A woman's blood-curdling scream rings out in the dark room. Dr Mahima Mittal, who is attending to a patient, shifts her gaze to the farthest corner of the room to locate the crying mother, but in vain. A power cut has made it impossible to see beyond a few feet. Otherwise, a cursory glance would reveal dozens of unconscious children huddled up in beds that cover the floor from end to end.
The scream signals the death of yet another child due to encephalitis in the paediatric ward of the Baba Raghav Das Medical College (BRDMC) in Gorakhpur, Uttar Pradesh. It’s the third death of the morning, on 29 September. By the end of the day, the toll would reach seven.
But the doctors have no time to mourn. They have to monitor the condition of 90 children who are fighting for their lives in the same ward.
BRDMC is the only medical facility that has a dedicated encephalitis ward in this region where more than 50,000 people have died of the dreaded disease since 1978, when the first case of encephalitis was reported from Gorakhpur. The medical college hospital serves encephalitis patients from 19 districts of Uttar Pradesh, Bihar, Assam and sometimes patients from the bordering areas of Nepal too.
For the harried doctors, it’s just another day in the paediatric-turned-epidemic ward, which has seen the most number of child deaths in the country. More than 400 children have succumbed to encephalitis in this hospital since June. The average toll is 3-4 per day, but on some days, the death count crosses double digits.
Last year, more than 450 children died in the peak season (July-October). In 2010, the figure was around 550. Almost 95 percent of the cases are of enteroviral encephalitis, in which the virus enters the body through the intestine.
Most of the victims are aged between six months and 12 years and come from the hinterlands, where primary health centres are in shambles. “All these patients are referral cases. By the time we receive them, it’s already too late. The survival rate is next to nil,” laments Bharati Bhandari, a junior physician at BRDMC. “Patients come with an inflammation of the brain and other vital organs such as heart, liver and kidney. It leads to organ failure.”
The symptoms include poor feeding, irritability, vomiting and body stiffness; such symptoms in an infant always constitute a medical emergency.
Four-year-old Raja lies unconscious in bed. His father Munnilal brought him from Kushinagar, located 53 km away, “when his high fever continued for more than five days”. The child received his first dose of medication only after reaching Gorakhpur. Same was the case with Prince, a three-year-old from Gopalganj, located 122 km away. “The moment he had fever, we decided to bring him here. Some kids died recently in the nearby villages due to fever,” says Prince’s grandmother Meera.
But none of these people have any knowledge about encephalitis because the Uttar Pradesh government has rarely run campaigns to spread awareness about it.
The virus is more lethal in children because they often suffer from chronic malnourishment. “None of the kids receive the minimum calories required. As a result, their bodies lack any immunity, which makes them an easy prey,” says Dr Aftab, a resident physician at BRDMC.
The lack of awareness on hygiene and sanitation, coupled with groundwater pollution, have made this disease a major scourge. “Lack of hygiene has always been the root cause for the spread of the encephalitis virus in Gorakhpur. Be it the mosquito-borne Japanese encephalitis (JE) or the comparatively new water-borne enteroviral kind,” says BRDMC Principal Dr KP Kushwaha, who has been treating encephalitis patients for the past three decades.