Did those kids in Bihar have to die?

It’s the first day of school, that’s not why he’s happy, though. It’s not because of the new lessons, new friends or new experiences. It’s because, on his way home, he’ll pass by chacha’s field. Chacha’s field will be decorated with red this evening.

He rushes to school, his mind elsewhere but ever so grateful for the opportunity to learn. He was a smart one, he could glance at the books and hold answers to mind-boggling questions.

The final bell rings, he’s the first one out the door. Today, he didn’t mind his bare feet, nor did he mind the pencils falling through the holes of his school bag. He sees the field but not the red. The litchis are still green, they aren’t ripe yet. But he’s waited so long, might as well have a few.

That night he sleeps, unaware that it will be his last. At midnight, his sister feels the bed shaking, but how does a four-year-old know that her brother is having a seizure. The morning, the family spent with the rest of the village, mourning the death of their son.

The ever so sweet fruit held the antidote as well, a bit of glucose could’ve let him live, complete his education. A meal could have prevented the hole he left in their family. A bit of glucose, a bit of awareness. That’s all it would have taken.

This is the story of more than 1,000 children in Bihar who died during the past decade as a result of acute encephalitis syndrome (AES) due to the consumption of litchis (lychees).

After consuming the fruit, the children typically develop a high fever, followed by seizures, associated with high mortality. The fewer AES deaths this year compared to earlier years is no consolation as more than 100 children below the age of 10 have died.

What is painful is that these deaths are not new to Bihar; they occur from May to June every year. Muzaffarpur is the largest litchi cultivation district in the country and hence witnesses these outbreaks during the month-long litchi harvesting season.

The fatalities almost always afflict rural children from lower socio-economic backgrounds, very rarely urban children and those from the upper economic strata. These deaths must arouse the nation’s conscience. I wondered how to address this heart-wrenching issue.

I set out to understand the disease and realised that the symptoms appear in association with consuming unripe fruits. A recent article by public health luminary Jacob John says that even after consuming unripe fruits, a simple meal in the night can provide enough glucose to prevent death. Also, even after the fever and seizures set in, administration of 10% glucose almost always prevents death. Finally, nearly all the deaths so far have occurred in rural areas and in poor children.

While it is unethical to deny an easily available fruit to a hungry child, if people were aware of the unforeseen consequences, they might have prepared better. Preventing death requires, above all, a straightforward and pragmatic approach, but as much as the cause, essential management might be elusive in managing this public health crisis.

The consumption of litchis causes a sudden illness which affects the brain due to the accumulation of toxins (hypoglycin A
and MCPG toxicity), which results in a change in the way some components of the food are processed by the body (fatty acid metabolism). There are high levels of acids resulting from the accumulation of certain
fatty acids which might have further contributed to clinical encephalopathy, which could explain symptoms and signs.

Litchi fruit is available everywhere in the orchards surrounding the villages in rural Muzaffarpur. It is tempting for anyone to eat but minimising the number of litchis might have a beneficial effect on undernourished kids. One wonders, can organisations collaborate with the government to ensure that every child in the rural area has an evening meal.

Agencies such as Akshaya Patra Foundation, which have successfully implemented meal supplementation, can ensure that no child goes to bed without an evening meal. While the country can wait longer to improve the overall nutrition status of children, the least the government can do immediately is to invite partners and support them in ensuring meals are provided to every child.

Parents must be made aware that skipping an evening meal can be fatal for kids. Public health facilities must be strengthened with advanced facilities and necessary supplies such as glucose must be ensured to prevent these deaths.

(The writer is a science student at Sri Kumaran’s Children’s Home, Bengaluru. Moved by the deaths of children in Bihar, she consulted and took inputs from public health experts to write this piece)