Parents watch their sons and daughters die in Bihar's Death Ward
More than 200 children are undergoing treatment in Bihar's Muzaffarpur, which has emerged as a hotbed of an unknown viral fever, locally called chamki bukhaar and suspected to be acute encephalitis syndrome.
Chandrakant Mishra 16 Jun 2019 3:15 AM GMT
Muzaffarpur (Bihar). Chaturi Sahini was making preparations for the last rites of his seven-year-old son when the phone rang.
His younger son had died as well.
Seven-year-old Prince and five-year-old Chhotu died within a couple of hours of each other in the Sri Krishna Medical College and Hospital (SKMC) in Bihar's Muzaffarpur where children battling — and losing to — death lay in cobwebs of pipes. At least 85 children have already died of suspected acute encephalitis syndrome, and some 200 are suffering.
Chaturi Sahini came from his Harvanshpur village in Bihar's Vaishali district. Across the ward, sat parents from villages across the region, waiting desperately for the deadly fever that engulfed their children, to ease.
Twenty-four-year old Umesh Kumar refuses to put down his 10-month-old baby boy, Dilkhush, on the bed of children's ward in SKMC Hospital. After three days, his only child has come out of the intensive care unit (ICU) of the district hospital where the baby is undergoing treatment for suspected acute encephalitis syndrome.
"Till June 11, Dilkhush was doing fine. By night, he developed high fever and started crying uncontrollably. Then his hands and feet started to curl with heavy breathing," narrated Umesh Kumar sitting on the ward bed with Dilkhush in his arms. He lives in Dhanukhi village, Bochaha block of Muzaffarpur, about 40 kms away from the district Hospital.
"Next day, June 12 early morning, I got an auto-rickshaw and rushed my baby to a private hospital, which took about 20 minutes. The doctor at private hospital said my boy's condition was serious and I should rush him to the district hospital in Muzaffarpur. Reaching there in the auto-rickshaw took another 20 minutes," said Umedh.
Without further delay, his child, Dilkhush, was admitted at the paediatric ICU of the district hospital where he is still undergoing treatment for what is being suspected to be an outbreak of acute encephalitis syndrome in Bihar.
"For three days, my grandchild was in the ICU and every single moment I was praying to the God and the doctors to save his life," said Sukho Devi, maternal grandmother of Dilkhush who is at the hospital to take care of the little one. Her daughter, Dilkhush's mother, has fallen sick watching her own child suffer and fearing he may not survive, informed Sukho Devi.
Till June 15, at least 72 children, all below nine years of age, have died due to the viral disease outbreak in Bihar. More than 200 children are admitted in various hospitals and undergoing treatment. Condition of some children is claimed to be serious. Local people claim 72 is the 'official' death toll. Many more children have died before reaching the hospitals.
"So far, we do not know the reason for these deaths. A central team had visited and collected samples for analysis. The final result is still not out," Sunil Sahi, medical superintendent of SKMC Hospital told Gaon Connection.
According to S P Singh, civil surgeon (equivalent of chief medical officer) of Muzaffarpur, lives of some of these children could have been saved had they received treatment in the 'golden hour'.
"As soon as the child develops symptoms of what local people call chamki bukhaar, if he or she receives basic medication and health care, young lives can be saved," said Singh. "Unfortunately, primary health system in rural areas isn't up to the mark and parents lack awareness. By the time, a child reaches the hospital, the 'golden hour' is lost," he added.
On the rise
This isn't the first time children are dying in Bihar due to outbreak of an unknown viral disease, suspected to be acute encephalitis syndrome. In 2011, there were 147 cases and 54 acute encephalitis syndrome related deaths in Muzaffarpur. In 2014, there was a spike in such deaths after which there was a drop in death toll. This year, cases have spoken again (see graph)
Graph: Deaths due to suspected acute encephalitis syndrome in Muzaffarpur district of Bihar
Source: Sunil Sahi, medical superintendent of SKMC Hospital, Muzaffarpur
Acute encephalitis syndrome, commonly known as AES, is defined as the acute-onset of fever with change in mental status (including symptoms such as confusion, disorientation, coma, or inability to talk) and often with new onset of seizures. This syndrome is a major health problem in Asia. It includes illness caused by a wide variety of viruses, bacteria, protozoa, fungi. But, mostly considered as viral encephalitis.
Between 2008 and 2013, acute encephalitis syndrome cases have recorded an increase in the country, from 3,855 to 7,485 (see graph). As per news reports, last year 10,485 such cases were diagnosed and 632 deaths recorded across 17 states. India's fatality rate in acute encephalitis syndrome is 6 per cent, but in the case of children it is as high as 25 per cent.
