On the frontline of India's encephalitis war

Dr Komal Prasad Kushwaha Encephalitis has claimed 6,000 lives at Dr Kushwaha's hospital since 1978

Over the past month, we have been reporting on the deaths of hundreds of people in a fresh outbreak of encephalitis, in the northern town of Gorakhpur.

But death stalks the children of this chaotic border town in Uttar Pradesh unfailingly every monsoon. And for nearly four decades, Komal Prasad Kushwaha, a bespectacled and soft-spoken doctor, has seen hundreds of children die under his watch.

As a senior paediatrician at the Baba Raghav Das Medical College, Dr Kushwaha has been on the frontline of a decades-old battle against encephalitis, which has claimed some 6,000 lives at his hospital alone since 1978.

Horror stories are nothing new to Gorakhpur. In one case in 2007, local police picked up a dairy farmer and owner of a blood farm - "a ruthless modern-day vampire", according to one account - who locked up men and extracted blood to sell it in the black market.

But it is encephalitis that has been the leitmotif of Gorakhpur's unending misery.

Virulent outbreaks

Winter is upon Gorakhpur, but children are still dying of the disease. More than 500 have died at Dr Kushwaha's hospital in the past few months and "two to three are still dying every day".

"The worrisome thing is at least one child is still being admitted with encephalitis every day. The intensity of this year's outbreak is unimaginable, even for me," he says.

Over the past few months, I have had several conversations with this affable, hard working doctor. Down bad phone lines, I have asked him how it felt to be a doctor seeing so many children dying. What inspires him to stay on and fight another day?

Start Quote

The mothers look into my eyes and they know that their child is dead”

End Quote Dr Komal Prasad Kushwaha

Dr Kushwaha's story highlights the failings of the Indian state. It shows how things have improved, but not fast enough, despite a $14.3bn federal rural health mission. And how it takes a calamity and media outrage to shake the authorities into action.

"In the early days, the children would simply die because we lacked basic equipment," Dr Kushwaha says.

"There were no catheters, no central oxygen supply. We had to manually cart oxygen cylinders to the ward, and it would be too late sometimes.

"Half the kids who came in would die. I remember we used to ask how many children we can save - it was like a competition among the doctors. If no child died during my duty hours, I would feel ecstatic."

Things worsened over the next two decades, with hundreds of children dying from the mosquito-borne virus, the patients arriving from far-flung villages and poor districts of the neighbouring state of Bihar. In 2005, in one virulent outbreak, more than 1,000 children died.

"It was the worst of times," Dr Kushwaha says.

"I remember a time in 2002. It was apocalyptic. Hospital staff, parents, attendants were busy carting oxygen cylinders from the store to the ward to save the children. Children were dying faster than we could reach oxygen in time."

That was when the state Chief Minister Mulayam Singh Yadav came visiting the hospital.

"I told him our children were dying because of lack of oxygen and suction devices. He sanctioned over 7m rupees ($140,000) so that we could buy life-saving essentials."

'Beautiful boy'

Things have improved since the late 70s - a central oxygen system has been put in place and drugs made available.

Child suffering from viral encephalitis in a Gorakhpur hospital Dr Kushwaha has had some success in winning new equipment

But children suffering from encephalitis continue to flood the ward and die, Dr Kushwaha says.

How do you, I asked him one day, break the news to parents that their child is dead? How do you do it, a number of times, every day?

"I don't have to announce it. The mothers look into my eyes and they know that their child is dead. I don't have to say anything really. They know we try hard. And they, by just looking at me, know when I have failed to save their child."

I asked Dr Kushwaha whether he had ever broken down himself.

"I remember it happened last year. A handsome boy was wheeled in. He was conscious. They had brought him to our hospital thinking that I would be able to save him. The mother said 'I want my child to be treated by you, nobody else'.

"I feared the worst. I thought I should give him gamma globulin, a costly drug and try to revive him. But we did not stock it, as the government had prohibited us from using the drug at the hospital. The next day, the child slipped into a coma and died. He was such a beautiful boy," the doctor said, his voice quivering faintly.

'No hope in hell'

Dr Kushwaha is one of India's leading authorities on breast feeding and could work anywhere. So why stay on?

"Many a time I have thought of leaving my job," he tells me another day. "But here I at least manage to save some life. We have halved the mortality rate due to encephalitis in my hospital. It's a tough battle, but it has to be fought."

"These children have no hope in hell if they go to private hospitals. They won't be admitted there because they can't afford the treatment. If people like me don't stay on here, more children will die."

So Dr Kushwaha stays on and fights with his fellow doctors to save the lives of the children in Gorakhpur.

There is also one silver lining with all the hard work: this year's outbreak and the resultant media outcry has helped shake up the administration again.

Dr Kushwaha's hospital is now going to get 24 new ventilators for children. Presently it has 21, the majority of which have been borrowed from other hospitals.

Most importantly, a new 1.2m rupee ($24,000), 100-bed hospital for children suffering from encephalitis on the same campus has been promised by next year, a key move towards saving more lives.

