An epidemic in Uttar Pradesh

An outbreak of Japanese encephalitis claims a large number of lives in eastern Uttar Pradesh as in previous years and the State government is caught napping yet again.

JAPANESE encephalitis breaks out in eastern Uttar Pradesh with unfailing regularity year after year, in the wake of the monsoon. This July-August the disease, according to government figures, claimed 400 lives, most of them children. Unofficial figures have put the number of cases at a mind-boggling 5,000. Last year, the official toll was 228; again most of the affected were children.

The disease has been stalking the region since 1978, yet there has been no coordinated government plan to stop it. This year too the government was not geared up with preventive and curative measures. Mild infections of the disease occur with only fever and headache. Severe infection is marked by high fever, stiffness of the neck, stupor, disorientation, coma, tremors, occasional convulsions (especially in infants) and spastic paralysis.

The Baba Raghav Das Medical College in Gorakhpur, the district bordering Nepal, presented a pathetic sight with a stream of people carrying delirious children in their arms looking for medical support. Sixteen children, some of them infants, were admitted to the special wards when this correspondent was present in the hospital. On an average between 20 and 25 children, all below 10 years of age, were dying every day at the medical college. The wards were so crammed and there were not enough beds to admit the children. In Ward No. 6, two or three children, all of them in critical condition, were forced to share a bed. The overworked doctors and nurses were finding it almost impossible to tackle the rush of patients, which resulted in frayed tempers. "At the most we can only give curative treatment. Look at the condition [long after the onset of fever] in which these children are brought here. By the time they come here, it is almost too late. But still we try to do our best," said a young doctor. According to the doctors, the remedy lies in tackling the cause: prevention by fogging, making people aware of the dangers of encephalitis, and vaccination, which, however, is not proven effective so far.

Entomological surveys in the affected villages are known to have revealed a high density of the Culex mosquito population, the vector of Japanese encephalitis. The disease is caused by the female mosquito, which breeds in the monsoon months. Pigs raised in the rural areas and wading birds are the natural hosts of the virus. The mosquito transmits the virus to the pigs, which are the amplifying agents. When a mosquito, which has bitten an infected pig, bites a human, the virus is transmitted to that human. So the most obvious preventive measures should be the control of mosquito breeding, segregation of pigs from people, and vaccination. This is easier said than done. During the monsoon period, the paddyfields in the eastern districts of the State, which receive heavy rainfall, get waterlogged. These become breeding grounds for mosquitoes.

The government says it is impossible to separate the pigs from human habitations for the people who rear them depend on them for their livelihoods. The government claims that fogging is done as a routine in the seven eastern U.P. districts every year. But the villagers deny that any fogging has taken place. "We obviously cannot cover the entire area. This year the disease has spread to more districts. We have limited resources, such as a limited number of fogging machines. Malathine fogging should be done but we do not have required amount of the chemical," said Siddarth Behura, Principal Secretary, Health, in the State government. Even the efficacy of the vaccine had not been proven, he said. Besides, there is not enough vaccine available. The Central Research Institute at Kasauli in Himachal Pradesh, which manufacturers the vaccine, can at the most supply only about five lakh doses but the requirement is anywhere between 75 and 80 lakh doses. (Only two lakh doses reportedly arrived in Gorakhpur, of which one lakh were distributed to the neighbouring districts.) He also said there were reports that those vaccinated had also got infected.

Since the disease has acquired epidemic proportions, the Centre promised help. But the vaccine, ordered from China and Japan, was yet to arrive. Union Minister of State for Home S.P. Jaiswal, who hails from U.P., suggested aerial fogging. But State government officials have opposed this, citing its larger environmental ramifications. The government officials also said that the idea of providing "medicated mosquito nets" to those living below the poverty line had not been implemented.

Behura reiterated that preventive and curative action could only be effective to a limited extent. "The vaccine takes a long time to develop immunity inside the human system, so immediate prevention is not practicable," he says. The insensitivity of the State government to the dying children was evidenced from the fact that Sanjay Bhatia, the Director of the State Information Department, had no information whatsoever on the government's action plan to tackle the epidemic.

Chief Minister Mulayam Singh Yadav, who holds the Health portfolio as well, had not yet visited the affected areas. "The Chief Secretary and the Director-General of Medical Services visited the affected," the district hospital authorities said, in defence of Mulayam Singh.

Given the State government's lackadaisical attitude, the preparedness of the doctors and the staff at the district hospital in Gorakhpur, which has also admitted encephalitis cases, was commendable. "We had a contingency plan, with testing kits and medicine, ready to handle at least 25 patients even in July We had allotted a ward specifically for these patients," said Dr. Brajesh Kumar at the district hospital.

Nabi Ahmad, who was discharged after being cured of the disease, and Deepu, who was brought in the "gasping condition", the stage before death, but has since recovered, are examples of how better preparedness can improve matters

Union Minister Mahabir Prasad, who represents the neighbouring Bansgaon parliamentary constituency, arrived at the district hospital with a horde of slogan-shouting supporters, exhibiting their ire at the "ineffective" State government. When asked what the previous Congress governments in the State had done, as the epidemic is known to have affected the region since 1978, he lost his cool and lapsed into a diatribe against the State government. Lesser Congress leaders discharged their responsibility by busying themselves with a signature campaign against the U.P. government, which their party is supporting.

Cesspools of dirty water, choked, nullahs and heaps of rotting garbage are a common sight all along the route from Lucknow to Gorakhpur, which is a major city. The general administrative apathy to health care and hygiene added to the vulnerability of the poor to such life-taking diseases.