Amid coronavirus, Bihar Girl admitted to Patna Medical College and Hospital with fever.

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PATNA/KOLKATA: A 29-year-girl from Bihar’s Chapra district was referred to Patna Medical College and Hospital on Monday with flu-like symptoms. 

Ekta Kumari, who returned from China on January 22, is a student at China’s Tianjin University and had left the country after the coronavirus outbreak.

“She is coherent and not panicking. She wanted to get proper medical care,” said a doctor from Chapra, who did not want to be named.

According to principal health secretary Sanjay Kumar, Ekta reported a mild fever and is suspected to be suffering from the virus, but it hasn’t been confirmed. 

Meanwhile, a researcher from Bengal’s Birbhum district is stranded at a hotel at Wuhan City in Hubei province for four days because of the outbreak. He went to Hubei University on January 21.

“I have been in my hotel room since Friday. I am not allowed to leave. Doctors are visiting me thrice and the hotel authorities are providing food,” said Kazi Arif Islam.

In north Bengal, the state government has set up three checkpoints to scan those who are coming from Nepal.

TMH first Jharkhand hospital to get Bone Marrow Transplant facility.

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TV Narendran, CEO and MD, Tata Steel today inaugurated the recently established 2 bed Bone Marrow Transplant (BMT) facility at the JGMH Block of Tata Main Hospital (TMH) in the presence of R Ravi Prasad, President Tata Workers’ Union. Chanakya Chaudhary, Vice President, Corporate Services, Tata Steel and Air Marshal (Dr) Rajan Chaudhry, AVSM, VSM (Retd.), General Manager (Medical Services) were also present on the occasion.

The BMT facility – the only one its kind in Jharkhand and one of the few in the Eastern region – is a standalone dedicated facility which would bring international level care to patients from Jharkhand and adjoining areas at reasonably affordable rates. A team led by eminent Medical Oncologist Dr (Brig) Anil Kumar Dhar, ably supported by the departments of Medical Oncology, Pathology, Critical Care and Nursing under the guidance of Dr. Rajan Chaudhry has already conducted a successful transplant for a complicated case of Lymphoma. The transplant has given new lease of life to the patient.

Narendran said, “TMH has been selflessly serving the community in and around Jamshedpur for more than a hundred years. The addition of the Bone Marrow Treatment facility is a testament to the continuous effort to bring in advanced treatment for cancer care. The new facility addresses the complete ecosystem involving the entire ecosystem involving infrastructure, medical resources and research with the objective to offer state-of-the-art treatment to patients.”

R Ravi Prasad said, “With advanced treatment such as Bone Marrow Transplant now available in Jamshedpur, patients from this region will no longer need to travel across the country for such facilities. It is indeed a matter of great satisfaction that a successful transplant has already taken place. I congratulate the entire TMH team on this momentous occasion and wish them all the best in their efforts to alleviate the pain and suffering of cancer patients.”

Bone Marrow Transplant is a therapeutic treatment modality which is a boon for patients of leukemia (blood cancer), lymphomas (malignancies of the lymph nodes) and multiple myeloma (cancer of the bone marrow itself). It is also the only curative therapy for non-malignant disorders like Thalassemia and Sickle cell anemia which are endemic in this part of the country. BMT is a procedure in which the diseased bone marrow is destroyed and replaced by healthy bone marrow or stem cells transplanted from healthy cells of the patient or a matched donor.

Government nod for 30 bed ESIC hospital in Bokaro


Bokaro will soon get an Employees State Insurance Corporation (ESIC) Hospital which will offer medicine at subsidised rates and provide out-patient and in-patient facilities at a nominal cost.

Establishment of an ESIC Hospital at Bokaro was a much awaited demand of the locals. Jharkhand Government has finally given its nod to erect the 30-bed hospital, the tender for which will be floated soon, informed an official.

