In the run-up to this year's Assembly polls in Uttar Pradesh, the entire heat and dust revolved around complex caste equations, Dalit outreach, Muslim votes, Hindu consolidation, Ram Temple, free school bags, free laptops, free internet, shutting down of illegal abattoirs and even anti-Romeo squads.
As the polls drew near, Uttar Pradesh skies were crisscrossed by chopper-borne netas and celebrity scribes. Thousands of electoral rallies, yatras and public meetings were held, scores of journalists landed or motored their way into rural interiors, talking heads on TV engaged in 24x7 debates, tons and tons of newsprint discussed all angles a new and petabytes of data were generated in cyber space. Except for a passing reference here or a stray mention there, one struggles to find any references to acute encephalitis syndrome (AES) or child deaths in the state.
Issues like prevention and cure of one of the most deadly seasonal diseases that kills hundreds of children each year in the heartland of India were simply absent from public discourse.
It's as if neither the politicians were interested in talking about it, nor the journalists were interested in highlighting the danger of this mosquito-borne scourge which, according to government data, has claimed the lives of 25,000 kids and infants since 1978 in Gorakhpur alone. And this number, by all indications, could be a severely conservative estimate. The unofficial figure is at least double that figure.
BRD Medical College is the only hospital in eastern Uttar Pradesh — where the mosquito-borne viral fever is a seasonally endemic — to have a measure of the facility to treat AES-related symptoms and it is flooded annually by patients from nearby districts. Many kids die before even getting primary medical care.
AES is a broad-spectrum term used by the World Health Organisation to refer to a range of vector-borne diseases including Japanese Encephalitis (JE), symptoms of which are prevalent in many cases of deaths in eastern Uttar Pradesh. It is notorious for its lack of antidotes. The patient is totally dependent on critical care procedure. What makes matters worse is that a range of other pathogens have symptoms similar to the JE and treatment for one disease is often mixed up with another during an endemic, leading to higher child mortality rates.
The cyclical fatality of these deaths, helplessness of the parents and monumental apathy of the administration were highlighted in an exhaustive report last year by Priyanka Pulla, who in a piece carried by FountainInk wrote, "By September, around 50 patients arrive every day, and the medical college’s infrastructure stretches to breaking point. There aren’t enough beds: unconscious children, sometimes two or three, lie on a single bed. There aren’t enough doctors, so diploma students in child health from around Gorakhpur are drafted in. There aren’t enough mechanical ventilators, even though patients with severe encephalitis often need them."
Writing for Firstpost, Phalguni Rao quotes data from Directorate of National Vector Borne Diseases Control Programme to point out that between 2010 and August 2017, 26,686 cases of encephalitis were reported in Uttar Pradesh of which 24,668 were of AES and 2,018 of JE. Out of those reportedly suffering from AES, 4,093 died in the same period while 308 JE-related deaths were registered.
Bear in mind that even this staggering number is likely an under-reported one. Data journalists from Indiaspend, referring to a 2016 study in the Journal of Paediatrics, reveal that "JE cases could be many times the officially reported data… because the testing method popularly used to detect the virus infection in the patient’s blood and cerebrospinal fluid may be missing cases of JE among patients of acute encephalitis syndrome, a brain fever."
Let's recount the figures. Since 1978, more than 25,000 kids have fallen prey to AES-related symptoms in Gorakhpur alone (official figure). More than 26,000 encephalitis cases have been reported since 2010. Researchers say the actual figures could be at least 10 times higher. And yet, there were no discussions on this issue before 11 August when news first emerged that at least 30 children had died in the preceding 48 hours at BRD Medical College. The number eventually has crept up to more than 70 till the writing of this piece.
The media narrative has centred around cutting off oxygen supply by the hospital vendor leading to deaths. This, however, has been contested by hospital authorities and the state government who admitted to the paucity of oxygen cylinders but claimed that it was unconnected to the instances of death. Sanjeev Singh writes in Times of India that Pushpa Sales, the oxygen suppliers, is believed to have cut oxygen supplies last year as well when the hospital dues touched nearly Rs 50 lakh.
