DNA has learnt through internal communications between the Centre and the state.
Over 9,000 persons have died due to brain damage or Acute Encephalitis Syndrome (AES) in India since 2010. Of these deaths, 4,118 have occurred in Uttar Pradesh alone. Other affected states are Assam and Bihar. The most vulnerable to die are children.
The children who died due to lack of oxygen in Gorakhpur would not have been admitted to the tertiary-level hospital, had timely care and attention been provided to them at primary health centres or by village health workers.
The root causes of UP's spiralling health crisis include: inadequate diagnostic facilities for diseases causing brain damage, unavailability of basic drugs and an overwhelming presence of quacks. "Patients reach the medical college after close to a week or even later. As many as 70 per cent of of these patients first visited quacks who administer high-end cephalosporin drugs," says an official.
On August 10, when 23 deaths were reported from Gorakhpur, Ajay Shukla's 16-day-old baby girl also gasped to death. She was suffering from brain damage, amongst a host of other conditions. Shukla or the doctors do not know what killed the baby, or what may have caused the root infection. She succumbed way too fast for investigations to reach their logical conclusion.
The Gorakhpur medical college is a major government-run health facility, out of which operates the oldest field unit of the National Institute of Virology (NIV) to investigate brain damage causes.
In 2016, 408 children below 15 were studied. In 199 of 397 samples processed (49.4 per cent), parasite O.tsutsugamushi or Scrub Typhus emerged as a causative agent of infection. Japanese encephalitis and dengue caused by mosquitoe bites were other reasons, and prevailed in 8.3 per cent and 6.9 per cent cases, respectively in 2016. In 2017, of 378 samples tested, 83 (22 per cent) have come positive for parasitic infection. "A clearer picture will emerge after August. The 2017 data is only for six months," said an NIV official in Gorakhpur.
From 2014, after alarm bells started ringing due to UP's non-preparedness, the Centre wrote letter after letter to state health officials. Numerous meetings with state health officials have not yielded any result, DNA has learnt through internal communications between the Centre and the state.
On April 27, the Union Ministry of Health and Family Welfare wrote to UP Health Minister Siddharth Nath Singh that Scrub Typhus is very easy to diagnose in laboratories with a simple enzyme-linked immunosorbent assay or ELISA and a Weil-Felix test, and that the condition is fully treatable if diagnosed early. Till date, no health centre of district hospital has been equipped for Scrub Typhus tests.
Scrub Typhus is a reversible condition, but not after the patient has slipped into multi-organ failure. Early care at grassroots is a must, the letter says and adds that basic antibiotics Doxicyclin and Azithromycin should be made available. "It is worthwhile to treat even suspected cases with these drugs to save thousands of lives with timely intervention," it says.
"Primary health centres are ill-equipped with Doxicyclin and Azithromycin till date. Diagnostic facilities are unavailable. Both these are of utmost importance to save children's lives," says an Indian Council of Medical Research (ICMR) official who took stock of the situation in July.
Two sets of training, one in September 2016 and another in February 2017 were conducted by ICMR officials for clinicians, technicians and nurses. Another round of training for BRD Medical College doctors took place in June-July this year. The Centre recommended many measures. "Even three months after the letter was sent, there is zero response from the state," an ICMR official says.
Dr Soumya Swaminathan, secretary (health research), Health Ministry, says the infection is caused by mites, and rodents and shrews are the carriers, mostly residing in kitchens and biting patients, causing fever and rashes.
"There would have been no need for patients to travel long distances and come to the district-level centre, if mechanisms to tackle Scrub Typhus were put in place in primary and community health centres," says Dr Swaminathan, who is also the ICMR Director General.
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