“Over 70,000 workers and their families are associated with ESIC at Bokaro and they are not being able to avail the health benefits under the scheme as ESIC does not have its own hospital at Bokaro,” said SK Verma President of BMS.

“The move may help decongest private and government hospitals in the district. It will also reduce healthcare cost for millions by easing dependence on private-run medical facilities,” he said.

The Government has taken this decision on the initiative of Bermo MLA Yogeshwar Mahato Batul, who raised the issue in state assembly, claimed Ranjan Mahato an MLA supporter and party worker.

Meanwhile, run by labour ministry ESIC has over 150 hospitals and 1,500 dispensaries across the country which are catering to the healthcare need of industrial workers (who are subscribers of the corporation), said an official requesting anonymity.

The hospital will provide the out-patient facility to common people at just Rs 10 per visit, for in-patient treatment, it will charge one-fourth of what CGHS (Central Government Health Scheme) hospitals charges, he informed.

The ESI Act applies to organisations where 10 or more persons are employed and all employees drawing salary up to Rs 21,000.

Under the Act eligible employees contribute 1.75 percent of their salary (basic+ allowances) and employers contribute 4.75 percent to the ESI corpus every month. Now the Government had recently sought an amendment of the Draft Rules concerning ESI contribution. The Gazette Notification dated February, 15, 2019 proposes a reduction in both the employees’ and employers’ ESI contribution towards the scheme which would be 4 percent–for the employers and 1 percent–for employees.

“Recently ESIC has taken a decision to set up one super speciality hospital in each State,” said the official.

Max Hospital, Vaishali raises awareness on rising incidences of kidney diseases amongst youth


(MENAFN – ForPressRelease) 5 Ghaziabad, 25th July 2019 – to discuss trends of increasing kidney diseases among adolescents, Max Super Speciality Hospital, Vaishali, today organised an interactive session and showcased two young patients who successfully underwent renal transplant procedure.
The doctors also highlighted the recent advancements in the field of renal transplant which has made the overall procedure of a kidney transplant a low-risk surgical process. While the patients spoke about their experience with the disease, the doctors shared knowledge on various precautionary steps and latest available treatments for better management of renal health by adolescents.
The session conducted by the Nephrology team deliberated various factors due to which a lot of young adults are being diagnosed with various stages of kidney diseases. Some of the most common factors which stood out were excess consumption of processed food, lack of exercise, obesity, diabetes and metabolic syndrome. Overuse of over the counter drugs like antibiotics, painkillers and steroids in early life also severely impact their kidneys.
19 year old Vivek Yadav from Gorakhpur was diagnosed with high BP and kidney failure two years ago. He was on hemodialysis since then and none of his family members had a similar blood group. He was brought to the emergency department, Max Hospital Vaishali, with the complaints of severe breathlessness and high blood pressure. Detailed investigation revealed excess water accumulation in his lungs that had caused breathlessness and was monitored on ventilator for 3 days. Upon improvement in his condition, he was tapered off the ventilator and was put on hemodialysis routine, thrice a week.
Talking further about the case, Dr Neeru P Aggarwal, highlighted, ‘While, Vivek’s blood group was O positive his mother’s was A positive. However, after complete evaluation, it was found that ABO incompatible transplant was a possibility in his case. The 5-hour surgery was successfully performed and there were no post-operative complications and his body adapted his mother’s kidney very well. After a span of 10 days or so, his kidney function improved significantly. Few of the precautions he was asked to take included using a mask when stepping out, maintaining personal hygiene and avoiding crowded places.’
Vivek has resumed higher studies and doing well in follow ups and is very disciplined with his lifestyle as well as transplant medication.
Case #2
Sanjay Sinha a 35-year-old gentleman was found to have advanced kidney failure in 2009 when he was 25 years old. He underwent kidney transplantation in 2009 when his mother donated a kidney to him. However, the transplanted kidney lasted for approximately 10 years and the graft failed in Jan 2019.
Speaking about his case, Dr Manoj K Singhal, said, ‘After evaluating Sanjay’s case, we advised him to restart his dialysis treatment.Fortunately, this time his elder sister stepped in and offered to donate a kidney to him. Since, it was his second kidney transplant; there was a high risk of his body rejecting the donor’s kidney post operation. Therefore, he was thoroughly investigated and was found to have DSAs (Donor Specific antibodies)which increases the risk of rejection of the new kidney. While this posed as a challenge for us, we desensitized him with plasma-exchange before the transplantation and the surgery went successfully.’
Sanjay has gone back to his normal life and doing well since last 2 months post his transplant. 