Is eastern Uttar Pradesh the only place in India to suffer from this seasonal pandemic? Hardly. This viral disease is also equally prevalent in West Bengal, Assam and Bihar and kids have also died in the southern states of Tamil Nadu, Andhra Pradesh and Karnataka. As the FountainInk story points out, over 2,000 people were affected in Assam in 2015 and close to 400 died of it.
In 2014, news agency PTI quoted West Bengal's director of medical education (DME) Susanta Banerjee as saying that 102 had reportedly died till the month of July. Virulent encephalitis attacks were reported from the northern part of the state where 42 fell prey to JE in just two days.
Instances of 'mysterious deaths' were also reported from West Bengal in January 2012, when 37 kids died in a week in Malda and in November 2014, when once again in Malda 13 young lives were snuffed out in 72 hours.
Which brings us to the nub of the issue. Why do we ignore vital signs of a looming disaster and wait till it befalls and a sensational headline emerges? Truth is, the Union and federal governments have routinely failed to provide even the most basic public service and they have been routinely let off by the watchdogs of democracy who are too busy chasing market share.
Journalist and author Neelesh Misra, the founder of rural media platform Gaonconnection, kept the finger on the pulse in a series of tweets after the Gorakhpur tragedy.
Dear mainstream media, #Gorakhpur is what happens when you don't do your job on health reporting and make it a headline only in tragedy.
— Neelesh Misra (@neeleshmisra) August 12, 2017
Polio eradicated. Why couldn't we end Encephalitis deaths for 30 yrs? Cos cities and villages aren't clean. And those dying are the poor.
— Neelesh Misra (@neeleshmisra) August 12, 2017
Among the SAARC countries, India has the third highest child mortality rate, after Afghanistan and Pakistan with 48 deaths reported per 1,000 live births. One of the chief reasons why we are in such 'exalted' company is that most of these deaths take place among the poorest strata of the society where children are regularly exposed to unhygienic conditions, malnutrition, lack of immunity and have no access to healthcare facilities. It is the government's job to provide these basic amenities, but they have no incentive to do so because there is nobody to hold them accountable for non-performance.
The media is in a position to make a difference. Ever since the highlighting of Gorakhpur deaths, the administration has been compelled to act and Opposition leaders have made a beeline to meet victims' families. If even a fraction of this outrage had been generated in earlier instances of an annual tragedy, maybe eastern Uttar Pradesh would have already had a regional medical centre for research into vector-borne diseases (which Union health minister JP Nadda has promised to set up only now) and many of these unfortunate deaths could have been avoided.
The question — why governments over the years have failed to provide even basic public services and why media has failed in its primary job — is worth pondering over.
It boils down to the fact that the empowered elites and the upwardly mobile middle class who set the public discourse and media narrative in India, have been totally disinterested in lacklustre government services. They have instead put their faith in private service, leaving the government to take care of the unwashed masses who have little political agency except during electoral season when they are usually placated with monetary entitlements instead of public services like better sanitation and healthcare.
This is where India lags behind SAARC nations. As Monica Das Gupta of The World Bank's Development Research Group points out in her paper on Public Health In India, "selling a public health success electorally requires creativity, since the successes are by nature negative ('no cases of typhoid last year' does not hit the headlines, while advances in surgical techniques is big news)… It is notable that the non-democratic regimes of East Asia were the most successful in the developing world in improving health outcomes, by focusing their scarce resources on public health measures rather than on providing advanced medical care."
As long as the government finds no incentive to treat the poor as equal citizens and the media finds no merit in holding the government responsible except in spasmodic outbursts of outrage, many such Gorakhpurs will be repeated.
Updated Date: Aug 14, 2017 16:10 PM