CM Nitish Kumar is facing criticism for the mismanagement of prevention of Acute Encephalitis Syndrome.
New Delhi: Families across Bihar are asking “Where is Prashant Kishor?” The former public health expert with the United Nations, who is the right hand of Chief Minister Nitish Kumar has stayed away from the viral epidemic that is taking so many lives. Rather than seek to combat the disease, Kishor has been busy getting assignments to help politicians in other states. Chief Minister Nitish Kumar seems not to mind. Meanwhile, take the situation of Hare Ram Manjhi, Kamlesh Manjhi, Soman Mandal, Jagan Ram, Shivam Paswan, Suresh Kumar Sahu and Jowna Rajkumar. They have different names, but several things in common—they are all poor, they have all lost their children in the past 15 days in Muzaffarpur due to an unknown viral fever, and more importantly they are all victims of Bihar’s crumbling health structure.
Since the past 15 days, Muzaffarpur is in the news for the Acute Encephalitis Syndrome (AES) endemic. Till now, as per the government’s estimates, more than 150 children have died due to suspected AES, while private watchdogs estimate the number to be nearly 400.
The cause of children’s death is being linked to an unknown fever which is locally called chamki bukhaar and suspected to be AES. In 2008, the WHO defined AES as the acute-onset of fever with decrease in the glucose level that seizes the mental status of the individual suffering from it. It includes illness caused by a wide variety of viruses, but mostly considered as viral encephalitis.
There is no concrete research which can suggest the reason behind the AES outbreak and provide the protocol for its remedies. With the rising number of death of kids, the Janata Dal United (JDU)-Bharatiya Janata Party (BJP)-led Bihar government is at the receiving end.
Chief Minister Nitish Kumar himself is facing wider criticism for the mismanagement of prevention of AES and it took him almost 15 days to pay a visit to the dying children battling their life in Bihar’s Sri Krishna Medical College and Hospital (SKMC). Kumar even failed in assessing the situation when his own deputy, Prashant Kishor, prior to joining his current profession, was part of the WHO.
After his visit to SKMC, Nitish Kumar announced a compensation of Rs 4 lakh each to families of the children who died due to AES and he also promised to increase the number of beds in hospitals, besides building new hospitals. Kishor, who is a trained public health expert and has worked with the United Nations in this capacity for seven-eight years, is nowhere to be seen while the deaths multiply in a state ruled by a party of which he is a senior leader.
When this reporter contacted Prashant Kishor to get his comment, he said: “I am not part of the government and the government is dealing with the AES problem. You should talk to the government, who am I to answer you on this issue? I am not part of the government, so you should ask these questions to the health minister or the government’s officials. I am not an expert on AES.”
This reporter also contacted JDU leader Neeraj Kumar who said: “I won’t be able to comment as a spokesperson of JDU, but as an individual, I would say that Bihar is facing a devastating natural calamity, as till now, the country’s medical science is not able to suggest the reason for the outbreak of AES. They have no fixed remedy to treat AES.”
“The state government is taking all possible steps available to deal with this calamity. Various medical teams are there to provide treatment to the children suffering from AES. Chief Minister Nitish Kumar himself is watching the situation closely. The Chief Minister has already announced that the state government will improve the health infrastructure. But for now, it is a big calamity that Bihar is facing,” Neeraj Kumar told The Sunday Guardian.
Not only the Bihar Chief Minister, Union Health Minister Harsh Vardhan is also facing criticism for not fulfilling the need to come up with a medical solution for AES. In 2014, during the same AES outbreak, Harsh Vardhan had promised to open a 100-bed capacity hospital, but ever since nothing has happened in this direction. In 2014, Harsh Vardhan was the Health Minister.
Similar to that in 2014, this year again, Bihar’s Muzaffarpur, Vaishali, Samastipur, Gopalganj, Gaya, Darbhanga and Madhubani districts are witnessing an AES outbreak, though Muzaffarpur has been the worst hit among all the districts.
Four-year-old Sonali died on Thursday within a couple of hours after reaching the SKMC in Bihar’s Muzaffarpur where children are battling for life.
