“Poore ward me jitni bachhiyan bharti thi, unme Priyanshu sabse sundar aur sabse tandurust thi. Ladka jaisa baal rakhti thi.”
"Of all the girls admitted in the ward, Priyanshu was most beautiful and healthiest. She sported boy-like hair"
This is how Ranjeet Ram describes his five-and-half-year-old daughter Priyanshu Kumari, who died in Sri Krishna Medical College and Hospital (SKMCH) in Bihar’s Muzaffarpur due to Acute Encephalitis syndrome (AES), locally known as Chamaki Bukhaar.
Ram, 40, a vehicle mechanic working at a garage in Delhi, had recently come to his home in Harpur village, around 50 kilometres from Muzaffarpur town. On June 6, he admitted his daughter to hospital with fever and "unfamiliar activities" in her body.
“I woke up at around 6 am and took Priyanshu outside our house. After some time, I thought of waking her up to send her to tuition. But before I could wake her up, she started behaving abnormally,” said Ram.
Without wasting any time, Ram took Priyanshu to a local doctor who told him to admit her in SKMCH immediately. “I took a private vehicle and reached SKMCH in an hour. Treatment was on but there was no improvement,” he said.
Around 2 am on June 10, Ram sensed that her daughter is lying motionless. He immediately informed the security guard of the Intensive Care Unit (ICU) as no nurse was present. After a brief check, the nurse told Ram that his daughter is dead.
Priyanshu had started going to school from this year. "I got her admitted in the government school this year only. She was good at her studies," recalls Ram.
The case of Priyanshu is not isolated. More than 130 children have died so far in Bihar this year due to AES. The biggest concern is that AES-related deaths have been occurring in Muzaffarpur and nearby areas since 1995, and still, no one knows the exact cause.
What causes Acute Encephalitis Syndrome?
“ 136 deaths have been reported till 4 pm today (Thursday). Out of 136 deaths, 110 were caused by Hypoglycemia and 20 were due to unknown AES. Three deaths occurred due to Japanese Encephalitis (JE), two deaths were due to Dyselectrolytemia and one death was due to Herpes,” Dr Kaushal Kishor, Additional Secretary with the state Health Department told Outlook.
AES is bunch of 11 syndromes. And JE, Dyselectrolytemia, Herpes are only a few among them.
This disease was first reported in Muzaffarpur in 1995. Since then much research has been conducted to examine AES, but no one knows the exact cause of the disease. Hence, with some assumptions, experts have come to the conclusion that excessive heat, poverty and malnutrition, sleeping on an empty stomach, and consumption of unripe or rotten Litchi could be the reasons that act as a trigger for AES.
“Just check affected children’s family background. All these children are poor, poverty-stricken and malnourished,” says Dr Arun Shah, a paediatrician who has been associated with research on AES in Muzaffarpur.
Maximum cases that are reported are of Hypoglycemia – low sugar level in the body which causes dysfunction in the brain. “Litchi has a toxic substance which is present in more quantity if the fruit is unripe or rotten. What our research concluded is that Litchi may trigger AES but only if the child is poor, malnourished and he/she doesn’t get proper food,” claims Dr Shah.
Ram, however, says his daughter didn't consume the fruit at all. “She had not consumed Litchi. She never visited any Litchi orchard recently. She had consumed chapatis and vegetable for dinner and suddenly fell ill in the morning.”
Delay in awareness programmes
Deaths due to AES were reported as early as in May, but the government did not start any awareness programmes. In 2015, the Bihar government, with the help of UNICEF, had prepared Standard Operating Procedures (SOPs) to tackle AES. The SOPs combined awareness programmes and interventions to ensure better preparedness. For example, as per the SOP, ASHA workers are given electrolyte sachets to be distributed in the villages and are asked to raise awareness on not letting children sleep on an empty stomach.
This practice, officials in Muzaffarpur say, was followed successfully for last two years, but seems to have missed the government's priority list this year. “Due to election duty, awareness programs were delayed," a Health Department official told Outlook on the condition of anonymity.
“Before Priyanshu fell ill, no ASHA worker came to our village. When my daughter died, an ASHA worker came with a bag full of electrolyte sachets and told us to use it as soon as possible as it will get expired in one month," said Ram.
Shah too raised questions on state government's preparedness. “Awareness program this year failed due to elections. Primary Health Centers (PHCs), which are supposed to give primary treatment, lacked basic infrastructure. There are no doctors and staff to treat patients. I have visited the countryside and I can tell you very few PHCs are functional," said Shah.
In Bihar, total number of PHCs is 103. According to health experts, as per government recommendation, there should be one PHC for every 30,000 people. This means Bihar needs around 70 additional PHCs.
‘…then Muzaffarpur will become childless’
As the death toll in Muzaffarpur rose steadily, Chief Minister Nitish Kumar visited SKMCH on Tuesday, where he faced protests from family members of patients. Before him, Union Health Minister Harsh Vardhan had also visited the hospital.
Kumar ordered to put additional doctors on duty in SKMCH. Around a dozen additional doctors have been deputed at the hospital since then and additional pediatric wards have been set up.
Health department officials say all the PHCs have been activated so that primary treatment is readily available. All ambulances, private or public, have been instructed to ferry patients to hospital free of cost.
Meanwhile, a research team has also been set up to investigate the different aspects of AES.
“We instructed the ANM, ASHA workers and doctors that they should first give treatment at local PHC and if matter is serious then patients can be sent to SKMCH,” said Shivchandra Bhagat, a civil surgeon working in Muzaffarpur. “There is a decrease in the number of patients coming to the hospital. We hope we will be able to control the situation in a few days,” he said.
In between, Ram, who is mourning the death of his daughter Priyanshu, has a message for government – “I have lost my child. Please do whatever is needed as soon as possible…otherwise, Muzaffarpur will become childless one day.”