40 Days On Ventilator, 83 Days In Care: Public Hospital Helps Little Gargi Fight GBS

After spending more than 80 days in hospital, including nearly 40 days on a ventilator, 11-year-old Gargi is finally back home in Nandnagri in the national capital. She is slowly regaining her strength after battling severe Guillain-Barré syndrome (GBS) at Delhi’s MCD-run Swami Dayanand Hospital.

The 7-year-old is now gradually regaining her strength after the life-threatening neurological illness.

However, her recovery is not simply the story of a child coming off a ventilator. It also shows what sustained public healthcare infrastructure and trained human resources can mean a lot for low-income families like hers.

That is it means access to prolonged, specialised care without having to bear the private-sector cost of keeping a critically ill child on a ventilator for weeks.

Dr Surendra Singh Bisht, Head of the Department of Paediatrics at the municipal hospital, told The Health Outlook that the girl had developed extensive paralysis and respiratory failure and needed prolonged ventilator support.

Gargi had experienced a similar problem about a year earlier, and the family had struggled with the cost of treatment at that time, particularly the expense of immunoglobulin therapy.

“An immunoglobulin injection can cost around Rs 15,000, depending on the preparation and dose, and the overall treatment can become costly,” Dr Bisht explained. Rajeshwari, the girl’s mother and a domestic cook, said many hospitals had rejected her from admission. So, when Gargi reached SDN hospital, she was in a critical condition.

“By the time the child came to us, the paralysis had already progressed considerably,” Dr Bisht recalled. What followed was an 83-day battle involving 40-day intensive care in ICU, close monitoring, coordination between departments and a gradual return of vital functions.

Needless to say, for a municipal hospital, managing a child who required prolonged ventilator support was a demanding test of its critical-care capabilities.

GBS is a rare neurological disorder in which the body's immune system mistakenly attacks peripheral nerves. The condition can progress rapidly, causing weakness that often begins in the legs and moves upwards. In severe cases, it can affect the muscles responsible for breathing, swallowing and speaking, making intensive care necessary.

Explaining the disease, Dr Bisht compared nerves to electrical wires, which carry signals between the brain, spinal cord and the rest of the body. The nerves have protective structures that help conduct these signals. In GBS, the immune response damages nerve components, disrupting communication between the brain and muscles.

“When the nerves are damaged, the muscles do not receive the signals properly. That is why patients can develop weakness and, in severe cases, paralysis,” he explained.

Patients need continuous monitoring of respiratory function, swallowing, blood pressure and other vital parameters. Prolonged ventilation also carries risks, including infections and other complications associated with critical illness.

Contrary to the general perceptions that local government hospitals are devoid of facilities, Dr Bisht said their healthcare facilities had the necessary critical-care infrastructure and staff to take up the case.

In fact, Dr Bisht shared how the hospital’s preparedness had been strengthened during the Covid-19 pandemic, when critical-care facilities and equipment were expanded to deal with seriously ill patients. A non-profit organisation Care India had supported paediatric critical-care infrastructure, including ventilators, while additional ventilators had also been received through MP funds provided by area parliamentarian Manoj Tiwari.

This investment in infrastructure proved important, as did the trained and dedicated team. In Gargi’s case, the paediatrics team worked with ENT specialists, anaesthesia staff, nurses, dietitians and other healthcare workers.

Dr Sunita Kujur, medical superintendent at the hospital, said their hospital has required facilities for underprivileged patients suffering from GBS.

Since private care involving prolonged intensive care and mechanical ventilation often leads to catastrophic out-of-pocket expenditure, SDN Hospital with advanced neurocritical support has handled severe GBS variants such as Acute Motor Axonal Neuropathy, or AMAN, providing a crucial public safety net for needy patients.

Since, in severe GBS, even after the immune attack is brought under control, damaged nerves need time to recover, and muscle strength may return gradually, Gargi was subsequently weaned from the ventilator and later from oxygen and continuous positive airway pressure (CPAP) support.

Physiotherapy was introduced as her condition stabilised. Nutrition was also closely monitored because adequate nutrition is important for rebuilding strength after prolonged illness.

The doctors’ approach was to stabilise her first and then support her gradual recovery.

Dr Bisht recalled another child who was brought for evaluation soon after developing symptoms suggestive of GBS. Early treatment was initiated, and the child experienced a shorter illness with relatively mild weakness. He contrasted that experience with Gargi’s advanced condition when she reached his team.

The comparison, he said, underlines the importance of not overlooking rapidly progressing weakness and seeking medical attention promptly.

Early warning signs matter, Dr Bisht said. GBS can progress rapidly, making early recognition important.

Parents should seek medical attention if a child develops sudden weakness in the legs or arms, difficulty walking or weakness that appears to be moving upwards. Problems with swallowing, speaking or breathing require urgent assessment, he said.

For Gargi’s mother, Rajeshwari, the 83-day hospital stay was a long and anxious wait, whether she would ever be able to walk and return to a normal life.

Now, watching Gargi slowly regain her strength and take steps again, Rajeshwari said she had no words to express her gratitude to the doctors and hospital staff who stood by her family through the difficult days.

“I am happy that my child has crossed the most critical phase.”