As monsoon sets in, encephalitis claws its way back in eastern U.P.

Aarti Dhar
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The disease has already claimed 145 lives in the region this year

Innocent victim:A child suffering from encephalitis with his mother at BRD Medical college in Gorakhpur.Photo: Subir Roy
Innocent victim:A child suffering from encephalitis with his mother at BRD Medical college in Gorakhpur.Photo: Subir Roy

At a time when people are praying for a bountiful monsoon, rains bring death and devastation in the eastern belt of Uttar Pradesh. And if the locals are to be believed, the season of death has started as encephalitis cases are reported from across the region.

For years now, hundreds of children have been dying and an equal number have been disabled for life because of Acute Encephalitis Syndrome (AES), more specifically Japanese encephalitis (JE), commonly called brain fever.

This year is no better, as 145 AES-related deaths have already been reported from Baba Raghav Das (BRD) Medical College & Hospital here, the only hospital in the region equipped to handle such cases.

Jaswant, 12, of a nearby village, died of the disease one afternoon recently. He had been under treatment for several days. As the doctors declared him dead, a stunned silence descended on the Intensive Care Unit of the Epidemic Ward as the attendants of other children watched with disbelief and fear.

“We have had 595 AES cases since January this year, and only 12 of them were confirmed JE; as for the rest, the cause was not known. Unfortunately, 145 deaths have occurred so far, and 53 AES cases are under treatment,” says Dr. K. P. Kushwaha, paediatrician and Principal of the college.

Japanese encephalitis, said to be caused by mosquito bite, and AES, believed to be caused by bad sanitation and unsafe drinking water, affect mostly children aged below 15; 25 per cent of the victims die and 30-40 per cent of the survivors suffer from physical and mental impairment. Between 70-75 per cent of the cases are reported from Uttar Pradesh alone and the rest from Bihar, Assam and as far away as Nepal, all of whom come up to Gorakhpur for treatment. Last year, the disease claimed close to 900 lives, with eastern Uttar Pradesh alone accounting for more than 470.

Sitting on a bed, Ramrati, a middle-aged woman, was fanning her four-month-old grandson Ashish in the special ward for AES cases. She hails from Gola block, about 60 km away from the district headquarters. She had brought Ashish a month ago with high fever, but he was discharged after 15 days. “He developed fever again and we had to bring him back,” she says. Most of the patients come here when they are critically ill. The children are undernourished, a condition that adds to the mortality.

“The burden on the hospital is immense. We are preparing ourselves to deal with the situation better this time,” says Dr. Kushwaha. After infant deaths were highlighted last year, funds were released under the National Rural Health Mission for building a dedicated ward for brain fever cases. “The construction of a 100-bed ward, with a 20-bed ICU, has finally started with a lot of effort, but it will take several months before the facility is operational, and it doesn’t mean much if there is no skilled manpower.” Things are slowly moving in the right direction for the hospital: the two epidemic wards are now air-conditioned and space is being built for attendants who otherwise settle on the corridors.

A Group of Ministers set up last year has recommended that a dedicated ward be established in seven district hospitals that treat such cases in large numbers. Gorakhpur will get a new ward, but most others will upgrade the existing structure.

The National Programme for Prevention and Control of Japanese Encephalitis and Acute Encephalitis Syndrome has identified 171 high-burden districts spread across 19 States and decided to take up 60 districts in the first phase for reducing morbidity and mortality and disability among children due to the disease by strengthening vaccination, surveillance and vector control and through proper sanitation.

“There needs to be a nodal agency, or a single window, to implement the programme because many departments and Ministries are involved. Unless that happens, it will be difficult to achieve much,” explains Dr. Kushwaha. He reckons that there is no alternative to creating awareness of sanitation and providing clean drinking water to the people from the deprived sections.



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