In August 2017, images of distraught parents and children dying due to the scarcity of oxygen flooded television screens in India, even as the print media announced the outbreak of Japanese encephalitis, a mosquito-borne viral infection of the brain, in 38 districts of eastern Uttar Pradesh. There were reports of the deaths of 23 children in 24 hours. The city of Gorakhpur, with a tertiary care centre with 100 beds, was the nodal centre for treatment.
In this grim situation, the paediatrician Dr Kafeel Khan became a hero for working tirelessly and trying to arrange oxygen for the children in Baba Raghav Das (BRD) Medical College’s Nehru Hospital. Reports of his frantic calls to his higher-ups became part of lore as the young doctor suddenly found new fans on social media. Even national newspapers hailed his efforts to save lives.
It did not last long. The Uttar Pradesh government under Chief Minister Adityanath accused the doctor of being involved in private practice; worse, the National Security Act (NSA) was invoked against him. And Dr Khan was jailed not once but three times.
Now acquitted of all charges and released from prison, Dr Khan has penned a book, The Gorakhpur Hospital Tragedy: A Doctor’s Memoir of a Deadly Medical Crisis. Published by Pan Macmillan, the book is being talked about for its detailed account of the events surrounding the deaths of the innocent and the aftermath of political intervention. The book takes the lid off the ailing public health system in the country where, Dr Khan says, “the primary health care centres are in a shambles”. Calling them “a white elephant”, he is now striving for right to free health care for all citizens.
Taking time off from his multi-city book launches, Dr Khan spoke to Frontline about the book. Excerpts:
The book begins with a long flashback to August 10-11, 2017. How did the senior resident Dr Satish Choubey’s midnight message about the lack of oxygen in the BRD Medical College’s Nehru Hospital change your life?
One message changed my life. Before that message, I was just a doctor who used to go to hospital, come back, spend time with my family, wife and child. I was never involved in any activist activity. One knew who was Akhlaq, or why Gauri Lankesh was killed, but I never knew this hate in the name of caste and religion. I had gone [to the hospital at night] because I had done my MBBS and M.D., and was told that the patient was God. You had to do everything to save their life. So, I did what I could do.
Things have changed for me in these four years, after 500 days of incarceration. Three times I was sent to jail, called murderer, thief, and so on. My family was broken. My mother had to go from the police station to the court, my wife had to go to the district magistrate, to the Commissioner. I became an untouchable in my birthplace Gorakhpur. Nobody comes to our house; nobody came to meet me in my nine months in prison. My brother was shot. I was suspended for more than four years. Even after the court gave me a clean chit, I was terminated. Life turned upside down with that one message.
Now Dr Kafeel is not just a doctor, he has become an activist, a history-sheeter, and finally a writer. I continue to do my medical camps. The mission of my life has changed. My mission is to bring Right to Healthcare as a law. Everybody should have access to medical care within three-four kilometres of their homes. I am working towards that.
How do you think the Gorakhpur hospital tragedy could have been averted? Children are said to die of Japanese encephalitis every year…
Pushpa Sales, the supplier of oxygen, had written 14 letters to the Principal, the Health Minister and the Chief Minister. All those who had received that letter ignored the warning. If they had paid the money on time [it was paid was August 11, 2017], the tragedy could have been averted. The same year, the Uttar Pradesh government slashed the Health Budget by 50 per cent.
The fact that children die every year cannot be an excuse. Every single life is precious. It is a lie to say that every patient died of Japanese encephalitis. Seventy per cent of those kids who died in those 54 hours were newborns; they were less than six months old. No newborn dies of Japanese encephalitis. They died of lack of oxygen. Eighteen adults also died of lack of oxygen.
You hint at the indifference of Dr Ramashanker Shukla, the chief medical superintendent of the college, and Dr Satish Kumar, the administrator. What explains their conduct, and that of others, and the paucity of oxygen for little patients?
My Head of Department Mahima Mittal got the letter on the morning of August 10 itself that oxygen was short and ignored the warning. I don’t know why Dr Satish Kumar just forwarded the letter to the Principal and left for his son’s convocation in Mumbai. Dr Shukla did not even come to the paediatric ward. When I called him, he was in his private practice. They all showed up when it [the deaths of children] became national news.
Throughout the book you talk about the shortage of oxygen cylinders. But the District Magistrate told the media that there was no shortage. Yet we heard of 23 children dying in 24 hours. Can you apprise us of the facts?
No, the District Magistrate had given an interview in the afternoon in his office, and clearly said there was shortage of oxygen, and cylinders were arranged from different sources. Even the Commissioner has given a report of the shortage. In the evening the District Magistrate changed his stance. There was no liquid oxygen for 54 hours in BRD Medical College.