"You can never lose hope," Dr Kushwaha tells me. "Even when everything looks hopeless."

Soutik Biswas Article written by Soutik Biswas Soutik Biswas Delhi correspondent

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  • rate this

    Comment number 19.

    The high risk of child death is one of the reasons people in poor countries try to maximize the number of children they have--to ensure that some few will survive. Eradication of encephalitis and other diseases will reduce this frantic pressure on the poor and lead to lower birth rates. This doctor should be given all the gamma-globulin the patients need. Better water supplies needed.

  • rate this

    Comment number 18.

    I'm sure this doctor has to remind himself often that you can't save them all, but you can save some. What a dedicated man.

  • rate this

    Comment number 17.

    What a wonderful man. If only Indias resources could be more focused to help him in his fight. He is an inspirational doctor, showing the dedication that many show, dealing with heatbreaking circumstances and battling to give patients the care they need. In such a sad story Dr. Kushwaha is a ray of hope.

  • rate this

    Comment number 16.

    Why The BeeB delete South Asia tab, it given full news about its countries. In Asia group where is theese countries. We need now microscope to read India and Afghanistan news.

  • rate this

    Comment number 15.

    I agree with you. My previous comment, explaining what it has to do sport/space program in response to certain comment, was removed!! I mentioned how the local politicians should spend the welfare money on the people and not on themselves. I don't understand why it was removed! Anyway, why Biswas do you make this as a general India story when it happens only in a wee bit of India?

  • Comment number 14.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 13.

    hi soutik,
    a peice of advice, why dont you write something positive abt the country you represent. Its such a shame, where there are 1000 things positive and vibrant happening, you seem to highlight only those which are more regional and is not what India is all about. Wish someone who understands real India represent. Jai Hind.

  • rate this

    Comment number 12.

    What an amazing man! The conditions he has to work in are appalling and he sees the most terrible things, but he keeps going regardless because he knows how much the children need him. Shame on the government for letting this happen, but thank goodness for people like Dr Kushwaha who never give up. Truly an inspirational man.

  • rate this

    Comment number 11.

    While everyone is busy commenting on why India is doing this and not that, we are failing to appreciate the hardwork and dedication of this individual who has dedicated himself to helping others. We need more people like him in the world! That is what will make the real difference.

  • rate this

    Comment number 10.

    I think India needs to control its population growth rate, or else it is going to become unbearable burden to this planet.

  • rate this

    Comment number 9.

    It comes down to the quality of governance. Why can the Indian space agency launch satellites at a fraction of the cost compared to its competitors? Because of good governance. Why can't UP handle the outbreak? Because of bad governance and corruption. Why can one side of India solve complex problems whereas the other struggles with the basics? Compare UP with states that are better governed.

  • rate this

    Comment number 8.

    I almost cried reading this. So hard to imagine things like this happening in the world when I'm sat here in comfort.

  • rate this

    Comment number 7.

    For a developing country like India, the focus should be on basic health care, education and core infrastructure. Unfortunately the government is busy hosting expensive games, building Mars explorers and maintaining a elite class of citizens who are above law. Its heartening to see small kids dying in hospitals, people experiencing Hunger, women & children exploited both physically and mentally!

  • rate this

    Comment number 6.

    Multiplex polymerase chain reaction (PCR) was applied in 127 samples that tested negative in conventional tests, diagnostics identified 83 of them. Cerebrospinal fluid of ACS patients is collected in such a manner the genetic material remains intact. Tiny drop of sample (0.5 cc) is required for elaborate test that lasts for 7 hours.

  • rate this

    Comment number 5.

    Xycton Diagnostics Ltd claims to have developed detection kit with funding from Council of Scientific & Industrial Research. Even though Japanese Encephalitis, originally main cause of UP outbreaks, JE dropped to 7% in 2011 (vs 36% in 2005). But AES has risen quickly. AES is due to entero-viruses, transmitted through water. 75-100 organisms cause AES, out of which 22-25 are found in India.

  • rate this

    Comment number 4.

    Diagnostic kit has been developed by Bangalore scientists which looks for as many as 23 pathogens – all causing acute encephalitis syndrome (AES) - & provides results in 7 hrs. Notwithstanding recurring nature of AES outbreaks in Uttar Pradesh in the last 7 years, medical investigators still have not been able to identify the causative pathogen.

  • rate this

    Comment number 3.

    A shocking condemnation of the neglect shown by the Indian government, completely failing in their duty of care to the citizens who employ them.

  • rate this

    Comment number 2.

    I agree with Classic Ray but this is symptomatic of the whole world. Why do we need to think of exploring Mars? Why do people want laser surgery to change the colour of their eyes? Why do people need newr bigger televisions and cars etc. We should be seeking to care for people and the environment ON EARTH

  • rate this

    Comment number 1.

    Someone please tell me why India can pursue an expensive space programme whilst basic medical infrastructure is obviously still so lacking in much of the country. Is international prestige or competition with neighbours so much more important than enabling children to have a chance of survival?



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