A rare killer disease, Japanese encephalitis, has been annually and invariably breaking out in eastern Uttar Pradesh, India. This year, so far, 3,952 people have been affected. 914 are dead.
It transpired at a Down To Earth editorial meeting on September 5, 2005, that such outbreaks are legion in this region: they have been happening for the last 27 years.
Questions flew. What do people do? What action does the administration take? For the last 27 years? What's the procedure? Why here, every year?
Storylines began to emerge. Among other possibilities, there came to light a prevention programme undertaken in affected areas, on paper only, indicating the state of public health initiative in Uttar Pradesh. Can nonchalant non-performance be the best way for a state administration to tackle disease? What was the future scenario?
vibha varshney left immediately afterwards for Gorakhpur, along with photographer surya sen
In the rural heartland of eastern Uttar Pradesh (up), it is difficult to find that criminal called Japanese encephalitis (je). je is transmitted from infected pigs to humans by mosquitoes. So I decided to track down villages with piggeries (pig-keeping is a survival profession here). Travelling from Gorakhpur city to Sardar Nagar block, I found villages with pigpens but no reported je cases. There were villages with je cases that had no pigs. No village I went to had reported more than two cases of je, called mastishk jvar (brain fever).
Perfect name: it signifies the nature of this rare disease. Most people develop immunity to the je virus naturally after catching the infection from a carrier mosquito. But not all. In the 'not all' people, it reaches the brain.One out of three such people die. Up to half the affected get maimed.
In the villages there is a tranquillity that gives no clue to what follows:
Baba Raghav Das Medical College (brdmc),
Nehru Hospital wards 1, 6 and 10.
Most people diagnosed with je in eastern up and western Bihar come here. Ward 6 is on eternal boil. About 100 patients, 200 parents and relations, and 50 staff: 8 junior doctors, 4 more senior, about 10-12 nurses (talking, making notes, adjusting an iv needle, administering saline, glucose).
Bed 41. Harikesh, 14, on it. Two doctors and two nurses are trying to revive him. After about 15 minutes, they give up. About 40 people seated on nearby beds look on sideways, from the corners of their eyes, hoping that by not turning, they would ward the same fate off their ward. Around bed 41 it becomes deathly quiet; from beyond comes the raucous philharmonic of medical mayhem, of epidemic beyond grasp.
The dead child's uncle carries the body out, face expressionless, body shuddering. He goes to get a death certificate.
I return the next day, I watch another child die on the same bed. Already, it seems easier. Most beds have two children sprawled on it, each connected by a narrow plastic pipe to a pouch of fluid, metal stands hovering over bedsides. More than a dozen children die every day.
Sporadic cases in the villages. Horror in the wards. How many patients manage to reach brdmc ? How many deaths have no names/addresses in hospital records? How can a rare disease kill so many? Who's responsible?