Ground zero @ Gorakhpur as the sky darkens

In a small hut in Natwa jungle village in eastern Uttar Pradesh, 25 km from Gorakhpur’s BRD Medical College, Saroj Chaurasia (32) is scared for her two boys, Ankit (11) and Amit (4). Her only daughter Jyoti (7) died last August of Acute Encephalitis Syndrome (AES).

On August 9, in the dead of the night, she was restless. “She asked for her cot to be kept near the hand pump. She was getting thirsty every few minutes. She suffered from seizures early in the morning. We rushed her to the medical college where she was admitted in the AES Ward,” recalls Saroj.

At about 7 pm on August 10, Saroj was handed an ambu-bag, as were the other parents of sick children, she recounts. The oxygen supply in the central tank had run out. “We kept pumping hard for the entire night but she breathed her last at 6 am on August 11,” says Saroj.

Jyoti was labelled “AES no 17011” by State health authorities in a document handed over to her father Binod (32).

As the monsoon looms over Gorakhpur, fear grips residents in and around it as the possibility emerges of another spate of brain fever death or “dimaagi bukhaar” as the locals put it.

And here’s why. Of the 1,421 AES cases at BRD since last August when the oxygen shortage tragedy struck, about 319 died in the months up to May 2018 , reveals data accessed by BusinessLine’s Pulse from UP’s state health department. A few kilometres away at Gorakhpur district hospital, 1,000 AES cases were recorded and 27 of them died; primary health centres in the neighbouring regions recorded 236 AES cases and one death.

“Because of inadequate facilities to diagnose and treat symptoms of seizures and delirium at primary and district-hospital levels, patients are referred to the tertiary set-up. There may be an overlap in recording admissions, but deaths are ultimately higher in the medical college,” clarifies a State official.

Inadequate infrastructure

On the ground, though, district and primary health centres do not seem to be extra prepared for a fresh wave of infections and death that rains could bring. The BRD Medical College, for example, overcrowded as it is, supports patients and families from up to 12 neighbouring districts as well as Nepal and Bihar.

“Earlier we had only 16 warmers even as the load of sick neonates was huge. Since last year, we have scaled up to 48 warmers. Each year, we see 1,500-2,000 children with AES symptoms, the pressure is immense,” says Dr Mahima Mittal, BRD’s head of paediatrics.

T Jacob John, Head (Microbiology and Virology) at Vellore’s Christian Medical College adds, “If diagnosed differentially, many are easily treatable, saving lives. Lumped as AES, many will die without diagnosis and treatment.”

Sub-centres, or the first point of contact in hamlets, are mostly closed and open only once in a month for vaccination. The nearest Primary Health Care Centres (PHC) are mostly under-staffed, with a pharmacist examining patients and a ward-boy meting out basic drugs. In some others, there is a doctor, and a two-bed ‘Encephalitis Treatment Centre,’ with an oxygen cylinder.

Not always diagnosed

“We try to manage patients, but in complicated scenarios, we refer patients further to the medical college as we cannot risk worsening of a patient’s health,” says Dr B. Vikram Singh, medical officer in-charge at a PHC in Maharajganj.

Though children die through the year, with deaths peaking through monsoon, in almost 50 per cent of the AES cases, the cause of disease is not always diagnosed.

Children show symptoms of brain swelling, high fever and seizures but no one knows the cause, say experts.

Dr Arun Kumar, who heads the Manipal Centre for Virus Research, says that bacteria and virus cause AES in Eastern UP, unlike Bihar, where acute hypoglycaemic encephalopathy occurs in malnourished kids due to toxins in the litchi fruit. Or Odisha and Saharanpur (Western UP), where AES is linked to children eating the raw beans of a local weed.

In fact, he investigated 250 children at BRD hospital reeling under AES, 160 revealed Scrub Typhus, an infectious disease caused by mites, etc. He was not allowed to publish this by the government in a scientific paper, he alleges, adding that “Japanese encephalitis was only around 3 per cent, most other causes were not identified, in eastern UP the cause still largely remains a ‘mystery’.”

Citing a study done about two years ago at BRD, Dr Soumya Swaminathan, former director general, Indian Council of Medical Research (ICMR), also mentions Scrub Typhus being revealed in almost half the processed samples. Japanese encephalitis and dengue caused by mosquitoes were the other reasons. But “we do not know what the cause is in close to 35 per cent cases,” she says.

A walk through the corridors of BRD Hospital shows little preparedness to tackle these known and unknown causes of killer diseases. The stench of urine pervades the air. And flies hover around the families of sick children, sitting in an eternal wait for news of their baby’s probable recovery.

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