The scenes at Sri Krishna Medical College and Hospital in Bihar’s Muzaffarpur are eerily familiar to Dr Kafeel Khan. Wailing parents, children squeezed together on narrow beds meant for one, frantic nurses and overwhelmed doctors trying to deal with a massive outbreak of encephalitis—all of this brings back memories from two years ago, when BRD Medical College in Gorakhpur, Uttar Pradesh, had to deal with a similar outbreak. Apart from the havoc wreaked by the disease, an oxygen shortage led to the deaths of at least 70 children and the Yogi Adityanath government pinned the blame on Khan, who was the nodal officer of the encephalitis ward then. The doctor spent more than seven months in jail before being released in April 2018. Later, the government admitted to have failed to provide the hospital with oxygen cylinders on time.
Now Khan, along with a few other medical professionals, has travelled to Muzaffarpur following news of the outbreak.
“We are not working in the hospitals or treating patients. But we are travelling around the periphery of the worst-affected region, checking patients for symptoms and recommending them to get tested immediately,” he told HuffPost India in an interview.
While the official death toll is 108 at the moment, Khan said that in his experience, the actual number could be much more, considering that the families of many sick children they checked during the trip weren’t even considering the possibility of their child having contracted encephalitis.
Khan said that he paid for calling out a system which systemically ignores encephalitis, even though it has claimed the lives of thousands of children year after year. In an interview with HuffPost India, Khan explained why the pleas of doctors to boost preventive measures against encephalitis have fallen on deaf ears.
What similarities do you see between what happened in Gorakhpur in 2017 and what’s happening in Muzaffarpur now?
The disease and the symptoms are of course the same. In Gorakhpur, we could identify the virus as Japanese Encephalitis virus, I guess we haven’t been able to identify the virus at Muzaffarpur yet. There is no treatment for encephalitis per se, the treatment is symptomatic. So if a child is getting fever, we treat them for fever. If a patient is getting seizures, we treat the patient for seizures. Which makes an outbreak chaotic and difficult to handle, if hospitals are short-staffed. Which is the case of what is happening at Muzaffarpur.
Why are children from economically backward sections of the society the worst hit?
A research that was conducted sometime ago found that five big factors determine who is the worst affected. The lack of safe drinking water, poor sanitation, lack of hygiene, overcrowding and malnutrition are factors that make children from poor families vulnerable to the disease. When 5-6 people live in one small room, sanitation is of course going to be affected. Plus, these people barely manage one square meal a day and their immune system is very weak. What happened in Gorakhpur was Japanese Encephalitis, spread through mosquito bites, right? Now a mosquito doesn’t see if it is biting a rich person’s child or a poor person’s child. Then why did only poor children die? Because all these factors aggravated their condition, plus they got medical attention when it was too late because the parents do not have the means or understanding to get them to hospitals when they start showing symptoms. Encephalitis is a disease of poor socio-economic status.
What about vaccinations?
Yes, that’s what I want to ask the governments. What about vaccinations? The WHO has been providing free encephalitis vaccines to India for the past 25 years (HuffPost India couldn’t independently verify this claim) and how come we still have these outbreaks? The outreach of the vaccination programme is questionable… the government has claimed over three crore children have been immunised under its programme, then how come these deaths keep happening? People have died from encephalitis in Uttar Pradesh last year also. And only poor people die… because others usually pay for the vaccines and get them from private clinics and hospitals. The vaccines cost around Rs 1,200 for two, way beyond the reach of the poor in our country, so they have to wait for the free stuff from government, which don’t always reach them.
Why do these outbreaks occur every other year and in specific places?
A lot of what an ‘outbreak’ is also depends on media’s reporting. Around June-July, poor children across the country, including states like Kerala, West Bengal, Rajasthan, Bihar, Madhya Pradesh, UP, become susceptible to encephalitis. Children and adults die from the disease every year, and ideally deserves to be highlighted all year. However, occasionally when the number of deaths in one hospital add up to a big number, it hits the headlines.
Why have encephalitis outbreaks been so difficult to tackle?
The government is claiming that only 103 people have died in Muzaffarpur, but what I have gathered from speaking to the people from the medical community and health workers, the death toll could be way more, close to 300. This is just the tip of the iceberg. People and children have died without even been able to make it to hospitals on time, or at health centres or private doctors’ chambers.
