Outrage over infant deaths in Indore | In India’s cleanest city, rats in a hospital

Out of use furniture and cushions lying in a room in the basement of the Maharaja Yashwantrao Hospital in Madhya Pradesh’s Indore.
| Photo Credit:
A.M. Faruqui

At dusk on August 29, Manju Devi was rushed to the primary health centre (PHC) in Rajod town of Madhya Pradesh’s Dhar district. Her labour pain had begun prematurely.

At the PHC, about 5 k.m. from her parents’ home in Nandana village, Dr. Anil Bhaware referred her to the district hospital, 65 km away, as there was a pregnancy complication and the PHC lacked oxygen support.

Also Read | M.P. High Court notice to government authorities over death of infants after rat bites at Indore hospital

Devi’s husband, Devram Katara, and her father, Harichand Meda, rushed to arrange for a private van as the government-run 108 ambulance was out of service allegedly due to a flat tyre.

In the early hours of August 30, Devi gave birth to a girl. The child had congenital anomalies and was referred to the Maharaja Yeshwantrao (MY) Hospital, one of the State’s largest government-run medical facilities, in Indore. While Devi remained at the district hospital, Katara and Meda rushed the infant to Indore in an ambulance.

Manju Devi, who lost her 3-day-old daughter days after being bitten by rats in the NICU of Indore’s MY Hospital, sits with her father Harichand Meda outside his house in Nandana village in Madhya Pradesh’s Dhar district.
| Photo Credit:
A.M.FARUQUI

On September 6, Devi saw her baby wrapped in plastic covers in a carton. Later, the couple found out that rats had bitten off four fingers of their daughter’s hand.

The child was one of two infants bitten by rats at the neonatal intensive care unit (NICU) of the MY Hospital. On August 30, the daughter of farmers from Dewas district had been bitten, an internal committee report confirms.

The two girls died on September 2 and 3 respectively. The tragedy sparked outrage over safety, health, and hygiene conditions, and overall management of the State’s government hospitals.

As the news of the deaths spread, the administration of the hospital suspended two nurses on duty at the NICU at the time of the incident and removed Nursing Superintendent Margaret Joseph from the post.

The main building of the Majaraja Yashwantrao Hospital in Madhya Pradesh’s Indore, where two infants were bitten by rats inside the neonatal ICU (NICU) and died days later.
| Photo Credit:
A.M.FARUQUI

A four-member internal committee was formed to probe the incident after State Public Health and Medical Education (PHME) Commissioner Tarun Rathi issued a notice to Dr. Arvind Ghanghoria, Dean of the Mahatma Gandhi Memorial Medical College (MGMMC), to which the hospital is affiliated.

Amid the growing outrage, Chief Minister Mohan Yadav and his deputy Rajendra Shukla, who also holds the Health portfolio, issued statements and assured people that strict action would be taken against those responsible for the negligence.

While Shukla admitted that pest control was not done in a timely manner at the hospital, Yadav told reporters that “a permanent solution will be found to prevent such incidents”.

Soon, the National Human Rights Commission and the National Commission for Protection of Child Rights issued notices to various government authorities.

The Madhya Pradesh High Court took suo motu cognisance of the matter, stating that the incident appears to be the result of “gross negligence” on the part of the hospital administration. While seeking a status report from the government, the High Court flagged the lack of action against doctors or senior officials. The court also sent a team of three senior advocates to inspect the hospital and submit a report.

Hours after the court’s intervention on September 10, Dr. Brajesh Lahoti, head of the department (HoD) of paediatric surgery at the hospital, was removed from the post, while acting HoD Dr. Manoj Joshi was suspended. Medical Superintendent Dr. Ashok Yadav went on 15-day leave, citing health reasons.

The probe panel found that the pest control team failed to show up after being informed about the first rat bite incident. Based on this report, Sandeep Yadav, Principal Secretary of the PHME Department, directed HLL Infratech Services, which was contracted for the job, to terminate the services of Agile Security Force, the private firm to which it had outsourced the task. Agile Security Force in turn terminated the contract of another private firm that it had hired for pest control. The hospital administration also imposed penalty of ₹1 lakh on Agile Security Force.

Congress leader and Leader of the Opposition in the Lok Sabha Rahul Gandhi said the deaths were “outright murders” and that government hospitals are “no longer life-saving” for the poor.

