Dying like mosquitoes

jeisn't new to up. Since 1978, the state administration has dealt with the disease. With great consistency and great efficiency. Consistently, it has done nothing. Very efficiently, it has ignored the disease. So far as democracy is concerned, the state has acquired special status.

Data of the past 27 years shows clearly the way je behaves (see table: JE peaks). It is rampant in the humidity of monsoon, as water accumulates and mosquitoes breed in it. Data from two major hospitals catering to je patients this year shows patients are mostly from districts Kushinagar, Maharajganj and Gorakhpur (see table: UP, 2005). The number of people affected is higher in Kushinagar. Mortality is higher in Gorakhpur. Data from Gorakhpur also shows the disease has a distinct cycle  (see table: 1978-2004).The most affected blocks in Gorakhpur include Pipraich, Bhathat and Sardar Nagar (see table: Affected).

Untimely rain
The state government blames untimely rain -- instead of coming late in August, it came in July this year, catching the administration unawares. Unbelievable. This, too, is true: when the health department machinery of eastern up should have been preparing for mosquito control, it was deployed in local body elections, till August.

The state has no long-term programme. Mosquito control measures occur under the rubric of the National Malaria Eradication Programme. When Down To Earth asked O P Singh, director general (medical and health), up, about the lack of fogging and insecticide treatment in villages, he said his information showed such work was done in May 2005.

If measures were taken in May, what went wrong? Most villagers say there has been little fogging or insecticide spray in the past decade, though these were regular earlier. Ram Daras, member of the block development council of Sardar Nagar block of Gorakhpur, says the village hasn't seen insecticide spraying since 1989. Arun Kumar, a 10-year-old from Jodhpur Bajah Tola village of the block, died of je at brdmc on September 8. Initially, villagers did not realise this was the village's first-ever je case. "After Arun's death, we are worried about our children," says Daras.

They have been reading about bed nets being distributed; Union minister of health and family welfare Anbumani Ramadoss told Down To Earth he's issued 300,000 bed nets. They haven't received any. The fogging machine did come two km away, but didn't fog Jodhpur Bajah Tola.

The non-action plan
2005 saw the up government come up with an action plan for je control. For the first time. It seems the news leaked out to the mosquitoes and the monsoon. The rains came in about the same time the action plan reached the district headquarters from capital Lucknow: July 21, 2005. The epidemic was already on: the first death was reported on July 29.

But let's talk action plan. It highlights the need to break the mosquito-pig-human link. Pigpens must be pushed five km away from human habitation. Cover pens with mosquito nets. People must be educated on the need to protect themselves from mosquito bites. Reduce areas where water can stagnate in; use neem oilcake in fields to reduce vector fertility; spray insecticides to reduce vector numbers. Last resort: vaccines.

The plan also maps out what should be done if a person falls ill with je. The person's house should be sprayed with insecticide, along with 50 surrounding houses. Burnt mobile oil should be dropped in stagnant pools to prevent breeding; pools should be filled up.

The district administration has failed to do these. In Harkhapur village of Pipraich block, 6-year-old Neelu developed je, and fortunately recovered. A health official came to her house for spraying, but didn't spray in the surrounding 50 houses. Reportedly, more than half the fogging machines in Gorakhpur district are in a state of disrepair. "The cost of spraying is very high," complains D P Mishra, additional director (health) at Gorakhpur. "Mosquito control ought to begin from mid-April. But spraying 20 km requires 10 litres of malathion, which costs Rs 1,000. This then has to be mixed with 190 litres of diesel, which costs Rs 6,650. And then there are transport costs," he calculates. Given most of eastern up is je -land, it would take crores to just spray malathion: those who made the action plan up never thought of this cost. They never thought of implementing the plan at all.

Placebo as remedy
Here is an instance of illogical planning: the female Culex has a lifespan of 21 days and can infect only 9-12 days after picking up the virus, and the disease is expressed in humans 5-16 days after infection. Thus, chances of killing infecting mosquitoes aren't spectacularly high. But this is precisely a measure the administration has prioritised, instead of pursuing more effective mosquito control measures. Says T N Dhole, department of microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, "There is no logic behind spraying 50 houses around the house with a diseased person." Adds he: "We are not called for meetings on je control as we have an independent critique of government efforts. They come up with an action plan every year. After the epidemic, you would not be able to find a single copy."

Even in Gorakhpur, the district administration maintains brdmc is exaggerating figures of je cases; it is doing so, the administration avers, so that brdmc can invite funds. But the fact is all additional funding for epidemic relief goes to the district health administration whereas brdmc falls under the medical education department. Irony of ironies, most people in the region take their je -stricken children to the medical college hospital, not the district hospital. The treatment at the college is far better, they say, even though the doctors are badly overworked.

Pigs might fly
The action plan also suggests relocating pigpens five km away from residential areas. This is a nice idea, eminently applicable in sparsely populated areas. But eastern up is densely populated: there would be no village that doesn't have settlements in a radius of five kilometres.

So, is it possible to remove the pigs? Gorakhpur district has about 24,000 pigs in 2,863 piggeries. The communities that rear pigs are also 40 per cent of the district's voters; thus, politicians don't take this step. But even if they were willing, it is mostly poor people from scheduled castes that rear pigs -- pigs provide insurance as they can be sold quickly at a neat price, thereby providing liquidity. The district administration has recently ordered a survey to find out if pig owners want to shift to an other means of livelihood, and if they need help to adopt new occupations.

Since the early 1980s, pig-keeping was promoted in the area as a means to generate income. Banks offer loans, here, to buy pigs (and goats). The scheme was prioritised to help people below the poverty line. Though loans for buying pigs are far less today, the Gorakhpur Shetriya Gramin Bank gave loans for 700 pigpens in 2004-2005 and for 800 pigpens in 2003-2004 in Kushinagar, Gorakhpur, Deoria and Maharajganj. The State Bank of India has earmarked about Rs 2.25 crore as loans for pig rearing in 2005-2006.

The solution here, as the action plan rightly recommends, is vaccinating pigs. One could argue, in the spirit of the action plan: pigs are bought on bank loans, so couldn't this measure be built into the loan procedure? There is only one problem: there isn't any pig vaccine in India. So the government has taken the next best option. It is administering 1,000 swine fever vaccines to pigs. Now, swine fever -- pig cholera, actually -- has no relation to je.

The action plan, quite obviously, is more like a dream document. But what deserves a closer look is the latest placebo on offer: vaccines. Read on.