Bihar: Union Health Minister repeats promises made in 2014 as AES death toll rises

The death of between 100 and 150 infants and children, most of them between the age of two and seven, generated plenty of high drama in Muzaffarpur this week.

• Journalists from Delhi winged their way to Muzaffarpur to report on the tragedy.

• Bihar Government declared a muwawaza (compensation) of Rs four lakh for each of the deceased.

• Union Health Minister himself visited SKMCH and made several announcements.

• Bureaucrats and health professionals debated on the cause of death, which were said to be anything from heatwave to litchis, from hunger to malnutrition to negligence.

• Chief Minister Nitish Kumar paid a visit to the hospital finally and declared that within two years, the bed-strength of SKMCH would be expanded from 600 to 2,500.

None of this will of course bring back the children. Nor are they likely to stop ‘destiny’ playing its part. For TV channels, it became an occasion to display some public service journalism. The images of a popular anchor from a Hindi channel invading the alleged ICU and subject doctors and nurses to her inquisition will also linger for long.

It may not entirely have been a coincidence that a large number of the dead were girls and they belonged to poor families and Dalit and Backward classes. Upper caste children seemed to have been spared by the scourge.

The deaths, it was pointed out, occurred every year and surged around this time. It has been easy therefore to blame them on heat strokes, dehydration or due to severe water-related diseases. But an article in the British Medical Journal, Lancet, in March provided a new fodder - Litchi or Lychee, the exotic and expensive fruit for which Muzaffarpur is known.

The study, conducted on 390 children brought to two hospitals in Muzaffarpur in 2014, established a link between the fruit and Encephalitis. As many as 122 of those children had died and the researchers concluded that a toxin in the fruit caused hypoglycemia, a drop in glucose levels in the blood. The study also established that evening meals neutralised the effect of lychees on the glucose level, leading doctors to suggest that the deaths occurred because the children were severely malnourished, hungry and had gone to bed without the evening meal.

Sceptics continue to be doubtful. Lychee orchards are guarded round the clock during the few weeks the fruit ripens and are harvested. It is expensive and beyond the reach of the poor. How did two-year olds get access to the fruit? Nor is there much research finding to establish what they ate.

Doctors pointed out that the symptoms of AES - high fever, convulsions and children falling unconscious - were almost in all cases reported early in the morning. A quick dose of glucose would have helped the children to survive but often they were taken to hospitals beyond the ‘golden’ hour of four hours. With few doctors available in rural areas of Bihar and PHCs and the facility for intravenous injection of glucose available mostly in district hospitals, any delay in taking the children to the district headquarters turned out to be fatal.

Indeed, Down to Earth quoted Dr Ajay Shah of Muzaffarpur claiming that a child with zero glucose level when brought to him, survived after Glucose was administered.

But while there is clearly a need for more studies and research to ascertain the cause of the deaths, the Government and politicians remain both clueless and insincere.

Union Health Minister Dr Harsh Vardhan, flanked by his MOS Ashwani Choubey, an MP from Bihar, and Bihar Health Minister Mahendra Pandey, provided a perfect photo-op on a visit to Muzaffarpur. In a video that went viral, Choubey appeared to be dozing, indifferent to the proceedings. The Union Minister, himself a doctor, solemnly answered questions put by newsmen while Pandey, in between questions, was overheard asking reporters about the score—of a World Cup Cricket match in India.

Ironically, Dr Harsh Vardhan had visited Muzaffarpur in June, 2014 as well following the death of over a hundred children. He had then made several promises. A 100-bed Paediatric ICU would be set up in the SKMCH, he had said. A research institute to study incidence of Encephalitis and Kala Zar would be set up besides a super specialty hospital, he had promised.

Five years later on his visit to Muzaffarpur in June, 2019, the minister is said to have repeated four of the seven promises he had made in 2014. For some reason, he again made seven commitments, the same number as in 2014, adding virological labs and expert committees.

None of them was honoured. Bihar and people of Muzaffarpur may have to wait five more years to see if he means business this time.