In the status report submitted to the High Court, the hospital administration claimed that the children died due to underdeveloped organs and other existing serious conditions.

Just as the controversy was spiralling, a probe was launched on September 16 at the government-run Netaji Subhash Chandra Bose Medical College Hospital in Jabalpur after two patients and an attendant alleged that they had been bitten by rats in the psychiatry ward. A video showing rat babies inside a bedside drawer at a ward surfaced on the Internet, though its source is not verified. Jabalpur Collector Raghvendra Singh says a notice has been issued to the hospital administration and a panel has been formed to probe the incident.

Outrage grew after the hospital administration said on September 2, the day Devi’s child died, that she had been “abandoned”.

Katara, a 25-year-old marginal farmer and labourer from Rupapada village, denies the allegation. He recalls rushing to Indore with Meda, with only ₹200 between them, and admitting his daughter to the NICU of the hospital. They were then asked to wait outside, he says.

“After reaching there, the ‘ambulance man’ asked us for some money even though it was a government service [supposed to be free of cost]. We told him we only had ₹200, but he insisted, so we gave him the money,” Katara says.

“For two days, we stayed outside the ward without any money. Someone from our village, who now lives in Indore, brought us food and a blanket as it was raining,” he adds.

They returned to Dhar to attend to Devi, who was still at the district hospital, he says.

Meda claims he saw rats outside the NICU and in various parts of the MY Hospital. “Khar jaise mote choohe the (There were rats as large as rabbits),” he says.

He claims that his granddaughter was not “as sick as the hospital claims she was”. “We believe she died because of the rat bites,” he adds.

On September 6, Katara and his family, who belong to a Scheduled Tribe, arrived at the hospital in Indore accompanied by Congress MLA from Dhar’s Sardarpur Assembly constituency Pratap Grewal and activists of the Jay Adivasi Yuva Shakti Sangathan, a tribal outfit. They staged a demonstration alleging that the hospital had kept them in the dark about their child’s death.

Grewal says he informed the couple about their daughter’s death after learning about it in the local press.

During the hearing in the High Court on September 15, the Bench asked the State government why an FIR had not been registered in the matter.

The MY Hospital is located in the heart of Indore, a city that for the past eight years has been declared the cleanest city in the country by the Central government. There are rat traps placed across the hospital, especially in the paediatric ward on the second floor.

On the lower floors, including the basement, where most rooms are used for storage purposes, there is a strong smell of bleach. The corridors are wet from washing. While most rooms are shut, some are packed with old furniture and mattresses. Disposable plates with namkeen mixed with rat poison are seen in several places.

Tara Chand, a sanitation worker with the hospital for the past eight years, says a drive to catch rodents is in progress in all wings of the government facility. “There is this drug [rat poison] everywhere, so we are finding many dead rats. Just this morning, I found five of them and threw them out. It is such a huge building and many more will be found,” he says.

There are still signs of rotting leftover food, piles of discarded clothes, and open garbage strewn across the premises.

Out-of-use furniture and cushions were lying in a room in the basement of the Majaraja Yashwantrao Hospital in Madhya Pradesh’s Indore, where two infants were bitten by rats inside the neonatal ICU (NICU) and died days later.
| Photo Credit:
A.M.FARUQUI

Patients, their attendants, and staff reflect on issues that pose a challenge in keeping the facility clean. Ravindra Malviya and Aman Shinde, who were in charge of Agile Security Force, blame the abundance of food served by various charitable groups and local leaders at the hospital. “You will find vans in different parts of the premises round the clock serving visitors and attendants. There is so much variety of food from fruit to poori that people throw away one item as soon as someone offers them a new one,” says Malviya.

Shinde adds that rotten food attracts rats and insects and “everybody is connected to some politician or official, so they dial them up and we are told not to interfere”.

They, however, insist that pest control is carried out regularly at the hospital. “But it is done inside the buildings and not across the grounds. That is not under our jurisdiction,” Shinde says.

Jyoti Goel, a nurse at the hospital, says the problem persists even in the wards. “Even though outside food is not allowed here, it’s very difficult to prevent the actions of the attendants of patients. There are garbage bins in each ward but some patients and their attendants leave their food under the beds,” she says.

Pramod Ahirwar, a resident of Khandwa who is admitted to the hospital with a fractured leg, points out that there are delays in cleaning the wards. “Yes, there are bins but they are open. If they are not cleaned at regular intervals, rats will still come searching for food,” he says.

