Encephalitis Scourge: Sensitivity Not Sensationalism Is The Panacea

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A woman’s 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. 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. It’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.”

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These are excerpts of a five-year-old report published in Tehelka magazine on the enormity of the epidemic which has come to grab eye-balls more for the reasons of sensationalism that concern for the death. BRDMC, where 60 children are reported to have died, 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 many times patients from the bordering areas of Nepal too. It’s ironic that the hospital is in controversy, when its main benefactor, Yogi Adityanath, is at the helm of affairs in the state. As the local Member of Parliament, Adityanath has pushed for a “holistic approach” to the scourge. While strengthening medical facilities has been on agenda, he has also focused on prevention.

A point he did not miss to make on Saturday while addressing a meeting in Allahabad. “There are vector-borne diseases, such as encephalitis, you must be hearing media reports of BRD medical college these days...it is a tragedy that lives of young children have been snuffed out at such young age because we do not lead a clean and hygienic life” he said while reminding the crowd that the disease has been the bane of eastern Uttar Pradesh since 1978.

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Japanese Encephalitis (JE) was detected in India in 1955, 84 years after the first case in Japan. The disease was initially confined to Tamil Nadu. In 1973, it struck West Bengal. The virus then invaded 22 rice-growing states, where its carrier, the Culex mosquito, which breeds in stagnant water, acquiring the infection from feeding on infected domestic pigs, the amplifying host, and migratory birds, the natural host.

Uttar Pradesh first reported JE in 1977. Outbreaks in Gorakhpur and neighboring districts became more frequent and intense when more farmers switched from sugarcane cultivation to paddy. Therefore, no wonder that most of the victims, who are aged between six months and 12 years, come from the hinterland, where primary health centres are in shambles. Almost all the cases of reported death in the past two days were referral patients. In the most of the cases by the time they are receivedat BRDMC, it’s already too late. The survival rate is next to nil, as the records would show, oxygen or no oxygen. Patients come with an inflammation of the brain and other vital organs such as heart, liver and kidney. It leads to organ failure.

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At pan-India level, while 24 states are endemic for JE, Uttar Pradesh has contributed more than 75%of cases during the past several years. Over the years, the seasonal trend has changed and the epidemic peak of the disease too has advanced by one month.

The Tehelka article of 2012 had mentioned that the lack of awareness on hygiene and sanitation, coupled with groundwater pollution, have made the disease a major scourge. “Lack 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 entero-viral kind,” then BRDMC Principal Dr KP Kushwaha, who had treated encephalitis patients for over three decades was quoted in the report.

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Therefore when the chief minister says, addressing a gathering at Allahabad that the death of these children in his constituency was caused by filth and scourge of open defecation, he is just recalling a medical situation.“Gandagi ki wajah se is desh ka bacchaa samay kaal kalvit ho raha hai (Unclean surroundings are causing untimely death of children),” he is reported to have said, while reiterating the need to give public support to Prime Minister Narendra Modi’s Swacch Bharat Mission aimed at ridding people of the dirty and filth around them.

Another disturbing factor is that JE cases now constitute only 2-4 percent of the mortality count. Since 2004, it’s the enteroviral encephalitis that’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 virusesis polluted groundwater. Years of large-scale irrigation have raised the groundwater level in Gorakhpur. One can get water by digging only 8-10 feet. People don’t bother if the water is safe or not because shallow water is always cheaper to pump.

One of the cheapest ways of fighting the scourge are Mark II hand pumps, which fetches water from 150 feet under the ground. while the need is for a Mark II for every 100 people in regions where hundreds are dying just because of contaminated water, as per the available Government figures there are less than 5000 Mark II hand pumps functioning in Basti-Gorakhpur Zone.

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While there is no denying the need to tone up the medical administration the state, it’s also the right time to create awareness about much needed hygiene to save victims from certain deaths. The longtime saying of prevention being better than cure, is certainly not without basis.

 

(Sidharth Mishra is Editor, Capital Khabar)

 

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