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Baby Jagan, two and a half months old, has just undergone major surgery for a liver condition called biliary atresia. He is recovering in the pediatric intensive care unit at the same hospital. The weight of the child is barely 3 kilograms (6.6 pounds). The pediatric surgeon, Dr. Shashank Shrotriya, is sure that the baby will not only live, but will shortly go home and do well.
I was pleasantly surprised to note this change in child health care in the past ten years. Fifteen years ago, when I graduated from medical school, a newborn baby weighing less than 2 kilograms had an almost zero chance of survival, for want of ancillary medical services. The NICU used to be just a small room, with heating lamps as the only available equipment.
Today, I see the NICUs are well equipped with all modern instruments. There are ventilators and incubators. Babies are attended round the clock with various monitors, and special feedings are prepared in-house under strict hygienic conditions. Infusion pumps are used to give potent drugs and nutritional fluids, slowly, over a period of hours. The unit in KEM Hospital is headed by a super specialist in neonatology, Dr. Umesh Vaidya, who received his training in Australia. The staff is also specially trained. This NICU has 40 beds and is the largest in Asia.
The PICU has become a haven for severely ill babies who need extra care, which may be in the form of oxygen to aid breathing and continuous monitoring. Babies who undergo major surgeries also need this kind of care.
"Most of my patients survive now, because they get excellent care in PICU after a big operation," comments Shrotriya. He undertook special training at a pediatric intensive care unit in Germany in 1996 and used the knowledge to set up this unit. "The very concept that children need intensive care was almost non-existent until then. Today children with severe asthma, poisonings and pneumonia can be salvaged in the PICU," he says.
India is a large developing country with a population of more than 1 billion. Thirty babies are born every minute. The government hospitals are obviously not enough to provide for such a growing population and it is common to receive medical treatment from a private practitioner. A very small percentage of people have medical insurance. Hence, the cost of treatment is often the determining factor in choosing a medical provider.
Until just 15 years ago, even in cities, it was common for midwives to deliver babies, without the attendance of a registered obstetrician. But now almost all women can afford an obstetrician's fee. This has resulted in a great reduction in deaths during birth.
Mothers today are better educated and take proper care and nutrition during pregnancy. This has improved the birth weight of babies and decreased the number of premature births.
When I was a child, I remember there was at least one child with polio in every class at school. Polio-stricken beggars were a common site on the streets in the 1980s. There have been intensive vaccination and immunization programs in the recent 10 years, which have penetrated even the rural areas in the state of Maharashtra. As a result, there has been a successful eradication of terrible diseases like polio and measles.
There is a general improvement in the hygiene and socio-economic conditions among city dwellers. There are few cases of long-standing diarrhea, worm infestation, cholera and malnutrition, say pediatricians Dr. Ajit and Dr. Jyotsna Padalkar, who have been running a pediatric hospital in Pune for the past 25 years. They note that parents today are well informed and educated. They also have better spending capacities. As a result, a child is brought to the practitioner well in time, before the illness worsens.
"We see far more women breastfeeding their children. They also opt for better and nutritious weaning foods. Thanks to the ban on the advertisements for baby foods and feeding bottles, mothers now are not aware of these options! So babies do not suffer from the hazards of bottle feeding and are much healthier."
"But don't get carried away by this rosy picture in the cities," cautions Jyotsna Padalkar. "The scene is not so pretty in the rural areas. The socio-economic prosperity and level of education is starkly low there."
Even today, there are hundreds of villages in the country which are as yet untouched by the economic boom. That population is still living way under the poverty line, in illiteracy and poor hygienic conditions. Here, all ailments due to bad hygiene are still rampant. Diarrhea, malnutrition and pneumonia are still common causes of death in children.
The cities boast of the most modern treatments but the villages still lack even primary healthcare. Child specialists are very few. The general trend at a primary health center in a village is to refer a sick child to the city hospital for further treatment. This entails a lot of expenditure. In a situation where parents have many children and low income, there is a marked reluctance to spend on a sick child. Often, when such a child does land in a city hospital, the disease is too advanced for the pediatrician to help.
The child mortality in cities is as low as 10 per 1000, but it is more than 150 in the villages. The major bulk of Indians still reside in the villages. The government needs to increase the health budget and divert it there. War-footing efforts are needed to make a difference to the health of those millions of children being born and growing up in the rural parts of India.
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(Dr. Pradnya Kulkarni is a former clinical pathologist for a private laboratory in Pune, India. She now devotes her time to writing medical articles.)
