Fruit scare

En­cephali­tis is not only threat­en­ing lives in Bi­har, but also the liveli­hood of litchi farm­ers as un­con­firmed re­ports link the dis­ease to the fruit

Down to Earth - - HEALTH - ALOK GUPTA | MUZAF­FARPUR, BI­HAR

MUZAF­FARPUR IN Bi­har is as in­fa­mous for en­cephali­tis as it is fa­mous for its shahi litchis. Acute en­cephali­tis syn­drome (aes) has been a lead­ing cause of child deaths in the state. Till the time of fil­ing this re­port, 210 chil­dren across Bi­har had died of aes since May this year. Ac­cord­ing to of­fi­cial fig­ures, since 1994, Muzaf­farpur alone has wit­nessed 995 aes-re­lated deaths of chil­dren. Un­of­fi­cial es­ti­mates put this fig­ure at at least 1,800 in the district ut­terly lack­ing health­care in­fra­struc­ture.

The dis­ease is now giv­ing sleep­less nights to litchi farm­ers in the state as sev­eral re­ports have sur­faced in the me­dia on the prob­a­ble link between aes and eat­ing litchi. Any con­firmed ev­i­dence will put at stake the liveli­hood of thou­sands of farm­ers as the state’s econ­omy de­pends on litchi cul­ti­va­tion to a large ex­tent. Ac­cord­ing to the Food and Agri­cul­ture Or­gan­i­sa­tion, litchi is the ninth most pro­duced fruit in In­dia and Bi­har is its big­gest pro­ducer. Muzaf­farpur is one of the lead­ing pro­duc­ers in the state.

Could litchi be the cul­prit?

Al­though there are no stud­ies that di­rectly link litchi to aes, me­dia re­ports claim that litchis have chem­i­cals sim­i­lar to those found in ac­kee ( Blighi­as­ap­ida), a Ja­maican fruit, which causes acute en­cephalopa­thy dis­ease in chil­dren called Ja­maican vom­it­ing sick­ness. Some re­ports have also linked pes­ti­cide use in litchi cul­ti­va­tion to aes. Vishal Nath,direc­tor of Na­tional Re­search Cen­tre for Litchi (nrcl),a re­search body that pro­motes litchi farm­ing, de­nies the link. “Farm­ers in Bi­har are not rich enough to buy pes­ti­cides. And even if they use pes­ti­cides, they use the very mild ones,”he says.

Sci­en­tists at nrcl have been flooded with queries from farm­ers and con­sumers.

“Litchi is grown in Tripura, As­sam, West Ben­gal, Bi­har, Hi­machal Pradesh and Pun­jab. If litchi causes aes, why are there no aes-re­lated deaths in the other states?” Nath asks (see ‘Ir­re­spon­si­ble re­portage can harm busi­ness’).

Dhanan­jay Singh, a litchi farmer, says farm­ers in the re­gion are always in touch with nrcl to en­sure bet­ter pro­duce. “I re­ceived a lot of queries from my buy­ers in Delhi and lo­cal con­sumers. For­tu­nately, our busi­ness did not suf­fer,” he says.

Creaky health­care, shifty virus

While farm­ers might heave a sigh of re­lief for now, chil­dren con­tinue to suc­cumb to aes in hos­pi­tals. In the in­ten­sive care unit (icu) of Sri Kr­ishna Med­i­cal Col­lege and Hos­pi­tal (skmch) in Muzaf­farpur, Roushan Ali, 16, sits stone-faced on a stool. Be­side him is the body of his 11-year-old brother, Parvez. “He is dead, he is dead,” Roushan mut­ters. Out­side the icu, a woman clutches the body of her three-year-old daugh­ter. A group of men, ap­par­ently her rel­a­tives, wait for her to loosen her grip so that they can take away the body for the last rites.

Corpses of chil­dren, wail­ing moth­ers and un­con­scious chil­dren in hos­pi­tal beds, with a web of tubes run­ning through their hands and legs, are a com­mon sight at skmch. Chil­dren bat­tle for lives in the icu, in the wards, in spa­ces between the beds and in the fan­less cor­ri­dors of the hos­pi­tal. Doc­tors and nurses rush from one pa­tient to an­other to save who­ever can be saved.

Braj Mohan, head of the pae­di­atrics depart­ment, skmch, who has been work­ing in the hos­pi­tal for the past 18 years, says that the symp­toms of aes have changed dras­ti­cally. “Till 2010, aes af­flicted chil­dren had three prom­i­nent symp­toms—high fever, seizure and froth­ing. In the past few years, chil­dren suf­fer­ing from aes have not re­ported fever,” he says, adding that this year pa­tients have also re­ported low sugar lev­els. The med­i­cal fra­ter­nity is, there­fore, clue­less about the mea­sures to be taken.

The sit­u­a­tion is wors­ened by in­ad­e­quate num­ber of beds, doc­tors and nurses, and lack of ba­sic in­fra­struc­ture like elec­tric­ity and speedy am­bu­lance ser­vice. Emer­gency am­bu­lance ser­vices are not very effective be­cause most driv­ers have quit due to non-pay­ment of salary. Radha Devi brought her four-year-old daugh­ter, Munni, to skmch af­ter a twohour jour­ney by bus and au­torick­shaw. “We called the am­bu­lance, but it did not come. I could not waste time wait­ing for it,” she says.

Deepak Ku­mar, prin­ci­pal health sec­re­tary, claims the gov­ern­ment has adopted a pol­icy of pro­vid­ing speedy med­i­cal aid to aes pa­tients. At least 80 am­bu­lances have been pressed into ser­vice. “We want to solve the acute in­fra­struc­ture cri­sis at skmch. By next year, we plan to build icus with a ca­pac­ity of 100 beds,” he adds.

In a bid to con­trol aes-re­lated deaths, the Bi­har gov­ern­ment launched a Ja­panese en­cephali­tis drive in the state in 2012. The move helped con­trol deaths due to Ja­panese en­cephali­tis virus in Gaya and Sheo­har dis­tricts. Muzaf­farpur re­mains a chal­lenge be­cause the en­cephali­tis that has sur­faced in the district is caused by an un­known virus.

Chil­dren suf­fer­ing from acute en­cephali­tis syn­drome have to fight for space at

SKMCH hos­pi­tal

Link between litchi and en­cephali­tis, if proved, will af­fect the liveli­hood of thou­sands of farm­ers

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