india

Updated: Jun 19, 2019 14:10 IST

Simmering public anger over an outbreak of the Acute Encephalitis Syndrome (AES) in Bihar spilled over into the streets with protesters heckling chief minister Nitish Kumar outside a hospital as one of India’s poorest states struggled to fight the disease that killed 10 more children on Tuesday, taking the toll to 113.

Kumar, who has not visited the affected areas since the first death was reported on June 5, went to the Shri Krishna Medical College and Hospital (SKMCH) in Muzaffarpur, where 91 children have died and 300 more are in treatment. But he was accosted by irate families who fumed that the chief minister allegedly found time to visit the hospital only after the toll crossed 100. Many shouted slogans of “Nitish go back” while others waved black flags.

Kumar conducted an emergency meeting with his deputy, Sushil Kumar Modi, state health minister Mangal Pandey, urban development minister Suresh Kumar Sharma, and top bureaucrats. Officials present said the CM expressed displeasure over a large number of patients receiving treatment on the floor and ordered an expansion of the hospital.

Outside, protesters claimed that the government came in too late.

“Things are being spruced up so that it makes a favourable impression on the chief minister. Had the CM visited earlier, it would have made the officials concerned pull up their socks and many lives could have been saved,” said one of the protesters.

In Delhi, activists from different organisations protested outside Bihar Bhawan and demanded Kumar’s resignation. They accused the Centre and the Bihar government of not being serious about containing the outbreak, and said the health-care system in the state was mismanaged. “We are anguished and urge the government to provide adequate medical facilities, particularly in Muzaffarpur, to attend to the patients,” read a memorandum submitted to the resident commissioner of Bihar in Delhi.

AES can be caused by a range of factors, including toxins in unripe litchis — Muzaffarpur is the litchi hub of the state — viruses, bacteria, fungi, parasites, and chemical poisons. Bihar’s principal secretary, health, Sanjay Kumar confirmed that 501 cases had been reported this year with 113 fatalities.

Seasonal outbreaks of the disease, which causes brain swelling and high fever followed by disorientation, seizures, coma and death — with malnourished young children the worst affected — are common every year in Bihar, which has weak health infrastructure, under-equipped hospitals and roughly one-tenth the national average in terms of medical staff per patient.

Moreover, the poor condition of state finances and widespread poverty – Bihar routinely finds itself at the bottom of socio-economic rankings – hinder simple steps such as ensuring an evening meals for children, controlling litchi consumption, and implementing rapid glucose correction in patients that may have arrested the swift spread of the disease.

Every year, as deaths pile up, temporary encephalitis wards are set up, patients are treated in shared beds, ward floors and hospital corridors, the government announces compensation and launches sanitation drives. Experts say that once the disease wanes by September, the administration falls back on vaccination and lukewarm awareness campaigns till the next outbreak.

Chief secretary Deepak Kumar said the CM had ordered an awareness drive, regular health bulletins to rural areas and that the 600-bed SKMCH be upgraded to 2,500 beds. “The CM and his team went to almost every bed and enquired the patients’ parents. None of them complained about arrangements [in hospitals], nor made any comment. We are satisfied with the doctors’ work,” he said.

But he admitted that the government is unclear about what exactly was causing the AES outbreak, which has been recorded in Muzaffarpur since 1995. “We are still not aware if the disease is caused due to some virus, bacteria, toxin effect due to consumption of litchi, malnourishment, or due to environmental conditions such as high temperature and humidity. Several researches have been done, including one from the Centre for Disease Control (CDC), Atlanta, but the finding is inconclusive,” he said.

The government has now commissioned a survey in blocks where the death toll is the highest to study socio-economic profiles of people and the environmental conditions. Kumar has already said that the government would bear the cost of treatment and also reimburse transport charges incurred in ferrying patients to hospitals. A compensation of ₹4 lakh to families of the deceased children has also been announced.

In recent weeks, Bihar’s fragile health-care system has been stretched thin with hundreds of people being admitted to hospitals with heat-related ailments that have claimed 90 lives. Deepak Kumar had on Monday admitted said that 562 people suffering from heatstroke were admitted in government hospitals. The district magistrates of Gaya and Darbhanga have invoked section 144 of the Criminal Procedure Code to ban all public activities during daytime.

Of the 113 AES deaths, 91 had been reported from SKMCH, 16 from Kejriwal Maternity Clinic (Muzaffarpur), two from the Nalanda Medical College Hospital in Patna, and four from other districts, said Sanjay Kumar.

Cases have been reported from Samastipur, East Champaran and Vaishali.

The Centre has also stepped in, with Union health minister Harsh Vardhan visiting SKMCH on Sunday and directing high-level multidisciplinary teams be sent to Bihar. On Tuesday, he decided to constitute a permanent multidisciplinary group of experts at the Centre to monitor and formulate measures to be taken up in the event of such an outbreak.

“We discussed the socio-economic profile of the households which have reported such cases, their nutrition profiles, ongoing heatwave, reported high percentage of hypoglycemia in children who have died, prevailing health infrastructure in the district and other factors that could significantly be considered in these cases,” the minister said.

(With agency inputs)