ENCEPHALITIS IN BIHAR
In the paediatric ICU of the government-run Sri Krishna Medical College and Hospital (SKMCH) in Muzaffarpur, Bihar chief minister Nitish Kumar had only one question for the parents of the children stricken with acute encephalitis syndrome (AES): “Bachche ko khana khilaya tha raat mein?” Poor and struggling, many admitted sheepishly, “bhookhale so gayi thi (she went to bed hungry)”. The gender is telling. Of the almost 130 children who have died of AES in Bihar, the majority, 85, have been girls, less likely to be fed adequately in poor
families than their brothers.
“It reveals the underbelly of Bihar’s patriarchal society,” says an SKMCH doctor. According to a research conducted in Muzaffarpur and a lychee-growing area in Vietnam, undernourished children in both places suffered from AES and hypoglycaemia, or extremely low blood sugar. Dr Prabhat Kumar Sinha, former dean at Indira Gandhi Institute of Medical Science, Patna, says “Blood sugar usually dips in the early morning hours. In malnourished children, who have slept without eating dinner, it often develops into hypoglycaemia.” He adds that the brain needs “normal levels of glucose in the blood to function when the liver fails to supply this need. An alternate pathway of glucose synthesis, called fatty acid oxidation, is switched on in our bodies.” But methylene cyclopropyl-glycine (MCPG), a toxin found in lychees, “blocks this pathway, leading to seizures and, in many cases, death.”
Bihar produces 40 per cent of the country’s lychees, and hypoglycaemia has been reported in the majority of children who died in Muzaffarpur— though some doctors have pointed out that the root problem is malnourishment, not lychees. Nitish Kumar, an advocate for female rights—reserving half the panchayat seats and government jobs for women, declaring prohibition, demanded mostly by women, and giving free books and bicycles to schoolgirls, causing a leap in enrolment—has ordered a socio-economic survey of more than 450 people whose children have been either afflicted with AES or died from it.
Critics of Kumar have pointed to the success of Uttar Pradesh, and even West Bengal, in controlling outbreaks of encephalitis. But 16 children died recently in UP, suggesting the success is just partial. The Bihar government has struggled to find an obvious cause for AES beyond the links between hypoglycaemia and lychees (often unripe). Still, the Supreme Court has asked for a reckoning of the state’s facilities and preparedness. Will Kumar, with a reputation for good governance, acknowledge his government’s lapses?