Atharva: Tell-tale of a pneumonia crusader

15 OCTOBER 2011: Atharva, is a 2 years and 10 months old child who is battling for life at the Paediatric Intensive Care Unit (ICU), Chhatrapati Shahuji Maharaj Medical University. Hospitalized for over 3 months the child gets terrified even at the sight of equipments. He tried to hide in his mother’s lap seeing the CNS reporter’s camera and other gadgets. Atharva’s father is a PAC jawan. His mother Mrs. Renu Bala Sharma had a long painful story to tell. “He got fever on the 21st July. We consulted a private doctor in Sujanpura, Alambagh regularly for 3 days that is 22nd, 23rd and 24th July 2011. On the 25th July, he told us that our child has pneumonia.”

When enquired about whether she had heard about the disease earlier she says, “We had heard that pneumonia is a common disease of children and children do get infected with it often but we had never thought it would get so serious.”

Atharva’s parents are well-educated and showed no negligence towards their child’s illness. They consulted medical help as soon as Atharva got fever and chest congestion. His mother adds, “He had no disease before. The first day he got fever we brought him to the doctor. We can’t be careless with our child. We had sought medical attention immediately.”

From here began a series of hospitalizations. Mrs. Sharma says, “So we took him to another private children’s hospital in L.D.A. Colony and got him admitted there. He was treated there till 29th July. On the 29th July they told us that the bag of pneumonia has burst inside. There is a bag inside. Suddenly it appeared that he is not being able to breathe. We felt it is his last hour and it seemed very difficult that we would be able to reach a super-speciality mother and child Hospital in Alambagh (popular for IVF) in time. They said that if we can spend money then we can refer him to this hospital. We said that that money is not important we want our child. So he was brought to this hospital on 29th July and got him admitted around 4pm.”

Private hospitals mostly operate with the aid of on-call doctors who are called when a patient of their specialization is admitted. There is no 24 hour supervision of experts. In a serious illness as pneumonia where the patient’s condition deteriorates quickly, such an arrangement can put several lives at risk and it did in Atharva’s case as well.

At this super-speciality mother and child hospital, Alambagh, Atharva’s condition worsened until he was put on ventilator and taking probably his last breaths as the doctors there had declared so.

Atharva’s mother laments,“There they saw two X-rays which were of the initial stages. When they examined him they said that it has got filled with air. The pneumonia has burst, I’m expressing in my language from my understanding. They inserted I.C.D. after which he was relieved a little. It appeared that now he is able to breathe. Then they asked us to bring blood bottles for transfusion. We came to the medical college to get blood. The blood was given in three stages. They kept on giving their treatment. They did not tell us anything and carried on with their treatment. We felt very helpless. All we could do was shell out money and watch the doctors with hope. The condition of my child kept on deteriorating. They had inserted a single tube and following that another thick tube, which caused his body to swell tremendously. My two year old son appeared to be ten years old. His cheeks had swollen. It felt as if his eyes would fall off. It seemed as if air had filled up in his entire body. He would lie down and they would make incisions, then force out the fluids by applying pressure. His genital region had also swollen up. The doctors would do nothing despite our request. They would say we can take the child anywhere we wanted to. In the end they put him on ventilator.

They told my husband that now he has only two hours of life left. Your child will survive for hardly 2 hours.” For a middle-class family private hospital treatment can mean a life time’s saving, but Atharva was lucky to find help of some relatives. Mrs. Sharma narrates, “At that time all my family members, my sister, sister’s husband, brother, brother’s wife everybody had gathered there. They all were trying to find a way to save my child’s life. We have spent about INR 150,000 in his treatment already. I only want my child healthy and sound now.”

Private hospitals play very safe when admitting cases. A complicated case with meagre hope of survival is rejected to save the private hospital’s brand name. Athatva’s parents even tried to approach the city’s biggest multi-speciality hospitals for help. Mrs. Sharma says, “We tried to approach Lucknow’s new and biggest multi-speciality hospital in Gomti Nagar but they denied accepting such a severe case.”

Finally Atharva was brought to the government-run tertiary care centre and medical college, Chhatrapati Shahuji Maharaj Medical University (CSMMU) – erstwhile King George’s Medical College - on 5th August 2011. His mother takes a sigh of relief saying, “They did not leave any treatment. It was his destiny and our good luck that he survived. At one point we were at dead end. I felt my child won’t come back to me. Professor (Dr) YC Govil is like a God for me.”

Futher narrating the apathies of private hospitals she adds, “We feel that his condition got so complicated only because of negligence on the part of doctors. They did not get any tests done. They did not know what treatment to give. They were treating him on guesswork. They were even giving treatment for TUBERCULOSIS, the tablet which is given empty stomach in the morning.”

Atharva was a healthy child but wasn’t exclusively breastfed for the first six months, probably due to lack of awareness about its importance in preventing pneumonia and other childhood illnesses. His mother says, “I have breastfed my child. Even now he wants me to feed him but because we are in a hospital I don’t want to feed him. During the first five months I used to give apple juice and water along with my milk but I started giving him cereals only after his ‘Annaprashan’ at the start of his sixth month. He used to eat everything. Gradually he had started taking everything.”

The pneumonia vaccination because of its high cost has not yet been included in the Government of India’s vaccination programme. There is also little awareness among the masses about the existence of these vaccines and about the fatal nature of the disease. Atharva’s parents are no different. His mother laments, “We got him vaccinated against every disease. At the one and a half month then at two and a half months. There is a immunization card. We went by the card. We don’t know whether it had pneumonia vaccine also in it. We have spent lakhs of rupees already on his treatment. Had we known about the vaccine we would have definitely got him immunized.”

Development of antibiotic resistance among common pathogens is a global concern. Professor (Dr) YC Govil, Department of Paediatrics, CSMMU, remarks “There is a lot of disparity in between the treatment at private and government hospitals. Lot of antibiotic misuse is happening in our country and the reason is many a times patients are been treated by unqualified practitioners of medicine in rural areas. I think almost 20-30% of patients would initially go to an unqualified practitioner. So here they are in habit of advising lots of broad spectrum antibiotics in the beginning. Even in viral infection where antibiotics are not usually indicated. This is also prevalent in the urban setup as well. Before the first wonder drug penicillin was discovered men used to die like flies and if this trend continues that era would return.”

The senior resident doctor incharge of Atharva told the CNS reporter that Atharva was on ventilator when brought. Further he adds, “His sputum showed positive result for multiple pathogens like Streptococcus pneumonia and Eshcherichia coli. He did not respond to any of the traditional antibiotics. Finally was given tigecycline, a newly released and most advanced chemotherapeutic agent. The patient responded to it and was removed from ventilator. The patient is stable now. But under observation.”

Somya Arora - CNS
(The author is doing her post-graduation in microbiology from Lucknow University and writes on social justice issues for CNS:

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