Bihar's Encephalitis crisis reveals dismal medical infrastructure

Last Updated: Wed, Jun 19, 2019 15:09 hrs
Acute Encephalitis Syndrome

Bihar is the midst of a health crisis. Since June 5, 113 people have died due to Acute Encephalitis Syndrome (AES). The disease is marked by swelling of the brain, high fever, seizures, coma and death. Malnourished children are often the worst affected.

Since the outbreak began earlier this month, Chief Minister Nitish Kumar made his first visit to a hospital at Muzaffarpur on Tuesday. At this particular hospital 91 children have died and currently more than 300 are in treatment for the disease. Outside the hospital, he was met with angry protestors and hecklers angry with inaction from the government. The Times of India editorial sums up the situation in the state –

While the quality of healthcare needs improving all over the country, the confluence of weaknesses in Bihar – from malnutrition to poor hygiene and deteriorating law and order – is proving fatal. Nitish needs to haul up the standard of governance, particularly healthcare.

This happening in one of the country’s poorest states makes it harder for those affected to receive treatment. In India, Bihar and Uttar Pradesh are the worst affected. According to the National Vector Borne Disease Control Programme, in 2018, more than 600 people died across the country due to AES with more than 10,000 cases detected. In light of the recent deaths, the National Human Rights Commission (NHRC) Monday sent notices to the Union Health Ministry and the Bihar government seeking a detailed report on the situation.

The cause for the disease isn’t one particular thing. It’s a result of a mix of factors – an intense heat wave affecting the state which has killed 90 people, malnourishment among children, and a certain chemical found in litchis. The fruit contains Methylene cyclopropyl-glycine (MCPG) which hampers the body’s ability to synthesise sugar. Consuming this on an empty stomach leads to low blood sugar levels and inflammation of the brain. The government would do well to tackle malnourishment in children in rural areas for this can be a preventable way forward as the Indian Express editorial states –

The links between the fruit and AES have been debated but most researchers agree that the disease affects only under-nourished children. However, the state government has not taken the cue from medical research. It does not have a special nutrition programme for AES-prone areas.

Reacting to the crisis in Bihar, the centre has stepped in. The Union Health Ministry has called for the formation of a permanent multi-disciplinary group to review and tackle the crisis. This group will constitute experts from the National Centre for Disease Control (NCDC), All India Institute of Medical Sciences (AIIMS), Indian Council of Medical Research (ICMR), World Health Organisation (WHO) among others.

Indian healthcare is marred by an acute shortage when it comes to basic infrastructure. According to the Lancet’s Access to Healthcare Study from 2018, India ranks 145th among 195 countries studied when it comes to access to quality healthcare. This includes basic care and medical equipment. A common sight is hospitals overflowing with patients and many not having access to beds.

The way to prevent this disease is seemingly rather simple and easy to implement. Ensuring children have proper nutritious meals. As the main source of the disease seems to be the litchi fruit, which is harvested in the peak summer months between April and June, it is essential that the government be prepared for all eventualities. In the light of this crisis, the Odisha Health Minister Naba Kishore Das has ordered officials to ascertain the toxic content of litchi fruit that are being sold in the state.

Was this a failure of governance? Not necessarily according to Prabhat Kumar Sinha, former Dean at the Indira Gandhi Institute of Medical Sciences. In a comment to The Print, he cites the reduction in the number of AES cases in Bihar. He says in part, “this year’s epidemic of encephalitis is something that no one saw coming. In cases of such epidemics, there is very little that can be done.

The first case of AES in the region was detected in 1995 in Muzaffarpur. The number of deaths in the region due to the disease has been on the decline; from 355 in 2014 to 11 in 2017 and 7 last year. Jumping off Prabhat Sinha’s point, T. Jacob John, retired professor of Virology rom CMC Vellore, in a column for The Hindu writes on the unusually high numbers this time. He writes on how he was part of a team that investigated the disease from 2012-2014 and acknowledged the decline in deaths –

I don’t know what went wrong this year. In 2015, all primary health centres were supplied with glucometers to check the blood glucose levels of sick children. Glucometers have not been maintained well. Health education was not sustained.

With this latest outbreak, it is imperative that two things must happen on parallel tracks – the current situation be kept under control and the harsh lessons learnt from this should equip the government to prevent and be prepared if such an outbreak does occur. A reduction in the number of cases cant necessarily be used as an excuse.

More columns by Varun Sukumar