Kamlesh Manjhi, Sonali’s father, said: “Early in the morning, I saw that my daughter started breathing fast, and her eyes were closed. I tried to shake her body, I called her name, but she didn’t respond. Fearing her illness, I hired an auto and took my daughter to the SKMC that is 10 km from my home. She couldn’t get any medicine for more than an hour. Later, a doctor at SKMC gave her medicines. Around 11.30, I sensed that my daughter has stopped breathing and I ran to call the doctor. One doctor came in 20 minutes and after checking Sonali’s pulse, he declared that my daughter has died.”
Most of the victims of suspected AES in Bihar come from poor families of farm labourers, brick kilns workers and small farmers who hardly earn Rs 4,000 a month.
Shivam Paswan, father of another AES deceased, described how his seven-year-old son died due to AES. “On 9 June, my wife saw that our son was not responding to our call. He was as if he was in a deep sleep though breathing fast. I and my wife took our son to SKMC for treatment, but treatment was provided only after two hours. They injected one vaccine and asked us to take care of the kid; so many other kids were there getting treatment for the same symptom. In the afternoon, I was asked by the doctor to bring some medicine because the medicine was not available in the hospital. My son could sustain the AES attack for one day and he died the very next day. I believe that due to the unavailability of doctors and medicine, my son died,” Paswan said.
According to Dr Sunil Shahi, Medical Superintendent at SKMC, with the death of two more kids on Thursday, 100 children have already died of suspected AES in SKMC alone and as many as 250 children are still in the hospital suffering from AES.
Speaking on the issue of AES-related deaths in SKMC, Shahi told The Sunday Guardian, “Initially, there may have been some shortage of doctors and medicines, but since the last seven days, the numbers of doctors have been increased. Many teams on Central deputation from Delhi, Patna and other parts of the country have come to SKMC and they all are assisting us in providing treatment to the children suffering from AES. The Centre has sent 15-member teams, including scientists, doctors, laboratory technicians, and other such experts, to study and determine the cause of deaths. They are also providing treatment to the children. The Central and state teams are ensuring the availability of medicines according to the designed protocol.”
The Ministry of Health’s data shows that between 2008 and 2013, AES cases have increased across the country. In 2008, a total of 3,855 cases of suspected AES were witnessed and this increased to 7,485 in 2013. In the case of children, the fatality rate is much higher than adults.
Dr Ram Singh, Joint Director and in-charge NCDC Patna who is also part of the Central team at SKMC, said that the first case of AES was reported in Vellore in Tamil Nadu in 1955 (it used to be called Japanese Encephalitis) and the first outbreak of AES was reported in Bankura in West Bengal in 1973, but it was only in 1995 when the deaths of children from AES became endemic.
“History shows that the spread of AES occurs only in summers. Rain is the most suitable drug to stop the AES endemic,” said Dr Ram Singh.
Asked whether the outbreak of AES was avoidable or the deaths of hundreds of children happened due to the crumbling health infrastructure in Bihar, Dr Ram Singh replied, “We can say no, the outbreak was not avertable with the available knowledge and resources in our hands. The second question about the crumbling health infrastructure—yes, there is a problem, but we are managing our best.”
Data reveals the crumbling health infrastructure or the lack of it in Bihar is perhaps the reason behind the AES endemic.
After 49 years, SKMC, which has 610 beds, has not managed to open a post graduate study centre for the pediatrics department.
On the condition of anonymity, a senior resident doctor of SKMC told The Sunday Guardian that despite all the media attention, and alertness of Central and local administrations, the hospitals still have a shortage of doctors, nurses and medicines. Also, the state is facing a huge problem in providing treatment to thousands of other patients who are suffering from other diseases and are visiting other hospitals. All the resources are being mobilised for Muzaffarpur and surrounding areas. “We could stop the outbreak at an initial stage, but the state has no medical facilities available in the rural areas. This shortage of local hospitals causes the loss of vital hours for patients suffering from AES,” the same senior resident doctor added.