The epidemic no one cares about
ByÂ Soumik Mukherjee
A WOMANâ€™SÂ blood-curdling scream rings out in the dark room. Dr Mahima Mittal, who is attending to a patient, shifts her gaze to the farthest corner of the room to locate the crying mother, but in vain. A power cut has made it impossible to see beyond a few feet. Otherwise, a cursory glance would reveal dozens of unconscious children huddled up in beds that cover the floor from end to end.
The scream signals the death of yet another child due to encephalitis in the paediatric ward of the Baba Raghav Das Medical College (BRDMC) in Gorakhpur, Uttar Pradesh. Itâ€™s the third death of the morning, on 29 September. By the end of the day, the toll would reach seven. But the doctors have no time to mourn. They have to monitor the condition of 90 children who are fighting for their lives in the same ward.
BRDMC is the only medical facility that has a dedicated encephalitis ward in this region where more than 50,000 people have died of the dreaded disease since 1978, when the first case of encephalitis was reported from Gorakhpur. The medical college hospital serves encephalitis patients from 19 districts of Uttar Pradesh, Bihar, Assam and sometimes patients from the bordering areas of Nepal too.
For the harried doctors, itâ€™s just another day in the paediatric-turned-epidemic ward, which has seen the most number of child deaths in the country. More than 400 children have succumbed to encephalitis in this hospital since June. The average toll is 3-4 per day, but on some days, the death count crosses double digits.
Last year, more than 450 children died in the peak season (July-October). In 2010, the figure was around 550. Almost 95 percent of the cases are of enteroviral encephalitis, in which the virus enters the body through the intestine.
Most of the victims are aged between six months and 12 years and come from the hinterlands, where primary health centres are in shambles. â€śAll these patients are referral cases. By the time we receive them, itâ€™s already too late. The survival rate is next to nil,â€ť laments Bharati Bhandari, a junior physician at BRDMC. â€śPatients come with an inflammation of the brain and other vital organs such as heart, liver and kidney. It leads to organ failure.â€ť
The symptoms include poor feeding, irritability, vomiting and body stiffness; such symptoms in an infant always constitute a medical emergency.
Four-year-old Raja lies unconscious in bed. His father Munnilal brought him from Kushinagar, located 53 km away, â€śwhen his high fever continued for more than five daysâ€ť. The child received his first dose of medication only after reaching Gorakhpur. Same was the case with Prince, a three-year-old from Gopalganj, located 122 km away. â€śThe moment he had fever, we decided to bring him here. Some kids died recently in the nearby villages due to fever,â€ť says Princeâ€™s grandmother Meera.
But none of these people have any knowledge about encephalitis because the Uttar Pradesh government has rarely run campaigns to spread awareness about it.
The virus is more lethal in children because they often suffer from chronic malnourishment. â€śNone of the kids receive the minimum calories required. As a result, their bodies lack any immunity, which makes them an easy prey,â€ť says Dr Aftab, a resident physician at BRDMC.
The lack of awareness on hygiene and sanitation, coupled with groundwater pollution, have made this disease a major scourge. â€śLack of hygiene has always been the root cause for the spread of the encephalitis virus in Gorakhpur. Be it the mosquito-borne Japanese encephalitis (JE) or the comparatively new water-borne enteroviral kind,â€ť says BRDMC Principal Dr KP Kushwaha, who has been treating encephalitis patients for the past three decades.
The mosquito-borne JE virus thrived because of the sheer number of pigs that are reared in Purvanchal. Pigs act as a carrier of this virus. â€śIn the rural districts, rearing pigs is a popular livelihood and a profitable one too. Most of the pig farms are in residential areas and people share the same living space as pigs. This has been one of the principal reasons for the massive spread of the JE virus,â€ť says Dr Kushwaha.
JE cases now constitute only 2-4 percent of the mortality count. Since 2004, itâ€™s the enteroviral encephalitis thatâ€™s claiming most victims. While there is a vaccine against JE, prevention is the only way to fight the new virus.
The principal factor for the spread of entero viruses is the polluted groundwater. â€śYears of large-scale irrigation have raised the groundwater level in Gorakhpur. Now one can get water by digging only 8-10 feet. People donâ€™t bother if the water is safe or not because shallow water is always cheaper to pump,â€ť says Dr Kushwaha.
But the story is not just about poverty and lack of hygiene. Itâ€™s a story of state apathy as well. Even after 50,000 deaths in the past 30 years, the state government has done precious little to notify it as a health emergency or tackle it properly.
â€śThey are still treating encephalitis as any other vector-borne disease like malaria or dengue. Whereas it should be announced as a notified disease,â€ť says Radhe Mohan Mishra of the Gorakhpur Health Forum. Announcing it as a notified disease would make it a national health emergency.
But at the epicentre of the outbreak, no one is sure how many more deaths it will take for the state authorities to realise the gravity of the situation.