The death of over 50 children in Saharanpur district of Uttar Pradesh owing to a mysterious disease brings into sharp focus the dismal condition of the public health care system and the callousness of the authorities, including elected representatives.
Many times, the fact that there is an epidemic is realised only after numerous people have fallen ill and several deaths have occurred. Often it is the newspapers that are the first to report an epidemic. Both official reporting and notification of cases is poor or often lacking. Medical practitioners, people and health staff generally fail to report; they are unable to recognise the nature and significance of the disease or are ignorant of the need to report.
The report of The Independent Commission on Health in India, 1997.
THE death of more than 50 children, including infants, in the Saharanpur district of Uttar Pradesh as a result of an undiagnosed viral infection has come as a stark reminder of the decline of the country's public health care system. The unofficial toll is put at a hundred, but the figure may not be entirely in the realm of speculation as epidemiological surveillance systems are practically absent in Uttar Pradesh, as is the case in most parts of the country. The event would have gone unnoticed if it had not been repeated by the local media, and subsequently by some national newspapers.
The affected children, mostly from poor families, were brought to the district's only civil hospital in a critical condition. The children did not receive timely treatment chiefly because of the absence of fully equipped and competent Primary Health Centres and Community Health Centres. As the disease is yet to be diagnosed, treatment has by and large been symptomatic. Cases of infection were reported also from Muzaffarnagar, Baghpat, Bijnor, Hardwar, Roorkee and Deoband, all in western U.P. As a physician said, it has been a case of "shooting in the dark".
The most striking aspect of the episode has been the lack of seriousness on the part of the State government and the Saharanpur district administration. State Health Minister Vinod Tiwari and District Magistrate Suresh Chandra accused the hospital authorities of being negligent. However, the issue is much wider and calls for accountability on the part of the representatives of the people and not just the medical fraternity.
Finally, when the district administration woke up to the reality of the deaths, it appeared to be more interested in finding out who had leaked the matter to the media. According to Suresh Chandra, at the time the children where brought to the hospital, their condition had deteriorated to such an extent that there was little scope for improvement. Matters were complicated by the fact that in remote areas people first approached quacks. Chandra said that the National Institute of Communicable Diseases (NICD) was contacted only when news of the mysterious deaths appeared in the media. He seemed to indicate that the entire episode had leaked owing to some administrative rivalry between the Chief Medical Superintendent and the Chief Medical Officer of the civil hospital. Apparently, the former had "leaked" the deaths to the media instead of reporting it to the Chief Medical Officer, Chandra said. A magisterial inquiry was ordered and senior physicians were found "guilty" of administrative lapses. Subsequently, the Chief Medical Superintendent was suspended.
Most of the affected children belonged to poor families, mainly Muslim or Dalit. Further, the civil hospital was hardly equipped to deal with these cases there were no ventilators or facilities to examine blood. Teams of the district unit of the Communist Party of India (Marxist), which visited the hospital on several occasions, said that doctors began to treat the matter seriously only when local newspapers highlighted the deaths.
Although, initially, Japanese encephalitis was suspected to be the cause of the deaths, the disease remains a mystery. An NICD team that arrived in Saharanpur ruled out the possibility of malaria, dengue fever or Japanese encephalitis, after conducting an entomological survey. Samples taken by the NICD tested negative for meningitis and measles. However, tests continue to be done at the NICD headquarters in Delhi, as no laboratory facilities exist in the district. In almost all the cases, fever, vomiting, headache and seizures were observed. Within two or three days, the condition of the patients deteriorated, resulting in death. The majority of cases have been reported in the case of children in the age group of three to seven.
The situation at the hospital was pathetic. Two infants, one of them unconscious, were admitted to the separate isolation ward that had been created to treat cases of "suspected encephalitis". The place was infested with mice and the backyard, which was full of dung cakes, was being cleaned up by the hospital staff.
The paediatric ward was full of little children, most of them semi-conscious. The symptoms included common fever, vomiting and some degree of seizure. Within minutes, the few beds that were available were occupied as harried parents streamed in with their children, who were either semi-conscious or unconscious.
According to Dr. R.K. Goel, Additional Director, Medical and Health, for the Saharanpur and Meerut region, of the total number of deaths, some 20 cases may have been "due to encephalitis". He said that there was nothing novel about these cases except that there was a slight increase in the number this year.
According to Dr. Ankur Upadhyay, a private practitioner, there is no exaggeration in putting the death toll above 100. Differing with the official medical opinion, he said that the phenomenon was not normal. Several cattle deaths had occurred in the adjoining districts, but the matter was underplayed.
Upadhyay, who is the secretary of the local branch of the Indian Medical Association, said that over the past few months private practitioners had confirmed that they had received several cases with symptoms of "fever, vomiting and seizure", which was not a normal phenomenon. He said that there was panic as government doctors were not coming forward with any concrete information. "If it is cholera, they would prefer calling it gastroenteritis," he said.
Members of the U.P. Voluntary Health Association (VHA), who visited the district and inspected the PHCs, found that the situation was alarming. Dr. Shristi Shukla, executive secretary, State VHA, told Frontline that a child specialist in Roorkee received 25 cases that were accompanied by symptoms of "low-grade fever and convulsions"; and 23 of them, children in the age group of two to five years, died. Dr. Shukla said that although the PHCs in Saharanpur district had been put on high alert, there were no medicines available for treatment.
Investigations into the aetiology of the disease are being conducted by a team led by the Director-General of the Indian Council for Medical Research. According to Dr. B.M. Das, Director, Emergency Medical Relief, NICD, initially it was felt that the disease could be Japanese encephalitis as it was known to occur in a scattered manner, the carriers of the virus being mainly pigs. Lamenting the state of the public health system, he said that 95 per cent of diseases were owing to the non-availability of safe drinking water.
Basic health care remains a chimera for the majority of people and the Saharanpur events have only reinforced this grim reality.