Kolkata: Like with Edoardo Bove, the Fiorentina footballer who collapsed on the pitch on Sunday, it took a moment for Mohun Bagan and Dempo Sports Club players to realise that something was very amiss with Cristiano Junior. With Bove who looked like he was about to open his boot before keeling over, it was Inter Milan’s Denzel Dumfries who raised an alarm. With Junior, it could have been Dempo teammates Ranti Martins and RC Prakash, said Alberto Colaco.

It will be 20 years on Thursday, December 5, so Colaco cannot be faulted for not being sure. As All India Football Federation (AIFF) general secretary, he was not near the pitch but in the stands among 20,000-odd fans at the Kanteerava Stadium in Bengaluru (then Bangalore) for the final of the Federation Cup, a premier tournament. Alongside the report, Hindustan Times’s edition of December 6, 2004 has a photograph of a visibly panicked Martins and Prakash holding Junior’s hands after the Brazilian striker had slumped on the turf.

Seconds earlier, Junior had scored his and Dempo’s second goal to put them on course for their first Federation Cup title. “Thinking he had gone towards the television cameras to celebrate like he had for the first goal, referee SM Balu’s initial reaction was to move towards the centre circle to resume play,” said Colaco over the phone from Goa.

Having forged a reputation by helping East Bengal retain the National Football League, India’s top competition from 1996 to 2007, Junior had starred for Dempo in the Federation Cup with five goals in four matches. Dempo won the final 2-0 but even before the time the prize distribution was over, Colaco got a phone call he wished he never did. Junior had died after a cardiac arrest. He was 25.

While not regular, elite footballers suffering cardiac arrest is not rare either. No one really knows why but fixture congestion, underlying hereditary conditions such as hypertrophic cardiomyopathy, and the stress of competition can increase risks of sudden cardiac arrest, Dr Christian Schmied, a cardiologist with Zurich’s University Hospital, told TRTWorld, Turkey’s public broadcaster, in 2021.

Junior died less than 18 months after Cameroon’s Marc-Vivien Foé’s death during a match against Colombia in Lyon. Ferran Corominas, who played three seasons with FC Goa in the Indian Super League (ISL), was the first to see his roommate, friend and Espanyol teammate Dani Jarque motionless in his room in Italy in 2009. One year later, Andres Iniesta dedicated his goal in the World Cup final to Jarque. In 2018, Fiorentina captain Davide Astori suffered a fatal cardiac arrest before an Italian league match against Udinese.

But if Christian Eriksen, Fabrice Muamba, Iker Casillas and Bove have survived – and, in some cases like Nwankwo Kanu and Erikson, resumed their careers – it is also because of significant improvements in pitchside medical facilities in most parts of the world. A defibrillator, which saved Eriksen, is mandatory in ISL and I-League, the second tier of India’s league system. ISL, now India’s top league, also mandates partnership with a multi-speciality hospital within 10km from the stadium, rapid response teams and medical rooms in the stadium and Advanced Life Support (ALS) ambulances, including one for spectators.

Things were different in December 2004. “An ambulance at the ground was essentially to ferry a player or staff to the hospital. Sometimes, there would be no doctors accompanying the player,” said a former AIFF official requesting anonymity given the sensitive nature the issue. There was a tie-up with a hospital in Bengaluru alright, Colaco said, but it wasn’t the one nearest to the stadium. The match commissioner for the final, MG Suvarna, was quoted in HT’s day-after report that players trying to revive Junior had led to a delay in shifting him to the hospital.

In the immediate aftermath of his death, Junior’s family rejected the post-mortem report of the Bengaluru hospital that said he had died of cardiac arrest, got a second post-mortem done in Goa and met the Goa CM Manohar Parrikar. Dempo filed a police complaint and AIFF suspended Balu and Mohun Bagan goalie Subrata Pal, who had charged at Junior before being rounded off by the player from Brasilia, for aggressive behaviour.

And it upped attention to medical facilities, said Colaco, general secretary from 2000 to 2010. “Defibrillators were made compulsory. And teams mandated to have a qualified physio or doctor,” said Colaco. AIFF also arranged for National League clubs to do players’ medicals under the supervision of sports medicine expert Dr Vece Paes, he said.

ISL 24-25 has an 11-page medical protocol for clubs. That includes arrangements for training sessions and identifying hospitals close to the home team’s lodgings and the away team hotel. On match days, the home team must provide a doctor, medical intensivists, critical care nurses and medical rooms for players and spectators which must include defibrillators and resuscitation equipment such as laryngoscope, ambu bag and tongue depressor). Apart from three ALS ambulances, each venue must have two ambulances with Basic Life Support system, as per the medical plan.

“Any player who collapses on FOP (field of play) is to be regarded as potentially suffering SCA (Sudden Cardiac Arrest) and this should result in immediate response by Team Doctors and/or FOP Rapid Response Team and activation of necessary measures by the Club’s medical partner,” says the medical guideline.

The guideline for I-League 24-25 too mandate defibrillators on the pitch, “which must be placed next to the fourth official’s seat or the medical bench” and in the medical emergency room at least one doctor, a team of para-medics and two ALS ambulances with trained staff. HT has a copy of the guidelines for both competitions.

After Junior’s death, Subhas Bhowmick, the former India star then East Bengal coach, had in a column for HT asked AIFF’s top brass to step down. “Junior won’t come back but at least, the AIFF…will show it has woken from its slumber. If it doesn’t, we can’t call ourselves citizens of the modern world.”

Football in India has many problems but in trying to safeguard players’ health in its elite competitions, things have changed for the better.

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