In Bihar’s Darbhanga hospital, 50 kids die within one month


A month after 170 children died in Bihar due to Acute Encephalitis Syndrome (AES), 50 children have been reported to have died in Darbhanga Medical College and Hospital (DMCH) in a month’s time. According to a report prepared by the Child Department of DMCH, 50 children died in the hospital during the period from June 01 to June 30.

The hospital authorities came in for a shock when they learnt about the report. However, Superintendent Dr Raj Ranjan Prasad seemed to make a casual affair out of the tragic incident. Commenting on the alarming number of children deaths, he said, “Deaths occur every year when children are admitted to the hospital. However, this time the total number of deaths is a lot more than previous ones. We will have to see if proper treatment was given to these children. We have asked the concerned authorities to ascertain the cause of these deaths, he added.” Reports suggest that DMCH got timely help from UNICEF too.

Nitish Kumar led JDU government in Bihar has filed an affidavit in the Supreme Court regarding falling health standards in the state. But the opposition parties have left no stone unturned to criticise the opposition. While BJP MLA Gopal Narayan Singh said that the health conditions in the state have not improved since the time Lalu Prasad Yadav was the Chief Minister, leader of opposition Tejashwi Yadav said, “During the said 14 years of good governance under Nitish Kumar in Bihar, the posts of 47% doctors, 71% nurses, 62% lab technicians and 48% of pharmacists have been vacant.

In addition, Former CM Rabri Devi accused the government of doing drama. She said, “The government has been playing politics over the deaths of children due to AES and distributing mangoes in the assembly whereas the conditions continue to be pathetic in hospitals. There are neither adequate doctors nor beds.”

Bihar: Woman’s relatives claim newborn stolen from hospital, vandalise property


Relatives of a woman in Islampur of Nalanda, Bihar, pelted stones at a primary health centre and vandalised property after alleged theft of the woman’s newborn.

On Friday night, the pregnant woman’s family had come to a primary health centre in Islampur for the delivery of the child.

However, the infant was stolen by another woman from the hospital, media reports said.

Following which, aggrieved family members of the woman resorted to violence by pelting stones and destroying the health centre’s property.

The video of furious relatives pelting stone at the health centre is being shared on social media.

In the video footage, the woman’s family members were seen throwing stones at an ambulance that was parked outside the hospital.

Commenting on the matter, Vaibhav Chaudhary, SDO, Hilsa, Nalanda, told news agency ANI that the woman was brought to the health centre on late Friday night and she gave birth at 9 am on Saturday.
He further said that the police is looking into the matter and an investigation is underway.
However, he said, the situation was soon brought under control.

Jharkhand’s anti-pollution board offers 50% off on hospital registration fees


In a bid to deal with biomedical waste hazard in Jharkhand, the state pollution board on Tuesday held a meeting with the government authorities as well as private health service providers in Ranchi.

Jharkhand State Pollution Control Board (JSPCB) has come up with several offers to woo the hospitals, nursing homes and clinics to get their institutions registered with the board at the earliest.

The board has slashed fees for consent to establish (CTE), consent to operate (CTO) and authorisation by 50%, said JSPCB chairman AK Rastogi. “The offer is applicable for only two months. After August 31, the relaxation will be withdrawn,” he said.

