The Bihar government failed at nearly every level to prepare for the annual AES epidemic

12 June 2020
A man checks the drip line inside overcrowded Sri Krishna Medical College and Hospital medical ward where children suffering from Acute Encephalitis Syndrome are being treated in June 2019, in Muzaffarpur district, Bihar. This year, the Bihar government appeared to have done little to prepare for the outbreak and did not take into consideration how the nationwide lockdown would worsen the AES crisis.
Parwaz Khan / Hindustan Times / Getty Images
A man checks the drip line inside overcrowded Sri Krishna Medical College and Hospital medical ward where children suffering from Acute Encephalitis Syndrome are being treated in June 2019, in Muzaffarpur district, Bihar. This year, the Bihar government appeared to have done little to prepare for the outbreak and did not take into consideration how the nationwide lockdown would worsen the AES crisis.
Parwaz Khan / Hindustan Times / Getty Images

The Bihar government’s failure to prepare for the annual outbreak of the Acute Encephalitis Syndrome during the nationwide lockdown has led to the death of eight children in Sri Krishna Medical College and Hospital in Muzaffarpur. AES, known as chamki bukhar locally, is a lethal syndrome that primarily affects young children and toddlers. It is rampant in northern Bihar, particularly in the districts of East Champaran, Sheohar, Sitamarhi, Vaishali and Muzaffarpur. It is an epidemic that has been noted to return nearly every April and May, and has accumulated a death toll of more than 471 in the past decade.

This year, the Bihar government appeared to have done little to prepare for the outbreak and did not take into consideration how the nationwide lockdown to stop the spread of the novel coronavirus would worsen the AES crisis. Despite the annual frequency of AES, the government failed to address the social determinants of AES like malnutrition. The state was also unable to efficiently track cases of the syndrome or create medical infrastructure that could respond to the crisis.

On the intervening night of 24 and 25 April, Sukki Kumari, a four-year-old from Muzaffarpur’s Musahari block complained to her father, Sukhlal Sahni, of fever and nausea. She soon began having violent convulsions and was taken to Sri Krishna Medical College and Hospital in Muzaffarpur and was admitted in the paediatric intensive care unit—or PICU. The medical superintendent informed the family that had her glucose levels had dipped very low. She did not survive the night.

A day later, her twin sibling, Mausami Kumari, who had been admitted with similar symptoms, also succumbed to the syndrome. Their deaths had pushed Sukhlal into inconsolable grief. The contagion had become an indelible part of their village and the ones around them. Less than a month earlier, Aditya Kumar, a three-year-old from Sakra block, became the first to succumb to AES this year. Seven more have followed him during the lockdown, all under the age of ten.

Dr Gopal Shankar Sahni, the head of the paediatric department at SKMCH, said that Sukki and Mausami’s lives could have been saved had they been brought to the hospital earlier. “The twins were brought to hospital ten hours late,” he told me. AES requires rapid intervention after the first symptoms are seen, failing which severe hypoglycaemia—or low blood sugar—sets in, putting the patient in a critical condition. When the infection affects children suffering from chronic malnutrition, a common problem in the region, it greatly increases the likelihood of fatalities. Dr Sunil Kumar Sahni, the medical superintendent of SKMCH, said that on 20 May alone, five children were admitted with severe hypoglycaemia in a critical condition. All tested positive for AES.

Saurav Kumar is an independent journalist based in Muzaffarpur who writes about public health.

Keywords: Bihar public health coronavirus lockdown Muzaffarpur
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