Guest post by : Aarti Kelkar-Khambete
The encephalitis episode aptly indicates that temporary solutions that do not seek to address the root of the problem cannot help and that there is a risk that one problem gets replaced by another, like Japanese encephalitis being followed by viral encephalitis. The time has certainly come to end the long wait and the plight of the poor who continue to be deprived of basic health and sanitation needs in the area.
Following the news on extensive rainfall in the north and south of the country and reports of heavy flooding in the north and the east, the story that has been making headlines has been that of the rapid spread of viral encephalitis in the northern parts of the country, with the most severely affected being Gorakhpur district in Uttar Pradesh, which has witnessed one of the worst outbreaks.
Current figures indicate that the cumulative death toll of encephalitis in Purvhanchal and adjoining regions of Gorakhpur, Uttar Pradesh has reached 488 with a majority of them being children [
At present, over 280 encephalitis patients are undergoing treatment at Baba Raghav Das (BRD) Medical College and in the nearby district hospitals [
What is encephalitis?
Encephalitis is an acute inflammation or swelling up of the brain caused mostly due to a viral infection. Acute encephalitis syndrome generally includes two types of infections, Japanese encephalitis, which occurs due to mosquitoes, and enteroviral encephalitis [
More serious symptoms can include:
Other symptoms of encephalitis can include:
Infants and the elderly are particularly at risk of severe illness [
However, until 2005, the majority of deaths were caused by Japanese encephalitis, caused by a mosquito-borne virus. But in the past six years, these cases have dropped and children have been dying of another form of viral encephalitis, which has been feared to be transmitted through contaminated water. Thus, the type of virus and the mode of transmission have changed.
Secondly, children in the age group of six months to 15 years are the worst affected and most of the victims have been found to be from poor economic backgrounds and from rural areas [
Lack of adequate sanitation facilities coupled with the regular habits of defecating out in the open often leads to the possibility of water getting contaminated with faecal matter. This increases the possibility of drinking water getting contaminated where water is consumed by people in the village using shallow hand pumps [
Experts inform that around 30,000 people may have been left disabled by the diseases since they were first detected in 1978 and government records show that 15,000 have died, and another 15,000 are permanently disabled [
Recent news indicates that following criticism from the National Disaster Management Authority (NDMA), a high-level committee of experts has now been constituted in the Ministry to deal with the encephalitis problem. Following discussions between the Union Health and Family Welfare Minister who visited the site and the State and Central government officials, it has been realised that the acute encephalitis syndrome (AES) needs to be dealt through a multi-pronged strategy that would require involvement of mainly the Ministries like Drinking Water and Sanitation as well as Social Justice and Empowerment and Women and Child Development [
The encephalitis episode thus calls upon an urgent need to set right a number of lacunae in the public health system in the area that include:
Time and again, evidence has indicated that providing temporary fixes to deal with situations such as this epidemic in Gorakhpur cannot help in finding long term solutions because they often do not address the root cause of the problem. For example, vaccines cannot be found to be the only solution to the problem in the area where long term efforts should also focus on mechanisms to take care of the poor water and sanitation situation in the area, which gets exacerbated during natural events such as floods.
This case amply indicates that temporary solutions that do not seek to address the root of the problem cannot help and one problem gets replaced by another, like Japaneses encephalitis being followed by viral encephalitis. The time has certainly come to end the long wait and the plight of the poor who continue to be deprived of basic health and sanitation needs in the area, but for how long?
(The author is a public health researcher based in Trivandrum, and also works with the India Water Portal)
The author is grateful to Dr Shiraj Wajih, President, Gorakhpur Environmental Action Group (GEAG), for his valuable insights, while writing this article.
References
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