The state health minister of CPI(M)-ruled (Communist Party of India-Marxist) West Bengal says there is "nothing unusual" about 14 children dying within two days in a state-run hospital. The opposition
parties express 'concern' by protesting with loudspeakers blaring in the hospital zone. Pigs and cows roam in the hospital compound. Four to five infants share a single oxygen cylinder, at the same time!

Scenes from a drama of the absurd? Or a satire on the current state of affairs? Whatsoever it may seem, this is exactly what happened in the first few days of September in Kolkata's B C Roy Memorial Hospital for Children, the only referral pediatric hospital in West Bengal.

Ironically, the hospital is named after the legendary doctor, Bidhan Chandra Roy, who also became the first chief minister of the state after Independence. After widespread media focus on the appalling events, many needy patients were turned away on the plea of "inadequacy" of infrastructure. According to the hospital register, 955 deaths occurred between the 1st of January 2002, and the 31st of August 2002. In August alone, there were 140 deaths.

The B C Roy Hospital tragedy inevitably draws attention to the other city hospitals, like the oldest and well-known Calcutta Medical College and Hospital. The superintendent here admitted that at the Shishu Niwas (Children's Home) and Eden hospital (the maternity wing) 16 infants died between September 1 and 6. In addition, there were 10 still births. The 85 beds - with double the number of patients - need a minimum of 20 oxygen cylinders, but only 10 were available. Mothers and children share the hospital beds routinely.

At the Nil Ratan Sarkar Hospital, another well-known hospital, cats roam around freely in the pediatric ward.

If this is the state of the city hospitals, one can well imagine the situation in rural areas. In fact, the overcrowding of patients also reflects a breakdown of healthcare facilities in a state that has been
under Left rule for two decades and where 'people's power' is said to be the guiding principle.

Patients at B C Roy Hospital are mostly from the slums and rural areas. A hospital staff member complains that patients come for minor problems that can be taken care of by the primary health centre (PHC) in their village. However, the complaint is only another pointer to the poor health infrastructure in the state: at any given time, the PHCs do not have doctors, or medicines. Doctors - on occasions when they can be located - openly enquire about the patient's political party allegiance, say harassed patients. Many people in the 24 Parganas district say they would rather go to the homoeopath than to the PHC.

The death of infants because of infections at childbirth has reached alarming proportions in West Bengal as a whole. According to the status paper of the family welfare wing of the state health department, 44 per cent mothers deliver their babies without trained help, or outside the government healthcare infrastructure. Women in labor are often carried in open cycle-vans over uneven roads to a distant block hospital; the use of unsterilized instruments and subsequent infections are common.

In West Bengal, about 65 per cent neo-natal deaths (deaths of babies one-month-old or less) occur due to unsafe delivery; the infant mortality rate (IMR) is 51 per 1,000. In the face of such grim reality, state officials are quick to point out that this figure is far below the national average - 68 per 1,000. In its report of 2000-2001, the Comptroller and Auditor General (CAG) of India rapped the West Bengal government for its inadequacy in preventing and controlling disease.

At another level, some experts put the blame on the people - the lack of education and information makes parents in rural areas wait, and wait, or go to a quack. Only when things take a turn for the worse do they go to the PHC, the block hospital and then to the city hospital - and by then, precious time has been lost.

Facts show that half the neo-natal deaths occur in the first week which, UNICEF officials say, points to malnutrition of the mother. Incidentally, UNICEF plans to begin its integrated Management of Childhood Illnesses Program in the state shortly.

At the B C Roy hospital meanwhile, there is a scurry of activity to make amends for the abysmally inadequate facilities. One can only hope that the tragedy serves as a wake-up call, and that long-term monitoring is introduced to ensure accountability.

Although the Calcutta High Court has admitted a public interest litigation connected with the death of the infants, no one knows when the deeper malaise - the state's poor health infrastructure - will receive adequate attention.