The dead bitterness of litchis: Encephalitis, 'expiries' and my memories of a hospital ward

The toll has crossed 100 this year.

Five years ago, I sat in the corridors of Sri Krishna Medical College Hospital (SKMH) in Muzaffarpur, waiting for answers.

I remember, after just three days there, I had already watched many children die in front of me.

I remember the constant beeping from nine cardiac monitors, similar to what a cheap phone might emit while dying. 

Five years later, the story remains the same — the song of never-ending beeps from the monitors, the unblinking eyes of the children and their frothing mouths. 

On my way back, in 2014, I opened Fernando Pessoa's The Book of Disquiet and it eerily struck me, “I begin because I don't have the courage to think; I finish because I don't have the courage to quit.”

I tried to find drama for the sake of the story because, in journalism school, they taught us to locate the conflict and to show — but not tell.

But there's just too much conflict here between life and death, between the ethics of reporting and the lure of sensationalism. 

I stepped on the chlorine powder sprinkled on the ramps of the hospital and tried to look away when I crossed the corridors full of the sick and dying. I was in that district hospital five years ago to report on the Acute Encephalitis Syndrome that kills hundreds of poor children in Bihar's Muzaffarpur district every year.  

I had never covered an epidemic. To me, this was one — they just hadn’t declared it yet. But children were dying in the temporary ICUs, were then loaded on to the mortuary vans and taken away in hordes. 

I walked into the PICU on the second floor of the hospital in Muzaffarpur, and nobody stopped me. They let me sit there. For three days, I recorded the deaths of a three-year-old, and a seven-year-old, and others. I sat there, determinedly taking notes.  

“They are temporary people. This is the suffering that comes from indifference to it. Dejection is a permanent feature of this place. This is a temporary place,” I had written in my notebook. 

They said the epidemic will go away when the rains come. But the sky looked like a blasted furnace — white and blue, shimmering and merciless. Relentless, too. I sat and watched the nine cardiac monitors that showed the pulse rate and the arterial pressure. I didn’t know what these digits meant. The doctors told me everything was dismal. I walked up to one floor, and then another, and outside this PICU 1, I met these people waiting for news of death or life. It doesn't take too long in either case.

The poor seldom blame anyone.  

This hospital is a timeless place — here, nothing ever changes. There's deprivation and death, sadness and resignation. In the PICU, they told me not all will survive. A doctor told me to take his photograph.

He posed with a dying child.  

I tried not to cry.  

I walked out. It was evening. The skies had turned orange.

*** 

Journalists are often scoffed at for their lack of expertise or domain knowledge. But there's curiosity. I didn’t even know what I was looking for. That I was a reporter had no meaning here. A notebook and pen, and a camera slung over my shoulder was all so out of place here. I resumed my place in a corner. They had told me for the sake of reporting, you must also learn to be a fly on the wall. 

The guard outside the PICU 3 wielded the stick. He wanted to sit in the chair. The husband looked up, vacated the seat.

The hospital was full of poor people who didn’t blame anyone for deaths, collected the bodies and went home.

Like life, death is also about class and caste.  

A mother continued to sing lullabies. Perhaps for the last time. 

A father took me to the ward. On a bed lay his child’s body — a face framed by golden curls coloured by malnutrition, big eyes, a tiny, amorphous being.

His brother picked up the body, the father followed him. The mother was still singing outside. She addressed her dead daughter and asked her to take her along with her. It was a dilemma I have faced often. I wanted to offer money — but I didn’t know how to do it. I did it anyway only because I had overheard the steep transport cost. There was that awkwardness of being grateful at both ends. I followed them to the van headed to the mortuary. They turned back to look at me. I waved back. 

They were gone. Just like that.

Her name was Kajal.

That morning, she woke up with a high fever, the convulsions started soon after and then, she fell unconscious, only to die soon after. She was her mother's only child. 

There was a moment in the makeshift PICU 1 at the Sri Krishna Medical College Hospital in Muzaffarpur that all cardiac monitors showed no digits — they went blank. There were dots and beeps. Gasps, cries. Hope and despair.  

They didn't stop you when you walked in through the door with blue curtains on a hot and humid June afternoon in 2014. I remember the colour of the sky — blasted white. They told me in the 1930s, an earthquake had altered the topography of the region, making it like a bowl, a collectable for water, filth and everything else. Of death, too.

All consolation inspired by the theory of Karma didn’t work. How do you even begin to rationalise the deaths of those children who hadn’t lived long enough to commit any sins that would justify their bitter end?  

Five years later, I see the same corridors and wards yet again on the television.

I see a horde of reporters confronting doctors and nurses while the staff are trying to save as many children as they can. Everybody seems to be in the ICU. I see the faces of the poor parents. They look confused.  

Back then, the staff had offered me a stool to sit on the condition that you would remove your shoes and sit quietly. I was there to chronicle the deaths of children in the hope that maybe, someone would read the story and do something. But five years are enough to make one stop believing in miracles and enough to accept that stories are forgotten.

Except sometimes, you remember the stories that you wrote. 

 *** 

The PICU 1 was full of small children who had been labelled as suffering from AES (Acute Encephalitis Syndrome). Back then, the official toll had crossed 100 from the report books of the nurses in the four PICUS at SKMH, and whatever else was collated from Kejriwal Hospital in Muzaffarpur.  

But deaths happened outside these wards or temporary PICUs. The district recorded 44 deaths in 2011, 121 in 2012 and around 40 in 2013. In 2019, the outrage has finally made it to the mainstream media. But one way to decipher all of this burgeoning interest is the inherent politics.