For example, authorisation fee for the hospital having up to four beds is ?1,000 annually. If hospital takes authorisation by August 31, it will have to pay ?500.

Similarly, hospitals having bed capacity of more than 200 have to pay ?6,000 annually, while the actual fee is ?9,000 to ?11,000. JSPCB member secretary Rajiv Lochan Bakshi said that the board would prohibit the operation of individual or private incinerators and the wastes of hospitals in periphery of 70-km radius would be treated at a common bio-medication waste treatment facility (CBWTF).

Bakshi said that two CBWTFs, one at Ramgarh and another at Lohardaga, were functioning. The CBWTF of Saraikela-Kharswan would start functioning very soon, while three more CBWTs are proposed and will be coming up in Dhanbad (Sindri), Ramgarh and Santhal Paragana.

The hospitals have also been asked to establish sewage treatment plants and effluent treatment plants by December 2019.

The pollution board officials said if hospitals failed to get them registered with the board, they might have to face legal action. As per the provisions under Section 15 and Sub-section-1 and Sub-section-2b of the Environment Protection Act, 1986, the defaulter could face five-year jail term or ?1 lakh fine.

Jharkhand’s most hospitals, nursing homes and clinics are not registered with the board so the latter doesn’t have actual figure of bio-medical waste generation. As per the Bio-Medical Waste (Management and Handling) Rules, 2016, every health care centres, be it government or private, should be registered with the board.

Notably, the meeting was called a day after the report, highlighting the problems of bio-medical waste in Jharkhand, was published in HT on Monday.

As per a survey conducted by Delhi-based environmental group Toxics Link and Ranchibased NGO Lok Swar in 31 government and private hospitals of Ranchi, Jamshedpur, Dhanbad, Bokaro and Deoghar, found that these hospitals produce around 4,700 tonnes of bio-medical waste annually but 59%, around 2,700 tonnes, are left untreated and turns out to be harmful.

Smart City, AIIMS, 500-bed Dumka hospital get environmental clearance


The Jharkhand government’s five big-ticket projects, including Smart City, AIIMS and 500-bed Dumka hospital, got the much-awaited environmental clearance (EC) from the State Level Environment Impact Assessment Authority (SEIAA), officials said on Wednesday.

SEIAA chairman SEH Kazmi said, the environmental clearance for five building construction projects -civic tower, convention centre, Rabindra Bhawan in Ranchi, AIIMS Deoghar and 500-bed hospital building in Dumka- was given in SEIAA’s 74th meeting held on Tuesday.

Construction work of multistorey civic tower and convention centre under Ranchi Smart City scheme were stopped for want of environmental clearance around three months back.

The Centre had picked Ranchi under its ambitious Smart City project in May 2016. Jharkhand is developing country’s first Greenfield smart city project on an area of 656 acres of land, acquired by the state government from Heavy Engineering Corporation (HEC) Limited.

Vice-president, Venkaiah Naidu on September 9 in 2017 laid the foundation stones of three major projects such as convention centre, urban civic tower (UCT) and Jharkhand urban planning management institute (JUPMI)-worth around Rs 700 crore. Barring JUPMI, two other projects were waiting for the required EC.

Chief executive officer (CEO) of Ranchi Smart City Corporation Limited (RSCCL), Amit Kumar said, “With getting clearance, mobilisation of building materials and labour force have been started from Wednesday. Now, the projects are expected to progress with its schedule.”

However, the project proposals were given clearance with certain conditions. “We have decided to grant environmental clearance to the project proposals with conditions recommended by the State Expert Appraisal Committee (SEAC) subject to if remaining plots of the projects are found to be ‘Jungle Jhari (forest bush)’ in future, the project proponent will have to abide by the provisions of Forest (Conservation) Act, 1980,” said SEIAA member secretary Kamlesh Pandey.

Meanwhile, the upcoming All India Institute of Medical Sciences (AIIMS), which is coming up at Devipur in Deoghar, was also granted the clearance. Foundation of the institute on 272 acres of land was laid in May last year. The construction work of the building is in progress.

