In recent weeks, the district of Muzaffarpur in Bihar has become the site for a deadly epidemic of Acute Encephalitis Syndrome. With the latest round of reports coming in from the two hospitals of the district on Monday, June 16; the death toll in Muzaffarpur alone has risen to 103 people. With above a thousand – and counting - children admitted in hospitals across the districts of Champaran, Motihari, and Muzaffarpur, the situation has rapidly spiraled out of hand, with local hospitals and authorities struggling to provide any concrete assistance toward the resolution of what can now only be called a crisis.

In the light of such dire circumstances, The Citizen spoke to Dr. Kafeel Khan, a former Nodal Officer for Encephalitis at BRD Medical College, Gorakhpur. Dr Khan made national headlines for his outstanding personal efforts to tackle the Japanese Encephalitis epidemic that gripped Gorakhpur in 2017, and is currently on ground with his team in Muzaffarpur, assisting with the mitigation of the ongoing crisis.

Image result for dr kafeel khan gorakhpur

There has been considerable public furor over the cause of the epidemic in Muzaffarpur, with several governmental and media organizations touting different sources for the same. Dr Khan believes that it is of primary importance to dispatch these uncertainties, given that the science behind the current epidemic in Muzaffarpur, and in other parts of the country in the past, is the same. “With regard to what the patients are getting here - it is the same as what happened in BRD Medical College, Gorakhpur, or what happened in Kerala – with the Nippa virus encephalitis. They’re all viral encephalitis, and different names have been given on the basis of the virus being isolated,” he says.

“In Muzaffarpur, they (the local medical facilities) have not been able to find out which virus is causing the disease, and so it has locally been named ‘chamki bimaari’,” he adds.

However, Dr. Khan says that Acute Encephalitis Syndrome is an umbrella, under which fall many other diseases, including Nippa, and several locally named variants, such as ‘chamki bimaari’, ‘nauki bimaari’, and ‘paani bukhaar’. He goes on to say that in 70 per cent of cases of acute encephalitis, the exact etiology is unknown, i.e., it is not known as to which specific virus is causing the disease

Accordingly, he says that regardless of the particular virus, the treatment is the same. Further, there is no specific treatment for viral encephalitis, in India, or the world over. “Some developed countries provide emergency viral therapy, but it is not effective, and is still in trial stage,” he says. Regardless of which virus it is, for fever, we give the patient antibiotics, for seizures, we prescribe anti-epileptic drugs, and if the child goes into a coma, we administer anti-edema measures,” he tells The Citizen.

In the case of Muzaffarpur, the spread of a rumour alleging that the epidemic has been caused by the consumption of lychees has received significant media attention from across the globe. “Lychees don’t have any toxins that cause encephalitis,” says Dr. Khan. He, however, goes on to argue that fruits can be a cause for contraction of the disease. “There is a possibility, much like in Kerala, that when a bat consumes coconut water, or bananas growing outdoors, it’s saliva transfers the virus to the fruit. When these infected fruits are eaten by children or adults, they contract the disease,” he says.

Regardless of the uncertainties surrounding the diagnosis of exact cause, the overwhelmingly high death toll has also directly resulted from the sub-standard treatment being given to patients in Muzaffarpur.

“What I found in Muzaffarpur, is that patients greatly outnumber doctors. Ideally, in such critical cases, there should be one doctor handling four patients admitted to the ICU, and one nurse should be treating two babies at a time,” he says with concern. He observes that at Shri Krishna Medical College, Muzaffarpur, there is only one senior resident doctor, alongside 3 junior residents, who are attempting to treat over a hundred people. “One doctor is treating 25 to 30 patients, and the number of nurses is also very low,” he adds.

Furthermore, the severe lack of adequate infrastructure and resources has exacerbated the epidemic exponentially. “Three of four babies are kept on a single hospital bed. There is also a sever lack of paramedical staff. Even our investigation into the circumstances could not be effectively carried out because of lack of equipment and resources, and a longer procedure had to be followed,” Dr. Khan tells The Citizen.

Image result for muzaffarpur encephalitis

Perhaps the fact of most telling significance is the extremely limited supply of medicines. The specific medication required to treat encephalitis is not available. “These severe limitations are accelerating the mortality of the disease,” he says.

Dr. Khan also refutes the statement issued by the Government of Bihar, explaining the aforementioned shortfalls in publicly-administered emergency healthcare. The statement said that all officers and political leaders were overtly occupied with the recently concluded Lok Sabha elections, and thereby were unable to devote significant attention to the issue at hand.

“This is not the real reason,” says Dr. Khan. “I condemn that statement. In actuality, they were never prepared for the sheer number of patients coming in now. Muzaffarpur’s two hospitals - Sri Krishna Medical College and Hospital and Kejriwal Matri Sadan – are accustomed to handling 30-40 patients, but the current numbers are 3 to 4 fold increase. Their unpreparedness is reflected in the lack of medicines and doctors,” he purports.

According to research that Dr. Khan and his team have carried out in the past three years, five extremely common causes of encephalitis in the territorial belt spanning from Eastern Uttar Pradesh and Bihar, to West Bengal and Assam have been identified. “The lack of safe drinking water, poor sanitation, poor personal hygiene, the overcrowding of large families into small houses, and malnutrition are the five factors that accelerate mortality of the disease most greatly,” says Dr. Khan.

In the process of underlining these crucial factors, he also highlights a further, and far more deep-seeded cause for the present epidemic. “If the same virus were to attack a healthy child, living in a good environment, eating good food, and taking care of personal hygiene, she would not be infected. Hence, while a mosquito can’t differentiate between a poor and rich child, this disease is being called the ‘disease of the poor’, because nobody with adequate access to these basic necessities died because of encephalitis in Muzaffarpur. It is malnutrition that makes the child more prone to getting seriously infected when the virus attacks,” he tells The Citizen.

The prospects for the coming days and weeks do not look especially bright either. Dr. Khan says that once the monsoon rains reach the district, the situation will only deteriorate, as exposure to contaminated standing water will increase further. He stresses, with urgency, the need for the government to prepare for this. “They have rushed in doctors from Patna, but they have to do more. I hope things will improve, let’s see,” he says.

Meanwhile, protests have broken out outside SK Medical College, the facility where maximum casualties have been reported. Aggrieved family members and relatives of patients are questioning Bihar Chief Minister Nitish Kumar’s inadequate response to the epidemic, chanting slogans like “Nitish Go Back”. They are also demanding that the government take necessary action immediately.

Encephalitis deaths

Dr. Kafeel Khan will therefore be leading his team of four or five doctors, in setting up a camp in Muzaffarpur, for at least the next week. Seeking not to treat encephalitis patients, but to screen patients with initial symptoms, and then refer them to a medical facility accordingly, his efforts highlight the need for outstanding initiative that is required at this moment, to bring respite and relief to the neglected, suffering citizens of the district.