Kafeel Khan, the paediatrician who was suspended from the Uttar Pradesh Health Department after the Gorakhpur oxygen tragedy struck two years ago, could not contain himself when Chamki Bimari struck Bihar, killing over hundred children.

Chamki Bimari is a condition seen in Bihar where children display symptoms similar to acute encephalitis syndrome (AES).

BusinessLine spoke to 35-year-old Khan and other doctors, who volunteered when AES peaked. The condition was attributed to the litchi fruit .

But doctors said it was not litchis, but the mismanagement of patients, that led to the deaths.

“We screened over 1,500 children, of whom up to 50 with suspected AES were referred to Sri Krishna Medical College and Hospital (SKMCH) for advanced treatment,” Khan said .

Khan conducted preventive screening health camps in Muzzafarpur, Champaran, Vaishali and Sitamarhi districts where deaths had occurred. Over the last 12 days, he held camps at Damodarpur, Chainpur Baangar, Chakia, Neem Chauk, Nathuni Chowk Sumera, Mekra Murra Tola, Ali Neura, Meenapur, Dumri Katra and Aurai.

Khan said that he spoke to parents of the deceased and they denied feeding litchis . to their children.

“ Litchi is not the cause of this disease. They said that we have not fed the children litchis. Babies just six months old died. The reason behind the outbreak is not yet known, but symptoms of seizures and fever are similar to AES,” he said.

“ Litchis do not seem to be the cause. We are yet to submit our conclusions to the Health Ministry,” said Chander Shekhar, Additional Director-General, Indian Medical Council of Research (ICMR).

Even as the official death toll stands at 157 — the number submitted by the Bihar government to the Supreme Court — Khan said that children have died in the care of quacks, in private hospitals, in government ambulances while being transported to SKMCH, or were brought dead to the SKMCH emergency ward. “If we add all of these deaths, the toll could be double,” he said.

Untrained doctors

Ravikant Singh, founder of non-profit Doctors For You, had gone from village to village distributing glucose supplements and spreading awareness about Chamki Bimari. He blamed untrained doctors in primary health centres for the deaths. “A few days ago, a malnourished girl with diarrhoea was discharged prematurely by a young MBBS doctor who did not know how to handle the case, and the girl succumbed after being discharged,” Singh said.

Khan agrees with Singh about early treatment of babies. In Gorakhpur, Khan had studied AES closely. After analysing three years of data, Khan and his team realised that nine out of ten children with AES, who had been stabilised at a PHC, survived when brought to BRD Medical College in Gorakhpur.

“But those directly brought to a medical college, 30-40 km away, one in two children died. That is, a mortality rate of 50 per cent. While in the case of stabilised children, who got early care, only 10 per cent succumbed,” he said.

Speaking on condition of anonymity, another doctor, who had volunteered when AES cases were peaking, alleged that no senior government doctor was on duty after 2 pm at SKMCH as they returned to their private practice. “In fact, the State government asked volunteering doctors to operate from HoDs’ rooms in the afternoon, as these doctors would not be in.

Poor infrastructure

Another key issue is poor infrastructure. The day Khan entered SKMCH to take a stock of the situation, after being given permission by the Bihar government to volunteer, he said was shocked to see more than 200 children admitted to a large room with no air-conditioning, serving as a 'ward,' with only four doctors on duty; three of them were junior residents.

“The ICU guidelines of 2017 mandate one doctor for every 5-6 patients, here there was one doctor for 50 children. By the time you put one kid on intravenous and reached the next bed, the last one in queue would succumb. Even five years after the announcement, no National Institute of Virology lab has been set up for research. At least Gorakhpur has a central lab and better facilities at BRD Medical College now, but Muzzafarpur has nothing,” Khan said.

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