By Ajit Chak
The lessons of the Gorakhpur tragedy are obvious but then someone has to listen to those who are willing to talk about the solutions to the epidemic of JE which sweeps rural Uttar Pradesh and Bihar and Nepal every year.
There was JE once in South East Asia and in Japan hence the name Japanese Encephalitis but how was it eradicated there is no mystery and the scientists of the ICMR must have briefed the politicians in power about this but there is no one to ensure that politicians implement what scientists recommend.
Why is JE caused in the first place and what are the obvious solutions that need to put in place. Yogi Adityanath knows what these solutions are and unlike Mayawati whoÔÇÖs tenure saw the highest rate of deaths due to JE in Gorakhpur and Deoria and unlike Akhilesh Yadav and others he has an advantage his party is in power in both the Centre and the state.
Yogi Adityanath had campaigned for an AIIMS type hospital in Gorakhpur to complement the stressed out facilities at the BRD Hospital. It is now time to bring an AIIMS to Gorakhpur instead of Rae Bareli. It is also clear that a oxygen plant needs to be set up in Deoria and Gorakhpur and the same should be done at the earliest.
For these all that Yogi has to do is push the right files and put the right officers in charge of the proposal and give them a time line to finish off the project. The next two years could actually see two huge medical facilities come up at Gorakhpur and Deoria. This will definitely make medical treatment more easy and maybe there will be additional capacity before the next round of deaths begins next year in 2018.
Apart from such interventions which are based on managing patients there are ways to reduce the incidence of the disease and while come may not be possible in Uttar Pradesh as the government may not have the political will to do it others can be implemented.
Gorakhpur will have mosquitoes because it has several natural water bodies and there is large scale paddy cultivation and pig farming and buffaloes in the state. If pigs and buffaloes are bred next to paddy fields or water bodies, then mosquitoes, which have a range of half a kilometre, will get a chance to spread encephalitis as they need to bite a host pig first before biting a human.
Now the farmers are a vote bank so the previous governments did not relocate them. So maybe the government needs to breed frogs to eat the mosquitoes that bite the pigs or it needs to release GM mosquitoes to kill the vectors of JE or hospitals need to buck up at this time of the year so that the media does not get a chance to blow incidents out of proportion? But frogs will not give bureaucrats a commission. And frogsÔÇÖ legs are not a delicacy in India.
However the government needs to revive the ponds and fill them with fish and frogs and bring back the original ecosystem which culls mosquitoes before they take to wing by making the breeding centres hostile to their survival. Fish will eat mosquito larvae, frogs eat their own weight of insects daily to survive and are natures natural insect killers. The culex mosquito unlike the dengue mosquito breeds in dirty water and muddy water. Therefore rice fields form the best breeding ground so government has to give incentives to farmers to breed fish along with rice as is done in most south east Asian nations.
Finally when JE broke out in Thailand and areas like that the army was called in to machine gun the pigs and the buffaloes and incinerate the carcasses. In the present situation in Uttar Pradesh this will be next to impossible. However the pigs and buffaloes were replaced with pigs and buffaloes that did not have the virus in them and the disease incidence fell dramatically. India will have to adopt the Plan A which is bringing back the live ponds and make it a social movement through NGOs and social workers in the states. This is the only way they can tackle the disease.
Better facilities for treatment are needed in India. However, there are two kinds of hospitals in the nation. There is the private sector and the public sector. The private sector flourishes whenever the public sector fails to redress the grievances of the local community. However the business of treating patients has become a commercial enterprise in India. Can the government tackle this commercial enterprise?
The huge queues for treatment in government hospitals are a sign of two things. Firstly these are an opportunity for government doctors to divert patients into the private sector. This opportunity arises when machines malfunction and cannot be repaired at the same speed at which a private nursing home would repair them. Secondly they are a sign that preventive health care which should be taken care of under the Swachh Bharat Abhiyan is missing from the cities and villages that breed filth and garbage and vectors and disease. Gorakhpur will lurch from one disease to another and when the floods recede it will be gastro and dengue and many more. The government needs to adopt zero tolerance for laxity in services of the Nagar Nigams too to sort out these problems.