Chulhai Ram, Chunchun and their children. Photo: Manoj Singh.
Manika Bishunpur (Muzaffarpur, Bihar): Chunchun Devi stands alone in front of her hut in Manika Bishunpur village’s Mushahari tola in Bihar’s Muzaffarpur district. Three of her children – two daughters and a son – are playing nearby.
On June 11 last year, Chulhai Ram and Chunchun lost their 4.5-year-old daughter, Raveena, to acute encephalitis syndrome (AES), locally known as chamki fever. She was the third of Chulhai and Chunchun’s four children, her brother being the youngest.
Tears well up in Chunchun’s eyes at the mention of Raveena. “The memory is still fresh,” says Chunchun. “Today, she would have been old enough to fetch a tumbler of water. The government did give us compensation of Rs 4 lakh, but that can’t replace my daughter.”
Chunchun Devi still shudders at the thought of what happened. Raveena initially had a mild fever, followed by tremors. They took her to a government hospital in Mushahari block, where the doctors immediately referred Raveena to Srikrishna Medical College. Chulhai and Chunchun then rushed her to the medical college – but Raveena died within 24 hours of being admitted there.
Chunchun says that she had no information about chamki fever before her daughter fell ill. After Raveena’s death, health department officials visited them several times and told them about the fever. They were told that children should not be exposed to the sun or sleep on an empty stomach. They must drink boiled water. The health workers visited them this year too, and gave the same information.
A month and a half after Raveena’s death, Chulhai received ex gratia compensation of Rs 4 lakh from the Bihar government. Chulhai, who was landless earlier, has purchased half a katta of land with the money. They have saved the remaining amount. However, he continues to work as a labourer even today.
In January this year, prior to the coronavirus-induced lockdown, he went to Hyderabad to work as a labourer but returned to the village during the lockdown and has been here since then. He plans to leave again after Chhath Puja. “If a poor man does not work, how will he eat?” he asks.
A water tap has been installed near his house, under the Bihar government’s much celebrated Nal-Jal Yojana for piped water supply to each household. But there is no water supply yet.
In 2019, four children died of the chamki fever in this gram panchayat area, inducing panic across the village. This year, no cases of AES have been reported in the village so far.
Arvind Kumar Singh, head of the Manika Bishunpur gram panchayat, says, “A community health centre (CHC) has been set up in Mushahari, but there are frequent complaints about doctors being absent at night. A pregnant woman recently died as there was no doctor to attend to her when she was brought to the hospital. There was much hue and cry over it.”
He said that this year, an awareness campaign regarding chamki fever was carried out early on.
Aradhya, the 19-month-old daughter of Ajay Paswan, a migrant labourer from the village, survived the fever but has not fully recovered yet. Aradhya was two months old when she got sick. She was taken to the CHC where doctors referred her to Sri Krishna Medical College Hospital (SKMCH). Though her life was saved after treatment which continued for several days, she is neither able to stand nor sit properly even now. Her eyesight has become weak and she gets tremors once or twice a month.
Ajay works as a labourer in Delhi. Aradhya is currently undergoing treatment at Delhi’s Kalavati Saran Hospital. Ajay’s wife Sangeeta is also living in Delhi. The doctors say that the child’s treatment will extend for a long time. This reporter met Ajay’s mother, Jayamala, at the village who claims that the family is distraught because of the expenses incurred in the treatment. Despite having no work, Ajay and Sangeeta stayed in Delhi during the lockdown, for Aradhya’s treatment.
This year, the onslaught of AES has not been as severe in Muzaffarpur and surrounding districts as last year. In 2019, more than 500 cases of AES were reported in SKMCH with more than 150 fatalities.
The superintendent of SKMCH, Dr Sunil Shahi, says that so far this year, 80 cases of AES, or chamki fever, have been reported at the hospital and 11 children have died.
Shahi says that a 100-bed ICU ward in the medical college was set up and became functional in March. “We had enough beds available this year but the number of cases reduced due to the awareness campaign in surrounding districts previously affected by the fever. Due to the availability of treatment at the CHCs and PHCs, many patients received medical attention there.”
According to the National Vector-Borne Disease Control Programme (NVBDCP), till September this year, 136 cases of AES were reported in Bihar in which 19 people died. Meanwhile, eight cases of Japanese encephalitis (JE) were also reported, along with one death.
According to the report, 124 cases of AES were reported in Bihar in 2018, while 33 patients died. Besides, 74 cases of JE and 11 deaths were also reported. The following year, there were 292 cases of AES and 82 people died while 135 cases of JE were reported and 27 people died.
According to the data, the number of JE cases reported in each year between 2014 and 2019 is 20, 66, 100, 74, 74 and 135 respectively.
Many people from Bihar’s Siwan, Gopalganj, West Champaran and East Champaran districts visit the BRD Medical College in Gorakhpur for treatment of AES and JE since there is no high-end medical institute specialising in the treatment of the disease in these districts.
In 2018, 106 AES/JE patients from Bihar were admitted to the BRD Medical College, Gorakhpur, of which 18 died. Among these patients, 29 suffered from JE. By October this year, more than a dozen encephalitis patients from Bihar have been admitted to the BRD Medical College.
After the outbreak of chamki fever last year, 20-bed Paediatric Intensive Care Units (PICUs) were announced in PHCs and CHCs affected by the disease, along with a 100-bed ICU ward at SKMCH. Though the SKMCH ICU ward is operational now, work is still in progress for units at primary and community health centres. The Super Speciality Block of SKMCH is not ready yet.
Clearly, Bihar has a long way to go in its fight.
Translated from the Hindi original by Naushin Rehman.
Manoj Singh is the editor of Gorakhpur Newsline.