Many thanks to the reader who sent the link to this report in The Indian Express: Been there, done that. Earlier reports kept saying "poor people" were the victims of the encephalitis outbreak; this is the first I've seen that describes them as Dalit, untouchables. Excerpt (but read the whole long, disturbing story):
Only the names of the patients have changed. Acute encephalitis syndrome is back in Bihar, hitting the same districts as every year, its victims once again mostly children of Mahadalit communities living in various degrees of poverty, their resistance levels lowered by malnutrition and exposure to heat.
And the government response has been repetitive to the point of being ritualistic. It has asked for Central assistance and set up yet another committee to monitor treatment, besides seeking cover behind a comparison with Uttar Pradesh, saying the annual mortality rate due to AES is 40-45 per cent there, even worse than Bihar’s 25-30 per cent.
The awareness campaigns promised every year are yet to start, the urgency watered down by the inevitable subsidence in the outbreak once the monsoon arrives.
The mystery around the disease persists, with tests every year establishing only what it is not — Japanese encephalitis — while people in most affected areas are yet to be vaccinated against even JE. There has been talk yet again of declaring it an epidemic but the government has never gone beyond announcing its intent.
Of the 458 patients admitted to Bihar’s major hospitals this year, 169 have died so far, the death rate higher than in 2009 and 2010. Around 90 per cent of the patients are children of Scheduled Castes from districts where the disease strikes between June and August. Here are six things that haven’t changed about the annual phenomenon.
Those who suffer
Expert opinion differs on whether malnutrition is among the main reasons for AES but there is no denying that those affected are invariably malnourished children from among the Mahadalit communities. These Scheduled Caste children, who live in low-lying areas with little access to proper drinking water, often show inadequate glucose levels.
“We are labourers and know nothing about the disease except that it kills fast,” says Nilam Devi, whose son Amit, 2, has been admitted to Kejriwal Hospital in Muzaffarpur. Three-year-old Rani’s parents wonders how children of better-off families in the same areas don’t suffer from AES.
A pediatrician from that district, who is in a government committee monitoring treatment, attributes AES to 4G (gaon, garibi, gandagi, garmi). Kejriwal Hospital administrator V V Giri says that apart from socio-economic profile of the patients, the government’s lackadaisical approach to tackle AES hasn’t changed either.
With the promised awareness programmes forgotten once the rains arrive, few families know about the little precautions that might have protected their children. “Parents don’t know the importance of even minor things like drinking boiled water, not allowing children to walk bare-chested in the sun, or eating a lot of jaggery to maintain one’s glucose level,” says Dr Rajiv Kumar, in charge of the special encephalitis ward at Kejriwal Hospital.
“No government doctor or any health worker has ever told us about any preventive measures,” says Sanjay Das of Bochaha. Health minister Ashwini Kumar Choubey says awareness campaigns are a continuing process and all areas cannot be covered at once.
So this outbreak is killing children because they are poor, and required to be poor. I would be grateful if someone could explain the meaning of "gaon, garibi, gandagi, garmi."