Times of India
13 October 2011
By , Shailvee Sharda
Gorakhpur , India

Acute Shortage Of Facilities Even As Hospitals Overflow With Patients

The inconsolable cries of women can be heard in the overcrowded out patient department of Baba Raghav Das (BRD) Medical College, Gorkahpur. In stark contrast, a dead silence prevails in the epidemic wards of the hospital. The OPD and the epidemic wards of the hospital are jampacked with patients suffering from encephalitis, majorityof thembeing children. Similar conditions exist in other hospitals of the district.

The maximum cases of encephalitis in the country are reported from Gorkahpur. Official data show that six out of 10 encephalitis deaths occur in this district. This year, 412 persons, including 328 children, have died at the BRD Medical College. Between January 2007 and September 2011, 2,750 persons died from the disease here. On Wednesday, five more children succumbed to an unknown virus that causes encephalitis, taking the toll this month to 54. “On an average, 12 deaths are reported every 48 hours here,” said a data entry operator in the district. Despite the rising toll, the health machinery has not swung into action.

Half the wards in the BRD Medical College are occupied with encephalitis patients. Gorakhpur, Kushinagar, Deoriaand Maharajganj have reported 12, 87, 67 and 33 deaths respectively in 2011. The number of those needing medical attention and management is five times t h e d e at h s. More than 2,000 patients have been admitted to the hospital since January this year. The hospital has run out of beds, with 2-3 patients sharing a single bed.

“Against a bed-strength of 108, the hospital attends 250 cases of encephalitis at any given point of time,” said Prof KP Kushwaha, head of BRD Medical College’s pediatric department. Acute shortage of doctors, paramedics and nurses further adds to the chaos. The shortage of doctors is due to confusion over renewal of work contracts. Two months ago, the medical college got 28 residents from various state medical colleges to aid it but six of them left due to immense work pressure.

Experts have categorised the killer encephalitis. While Japanese encephalitis which is mosquito-borne and vaccine-preventable, the other is lodged as acute encephalitis syndrome (AES). The exact cause of AES is not known, but experts at National Institute of Virology’s (NIV) research centre at the medical college associate entero virus with it. “This is mainly a water-borne infection that is as lethal as any other viral infection,” said Gorakhpur commissioner K Ravindra Naik. “JE is now limited to just 6% cases which means that vaccination could help. Since there is no vaccine for AES, all we can do is bank on prevention,” he added.

Elaborating on the steps taken for prevention, Naik said, “The source of entero virus is either water or fecus. So, ensuring safe drinking water and sanitation is the focus. Indigenously made small handpumps, which are the chief source of contaminated water, have been banned while village health and sanitation committees undertake insulation activities in villages where encephalitis cases are reported. But, it will tak time before these measures yield positive results.”

Social activists in the region negate the researches to isolate virus causing AES. “The situation is epidemic and saving lives is more important,” said Dr RN Singh, who has been demanding a dedicated programme for encephalitis control. He mobilised the people in the region and has written letters to President Pratibha Patil, UPA chief Sonia Gandhi, Prime Minister Manmohan Singh and Congress leader Rahul Gandhi seeking their attention. But, all in vain.

Pediatrician at Lucknow’s Balrampur Hospital, Dr GK Singh, agrees with Dr Singh “There is no way to check a virus. Then, the baseline treatment for all types of encephalitis is the same. We should also think in terms of our limitations as well We cannot be like America where vaccine hits the mar ket soon after a strain of virus mutates,” he said. Political parties have found an elec tion agenda in the plight of parents losing children. BJP MP Yogi Adityanath and his supporters recently staged a demonstration outside the Medical College for 10 days “How can we let ignorance kill our children,” Yogi had told reporters during the protest.

But amid all the aspects it is poor people who are los ing their children. About 75% encephalitis cases include males.
Encephalitis refers to inflammation of brain. It is a condition and not a disease. It has killed 3,824 persons, mainly children, in India over the past five years. Of those died, 2,571 or 67.2% persons are from UP In UP, 2,385 deaths have been documented at Gorakhpur Medical College. The numbers are despite common knowledge that more than 50% cases go unaccounted for. It could be viral as in case of JE Certain bacterial, for example the one causing TB, can also cause encephalitis. The condition (technically known as encephalitis of pyogenic origin) may also occur due septicaemia

The specific cause, (type of virus causing the condition) may not be known all the time. But this does not change the baseline treatment and management Source housing pathogens are, however, known. Eg: Pigs, ducks and certain birds are reservoir of arbo-b virus that causes JE while culex mosquito is its carrier. Breaking the cycle of pathogen can help in saving lives