Teachers’ recruitment process for AIIMS has already begun. A recruitment notice by AIIMS Patna was issued recently for appointment of eight professors, 11 additional professors, 13 associate professors and 30 assistant professors. If sources in the health department are to be believed, the session of the institute will begin from August this year with 50 seats of MBBS.

Similarly, SEIAA also granted environmental clearance to 500bed hospital coming up in Dumka district. Besides, the Rs 155-crore Rabindra Bhawan, proposed to be a cultural hub of Ranchi, also got the clearance for its speeding construction.

Ground Zero | Bihar AES deaths: A hundred deaths, and no answers


Cases of acute encephalitis syndrome have seen a spike in Muzaffarpur this year, already claiming more than a hundred lives. Jacob Koshy reports on the appalling state of health care in Bihar, even as the debate on what is causing the deaths rages on

For three days, Bihari Mahato and Shyam Babu Saha’s families have shared a hospital bed. The two daily-wage labourers, who have had to give up work for three days, haven’t exchanged a word, though they have much in common. Both have a boy and a girl each. And their children are battling for life.

Sundar, Mahato’s three-and-a-half-year-old son, is naked, emaciated, delirious and has a distended stomach. Himanshi, six months old and in a striped shirt and shorts, looks bigger and healthier than Sundar. She sleeps longer — fitfully, her mother Vimla says. Both families are from different districts of Bihar. Mahato is from Muzaffarpur and Saha is from Sitamarhi district. Their children were suddenly taken ill. When the children were convulsing and feverish, they were rushed to the Sri Krishna Medical College and Hospital (SKMCH) in Muzaffarpur. The doctors noted that their blood sugar had dropped precipitously.

Both children are being given dextrose saline (a sugar solution often administered intravenously), but their parents are nervous. “The fever has subsided but it keeps returning,” says Saha. “The doctors aren’t paying us much attention.” But that’s a quibble given that many other ailing children are sprawled out on mattresses on the floor. Amidst peeling plaster, strewn banana peels, stomping doctors, nurses, journalists and television crew, the children’s ward at SKMCH is symptomatic of the confusion and panic that has gripped Muzaffarpur since early June.

The floor above the general ward is home to the Intensive Care Units (ICUs). Each of the five ICUs has eight beds. Not one of the beds has fewer than three children hooked to bleeping monitors and intravenous lines. Unusually for an ICU, there’s little restriction on non-hospital staff shuttling in and out, but unlike the squalid paediatric wards below, there are no patients sprawled on the floor. The floor is clean, the air-conditioners work, the nurses are extra vigilant, and yet here’s where death lurks around the corner.

Season of trouble

There is a protocol for doctors. As soon as children are wheeled in, they are monitored for fever, convulsions and signs of confusion or loss of consciousness. “What I’ve seen is that several children are brought too late. Unfortunately we lose them,” says J.P. Mandal, a resident doctor at SKMCH. Between June 1 and 17, 312 children were admitted to the hospital under the umbrella diagnosis of acute encephalitis syndrome (AES). According to the Bihar health department, 85 died. The bulk of the dead, 48, were children aged three to seven. Twenty-nine children were less than three years of age. As of June 21, 104 of the 424 children admitted since January 1 had died. Encephalitis, which refers to an inflammation in the brain due to a viral or bacterial attack, causes fever and almost never a drop in blood sugar. In the current epidemic, as well as in previous ones in Muzaffarpur, the doctors have marked cases of and deaths by hypoglycaemia (drop in blood sugar), which is unusual.

