Getting hold of encephalitis
It's high time that the administration, both at the Centre and States, instead of playing the blame-game, pull up their socks and take corrective, coercive and cohesive action to ensure health to all and provide basic amenities
Of late, intense focus, and for the right reason, has been on the tottering healthcare system in Uttar Pradesh’s Gorakhpur district, where more than 70 children succumbed to Japanese Encephalitis (JE) and Acute Encephalitis Syndrome (AES) in a fortnight this month in a major referral hospital.
However, this is not the first time that JE and AES have raised their ugly heads in the region and this is surely not the first time that the episode has triggered reaction from the media, health activists and political parties. In fact, in what can be called ‘a criminal neglect’ on the part of successive Governments, both at the Centre and in Uttar Pradesh, in the last three decades, more than one lakh kids have died due to AES, including JE in the region, besides leaving many crippled.
JE and the AES, which mostly afflict children between one to 15 years of age, are easily preventable through intensive vaccination, clean sanitation, safe drinking water, hygiene and timely medical care. But the deaths show how the State is still grappling to provide even basic amenities to the locals.
Because of its eco-epidemiological complexity, AES and the JE pose a serious challenge in terms of prevention and control. AES, including JE, is a group of clinically similar neurological manifestation caused by several different viruses, bacteria, fungus, parasites, spirochetes, chemical/ toxins etc. There is seasonal and geographical variation in the causative organism.
Even when treated, JE can leave significant neurological effects, especially in children. About 30 per cent to 50 per cent of the survivors struggle to walk or suffer cognitive disabilities. The Centre and the State Governments, however, it seems, have not learnt lessons despite plethora of studies and guidelines issued from time to time, outlining the dos and don’ts to tackle the disease. It was in 2005, when subsequent to a major outbreak of JE in eastern Uttar Pradesh, including in Gorakhpur, that resulted in recording more than 6,000 cases and 1,500 deaths. The then Government had introduced JE vaccination with other vaccines in a phased manner, starting from 2006. During the same year, directorate, National Vector Borne Disease Control Programme developed surveillance guidelines and issued the same to all JE endemic States with the advice that the JE be commonly reported under the AES.
In 2009 too the Centre framed guidelines on clinical management of the killer diseases and just three years later, a Group of Ministers (GoM) was constituted by the Centre, envisaging multi-pronged strategy encompassing preventive (sanitation, safe drinking water, improvement in nutrition etc) case management (capacity building of medical and para-medical staff, referral etc) and rehabilitation (physical and social rehabilitation of disabled children), measures to address the problems relating to JE/AES.
After a much-reported crisis in 2012, the Centre again issued guidelines for treating JE and AES more effectively. But clearly, where they are most relevant, they are hardly followed because of apathy, red-tapism and prevalence of shortage of doctors and health workers besides ignorance among the locals.
In January 7, 2015, Union Minister of Health and Family Welfare, JP Nadda chaired a high-level inter-ministerial meeting of secretaries and senior officials from participating ministries of the Government as well as the health secretaries of Uttar Pradesh, Bihar, West Bengal, Assam and Tamil Nadu. Nadda emphasised that appropriate steps should be taken to prevent deaths due to JE and AES. However, unabated deaths show that nothing has changed. Suggestions have remained on paper. Reducing incidence of fatal or crippling disease requires will, which is lacking.
First aid is inaccessible, primary health centres and community health systems have not been equipped enough to handle such a deadly disease. District hospitals lack required number of doctors and beds to meet the increasing health demand of the people — all pointing to the lack of willingness on the part of the Government to change things.
There are flaws in the implementation of the JE vaccination programmes too in the region. A recent study published in Indian Journal of Medical Research has pointed out lapses in the JE vaccine immunisation programme. The 2015 survey notes that only 42.3 per cent of Gorakhpur division’s eligible children had the two recommended doses of JE vaccination.
Poorly educated health workers, who believed the JE vaccination could not be simultaneously administered with the measles and diphtheria, pertussis and tetanus (DPT) vaccinations prescribed in India’s Universal Immunisation Programme, were the main reason for the poor vaccination record. The health workers believed that simultaneously administering multiple vaccinations could overload children’s immune system and increase the risk of side effects, so they asked mothers (or fathers) to return for the JE vaccination.
The low coverage suggests that many parents, who lived a ‘hand-to-mouth’ existence, did not return, as per the study. Another study, which is being conducted in the Gorakhpur region, in its preliminary report has noted, locals preferring to approach community doctors/ojha and Bangali doctors as first point of care, low handwashing habits among them and disposing waste in open areas. The brief report was submitted by Seema Sahay, scientist from the National Aids Research Institute, on June 7, to the Ministry of Health and Family Welfare.
It’s time that the administration pulls up its socks, take corrective, coercive and cohesive control action to ensure health to all. If the Government continues to pass the blame, instead of opening its eyes to ensure holistic measures, the shocking incidents will continue to torment us at the cost of our future ie children.
(The writer is Special Correspondent, The Pioneer)
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