The surface calm in the tiny village called Phulmanaha in Maharajganj, Uttar Pradesh, barely masks the latent anxieties that the death of nine-year-old Manisha earlier this month has stoked.

Manisha died on September 4 due to Japanese Encephalitis (JE), a killer disease that has haunted these parts for the last several decades.

For the villagers, the girl’s sudden death has come as a grim reminder of their own vulnerability to pollutants in groundwater and pathogens in the air.

The remote village, mostly inhabited by marginal farmers, landless labourers and small shopkeepers, has only one protection against disease — in the form of bottled drinking water, selling at Rs. 15 for 20 litres.

There are innumerable pathogens that still remain unidentified, but the two most common afflicting the local population are the viral and bacterial strains Japanese Encephalitis and Scrub Typhus, respectively, which cause Acute Encephalitis Syndrome (AES).

While JE is a viral disease caused by the bite of the vector-carrying mosquitoes, Scrub Typhus is transmitted by the bite of the mites found in areas of heavy scrub vegetation common to these parts.

Additionally, contamination of groundwater through open defecation has led to a proliferation of entero virus, which can cause encephalitis and other infections.

Safety comes bottled

The villagers are scared. The only source of drinking water in Phulmanaha, located in the terai region of eastern UP, is a locally-made hand pump called ‘Khichchwa’ in the demotic.

The water table here is high. A shallow pump can draw water even at the depth of 10-15 ft. Open defecation leads to seepage of faeces and urine in the soil, leading to a high level of contamination in the groundwater.

The fear of this water causing dimagi bukhar (brain fever, a common term for encephalitis) has led to the villagers buying bottled water, but it is hardly sustainable.

“It is expensive to buy water. Normally, two or three families together buy a 20-litre bottle and share the cost. We can only use it for drinking. For cooking, washing utensils, we still use the hand-pump water. It is not safe, but how many bottles of water can we buy?” says Janaki, an elderly woman who lives next door to Asmita and Dinesh Thapa, the village gatekeeper, whose daughter Manisha succumbed to the dreaded fever.

“We are scared for our children. Our water, air, everything is poisoned. This pump is all we have to get water, there is no piped supply,” says Mina, another neighbour.

Price of prevention

According to Kailash Pande, a scientist with local voluntary organisation Gorakhpur Environmental Action Group, villagers have been advised to use the India Mark hand pump, which goes down to 120 ft, where the water is relatively safer.

“But mostly, locally-made hand pumps are used. Water here is polluted. In the main towns and cities, most people use water filters or the reverse osmosis (RO) filters or buy water. But in the villages, the RO-filtered water is less easy to access and there is a cost to pay. Villagers are still using the untreated groundwater, which is dangerous,” says Pande.

The local bottled-water industry is thus flourishing in these impoverished parts. Access and use still remain limited, at least for those in the remote rural parts.

“A large number of patients belong to rural parts, where lack of awareness and access to potable drinking water and preventive measures such as vaccination is still the main cause of disease,” says Dr Bhagwan Prasad at the Campierganj community health centre, which is nearest to the village.

Normally, two or three families together buy a 20-litre bottle and share the cost. We can only use it for drinking. For cooking, washing utensils, we still use the hand-pump water. It is not safe, but how many bottles of water can we buy?