While Bihar loses hundreds of children to AES every year, there were sharp spikes in 2012 and 2014, when 395 and 372 children, respectively, lost their lives. Through the years, AES cases have been reported from several districts in Bihar: Gaya, Patna, Aurangabad, Saran, East Champaran, Sitamarhi and Vaishali. Government figures show that the peak years of 2012 and 2014 saw Muzaffarpur account for 35-40% of hospital admissions. While this year’s incidences and deaths are fewer in comparison, the season of trouble is far from over. The outbreak in 2012 took place between May and November. In 2014, it was from May to July. There’s no saying how long the current outbreak will last. A common refrain among district administration officials and some doctors is that the yearly outbreak ceases in intensity soon after the monsoon rains begin in Bihar. Why is that? Nobody ventures an explanation.

Sanjay Kumar, the State’s top civil servant in charge of health, says he cannot quite put a finger on a “single, determining factor” that is responsible for 2019 turning out to be a bad year. It could be the ongoing heatwave — several parts of Patna, Gaya and even Muzaffarpur have recorded temperatures in excess of 4-5°C over what’s normal for this time of the year. At least 80 people have succumbed to the heatwave. “The added heat and humidity could have made young children particularly susceptible to dehydration,” he reckons. “It could also be an infectious disease. It could also be because of children eating litchis.”

Kumar says all the children who are admitted belong to the lowest socio-economic rung; there are no instances of infection in cities or even semi-urban localities. He emphasises that the government had been prepared this year too, like in the past, for the outbreak. It stocked up and supplied oral rehydration solution, ensured that medicine and equipment were provided at medical colleges and district health centres, and conducted public awareness campaigns about the imminent outbreak. However, he admits that the district’s key referral hospital, SKMCH, wasn’t equipped to deal with the deluge of patients. “This year will be a turning point. The bed capacity will be increased to 1,500 and we will have a virology lab [to better investigate vitals of patients and determine disease causes].”

Debating the litchi link

Arun Shah, a paediatrician and private practitioner who has been working in the city since 1984, insists that the spike in AES cases and in fatalities is a result of malnourished children suffering brain damage after eating litchis, particularly unripe or overripe ones. In a 2014 paper, Shah and virologist T. Jacob John had argued that the children in Shah’s clinic in Muzaffarpur were found to have extremely low blood sugar levels and signs of brain damage. While viral or bacterial infections that cause encephalitis (an inflammation of brain cells due to an infection) were well known in Muzaffarpur and neighbouring districts, many of them were taking sick and dying due to encephalopathy (brain damage, in this case, due to an environmental toxin). In 2016, a detailed investigation, published in The Lancet Global Health by the National Centre for Disease Control, India, and the U.S. Centers for Disease Control and Prevention, found “confirmation” that litchis contained a chemical called methylene cyclopropyl glycine (MCPG). These are naturally occurring toxins that cause hypoglycaemia and metabolic derangement in children.

When a child is malnourished, her body, having exhausted its reserves of glucose from the digestive tract and the liver, typically turns to fatty acids in biochemical desperation to supply blood sugar to the brain. MCPG, the theory goes, thwarts this mechanism. This can send the brain into hypoglycaemic shock triggering convulsions and, if unaddressed, even death. “But please don’t blame litchis,” stresses Shah. “It is the pride of Muzaffarpur.”

At a press conference two years ago, to underline that the litchi fruit was only a triggering factor and sickened only malnourished children, Shah and John ate a bowlful of the fruit in front of television cameras to emphasise that it was malnutrition, and not the fruit, that was the dominant cause of the disease. Shah is unambiguous that the children are suffering because the government didn’t do enough. The recently concluded Lok Sabha election distracted the government from adequately preparing for the outbreak, he says. In 2016, he was part of a government-constituted committee that prescribed guidelines: Children shouldn’t be allowed to skip their evening meal, they should avoid stepping out in the heat, and local public healthcare centres must stock up on anti-convulsion drugs as well as dextrose. These were adhered to in 2017 and 2018. And that’s why there were relatively fewer reports of AES, he argues.

