July 12, 2014

Crib Deaths: From medicine to society and sociology

News about the deaths of seven new-borns in a hospital in Malda, north Bengal, left me depressed. I phoned an old friend, Dr Tridib Banerjee, a renowned Kolkata paediatrician and chairman of the West Bengal Task Force on Crib Deaths. These were not the first crib deaths in recent months. Why was this happening? Couldn’t we, with all the technology at our command, save those precious little lives?

I was hoping Tridib, with his experience of decades, would be able to enlighten me about this recurring phenomenon. Talking to him proved quite educative, as he suggested ways to bring down the infant mortality rate.

Malda has made it to the news often for crib deaths. Each death is a tragedy and brings an irredeemable sadness to the family in which it occurs and for the parents who have lost their child. Yet, as Tridib told me, it is not as if such deaths are “everyday phenomena”. “Besides they take an enormous emotional toll on the doctors,” he said, “and place the hospital under stress. Failure to save a life is never easy to cope with.”

It needs to be noted that even on a “normal” day, the infant mortality is about three to four in tertiary hospitals such as the one at Malda, where critically ill new-borns are brought in. On some days, there is a clustering of seven babies gone in a single hospital on a single day. This makes the picture seem ominous.

The Malda hospital is a referral centre. It has what is called an SNCU or Sick New-born Care Unit, which is where extreme and critical neonatal cases are sent. The babies who arrive at this Malda facility are already very ill, critically ill. Saving them becomes that much more difficult. Take the seven crib deaths that occurred the other day; six of the children came from far-flung areas of the district. Already very sick – too ill for a local doctor to help – they had to bear an arduous and long journey to the city. This weakened them further, leaving them at greater risk of death due to asphyxia or infection.

Why were these babies brought in at a terminal stage? Were they born worse off, and weaker, than most other babies who survived and didn’t need to be taken to an SNCU in the first place? It was a simple, even na├»ve question, but Tridib was patient.

“Frankly,” he said, “there we move from medicine to society and sociology. Most of these deaths can in a sense be blamed on the fact that very young women, with immature bodies and in poor health conditions themselves, give birth to underweight and undernourished babies. If the practice of marrying off girls at a very young age, in their teens, could be put to an end, it would be a big help.”

Could the Kanyashree scheme, launched by the West Bengal Government and aimed at incentivising girl education and delaying marriage, achieve this? I live in optimism.

That is, however, a long-term solution. In the short run, health facilities and capacities have to be boosted. Till 2011, when the Trinamool came to office, West Bengal had six such SNCUs. Today, it has 40. By the end of financial year 2014-15, it should have 50. The idea is to spread the SNCUs across the state, so that, for instance, the babies who needed to be taken to Malda could have gone to a facility much closer and cut travel time.

Will this enhancement provide succour to those seven bereaved families? No.I do hope and pray, however, that it will help other parents, those whose little ones need critical care.

Derek O’Brien
Member of Parliament
Chief Whip in the Rajya Sabha and National Spokesperson, Trinamool Congress