AES Outbreak – Indian Outburst

As of 26th June, the death toll has crossed 140 and the total number of reported cases in Muzaffarpur has crossed 600. As the death toll mounts and children continue to die, we still find ourselves at square one. We don’t know what is causing these infections, we don’t know what type of AES it is, we have no clue of when it might stop, and we most certainly have no answers from the government at the state or at the center.

The district of Muzaffarpur has been at the receiving end of these outbreaks since 1995. There have been multiple commissions and research benches trying to get to the bottom of this, but none of them have turned up with usable knowledge. This form of encephalitis happens every year in Bihar, in 2014, as many as 355 lives were lost due to this disease. Although we have not yet identified the cause of this outbreak which has now become a periodic activity, the number of fatalities had started reducing post 2014 due to health awareness programs initiated by the government. Why then has it gone so bad this year?

2013 2014 2015 2016 2017 2018
143 355 11 4 11 7

While the news first broke in the first week June, well, let’s be honest, there was hardly any news coverage since it was election season, even so, there was no clue of it escalating so fast. Soon the fever rose – quite literally, and everyone was talking about what’s happening in Muzaffarpur and why so many children are dying.

While the usual question arose of why this is happening, doctors and researchers started looking for answers that was already at hand – some started by saying AES is a very broad term and can mean too many things, ‘we need more information’, they attributed it to the weather – hot and humid weather conditions, and then the fact that most of the patients are malnourished children from poverty ridden families, and the most atrocious argument – litchi.

ICU of a Public Healthcare facility

Our researchers blamed a fruit. That’s right. Apparently raw litchi has chemicals called Hypoglycin-A or MCPG which can cause hypoglycemic conditions that in turn triggers the symptoms of AES. The argument made sense first as we were dealing with the litchi bowl of India and poor families who might resort to eating litchis due to the lack of availability of a proper meal. As time passed and sanity descended, this argument was termed atrocious because quite a large number of children were too young to eat litchis and the fact that the litchi season was already over – which leaves the weather, malnutrition and the living conditions as the possible causes.

But do we really need to care about the cause? Doctors would know that many times we can’t really isolate the problem, but we go about having a general idea of the problem and the various measures we take helps solve the problem without us having put a finger on it. Would it be too much to ask to forget about the cause and concentrate on the treatment?

This brings us to another problem. How to treat and Whom to treat? The two medical facilities in the district are brimming with patients. One bed has 2 children lying on it, and the floors of the ICU’s are occupied by patients. One simple course of treatment is just hooking up the patient on glucose – for this, the poorly equipped hospital is struggling to make ends meet. There are not enough IV sets, not enough glucose, not enough staff to administer the treatments. Who is to blame here? I’m not looking for someone or a reason to place blame, but this needs to stop.

In the days that followed, the Indian politicians were barely questioned, though the CM or Bihar and the health minister visited the district, there was no respite. Poor children kept pouring into the facilities, and the facilities just had no facilities! The doctors were pulling in 18-20 hour shifts and yet there was no respite. The mainstream media conveniently forgot to question the politicians, the medical officer – who in his own words had been transferred just 2 months back pointed the finger to the lack of awareness programs. He said, we know this happens, but we don’t know why it’s happening, only way to stop this is by creating awareness and raise the general standard of sanitation and living. He also pointed out that due to the election, the health awareness programs were not run as efficiently as they were run in the previous years – this is truly disturbing.

Speaking of the media, it sunk to a new low when anchors kept parading into the ICU of the SKMCH with cameras and other media equipment and started heckling and bellowing at the top of their voices over the doctors. One journalist even went so far as to ask a doctor “how many children died today” is she being a hero by asking pointed questions? Where is this grit and candor when it comes to asking questions to the politicians? The role of media in this whole charade has been appalling.

The fever like all fevers will run its course, it will just leave a bad memory and a number behind.  Is this what we want? Have we as a society become so used not caring? Should no one be brought to book? Well actually no, there has been a suspension of a poor lowly doctor for negligence. Really? Just days ago, we were talking about and going gaga over how badly doctors are treated and practically everyone was one with the IMC for calling an all India doctor’s strike, and suddenly doctors are the villains?

Media Reaction

There is no easy fix to this problem, we don’t have a cause, and hence we need to live with the reality that this AES has become a recurring yearly ordeal. We can only reduce the intensity by employing preventive measures like awareness programs, government nutrition programs, capacity management at health care facilities and some basic level of accountability in each of us as politicians, or media or the general public. But as we learn to live with this problem, let us not misdirect our anger and frustration at the doctors or the weather or a fruit.

~*~

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