While encephalitis outbreaks in Uttar Pradesh’s Gorakhpur were due to other causes, and children from Muzaffarpur and neighbouring districts have battled viruses such as the Japanese encephalitis virus, the large-scale litchi cultivation in Muzaffarpur, which contributes about 40% of the State’s litchi production, “can’t be ignored as a triggering factor,” he points out.

At SKMCH, several parents of the ailing children are categorical that their children did not eat litchis. The authors of The Lancet study found that two-thirds of children who were sick had eaten litchis. “We work in the fields and there are litchi orchards aplenty where we live,” says Indal Paswan, whose two-and-a-half-year-old son is prostrate on a hospital bed. “But this boy isn’t capable of plucking fruit on his own. We do feed him some fruit as well as other food but we don’t starve him.”

Mandal is insistent that there is a virus or some biological agent that is responsible for the recurrent outbreaks. He scoffs at suggestions of the litchi’s complicity. Children who were brought to the hospital were “poor but not classically malnourished,” he says. If malnutrition and litchi consumption were the causes, then there ought to have been a fairly constant number of deaths every year. This has not been observed, he says. “A peak and an ebb in cases and deaths is what we see. And that’s more typical of a biological agent.”

That no virus or bacteria has been isolated yet in Muzaffarpur is because the hospital lacks adequate facilities to collect tissue and blood samples from patients and preserve them adequately for examination. “I’m confident that at some point this will be found and there will be no mystery,” Mandal says. The focus of treatment, he adds, is to ensure that convulsions are brought under control and blood sugar levels are restored.

What Shah and Mandal do agree on is that the vast majority of deaths could have been prevented if the children had made it to a hospital on time. The most important medicines were easily available, and most of the primary health care centres were well stocked and equipped to deal with AES cases.

No time to grieve

Yet, four-year-old Mohammed Jahid lost his life. Until he fell sick, Jahid had spent his days playing with his older siblings and cousins in the village of Bishnupur Chand, Musahari. His home was a single room thatched hut that did not have a toilet. His and his cousins’ houses lay at the edge of an orchard that had several rows of tall, stout litchi trees. In June, there were only a few fruits that clung to the trees. Most had been plucked and carted away for sale by the owner of the orchard who lives in Patna. “He didn’t show any signs of illness. He had a fever for two days,” recounts Jahid’s aunt, Asha Khatoon. “We took him to a private doctor nearby.” One night, Jahid became delirious, and his father Mohammed Idris rushed to get an autorickshaw to take him to a hospital. He didn’t find one immediately as the roads had been dug up. When they made it to SKMCH, Jahid was immediately taken to the ICU, but he didn’t survive beyond three hours. A day after burying Jahid, Idris was away to find work as a daily-wage labourer. There were still two boys, two girls and a wife to feed.

What’s causing ‘brain fever’ in Indian state Bihar?


Muzaffarpur, India: The stench of urine, chlorine, vomit and death fill the main hospital in Muzaffarpur, the epicentre of a brain fever outbreak in India that has killed more than 100 children since June 1.

Doctors are not sure what the cause is, but one theory is that the culprit is a toxin found in lychees eaten by children of poor families who go to bed with empty stomachs.

One of the distraught parents crowding the chaotic corridors of the Sri Krishna Medical College and Hospital (SKMCH) is Dilip Sahni, 25, a construction worker and father of three.

He brought his four-and-a-half-year-old daughter Muskan early in the morning, only 24 hours after she fell ill, to SKMCH. There almost 100 other children are being treated, many sharing beds.

“When her mother went in to wake her yesterday at 11 am, she was shocked to see her hands and legs tightened and her teeth sticking together,” Sahni told AFP.

“Her mother started screaming for help, and we rushed her to the Kejriwal hospital. At midnight the hospital doctors told us to take her to SKMCH,” he said.

“Early morning we shifted her here but her condition has been deteriorating,” Sahni said before breaking down.

Not long afterwards came the news that little Muskan had died.

The night before she had eaten bread, she did not have any lychees. It was 10 days ago she had the fruit.

