Poor families, girls lead encephalitis death tally, says Bihar survey

Read | Central team says heat wave key factor in outbreak

The Bihar socio-economic survey, conducted in June this year at the peak of the AES outbreak, besides putting the income of affected families at between Rs 2,500 and Rs 5,500 a month, pointed out that less than 10 per cent of them were beneficiaries of the Mukhya Mantri Kanya Suraksha Yojna (entailing Rs 2,000 per month for up to two girl children per family).

Kavita Devi, of Ali Neora village in Muzaffarpur district, says they rushed their four-year-old daughter Sandhya to Shri Krishna Memorial Charitable Hospital (SKMCH) in Muzaffarpur when her condition worsened on June 13, after mild fever for two evenings. “She passed away within hours.”

Her eyes welling over, an incomprehending Kavita says, “Sandhya did not play outside the day before she passed away. But, we are daily wagers, this is the lean season and we have to go out looking for work. Where do we keep our children? So, they play in the sun. It’s quite likely Sandhya did so too.” A Central team has identified heat stroke as a contributing factor in AES deaths.

While Kavita did not take Sandhya to a primary health centre (PHC) as SKMCH was nearer, the Bihar survey found that most patients who approached PHCs were told to go to bigger hospitals.

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Mohammed Shajan of Sahpur says that medical workers at the PHC where he and his wife Chandni Khatoon took their three-year-old daughter Gulfsha were clueless. “They advised us to go to SKMCH. The doctors there told me we had wasted precious hours. We are poor people. How do we know of such complications?” Shajan says.

Dr Shakeel of the Jan Swasthya Abhiyan believes that, “left to auxilliary nurses and midwives”, Bihar PHCs are not equipped to handle AES. Dr Ravikant Singh, whose Mumbai-based outfit Doctors For You aided the Bihar government’s relief operations, says the state’s medical system failed to prepare for the seasonal outbreak.

In 2016, the Bihar government had drafted a well-appreciated standard operating procedure (SoP) to deal with AES, and revised the same in 2018. As per the SoP, ASHA workers and auxiliary nurse midwives (ANMs) were to visit vulnerable areas from the last week of April to end of June to spread awareness about the disease.

According to Dr Ravikant Singh, the drive has been losing steam, and especially suffered this time on account of the general elections.

Mintu Devi, an ANM from Minapur block of Muzaffarnagar district, says that while it was wrong to say there was no push behind awareness drives, they “did not receive much guidance from higher-ups”.

“In earlier years, we got written orders from the Health Department in mid-April. This time the orders came only in June, after the disease had struck,” adds an ASHA worker from Vaishali district who did not want to be identified.

Denying there had been laxity, Bihar Principal Secretary, Health, Sanjay Kumar, says, “What role does the Health Department have in elections?” Claiming they had conducted sensitisation drives for “more than 270 PHC doctors a month” before the outbreak, Kumar adds, “We will probe if there have been any shortcomings.”

He also denies that the PHCs turned away patients, saying that while families of 374 had consulted them, only 170 were referred to other medical centres.

Both Kavita and Chandni Khatoon deny having been approached by any health worker and say they had no idea about “chamki (as the locals call AES)” before their children fell ill. “Nobody told us about the precautions to take,” Kavita says. “They (the ANM workers) came a few days after Sandhya died and offered ORS pouches for my nine-month-old second daughter. What do we do with them?”

Apart from awareness drives, Dr Singh faults the state government for not doing enough to lift “nearly half of its children who are malnourished” out of that state. “We also know that the girl child is more prone to malnutrition than the male child,” he says. “Could this be the reason girls are more affected by AES than boys?” asks Dr Shakeel, noting that 62 per cent of those who died of AES were girls.

Rupesh Kumar, an activist with the Right to Food campaign, says that in its initial years the Nitish Kumar government had improved the mid-day meal programme, but now it wasn’t functioning well except in Purnea and Gaya districts. He also points to changing dietary patterns as responsible for malnutrition. “Earlier, during lean times, people fished at ponds. But where are the ponds now? Besides people now consider it below their dignity to eat some things they used to — insects, rats. The trouble is that even in the non-lean season they do not have adequate amounts of the so-called respectable food.”

Principal Secretary Kumar promises this will change soon. “We have asked for an even more rigorous socio-economic survey to help us iron out deficiencies.”