For a little while, you were everybody’s hero. How did the script suddenly turn around?
That’s true. Not for a little while but for two days, from the night of August 10 onwards, the mainstream media ran the story filed by a local stringer who had seen me running around to save kids. That story made me a hero. But on the night of August 13, following my meeting with the Chief Minister, I became a villain.
I think there was a conspiracy within the BJP [Bharatiya Janata Party] to dislodge Adityanath, and I still remember Prime Minister Narendra Modi had sent a team of doctors from Delhi’s Safdarjung hospital. Union Health Minister J.P. Nadda had also come. The Chief Minister accompanied them to the hospital. To save himself, the Chief Minister needed a scapegoat, and he found one.
The mainstream media did not come to Gorakhpur to speak to me. So, the CM’s statement, “ Tu sochta hai cylinder laa kar tu hero ban jayega (you think you will become a hero by getting cylinders)” was not just for me. It was for Nadda sahib also, that ‘This is my [Adityanath’s] Gorakhpur’. The message was distributed by select media houses. They accused me of stealing oxygen and taking it to my private clinic. The disinformation on social media spread. Those people who helped in hiding the incident got their prize. For instance, Dr Mahima Mittal, HoD of Paediatrics, is now head of the department of All India Institute of Medical Sciences, Gorakhpur. Nobody questioned her.
In your book, you have alleged corruption inside the prison at various levels, including prisoners buying comforts, living space, even cigarettes and drugs.
I have clearly said that the prison system works at its own pace. The money flows, it does not matter who is the Chief Minister, who is the Prisons Minister. Inside the jail, everything remains the same. I have been inside three prisons, Gorakhpur, Bahraich and Mathura. I have seen the same system working. If you don’t want to work in jail, you pay money. If you want cigarettes, drugs, … if you want a cheap slave for a little massage and forwashing your clothes, you pay money.
[It’s the] same for hospital stay. In the same barrack where I stayed with 160-180 prisoners sharing one toilet, an ex-Minister was serving life imprisonment. He stayed alone with television, cooler, everything. Money plays a big role in prison.
What is the role of a writer inside the jail?
Writers are the ones who are serving life imprisonment. Mostly, they are well educated, graduates or MBAs. They manage everything. From newcomers, they collect money, tell them they should not fight, should not use mobile phones, not smuggle home-cooked food, and so on. If something happens to a prisoner, they are also held responsible, though prison officials are there too. They do night duty also.
Could the Indian Medical Association (IMA) have been more proactive in your case?
The IMA came but they came very late. They came after almost eight months. I had written to them many times, but they did not listen even though I am a lifetime member of the association.
After the 2017 deaths in Gorakhpur, we had the spectacle of shortage of oxygen during the second wave of COVID, and corpses floating on the Ganga. What is ailing our public health system?
It was one of the reasons I wrote this book. What I had seen in those 54 hours in BRD Medical college, was the core of India. The elite in the metropolises in Delhi, Mumbai, Bengaluru, and so on think health is a commodity, they can throw money and purchase it, get the best medical facilities. In reality, 75 per cent of Indians suffer the same pain like the one faced by the metropolises in the second phase of COVID every day.
You go to rural areas of Uttar Pradesh, Bihar, Assam, Bengal, Rajasthan, Chhattisgarh; if somebody has high grade fever at night, heart attack or labour pain, where do they go? They go to the primary health centres which are in a shambles.
I call them a white elephant. They are often closed at night. So people go to the district hospital. There the doctor tells them they do not have any facility, and refer them to a medical college. By the time they reach the medical college, 100-200 kilometres away, most of them die. Those who manage to reach there struggle to get a bed or oxygen.
I always believe that COVID-19 just exposed our already collapsed health care system. India spends only 1.25 per cent of GDP on health expenditure. The whole world spends six to eight per cent. Post-COVID, countries are spending 10 per cent of their budget on public health. India has to do a lot more. We have started a Right to Healthcare campaign, demanding a law that every citizen should get health care free of cost, irrespective of their caste, religion or region.
Has the doctor in you been overtaken by the activist?
Yes, in a way, I agree. Dr Kafeel Khan has become an activist now. In prison, I realised that even after doing good work in life, after getting higher education, one can be penalised. I was lucky I came out after 500 days, but what will happen to those who do not have education, who are poor, downtrodden, and have no resources to go to high courts, Supreme Court, and so on? I have seen people in jail for 10 years, 20 years, nobody cares about them. I feel lucky that despite the NSA being invoked against me by the Adityanath government, the court has given me a clean chit every time.
As a citizen I have decided to speak out against injustice done to anyone, anywhere. But being a doctor is my love, my profession. The day I cure a child I feel happy, and get good sleep. I will continue doing that.
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