only place in the world of encephalitis that is toxic encephalitis which is related to young malnourished children eating unripe leaches. Now normally leaches is something that many people eat and it is very safe but there is a toxin that is present in unripe leaches which affects only children who are malnourished. So it is also a marker of the level of malnourishment in the area and the fact that children are forced to forage for wild fruits like unripe leaches. In addition to that because encephalitis is swelling of the brain you have encephalitis right after birth due to problems of difficult labor for example. So simply put it you have a swelling of the brain when during birth the child is starved of oxygen. Important thing to underline and understand is all of them are related to living conditions in that region. What are the ways in which encephalitis can be avoided and it can be treated? There is a vaccine for Japanese encephalitis it has been used sporadically in India in UP I think there was an announcement in May that it would be used in the primary immunization program. I do not think it has been used very effectively and it is anyway too late to stop an epidemic. This vaccine actually has been around since the 1960s so it is not a new vaccine but the fact that we have not been able to deploy this effectively speaks volumes also for the kind of epidemiological data that we produce that that entire region infested with encephalitis for decades and yet we do not have confirmed epidemiological data regarding one the types of encephalitis which is causing the epidemics every year what are the public health measures that are required etc. Other than Japanese encephalitis there are no vaccines for the others that area requires many more health facilities which need not be tertiary but can be equipped to deal with at least the less severe cases. Currently what is happening is all the cases move to this hospital because there is nothing in between. The basic treatment for encephalitis is supportive there is no medicine so supportive means that you try to support the child or the baby with the hope that eventually the body's own mechanisms will recoup oxygen is key in the support that you provide in addition you provide support in terms for example of artificial feeding etc. So that's the basic support that and most children in good hospital conditions will actually survive and will get out of this syndrome. So in this Gaurakpur incident when the oxygen supply was cut off ambu bags were used to pump air into the children instead is that in effective is that in effective alternative for oxygen? What they only do is they pump ambient air into the child's or the patient's lungs so you keep sort of pressing the bag and it keeps so it's a manual method of pumping it and it is of really of very little use if you are going to use it as a substitute for oxygen because you're not pumping in oxygen you're pumping in air. How long can they be used for as an alternative? No you can keep pumping as long as the person who's pumping can go on pumping but it's useless beyond the point because it's a temporary measure. There were also a lot of other reasons a lot of other causes of deaths of children in Gaurakpur can you talk about some of those? The hospital is overcrowded so you had four patients per bed. This is a story of tertiary hospitals in many parts of the country so in that sense Gaurakpur is not alone that's something that the statistics of the Gaurakpur hospital show that even in ordinary circumstances which is what is ordinary for that hospital you have a lot of children dying. I think something around a thousand children die in two to three hundred died this year alone. So you already had very poor conditions and the disruption in the oxygen supply came as an extra challenge to the system. So many children very young children infants died in the most horrible of conditions died struggling gasping for breath and what we see right from the top political echelons right down to the bureaucracy is shifting blame on each other without assuming responsibility. Now the children who died are a mix of encephalitis cases but a majority are actually very young babies and infants. Number of children who were admitted for a variety of causes died because of the disruption in the oxygen supply. Who is eventually responsible for what happened was it the government was it the hospital staff or was it the private organization which was supposed to apply supply oxygen. Who is finally responsible for what happened here. This is really a symptom of the larger malaise now successive governments one are responsible for not putting in enough resources for public health successive governments are responsible for an ideological belief that public services do not work and that these need to be sort of given out outsourced to private facilities. So for example oxygen now why is it that such a vital as this incident shows such such a vital vital part of treatment which is oxygen supply is given out to a private contractor this is not just now it's been going on for years is just a symptom of the blind belief that people have in private services and every time you see that private services are not superior to public services if we are able to resource public services but the government of the day needs to assume responsibility. I think it is criminal for the government of the day to try to shift the blame to earlier governments this is not to say the earlier governments were not responsible as I said earlier if you do not learn from such tragedies as seems likely then you are consigned to have to repeat them again and again. If you talk about underfunding which was also a major problem here the government in its national health policy which was passed this year has proposed that the health budget should go up will go up to 2.5 percent of the gtb by 2025 is that measure sufficient this kind of a promise has been made for the last few decades so various planning commission documents earlier various government manifest party manifestos and government plans have all mentioned that India's health budget is too low that public spending needs to go up to 2.5 percent yet we have never gone beyond 1.1 1.2 percent. So first of all I would really question even the intent of the government to work on what is put down in the health policy second even the figure of 2.5 percent has to be seen in the context that even the target that you are setting yourself is half of the global average and it is half of what the WHO recommends as public spending on health care. So I would not go by what policies really sort of put down on paper but rather go by actually what we see happening on the ground. So the last the three successive budgets under this government all of them have either led to a slashing of the health budget or a stagnation. So in real terms the amount we spend on health as central allocation and as central and state combined is at the same level in real terms as it was five or six years ago in 2011-2012. So in fact it is lower than that so not only have we not moved forward we have moved back. So for us to believe the government when it says that it will increase the health budget by 2.5 which means a doubling of the health budget. Given the evidence that actually in the last three years the budget has been cut it's very difficult to actually even start commenting on whether this is enough or not. Thank you Dr. Srin Gupta for your valuable time in coming here to talk to us. Thank you.