– Dilip Sahni, father of Muskan

She was very likely just the latest victim in a health crisis blamed on Acute Encephalitis Syndrome (AES) in the dirt-poor, baking hot eastern state of Bihar.

The onset is lightning fast, its young victims quickly developing a high fever, seizures, and vomiting. All often, if treatment is not swift, leading to death.

A total of 128 have died so far.

“Obviously it is tough to make ends meet and raise three children. But I try my best. She was a healthy and playful child,” Sahni had said when he had brought his daughter in.

“The night before she had eaten bread, she did not have any lychees. It was 10 days ago she had the fruit,” he said.

‘Dying with worry’

As the hospital guards scream at parents not to crowd the wards, Raju Kumar, 35, a father of five, has just admitted his two-and-half-year-old son to the intensive care unit.

“I am dying with worry. So many dead bodies of little children I have seen standing here. I am just praying my son is saved somehow,” Kumar, a shopkeeper, told AFP.

“He fell unconscious suddenly the day before yesterday. We rushed him here immediately,” he says, holding his four-month-old baby in his arms.

Another being admitted is Krimta Kumari, a girl around nine years old sat on her father’s lap in a yellow T-shirt, visibly flushed with fever and unable to keep her eyes open or speak properly.

Just then, there is a power cut, leaving mothers in colourful saris and gold nose studs to try and cool their sick children in the sweltering hospital with hand-held fans.

Bihar, home to almost 100 million people, has also been hit by a heatwave, with temperatures of 45 degrees Celsius (113 Fahrenheit) killing 184 people this summer – including 78 since Saturday.

Not only is Bihar poor, its healthcare system is in a dire state. For every 100,000 people there are fewer than two health workers, compared to the average for India of around nine, according to the Hindustan Times daily.

“We as doctors are trying our best to save the lives of as many children as possible,” said Srikant Prasad Bharti, an overworked junior paediatric doctor at the SKMCH.

“No one talks about how many sleepless nights we have been spending to look after the sick kids. No one is talking about the children who have been cured. It is easy to blame hospitals and doctors,” he complained.

This is not the first outbreak of AES in Bihar. But fatalities – until this year – had fallen sharply since 2014, when 355 children died. There were just 33 deaths last year, the Hindustan Times reported.

“This is happening because the children come from very poor socio-economic backgrounds. The parents couldn’t care less whether their children have taken their meals or not,” Bharti says.

“The children wander around in heat and eat rotten or unripe lychee and go to bed on empty stomachs. This leads to a sudden drop in blood sugar levels and leads to seizures and convulsions.”

Frequently asked questions

What is encephalitis?

Encephalitis is an inflammation of the brain, caused by any one of a number of viruses.

Early symptoms can be similar to those of flu, with patients suffering from high temperatures or headaches. But symptoms can worsen within hours, and can include serious complications like seizures, paralysis and coma.

In Bihar, children were typically taken to hospital with fevers.

How could lychees cause sickness?

Researchers who conduced a study of 390 children who fell sick in 2014 in Muzaffarpur said that lychees contained hypoglycin A, an amino acid that can disrupt metabolism, lowering blood sugar levels. That can trigger hypoglycaemia, and in extreme cases, death.

The study by India’s National Centre for Disease Control and the US Centers for Disease Control and Prevention, added that when the brain lacks glucose, it turns to other sources of energy, which are rapidly depleted, eventually pushing people into coma.

“The synergistic combination of (lychee) consumption, a missed evening meal, and other potential factors such as poor nutritional status, eating a greater number of litchis, and as yet unidentified genetic differences might be needed to produce this illness,” the researchers said in their study, which was published in the Lancet in 2017.

Retired virologist T. Jacob John also raised the possibility that encephalitis cases in Muzaffarpur could be associated with lychees in a 2014 study published by Indian science journal Current Science. Muzaffarpur is a major hub for growing lychees, which ripen at this time of year.