Indian Express
08 September 2010
By Maulshree Seth
Gorakhpur, India

Fear And Panic Gorakhpur Hospital Overflowing Disease Not Japanese Encephalitis
AT the BRD Medical College in Gorakhpur, the paediatrics department emergency ward is overflowing with patients –two–to–a–bed is the rule, many beds have even three. There is no other way to accommodate 240 patients on 108 beds.

This is the season of the "mastishk jwar" which ravages Gorakhpur and ten adjoining districts in eastern UP from mid–July to October every year.

About 250 children have died this year. Many who survived have been disabled by the virus that attacks the brain.

Last year, 556 died. In 2008, the count was 495; in 2007 it was 525; and, in 2006, 476. In no other place in India does a disease kill so many children every year.

Until 2004, there was uncertainty about the nature of the disease. But in 2005, when an outbreak killed 1,200 children, medical experts across the world started looking at Gorakhpur closely.

The Atlanta–based Centre for Disease Control and several others conducted studies and concluded that the main killer was Japanese encephalitis.

Despite reservations, the Centre and the UP government ensured extensive JE vaccination. But children kept dying and it turned out that a large number did not test positive for JE. All cases were classified as AES (acute encephalitis syndrome).

Two years ago, the Pune–based Na tional Institute of Virology set up a field laboratory in Gorakhpur to identify the cause of the disease. It came up with the finding that the culprit was a class of enteroviruses. Work is still on to make the research more specific.

Dr M M Gore, the scientist in charge of the NIV lab, said they installed equipment to speed up work. Samples have beensenttotheCentreforDiseaseControl and the results are awaited.

While the research will take time, a few things are clear. Both JE and enterovirusesarekillingchildren.Thoughit remains a problem, the JE mortality rate is declining. The main killer is the new class of enteroviruses; the disease these cause is, for want of a more specific term, still recorded as AES. Like JE, the new viruses attack children.LikeJE,theseattackthebrain,and other organs. Like JE, these have no medicine and patients have to be given symptomatic treatment. Like JE, these have a high death rate, in fact higher.

UnlikeJE,thenewenteroviruseshave no vaccine; that will have to wait until the nature of the viruses is fully understood.

Unlike JE, which is spread by mosquitoes, the enteroviruses spread via contaminated water through what medical experts call the "faecal–oral route".

ButlikeJE,AESispreventable.Iffogging, larvacidal sprays, removal of piggeries (hosts to the virus) and preventing stagnation of water can counter JE, hygiene and sanitation can tackle AES. Dr K P Kushwaha, Head of Paediatrics Department at the BRD Medical College, said: "We can only take measures to provide life support; recovery is natural in these cases.

In AES, multiple organs are affected and we can only give symptomatic treatment. It will be difficult to eradicate the disease unless there is a public movement for preventive measures."

To take a look at the conditions where the disease breeds, one only has to visit Rajdhani, 25 km from Gorakhpur city in Brahmapur block. Seven–year–old Khushi Prajapati has returned from BRD Medical College –two other children were not so lucky.

Khushi was hospitalised after she had convulsions and high fever.Though she has recovered, she can't move her hands properly and has a speech problem. Her father Rajendra Prasad Prajapati, who works in Gorakhpur city in an electric shop, has built a twostoried house minus a toilet. The family of 12 defecate in the open. There is stagnant water all around. There are also four piggeries in Bairagi Tola.

Residents say this has been the setting here for decades. Their children have been dying of “mastishk jwar" but no one ever told them that the deaths could have been prevented if some simple steps had been taken.

Dr M M Gore, who has been travelling through villages in the last two years, said: “Gorakhpur has a high water table which makes it prone to contamination. Many people here defecate in the open and use mud near handpumps to wash their hands. Eating utensils are washed at the same place. Villagers have constructed concrete houses but not toilets." “If such habits are changed, basic hygiene is taught to people, steps taken to ensure sanitation, and a proper drainage system put in place, it will go a long way in solving the problem," said Gore.

Gorakhpur district has 13 primary health centres and nine community health centres but not one has equipment like a ventilator.

So sick children have to be sent to the medical college. The Health Department has 21 fogging machines, but only five work – the other 16 have been undergoing repairs for a year now.