And in all the cacophony, the real issue of the children dying because they didn’t have enough to eat is drowned. Seven agencies were trying to decode the fever then, which is everywhere, the wards of this hospital, and the fields, and the homes of the poor, hunting and preying while they are oblivious.

They called it the wrath of the gods.

I remember another girl, Mani, whose father watched her die as he prepared himself to face the inevitable just because he didn't have enough money to pay for transport to get his child to the hospital in time. As he tried to arrange the money, the child’s body was being wrecked by convulsions that are a typical symptom of AES. The village moneylender gave him Rs 3,000 out of which he paid the driver Rs 2,200 and got to SKMH.

But the doctors said he was too late.

Once the hospital staff confirmed the death, the family would get a compensation of Rs 50,000 for each death.  

The poor were just grateful that the doctors were trying their best. Ram Bharose, the father of Mani, was a bonded labourer at the brick kilns and was planning on going to Punjab to find a job when the fever struck his daughter.

On days that he managed to find work, he got Rs 150 per day.

He had four children to feed and on days when there wasn’t enough to eat at home, the children would run around the litchi groves, picking up the fruits on the ground, and eating them.

At the time, Dr Rajiva Kumar of Kejriwal Hospital in Muzaffarpur told me there was a connection between the fruits that the region is famous for and the fever that returns every year to kill the children of the poor. There was a lot of speculation about the fever that seemed to afflict only the poor.  

Only in 2009, the administration started to take note of the mysterious fever. 

In 2012, there were 420 deaths. In 2013, there was a decline — 60 deaths. But in 2014, the fever struck again. And in 2019, it has become national news. 

The symptoms of the fever popularly called ‘Chamki’ vary. In the neighbouring Gorakhpur, Japanese Encephalitis has killed thousands of children. In 2012, Dr PK Kushwaha from BRD Medical College in Gorakhpur was invited to study the Muzaffarpur fever. But he noted in his report that the fevers in the two regions are different. 

In 1995, there was an epidemic declared here with regards to AES. And, in subsequent years, it slipped away from national consciousness. When the death toll rises, politicians visit hospital premises — in such times, the place is sprinkled with white chlorine powder to save them from all kinds of possible infections. 

***

Muzaffarpur is not far from Patna, the capital. In June, there is no respite from the hot winds that blow dust all over. This is the time of the epidemic. Hot, humid and oppressive. 

While the state government had equipped the PHCs in at least 25 locations to give symptomatic treatment to suffering children, the PHCs can only handle certain kinds of cases. For more acute ones, the patient needed to be brought to the hospital in Muzaffarpur. Three-year-old Mani was brought to the hospital in the afternoon. Her elder sister too had the same fever and had been taken to a primary health centre near the village.  

But to see a little bundle of a girl wrapped in yellow and red tattered clothes on a hospital bed while the cardiac monitor oscillated between hope and despair is a strange feeling.

From the 60s, it would dip to the 20s, then pick up again but it never crossed the 80 mark. Normal would be above 90 — that would mean the child would live. 

Ram Bharose didn’t say anything. He kept looking at the monitor. 

Mani continued to gasp. 

Outside, the few staff told me how the poor were getting two square meals a day here as arranged by the government of rice, dal and curry. I was the only outsider roaming around in hospital wards with a notebook. A team of eight doctors had been dispatched in addition to 14 other doctors who were stationed at various PHCs. They worked round the clock. They hardly slept and were overworked. They were trying to deal with it in their own unsentimental ways. But one of them told me they fought back tears too. A story’s purpose should not always be to indict. 

***

 At some point, Mani's cardio meter showed 19/86. I remember that. 

 One of the doctors told me the fever is a socio-economic problem. Poor hygiene, malnutrition, etc.

 ***

 The next morning, I tried to call Ram Bharose. But I couldn’t. I called the doctor instead. I asked about Mani.  "Gone. A few others also gone,” Professor Arvind told me over the phone.  

*** 

In Sendhwari village, we found a dilapidated additional PHC with two doctors. There were no beds, no fans and no lights.

“Have you seen a rich child suffer from it?” asked one of the two doctors. 

In the villages here, there are children with golden hair and bloated stomachs. They all look shrunken. They don't grow. They have nothing to grow on.

In my archives, there is still that photo of a ration card and a photo of a grandmother with her five grandchildren. Shobha stood in the left-hand corner in a pink frock. She died in 2014, at the age of seven, in that village, of AES. 

***

At some point, I remember getting angry. Perhaps it was because I couldn’t believe my own stoicism in chronicling these deaths. And perhaps it was because the story would be soon forgotten. Back then, the media was celebrating FIFA and Schumacher's return from his coma. The AES deaths were being reported in the local papers, and a few national dailies.

In the wards and corridors of the hospital, I was told how the Asha workers had been given Paracetamol tablets and how the government had equipped the PHCs to treat children. There were ambulances and about 24-25 PHCs in the zone were on full alert with doctors doing round-the-clock duties. 

They were even reimbursing the fare of the vehicle in case the family had to hire a car to get the child here. But Ram Bharose’s daughter died because he couldn’t arrange for money in time to pay the fare to transfer her to SKMH. There was coarse rice, watery dal and potato curry. Same menu for the last three days. Each family was entitled to food for two people. I remember the shiny steel plates that the staff handed to the poor, so they could collect their entitled quotas.  

Almost all those who lost their children said they were very obliged. They said the doctors tried their best.  

They silently took the bodies and left.

Poor people with big, big hearts. 

I have switched off the television. Sometimes it becomes unbearable. All this loss. 

Also read: By Karma and God's Grace: Why Hindutva economics never discusses poverty or the poor