Hot in Ballia

sunset view

More than half of the deaths reported during the heatwave in Uttar Pradesh and Bihar this week were reported from just one district in the former, called Ballia. On (or around) June 17, the medical superintendent of the Ballia district hospital was transferred away after he attributed the deaths (until then) to the heat. He was replaced with someone else.

The state government also dispatched a team of two experts to the district to assess the local situation (as they say). One of them was director of the Uttar Pradesh health department for communicable diseases, A.K. Singh. In one of his first interactions with the press, Singh indicated that they weren’t inclined to believe the Ballia deaths were due to the heat and that the team was also considering alternative explanations, like the local water source being contaminated. I think something fishy could be going on here.

First, Hindustan Times reported Singh saying “the deaths at the hospital were primarily due to comorbidity and old age and not heatstroke”, erratic power in the area, and the time taken to reach the hospital — in effect, everything except the heat. Yet all these factors only worsen a condition; they don’t cause it. What was the condition?

Second, a reporter from The Hindu who visited Ballia learnt that it will take “more than seven days” to issue the medical certificates of the cause of death (MCCDs), so the official cause of death — i.e. what the state records the cause of each death in this period and circumstance to be — won’t be clear until then.

Aside: During the COVID-19 pandemic, the Indian Council of Medical Research issued guidelines that asked healthcare workers to not list comorbidities as the underlying cause of death for people who die with COVID-19. This didn’t stop workers from doing just this in many parts of the country. I’m not sure but I don’t think similar guidelines exist for when the underlying cause could be heat. The guidelines also specified the ICD-10 codes to be used for COVID-19; such codes already exist for heat-related deaths.

Third: Do the district authorities, and by extension the Uttar Pradesh state government, have complete knowledge of the situation in Ballia? There was the unfortunate superintendent who said there was a link between the heat and the deaths. Anonymous paramedic staff at the Ballia hospital also told The Hindu that “some of the deaths were heat-related”. Yet the new superintendent says the matter is “under investigation” even as one member of the expert team says it’s yet to find “any convincing evidence to link the deaths with heatstroke”.

I really don’t know what to make of this except that there’s a non-zero chance that a cover-up is taking shape. This is supported by the fourth issue: According to The Hindu, “the [Uttar Pradesh] State Health Department has asked the Chief Medical Officers of districts and the Chief Medical Superintendents of district hospitals to issue statements in coordination with the concerned District Magistrate only during ‘crucial situations'” — a move reminiscent of the National Disaster Management Authority’s response to the Joshimath disaster.

For now, this is as far as the facts (as I know them) will take us. I think we’ll be able to take a big stride when the hospital issues the MCCDs.