Cases of acute encephalitis syndrome are reported throughout the year, but there is an increase in these cases in June, which peak during July and August, and then decline in September-October.
Combination of factors
According to a 2014 research study, 'Possible factors causing Acute Encephalitis Syndrome outbreak in Bihar, India', published in International Journal of Current Microbiology and Applied Sciences: "The first epidemic outbreak of Acute Encephalitis Syndrome appeared in North Bihar districts during 2011 particularly among poorest community in the paediatric age group… The disease appeared in paediatric age group coinciding with the litchi (Litchi chinensis) fruit season." The authors of the study go on to note that "heat stroke was suspected as major possible factor".
There are various theories behind the outbreak of acute encephalitis syndrome in Bihar. Some claim children die due to eating litchi, which contains toxins. This has been categorically denied by doctors at the district hospital. "It is incorrect to say that children are dying due to litchi consumption," said Sahi. For instance, 10-month-old Dilkhush didn't eat litchi, but still developed acute encephalitis syndrome.
A 2014 research study authored by the scientists of National Vector Borne Disease Control Programme of the Directorate General of Health Services reads: "The AES cases in Muzaffarpur and adjoining litchi producing districts have been observed mostly during April to June particularly in children who are undernourished with a history of visiting litchi orchards; many of the cases are hypoglycaemic." Hypoglycemia occurs when blood glucose levels fall below normal levels. But, what causes this health condition isn't still clear.
Sahi informed Gaon Connection that a number of children admitted at SKMC Hospital were hypoglycaemic. Some of these kids died. The press release of state health department said that maximum deaths have occurred this year due to hypoglycaemia resulting from high heat, humidity and no rains.
The 2014 study also notes that "social and economic factors play an essential role in occurrence of AES… AES in Muzaffarpur has mostly been observed amongst the children with low socio- economic background."
There are other studies that point towards a combination of malnutrition, heat, humidity and poor hygiene leading to AES.
Whose child will be next?
A sense of gloom prevails over the children's wards in SKMC Hospital, and Krishna Devi Prasad Kejriwal Hospital at Muzaffarpur where majority of children affected due to acute encephalitis syndrome are being treated. Parents of sick children do not talk to each other. Fear is written all over their faces as they worry whose child may be the next to join the rapidly growing death toll list this year.
On being asked about the condition of his daughter, 44-year-old Suresh Sahini of Vaishali retorted: "Our children are dying, but it doesn't matter to the politicians. Why will it matter as their children are not suffering? This year children are dying, next year more children will die, but it does not affect the authorities."
Ameena Khatoon's six-year-old daughter Farzana is also undergoing treatment at the SKMC Hospital. "Till four day back, my daughter was fine. Suddenly she got high fever, and her hands and feet started curling. I rushed her to hospital. Doctors say her condition is improving, but then why is Farzana not opening her eyes?" asked Ameena, who lives in Devariya Kothi, Muzaffarpur.
Right next to Farzana's bed in the hospital ward is Babua, a young boy lying listless on the bed. There is a pipe inserted in his nose through which medication and glucose [drip] is being administered. While pressing his legs, his helpless mother said: "My Babua is not speaking at all. For the last three days, there is no improvement in his condition. I don't know if he will be normal again."
Meanwhile, three-year-old Sudama Kumari cannot bear the pain of drip needle in her left hand. Her mother, Anju, keeps assuring the child: "Your baba [father] has boarded the train and is soon coming to take you home."
Majority of victims of acute encephalitis syndrome in Bihar belong to poor families — children of daily wagers, migrant labourers, or small and marginal farmers. For instance, Umesh Kumar gets daily wage work only two to three days in a week, and in a month earns maximum of Rs 6,000.
Meanwhile, people are angry and losing patience with what they call is an apathetic government. People held protests outside the Patna residence of Mangal Pandey, the state chief minister, who finally visited the SKMC Hospital on June 14 morning when about 60 children had already lost their lives.
In a usual response, Pandey said that life of each child was precious and the government was working towards protecting children suffering from suspected acute encephalitis syndrome.
It must be noted that in 2014, 390 such cases were reported in Muzaffarpur district of which 122 died. This particular outbreak was studied by scientists and a research study published in The Lancet in January 2017 which linked it to litchi consumption. Researchers "recommended minimising litchi consumption, ensuring receipt of an evening meal and implementing rapid glucose correction for suspected illness."
This year's death toll has already touched 72. The Union health minister, Harsh Vardhan is scheduled to visit Muzaffarpur on June 16.