Encephalitis, a Major Scourge in Gorakhpur for Decades

At least 60 children, many of them encephalitis patients, died in a Gorakhpur hospital recently, 30 of them over a span of just 48 hours. Shocking reports described a shortage of oxygen supply to intensive care units in the state-run Baba Raghav Das Medical College Hospital where the children were admitted, but the Uttar Pradesh government has denied that the cut in supply was the cause of the deaths.

But, whatever be the actual reason, the fact remains that encephalitis has been a scourge in Gorakhpur for nearly 40 years — and it has not been addressed by successive governments with the urgency it deserves. According to conservative estimates, 25,000 people have succumbed to it since the disease was first reported in the area in 1978. Encephalitis is a viral disease that mosquitoes transmit to humans from pigs. In most cases, it causes a mild fever and headache that recede within a few days. But one in 250 people develop high fever, severe headache and neck stiffness that exacerbates into seizures, paralysis and coma.

At times, survivors are left with serious disabilities, mental and physical. Children below the age of 15 are vulnerable. Japanese Encephalitis (JE) and Encephalitis Syndrome (AES) usually strike malnourished children under five years of age. The causes include viral infection, bacterial infection, among others. Sometimes, the brain’s immune system attacks the brain tissues leading to the fatal disease.

The deaths of scores of children in a Gorakhpur hospital have put the focus on Acute Encephalitis Syndrome (AES) and Japanese Encephalitis (JE). These deadly diseases have been creating havoc in Uttar Pradesh and other states for years. In 2006, a study in the journal, Emerging Infectious Diseases, pointed out why Gorakhpur is prone to the virulent form of the disease. An abundance of rice fields and a bowl-shaped landscape that allows water to collect in pools create ideal breeding grounds for mosquitoes.

Since then, several studies and reports have highlighted the link between poor sanitation facilities, open defecation and encephalitis in eastern UP where Gorakhpur is located. Gonda, which sends a large number of encephalitis patients to the Baba Raghav Das Medical College Hospital every year, has been named the worst performing district in the Swachh Bharat Survey this year. As per the data on the website of the Directorate of National Vector-Borne Disease Control Programme (NVBDCP), since January to mid-August this year, 1,208 cases of AES have been reported in UP, and of these 152 resulted in the death of the patient.

In the same period 112 cases of JE were reported in which three lives were lost, the data says. In UP, the most severely affected districts are Gorakhpur, Maharajganj, Kushinagar, Basti, Siddharthanagar, Sant Kabir Nagar, Deoria and Mau. Apart from UP, this year, AES and JE deaths were reported from Assam, Bihar, Manipur, Odisha and West Bengal. In Bihar, 29 AES deaths were reported from 66 cases reported, while 7 JE deaths were reported out of 19 cases, while in Odisha, 10 AES deaths out of 473 cases were reported. In Assam, 1,534 cases of AES were reported, and 128 patients lost their lives. The state reported 482 cases of JE of which 67 resulted in death, as per the data. Manipur saw 6 AES and 6 JE deaths.

As many as 690 AES cases were reported, while 141 JE cases were reported in the state. Coming back to Uttar Pradesh, which has been bearing the worst brunt of the disease, NVBDCP data reveal that in 2010, UP reported 3,540 cases of AES, which claimed 494 lives. JE saw 325 cases being reported in that year, and 59 lives were lost. Similarly in 2011, 579 deaths in 3492 cases of AES were reported, while JE claimed 27 lives out of 224 cases. In 2012, as many as 3,484 cases of AES were reported and 557 patients died, while 139 cases of JE and 23 deaths were also reported. The AES death toll breached the 600 mark for the first time in 2013. 609 out of 3,096 cases reported resulted in deaths.

JE deaths too crossed the 40-figure-mark in the same year with 47 deaths reported in 281 cases. In 2014, out of the 3329 AES cases reported, there were deaths, while for JE it was 34 deaths out of 191 cases. In 2015, as many as 479 lives were lost due to AES of which 2894 cases were reported. JE claimed 42 lives from the 351 reported cases, according to the official data. The year 2016 saw 3919 cases of AES being reported and 621 lives were lost. The death toll due to JE stood at an all time high of 73 out of 410 cases reported.

The pertinent question here is how important is health in a country that earmarks less than 1 per cent of its GDP for it? The National Health Policy 2017 promises to up this spending to 2.5 per cent by 2025. And though this may sound like good news, it isn’t because this has been a long-pending promise of successive governments, their political ideologies notwithstanding. By 2025, the population will increase, hospital infrastructure is woefully inadequate even today, and let’s not even begin to unravel the shortfall of doctors and supporting medical staff. For a country with 26 million births a year, an increased spending by 2025 is not good enough.

It needs to be at least 5 per cent or more because India is a country that is simultaneously home to malnutrition and lifestyle problems like obesity and diabetes; a thousand people die of tuberculosis a day and numbers dying of cancers and heart-related ailments are only increasing. The Gorakhpur tragedy reflects India’s worrisome track record on health, its spending, its delivery, lack of insurance support and the weak enforcement of rules on quality and governance.

Health is a state subject, but it is high time the Centre set the bar high by putting its money on health and prioritising it on the Government’s to-do list. Last year, Prime Minister Narendra Modi laid the foundation stone of an AIIMS at Gorakhpur. While the setting up of such an institution is welcome, encephalitis can be best combated by strengthening primary healthcare facilities. Epidemiological studies have shown that lives of encephalitis patients can be saved if they receive immediate treatment from trained doctors and are not forced to travel long distances to access medical care. It is not the time for debate whether the deaths in Gorakhpur took place due to the negligence. Parties should not politicise the issue.

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