However, displaying a resigned acceptance, he says, “It’s fine the way it is. We can’t expect facilities here like in private hospitals. I came here because I can’t afford treatment at a private one.”

Bedsheets on most beds in the wards are stained, but patients say they are replaced “almost every two-three days”. The nurses say stains remain on the sheets and there is no fixed interval to replace them with new ones as it depends on requirement and necessity.

Adesh Rajak, who is attending to his grandfather at the district hospital in Damoh, highlights several issues with cleanliness and the hospital staff’s behaviour. “If you ask for something to be cleaned, it will not happen at once. You have to ask multiple times and receive a rude response every time. The outside of the hospital looks clean, but inside, the walls are stained with betel quid and tobacco spit. All of this has been normalised here,” he says.

Dr. Arvind Shukla, acting Dean of MGMMC during the court-ordered inspection, acknowledges the food distribution and wastage problem. He reflects on the issues that lead to poor hygiene at government facilities. At the top are inadequate infrastructure and patient burden, he says.

While the MGMMC, formerly King Edward Medical School, was established in 1848, the MY Hospital was built in 1955 and continues to remain one of the largest medical facilities in central India. “It’s an over 70-year-old building and has been functioning 24×7 ever since. So, naturally it cannot survive with just regular maintenance. Any such problem is a byproduct of infrastructural issues that persist over a long time,” he says. “Mix an old building with unattended food and you have a perfect recipe for rodents.”

Indore is located in western Madhya Pradesh and the hospital caters to over 10 districts in the Malwa-Nimar region. Dr. Shukla says the hospital’s out-patient department sees an average daily footfall of about 5,000, while the number of patients admitted in a month ranges between 3,000 and 7,000. “If you count the number of attendants and visitors too, the average daily footfall goes up to 20,000,” he says.

The State Cabinet had sanctioned ₹773 crore in May this year for a new building with 1,450 beds at the hospital, but it could be years before the burden on the existing facility is lowered. The hospital currently has 2,400 beds.

The High Court’s inquiry threw up issues such as shortage of staff and poor maintenance of the building by the Public Works Department (PWD). The High Court has issued a notice to the PWD, seeking a response on various aspects, including the condition of the MY Hospital buildings, its life expectancy, the condition of the drainage system and electrification, and the required budget to make necessary improvements. The court also asked the PWD to prepare a detailed project report for the renovation, repair, and maintenance of the MGMMC building and hostel residential quarters.

Another senior doctor at the hospital, who was part of the internal probe panel, raises the problem of shortage of nursing staff. “Ideally, in an ICU, one nurse attends to three beds, while in our ICU, there are three-four nurses for 20 patients. This also includes senior nurses who issue instructions. All this reduces the number of working hands, so it is not possible to be attentive to every single patient at all times,” the doctor says on condition of anonymity.

“There is so much talk about the doctor-patient ratio in India but very little on the nurse-patient ratio, which is an equally essential part of the healthcare system,” the doctor adds.

The nurse-population ratio in India as of December 2022 was 1:476, the then Minister of State at the Union Ministry of Health and Family Welfare Bharati Pawar had told the Rajya Sabha in December 2023, citing the National Medical Commission data.

As per the National Health Systems Resource Centre’s 2021 health dossier, Madhya Pradesh has a sanctioned strength of 19,062 staff nurses against the required strength of 23,746 in government medical facilities. Only 12,925 staff nurses were in service, creating a gap of 10,821 nurses.

A senior Health Department official in the State capital Bhopal also expresses displeasure at the manner in which nursing staff at the MY Hospital were terminated. “Following outrage, immediate action was announced against the nursing staff without hearing their side or even probing the matter and finding the root cause,” the official says. The sentiment was echoed by several nursing staff members at the hospital.

Dr. Anand Rai, an RTI activist and whistle-blower, also questions the government action on doctors and nurses and criticises it for “going soft” on the company responsible for pest control.

“If you have outsourced a service, the accountability should be fixed on that agency. A mere fine of ₹1 lakh is nothing for a company, which has a contract worth crores per year,” Dr. Rai says, calling for the registration of an FIR against the private firm. He also alleges “multi-layered corruption” in the maintenance of such outsourced services at government facilities.

“All such contracts are issued to firms owned by or linked to senior politicians or bureaucrats. The company in question here is itself linked to an influential IAS officer in Bhopal,” he alleges without disclosing any names.

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