Dr Atul Gawande Explains Simple, Effective Ways To Bring Down Child Mortality in India

Dr Atul Gawande is a surgeon and author of 'Being Mortal'.

Davos, Switzerland: One in 20 babies die at the time of birth in Uttar Pradesh while less than 1 in 500 babies die in the rest of the world, said Dr Atul Gawande, surgeon, and author of ‘Being Mortal’ in an exclusive conversation with NDTV’s Prannoy Roy.

Dr Gawande, who is based in the United States, is working on a project in 25 districts of Uttar Pradesh to combat early childhood mortality. He said that childbirth is the biggest risk to the lives of women and children in India.

The project is being implemented with the state government of Uttar Pradesh, the Centre, the World Health Organisation and the Gates Foundation and Dr Gawande’s centre, Ariadne Labs, in Boston.

He laid emphasis on checking all the boxes of a 30-point checklist that he has made, that can save a newborn’s life. The checklist includes simple but very important points, he said. What is non-negotiable is, “Washing hands before the child birth and at any time before you touch the mother and the baby,” he said.

There are 10 per cent chances that the baby will have difficulty in breathing after birth. For that, “be ready with the baby mask and give the baby a puff,” he said, adding that the masks were simple and inexpensive and readily available at all the hospitals.

The most effective way to warm the baby is through skin-to-skin contact of the mother’s body with the baby as it naturally regulates the baby’s temperature, he said.

However, less than one per cent are hand washing and less than 10 per cent are warming the baby, he said.

According to Dr Gawande, these are not financial investments and they are not difficult in terms of skills. For instance, there are about 22 medicines that are important at the time of birth and must be available. Among these are antibiotic, medicine to deal with blood pressure and  medicine to stop the bleeding. But if you don’t use it at the right place at the right time then you have the breakdown.

A part of his project in Uttar Pradesh is to observe the care given to the new mother and the baby in the hospital. This approach is being tested across 120 hospitals and about 1,60,000 deliveries have been observed so far.

“The challenge is to get people to use the checklist. The project has nurses who will come and watch the care and record it in a smartphone. Did they wash hands? Did they have the medicines ready? Did the warm the baby? Did they treat bleeding properly?,” he added.

After this, a detailed feedback is given to the frontline workers, manager of the hospital, medical director of the hospital and the policy makers and emphasis is given not on the punishment but on the improvement. Our coaches keep coming back every week, until we see the change, said Dr Gawande.

According to Dr Gawande, there is 35 to 75 per cent improvement in the practices. He further said that no new money or skill training or new resources are required to decrease the deaths of the babies. The complexity is to get people work together towards a common goal.

“If there is no running water in the hospital, the nurse can simply inform the sweeper to get a new bar of soap, and keep a bowl of clean water ready by the side of the table. The idea is to work collectively – the nurse, the doctor, the sweeper – all need to work together because all are part of saving the baby.”

The project has collected all the information and has completed the trial. The data will be presented at the Global Scientific Congress on March 21.

Dr Gawande said, “The goal is to take that 5 per cent death rate and drop it by at least 1 percentage point. Uttar Pradesh has got a tough under resourced health system but even in a good centre in big cities in Karnataka in elsewhere, we see these significant gaps because people don’t work together towards our goal.”

Heart Diseases – Biggest Killer In India

Dr Gawande said that a quarter of the country has high blood pressure. High blood pressure and smoking are the biggest causes of heart diseases.

“High blood pressure is the starting point to inviting heart troubles. It’s is the untapped silent killer in India,” he said.

He advised that a regular medical check-up after mid-life is very important. The drugs are simple, inexpensive and readily available. They have been there for 50 years. With basic care and recognition, we can save millions of lives.

He further said that more than 80 per cent of cholesterol in the body is created by one’s own body. So advice like going on no-fat, no-cholesterol diets don’t work. What works is having a balanced diet. Avoiding sugar and meat, having lots of vegetables and exercising are effective ways to control cholesterol.

“The goal is not a good death. The goal is a good life, all the way till the very end.” Emphasizing on this, Dr Gawande said that in villages, younger generation is slowly moving away to the cities in search of better prospects and end up settling there. This breaking up of extended families and a system of care around people affects their well-being.

“We think that medicines will take care of ailments, but being on machines in a hospital is no life. Medicine and care should be aligned with what we want in life besides survival,” he said.


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