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In eastern Uttar Pradesh, a season of death by Aarti Dhar

Medical facilities have collapsed as encephalitis epidemic continues to rage

Even as the rest of India recovers from Deepavali celebrations, residents of Poorvanchal have been marking a grim time that descends on the eastern Uttar Pradesh region each year: a time local people call the season of death.

Ever since July, 470 people, mostly children, have died of viral encephalitis and its biological cousin, Japanese encephalitis — the first caused by a water-borne enterovirus; the second by mosquito bite.

Union Health Minister Ghulam Nabi Azad was here earlier this week to hold crisis meetings with high officials, but little has changed and children are continuing to die.

Patients at the BRD Medical College Hospital are packed three to a bed, even in the Intensive Care Unit, as a handful of doctors struggle to treat the 400-odd critically ill children. The overburdened X-ray machine at the hospital broke down this week; last month, the ventilators had broken down. Power cuts add to the problems.

Extra beds have been put up on the corridor to accommodate patients. Shankar has been here in the hospital for over a week now, where his 13-year-old daughter is being treated. “There are so many patients and so few beds but we try make do among ourselves,” he said.

The story has not changed much in the last three decades: every monsoon sees an outbreak of acute encephalitis syndrome, or AES, diseases.

Japanese encephalitis and viral encephalitis diseases, broadly classified as AES, are a poor man's diseases and affect the families of paddy farmers.

Like in past years, cases of the two kinds of encephalitis started pouring in by July end, when the monsoon sets in. While cases of Japanese encephalitis have dropped drastically because of a successful vaccination drive last year, cases of enterovirus have surged dramatically. The disease is less lethal — but involves a longer recovery time, which means greater pressure on hospital infrastructure and staff.

Experts estimate that up to 30,000 people may have been left disabled by the diseases since they were first detected in 1978 — and even government records show that 15,000 have died, and another 15,000 left permanently disabled. Reliable figures are hard to come by as government medical facilities are overstretched and many patients end up in facilities with no diagnostic facilities.

The diseases of peasants, unlike those of jet-age diseases such as the H1N1 “bird-flu” outbreak, have however drawn little attention in the national media.

Contaminated water

Programmes to improve personal hygiene, proper sanitation facilities, and access to clean drinking water could do a great deal for the fight against AES. In Gorakhpur, farmers often live near paddy fields where mosquitoes breed, and drink infected water from shallow tube-wells. Pig farms are often located inside communities, creating breeding sites for mosquitoes.

“Awareness programmes and a little help from the government can save precious lives,” says K.P. Kushwaha, head of the paediatric department at the BRD hospital. He has been on the frontline of the battle against the AES for years.

“Even though we are towards the end of the season now,” he says, “even today we get 30-35 AES cases every day and most of them come when they are in a critical stage. They are poor and, therefore, undernourished, which even further lowers their chances of survival.”