Acute indifference syndrome

The annual scourge of acute encephalitis syndrome (AES) has returned this year also to Bihar’s Muzaffarpur district, this time with more virulence and severity. Over 160 children have died in the district in the last few weeks, and even after the first deaths were reported the health authorities were unable to stop the subsequent deaths, which were entirely preventable. Most of the deaths have occurred in the Sri Krishna Medical College and Hospital ((SKMCH), and even now infected children are being brought to the hospital. Many of the children are said to have died after eating the lychee fruit which is common in the district. The fruit becomes toxic if it is eaten by children with low blood sugar levels. Children who ate the fruit during the day and went to bed on an empty stomach were the unfortunate victims of the disease because the toxin worked internally during the night. The affected children could have been saved with dextrose infusion within four hours of the illness, but even this was not done in the case of those who died.

All the children who died were from the poor socio-economic background. Malnourishment of children is a serious problem in much of Bihar, especially in its most backward districts like Muzaffarpur. The tragedy is a combined result of malnourishment, the failure to create awareness about the problem among the people, and the inability of the state’s public health system to take immediate measures to tackle the situation. In the past years, too, Muzaffarpur has seen deaths of children due to AES. A medical team which had studied the problem had recommended preventive and remedial measures, but the state failed to implement them. In areas where there are high levels of backwardness and illiteracy, it is the responsibility of the government to ensure that such public health disasters do not take place.

The authorities at first blamed the summer heat or gave other reasons for the deaths. Though the disease has broken out every year for decades, the public health centres in the district are not equipped to deal with it. Most of them do not have facilities for testing blood to check the sugar levels. The SKMCH, the designated hospital to tackle the disease, does not have a virology lab or even an adequate number of beds. Ambulances were not available to take the affected children to hospital. The benefits under the Ayushman Bharat scheme were not available to most of the victims. Above all, the programmes to reduce poverty and malnourishment have not helped most of the people in the district. The children’s deaths are an indictment of the governance and public health systems in the state.