Four malaria strains in blood, Bastar boy is a test case

Science journal says 14-year-old Hunga Ram Kashyap of Bastar the first in India to carry all four types of parasites; a medical anomaly, he is currently healthy.

Written by Dipankar Ghose | Darbha (bastar) | Updated: October 25, 2017 7:18 am
malaria, malaria types, symptoms of malaria, malaria parasites, malaria treatment, malaria medicine, Darbha, Chhattisgarh, National Institute of Rural Tribal Health, Bastar, World Health Organisation, indian express Hunga Ram Kashyap has had malaria at least twice

In July this year, American scientific journal Public Library of Sciences documented the case of a 12-year-old boy from the forests of Darbha in Bastar, Chhattisgarh, as the first reported case in India of someone having all four types of malaria parasites in his bloodstream.

Hunga Ram Kashyap hasn’t heard of any such “first”. “Who will come and tell me?” he smiles.

In Bastar, it’s not uncommon for people to live the tenuous line between life and death. Now 14, Hunga has had malaria at least twice and has seen his family being attacked by Maoists and chased out of their home for defying a diktat to send him to school. He laughs as he tells these stories.

In July 2015, the National Institute of Rural Tribal Health (NIRTH), under the Indian Council of Medical Research, set up a malaria clinic at the primary health centre (PHC) in his village. Darbha itself is representative of the Bastar narrative — it is heavily forested and the PHC is less than 5 km from the site of the 2013 attack on a Congress convoy by Maoists, leaving 28 dead. Darbha has another problem too: Malaria.

A month after the small, one-room malaria clinic opened, Hunga, then 12, hobbled up to it, helped by a boy one year his senior. They both came from the Darbha government boys’ hostel, 2 km away, and Hunga remembers he could barely walk. The lines were long and everything was done in a hurry, and thus, Ranu Ram, a Class 7 student, became ‘Hunga’s father’ in the paperwork that was filled.

Dr Sanjay Basak, the then district malaria officer of Bastar district and one of the authors of the PLOS paper, told The Indian Express that after a consent form was filled, a little blood was taken from under the fingernails of the patient, and studied under a microscope. “The RD kit we used at the clinic could read two types of malaria bacteria — plasmodium of falciparum and vivax — and said ‘mixed’ if there were more types. We immediately started the boy on medicines for the two strands of malaria that we detected and kept him at the Darbha clinic, which has a few beds. Fortunately, he recovered after a week and was sent back to the hostel,” Basak says.

While Bastar has an acute malaria problem, he adds, the cases are usually limited to two strands. “There are four malaria strands in total — falciparum, vivax, malaria and ovarie. The first two are the most prevalent in Bastar, and in India in general. But in Bastar, falciparum is the real danger and often leads to cerebral malaria… Malariae and ovariae are similar to the first two in terms of their treatment, so the medication doesn’t differ much. But we had never before seen a case with all four strands in the bloodstream,” Basak says.

And thus, beginning August 2015, slides with Hunga’s blood on them travelled across the world, including the US. While NIRTH confirmed that all four strands were present, this was verified again by the World Health Organisation. The PLOS paper does not mention Hunga’s name but calls it the first such case in India and indicates a greater need for training of health staff in malaria diagnosis.

The paper says the boy checked himself out of the clinic against medical advice. However, both Basak and Hari Verma, the man who examined his blood at the clinic, say Hunga completed his treatment at Darbha. “The details were taken in 2015 and the paper written in 2017, so there was some communication gap, especially because it is difficult in these areas to track down the patient and his family,” says Basak.

But even as his blood was examined as a medical anomaly around the world, Hunga was blissfully unaware.

When The Indian Express tracked down the 14-year-old to the Darbha hostel and verified case details from government records, he was shy, speaking barely a sentence at a time, but laughing all through. Is his name Hunga Kashyap? Yes. Is he from the Madia tribe? Yes. Did he go to the clinic in Darbha with Ranu Ram on August 4, 2015? Yes. Does he know he is the first case in the country of four different strands of malaria in his bloodstream? A wide smile, masking confusion. “Phirse bolo (Say that again),” he says. And then laughing, he shouts out to his classmates from Class 9: “Did you hear? I’m the first in the country.”

One of his friends asks, in Gondi, “Is this after you fell sick this time or the last time?”

Earlier this year, Hungra was taken, with extreme fever and weakness, to a hospital in the Jagdalpur district headquarters, 45 km away. There is no telling if this time too there were multiple parasites in his bloodstream, for he wasn’t taken to the NIRTH centre in Darbha. “But like last time, I felt like I was dying,” he says.

Prescription reports he showed state Hunga had both malaria and jaundice. This time too, he recovered in a week.

M L Kacchi, the principal of the government boys’ school where Hunga studies, says, “Every week, one child or the other from here is admitted to the hospital with malaria. Even the teachers fall ill very often. There is not much we can do except get them treatment on time.”

R Prasanna, Director, National Health Mission for Chhattisgarh, acknowledges that the problem in Bastar has lasted a while, and says they are now adopting another approach. “The mosquito is only the carrier (of the parasite). Until two years ago, we were only attacking the mosquito, attempting to kill it. But now we are attacking the parasite through mass screenings and treatments, even when there are no symptoms of fever. We have also distributed RD kits across villages,” he says.

Ask Hunga if he is afraid of contracting malaria again and he again laughs. He says he is thankful it happened when he was in school. It was the only reason he got treatment. And the only reason he is in school is because his parents defied Maoist diktats against it. They now live in secrecy, Hunga says.

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