Acute Encephalitis Syndrome leaves at least 50 children dead in rural Bihar; health workers rue lack of infrastructure

Patna: An illness that’s an annual phenomenon is believed to have killed more than four dozen children in rural Bihar, with the government disputing the toll as well as the cause of deaths. In the state’s Tirhut range—comprising Muzaffarpur, Sheohar, Vaishali, East and West Champaran and Sitamarhi districts—Acute Encephalitis Syndrome (AES) has reportedly claimed the lives of 50 children. The disease is mainly caused by a virus, affects children and has a high mortality rate. According to a press statement issued by the health department of Bihar, from January 2019 till 8 June, altogether 48 cases of AES have been reported, with 11 deaths, whereas in 2018, a total of 40 cases and seven deaths were reported in the same period. AES is a bunch of 11 diseases – hypoglycemia, dyselectrolytemia, varicella (chicken pox), Japanese Encephalitis +ve, AES unknown, aseptic meningitis, measles, pyogenic meningitis, mumps, Herpes Encephalitis and acute disseminated encephalomyelitis (ADEM) – and this year, out of 11 deaths, ten have occurred due to hypoglycemia and one due to dyselectrolytemia. Some media reports have said that the deaths have taken place due to hypoglycemia and not due to AES. However, according to medical experts, hypoglycemia is one of the symptoms of AES and the recent deaths can be attributed to AES. Dr BN Jha, associated with Sadar Hospital in Muzaffarpur, said that it can be said that the deaths occurred due to AES, as hypoglycemia is one symptom of AES. Medical superintendent of Shri Krishna Medical College and Hospital, Dr SK Sahi said, “Our finding is that many of the deaths were caused due to low level of sugar which is called hypoglycemia." The death toll according to unofficial sources was 50 as on 11 June. Also, the government’s stance of blaming the weather is finding no takers since the same conditions prevailed over the last few years too, but the death toll then wasn’t this high. [caption id=“attachment_6802771” align=“alignleft” width=“380”]  Patients at the SKMCH, Muzaffarpur, where several children with suspected Acute Encephalitis Syndrome have been admitted. Image credit: Pushyamitra[/caption] Illness left unchecked? In north India’s rural belts, AES kills hundreds of children at this time of the year. The toll in 2012 was 120 and in 2014, it was 90. In 2015, the health department of Bihar and UNICEF laid down Standard Operating Procedures (SOPs) to tackle the disease. The ground reality shows that this year, the SOPs were not followed in letter and spirit. The SOPs mandate that the government’s grassroots health-delivery workers—Auxiliary Nurse-Midwife (ANM), Accredited Social Health Activists (ASHA) and anganwadi employees—visit households to check if any child has a high fever and/or low blood sugar. Every panchayat is supposed to have a health centre with equipment to check sugar level and Oral Rehydration Solution (ORS) packets to detect symptoms and begin immediate treatment. Requesting anonymity, a health department official said following the SOPs has helped check the number of deaths a great deal over the past couple of years. An ASHA worker, Manjula Kumari, working in Sakra panchayat in Muzaffarpur, said that they are asked to conduct door-to-door visits every year but no such order came this year. Further, she said they were given neither the device to check blood sugar levels nor enough ORS packets for the area they cover. However, Muzaffarpur district health director Dr Shivchandra Bhagat claimed an awareness program has started at the panchayat level through loudspeaker announcements. He said ASHA and ANM workers have been told to identify the affected children in their areas and supply ORS to every household. However, the parents who have thronged Sri Krishna Medical College and Hospital (SKMCH) in Muzaffarpur for treatment of their children categorically denied hearing any such public announcement. Further, Sanjay Ram of Sahebganj village said no ASHA worker visited his village to check on children or to distribute ORS. His four-year-old child Anshu has been admitted in SKMCH since Monday. Health officials said around 90 children with symptoms similar to AES are being treated in SKMCH and Kejriwal Hospital in Muzaffarpur. With all the beds in the two paediatric intensive care units of SKMCH occupied, hospital authorities are now planning to open another unit. On Tuesday, these reporters visited the over-crowded paediatric ward of SKMCH and witnessed helpless parents pleading with the staff to save their children. Children were wailing even as new patients were being brought in. Well-equipped? Dr Bhagat contended that the health department was ready to tackle the disease but as children started falling ill, their family panicked and brought them to the government hospital in the town, instead of taking them to their local Primary Healthcare Centre (PHC). He said the rush at the hospital caused unnecessary delay in treatment, which aggravated the children’s condition and contributed to their death. [caption id=“attachment_6802781” align=“alignright” width=“380”]  A patient at the SKMCH, Muzaffarpur. Image credit: Pushyamitra[/caption] Ram refuted Dr Bhagat’s claim about PHCs’ preparedness. He said the reason he had to bring his child to SKMCH is that their PHC is lacking in facilities. The government has also failed to provide the free ambulance service that has been instituted under the SOP for AES treatment. Dr Bhagat said health workers have been ordered to send patients to the hospital by ambulance; if they have to hire a private vehicle, they have to be reimbursed immediately. However, Ramkishore Mahato of Kodaria village narrated an instance of how this provision too is not being followed. He shared how he had to cough up Rs 700, an amount he can ill-afford, to bring his daughter to SKMCH from his village 45 kilometres away. When asked if the situation might worsen like what happened in Uttar Pradesh’s Gorakhpur in 2017, where more than 60 infants had died reportedly owing to shortage of oxygen, an official at SKMCH said they have made fool-proof arrangements. He said the hospital has enough oxygen cylinders and medicines. Further, he said doctors and nurses have been put on 24X7 duty. While the local administration is claiming it is fully prepared, Union Minister of State for Health Ashwini Choubey, who is an MP from Bihar, conceded earlier this week that health awareness programmes took a backseat this summer as government officials were engaged in election duty. The government swung into action only when the disease broke out and started making headlines. It was only then that the government starting publishing advisories in newspapers about how to identify AES symptoms and what steps to take next.

(The authors are Patna-based freelance writers and members of 101Reporters)