In the much discussed matter of a virtual epidemic of Acute Encephalitis Syndrome deaths of children largely between the ages of 4 and 7, in and around Muzaffarpur, the government of Bihar claims that while the rate of fatalities to admissions in 2011-12 was 35% and it has come down now to 26%.

However, the reported number of child fatalities due to AES in April, May and June 2011-12 at the SKMCH and Kejriwal Hospital in Muzaffarpur was 148 – and we are not even talking about children who couldn’t make it to the hospital at all and died before they could get there. Whereas the number of fatalities being reported in the media already in mid June 2019 is over 200.

One of the several shocking aspects of these deaths is that 80% of the children who died were girls.

More and more experts are weighing in to connect these deaths with litchi consumption in the region’s orchards, during peak litchi picking hours between 4 am and 6 am, mostly by poor daily wage labourers – men and women often accompanied by children, who tend to consume the fruit in the process of picking it in the early hours, on empty stomachs.

This causes severe and sudden hypoglycaemia due to the specific composition of fruit sugars and other elements in ripe or near-ripe litchis, especially if the child in question has not had a full meal the previous evening, or generally suffers from malnutrition. This leads to headaches, convulsions, unconsciousness, and severe to moderate brain damage if a proper dose of glucose in regulated conditions is not administered immediately.

We must ask ourselves some inconvenient questions:

1. Are these children getting proper nutrition at home and if not, why are our anganwadi centres and school midday meal programs unable to ensure proper nutrition for these children?

Could it be that schools’ closing for the summer holidays, during roughly the same period as the litchi picking season, has aggravated the situation?

If the schools are functioning for part of this period, is the incidence of AES greater on the morning after a holiday, say Monday morning, when the child did not even get a proper midday meal the day before?

Can we prevent this tragic epidemic merely by ensuring an evening meal as well as midday meals every day, including during school holidays, for these children instead of having to spend so much money and effort with little or uncertain effect for their treatment later on, or God forbid, large sums of compensation on deaths, which will never compensate the huge and tragic loss suffered by a family that loses a child?

Could it be that the solution is that simple, at least to a large extent, and we are simply beating about the bush to avoid admitting a huge nationwide nutritional deficit, semi-starvation virtually, among huge numbers of poor people, especially children?

This would be something very, very embarrassing for the government to admit, and pretty expensive to remedy on a regular basis, while the well-fed and subsidised rich cry wolf against “doles” to the “lazy, child-producing” poor.

An even more scary question is this:

What is the real extent of malnutrition in the poorest third of our rural and urban population, especially among the next generation, our children?

What does it portend for the future of our nation?

2. If this line of diagnosis is correct, would a mere awareness generation program among poor households be enough, so that they do not allow their children to eat litchis on an empty stomach?

It is important to face facts and spread awareness, but the compulsions of poverty and hunger are so great that neither will the parents be able to give up litchi picking (which in any case helps no one) nor will they be able to ensure that children don’t go to the orchards with them.

Nor will they be able to stop the children from eating ripe or unripe litchis if they are hungry in the orchards, while picking litchis for labour, or generally anywhere that they can lay their hands on the fruit, which is virtually everywhere in this region, even a tree in their own house or in a neighbour’s house.

The only real solution is to ensure proper nutrition for children in the vulnerable age groups and socioeconomic groups, especially a full evening meal.

Is it really so hard to do if the government and civil society decide to ensure it?

3. Since 80% of the fatalities among children in Muzaffarpur are reported to be female, does this point to an underlying fact – that in common Indian households, and more pronouncedly among the rural poor where there is less of everything to go around anyway, the female child is given less food than the male?

Perhaps we should think of programs and campaigns like “Beti ko khana toh khilao” (At least feed your daughter) at higher priority than “Beti Padhao” (Educate your daughter), for achieving the goal of “Beti Bachao” (Save your daughter)!

4. Almost all survivors will suffer from neurological deficits, some of which may be short term while others may last for life.

No one seems to be paying any attention to this aspect of the tragedy.

Some physical or motor issues can be resolved with proper and sustained physiotherapy, while others may require prolonged advanced neurological treatment and care.

The nutritional status of the survivors also may need to be monitored for some time to come.

These things, which come naturally for the children of the well-off, are totally forgotten for poor families, from whom 100% of the victims come.

The government has announced compensation of Rs 4 lakh to the families of the deceased. But what help is being extended to the survivors to be rehabilitated?

Have we alerted our PHC staff , health workers, schools and anganwadis to report on the follow-up status of the survivors? If they come to suffer from any learning disabilities, will we get to know about it? And how many of these children go to school or anganwadi preschool learning programs anyway, if these are available?

Any thoughts or ideas?