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6:14pm, 16th June, 2019

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The cycle of Acute Encephalitis Syndrome(AES) is back in Bihar’s Muzaffarpur, claiming the lives of 83 children in just 14 days. AES or locally known as ‘Chimki’ or ‘Dimagi Bhukhar’ is not new to the Muzaffarpur region. Since 1995 the syndrome has hit the area almost every year. In fact, in 2014 it killed 120 children of the city. Surprisingly, the administration still does not seem to be prepared, neither it is an election issue for the state.

Around 288 children have been admitted in two major hospitals of Muzaffarpur since June 1, while 197 have been taken to state-run Shri Krishna Medical College and Hospital (SKMCH), 91 were taken to a private hospital (Kejriwal hospital). They were all suspected of AES.

According to a press release issued by Muzaffarpur district administration, 83 children had died till Sunday morning at the SKMCH and Kejriwal Hospital.

The attendees of the victims have been claiming that there are no doctors at SKMCH during the night. “My daughter is in the ICU room of SKMCH. The toll is increasing day by day. There were no doctors after, and only nurses are here. There are four bodies inside the ICU,” Mohammad Aftab told news agency ANI.

Another attendant, Sunil Ram, said, “My four-year-old daughter was admitted to hospital on Saturday. She was declared dead today. There is no facility in SKMCH.”

Meanwhile, CM Nitish Kumar has announced an ex gratia of Rs. 4 lakh each to the families of the children who died due to AES in Muzaffarpur.

Earlier this Saturday, Bihar state health minister Mangal Pandey visited SKMCH after 14 days of the epidemic and said, “We are trying everything and anything that can save children’s lives. Everything is being made available, from medicines to doctors. We have even called doctors and nurses from AIIMS in Patna.”

“There is a protocol regarding what kind of medicines and facilities should be given, and we are doing the same. We are monitoring things regularly and trying to save our children,” Pandey said.

However, a senior doctor while talking to TV9 Bharatvarsh claimed that “there are less medicine, lack of ventilators and doctors. We have mostly student nurses who are taking care of hundreds of patients.”

“There are four doctors that include one junior resident doctor and two interns with the senior resident doctor who is handling four ICUs in SKMCH” alleged the senior resident doctor to TV9 Bharatvarsh. He further added that “the ideal ratio during such emergency needs to be two patient per doctor.”

On Sunday Union Health Minister Harsh Vardhan arrived at SKMCH to review public health measures for containment and management of the AES. Union Minister had previously said the Centre was continually monitoring the situation and supporting state health authorities to manage the encephalitis cases. The minister was greeted in the state capital with black flags displayed by workers of the Jan Adhikar Party Loktantrik who shouted slogans against him.

There has been a popular theory that connects AES with lichi harvesting. Let us find out what the researchers have found out.

The Bangladesh AES Outbreak

A similar AES outbreak has been reported nine times between 2008 and 2016 in Lichi harvesting area of Bangladesh. A research conducted by the team led by British Chemist Saiful Islam at the International Center for Diarrheal Disease Research in Dhaka investigated the 2012 outbreak in Bangladesh that affected 14 children 13 of whom died within 20 hours of the onset of AES symptoms. Based on the epidemiological and clinical analysis, they concluded that it was triggered by the liberal application of multiple, highly toxic pesticides – including endosulfan that is banned in 80 countries – in orchards where children used to play and pick up fallen fruit to eat without washing.

The Indo-US based report Denies Islam’s conclusion.

An indo-us study that investigated Muzaffarpur’s 2014 AES outbreak ruled out pesticides as a contributor and blamed the outbreak on naturally occurring toxins, hypoglycin-A and methylene-cyclo-propargylglycine (MCPG) in litchi seeds and pulp. Its authors had claimed it to be “the first comprehensive confirmation that this recurring outbreak illness is associated with litchi consumption and toxicity from both toxins.”

However, a popular argument that questions the above case asks why doesn’t the outbreak reaches to different regions where lichi is consumed.

A 2017 report published in natureasia.com claims that both the outbreaks in India and Bangladesh are “two different diseases both associated temporally and spatially with the litchi harvesting season.”

There is a need to understand both the reports or a new study to find out the solution to the epidemic. There is also a need for better outreach program by the state Government, state health care units, and local citizens in order to not let the cycle repeat.

While writing this story, one more kid died in SKMCH.

If you are in Muzaffarnagar right now, TheMatchbox.co urges you to help the nation understand the situation. Use #biharmedicalcrisis and put stories on social media. If you can volunteer and help the administration, please reach out. We cannot let our children die, and they are more than just numbers.

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