As is always the case during such outbreaks, the government is thoroughly unprepared. In Muzaffarpur, I saw the dismal number of doctors tending to a staggering number of patients. There are no nurses as well. Ideally there should be one doctor per four patients, here there is one doctor for 50 or more patients. Then there is always a shortage of medicines. So basically no resources, no manpower.
I faced the same issues and got punished for trying to find solutions.
This is not the first time an encephalitis outbreak has hit the headlines. The Gorakhpur one was extensively covered as well. Yet, how could governments afford to ignore the need to be prepared if this is a familiar, longstanding threat?
Because the people worst-affected are not a vote bank for them. They are poor and if they die, nobody cares. Even when their children die, they don’t have the resources to question the government and no one is doing it on their behalf. In the political scheme of India, they can be ignored without consequences for the political parties. The poorer you are, the more political parties will exploit you.
Primary healthcare in the country is in a shambles for decades now. Health centres don’t have equipment and doctors and these are crucial to save lives.
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BRD had a difficult time trying to get the wheels of the government moving on issues and some of the blame was pinned on you. When doctors are faced with these problems, how empowered are they to ask the government for remedies?
What can I say? You saw my plight. I have not worked in administrative capacities, so cannot say how easy or difficult it is to get government agencies and officials to listen to you, even when we are unfairly dependant for resources on them. But there is a deep political apathy towards public healthcare. For example, even if you earn Rs 15,000 a month and have a family to run, you will not go to a government hospital. You will cut corners and still go to private nursing homes. The people who end up at government hospitals are the poorest of the poor, they have no voice, no social capital to stand up to the system. So I guess governments can ignore hospitals and afford to be complacent even after similar incidents of children dying.
Plus there is always the issue of corruption. The owner of Pushpa Sales (the distributors of oxygen cylinders at Gorakhpur) was in jail with me. He said that the health minister demanded a 10% commission and he refused. The minister didn’t budge and the cylinders never got dispatched.
In 40 years, 25,000 children have died in Gorakhpur alone due to encephalitis. What have governments done? They offer a compensation of Rs 50,000 to families of the dead and Rs 1 lakh now to families of children who survive. Why? Because at times, the children are maimed from the effects. I have seen mothers carrying 16-17-year-old boys and girls on their backs to hospitals for treatment and they had suffered from encephalitis as kids.
In 2017, 8,00,000 infants died in India. That means approximately 2,200 children died in the country every day. The Modi government did not reveal the data, UN did. If all your vaccinations and medical schemes are working, how did this happen? Do they have an answer? I guess not.
Why do you think you haven’t been reinstated to your position at BRD, despite a clean chit?
On 25 April, 2018, the High Court gave me a clean chit saying that the UP government couldn’t produce a single piece of evidence against me. They could not prove medical negligence against me. The judgment also cleared the fact that I was not a part of any oxygen tender or anything. Why the authorities are still not reinstating me, that Yogiji has to explain. On 7 March this year, the Allahabad High Court directed the Yogi government to complete all work related to my suspension within three months, that deadline expired on 7th June and today is the 20th. The UP has given me no information. I think they are not reinstating me because they want to save their health minister Aushutosh Tandon, Siddharth Nath Singh and DGME KK Gupta and principal secretary. Because they are the ones who got 14 letters from Pushpa Sales demanding the company’s dues be paid. But thanks to corruption and alleged demands of 10% commission, the payments never came.
After the court gave you a clean chit, did anyone from the authorities approach you to make amends?
No, no one did. Even after the Supreme Court directed the government to pay my dues, the allowance I was entitled to when I was suspended, I did not receive a single penny. They just want to break me financially, mentally and professionally.
The BJP took the forefront in the doctor’s protest in West Bengal. Do you think it is genuine?
It’s not genuine at all. That’s why I said, I am with the doctors, medical interns in West Bengal. What happened was terrible. At the same time I condemn the way it has been politically used all over India. I don’t support that.
In situations like Muzaffarpur, or Gorakhpur doctors have to bear the burden of failure. Governments try to pass the buck like it happened with you. What can government doctors do to address this?
I am in Muzaffarpur and yesterday I visited the Sri Krishna hospital. There were just four doctors for 200 patients. Patients were lying on the ground, there were 2-3 kids lying on one bed. There were only 5 sisters and lack of medicine. So I think, whether it’s Muzaffarpur or Gorakhpur, kids are not dying only because of disease. It’s a combination of lack of manpower, infrastructure, equipment. How will one doctor treat 50 patients at once?