Can Encephalitis Ever be Curbed With Defunct Local Health Centres?

Conditions were so poor in both rural & urban areas that the state of the Gorakhpur hospital is almost unsurprising.

Encephalitis has had Gorakhpur and its neighbouring districts in such a deadly grip that the place has come to be synonymous with the disease.

(Photo: Vikrant Dubey)

For 40 years now, Encephalitis has had Gorakhpur and its neighbouring districts in such a deadly grip that the place has come to be synonymous with the disease. As soon as monsoon begins, the BRD Medical College is overrun with patients.

The construction of a special ward with 100 beds to serve the growing number of cases has not proved enough; reports of sick patients having to share a bed abound. It is clear that with encephalitis patients outnumbering hospital facilities, their chances of receiving adequate treatment are slim.

It is crucial at this point to remind our readers that each village at every block level is supposed to be served by a government hospital. A large number of these patients, if provided with good primary care, would never need to travel all the way to Gorakhpur to an already overburdened medical facility. How, then, did such a state of affairs come to be?

We travelled to Encephalitis-hit areas in search of answers.

The Magical Rituals

Kushinagar, a district near Gorakhpur, is one such place. We had travelled some 30-35 kms into the place when my eyes fell upon a structure where a group of women was gathered. From afar, the place looked like a temple.

Upon closer inspection, our guess was proved to be true – this was indeed a temple where Dinesh Maharaj was engaged in the task of “jhaad-phoonk”, or magical rituals intended to cure a disease. He stopped the minute we approached the women. I spoke to a young woman called Preeti who told me that she used to suffer from body aches and nightmares which stopped once she came to this temple for “treatment”.

Another woman by the name of Reeta, who suffers from fertility problems, has come here in the hope of a cure. Dinesh Maharaj, in the meantime, claims that he is able to cure any person with merely a prayer. It is a bitter irony that despite having recently celebrated our 71st Independence Day, our weakest and most vulnerable sections still remain slaves to superstition.

Losing Faith in Government Hospitals

We travelled further inland, soon reaching a village by the name of Chanp in Kushinagar’s Dudahi block, situated at a distance of some 90 kms from Gorakhpur. It is at a gathering near a shop there that I met Mukhlal Kushvaha. Kushvaha, who lives a mere 2 kms away from the government hospital, seems to have lost all faith in the institution. One should take one’s child to the hospital only if one wants to kill the child, he says.

Liyakat, playing cards nearby, adds his own two cents to Kushvaha’s opinion. How can a hospital that can barely treat a simple fever address such a serious disease as encephalitis, he asks. In the middle of this conversation arrives Islam, who has recently lost a child to the vector-borne disease.

He tells us that he shifted his child to a private hospital from the government one but to no avail; he could not save him. After talking to these men, we made our way to the Primary Health Centre in Champ where we were told that no doctor ever visits. The pharmacist not only dispenses all medicine but doubles up as a physician too. 

From the anger and the frustration of the citizens here, it is clear that gross mismanagement and neglect on the part of the government has led to this situation. Men like Dinesh Maharaj thrive in the vacuum created by the absence of reliable healthcare options.

Also Read: Gorakhpur: As Families Mourn Children’s Deaths, Who’s Responsible?

(Photo: Vikrant Dubey)

Pharmacists Replace Doctors

Our next stop was the Tharibhar Primary Healthcare Centre where the situation was equally bad. The main gate, wide open, had an ominous air, as if it had never once been shut since the hospital was first set up. Within the hospital premises, I met Sheela, an auxiliary nurse midwife (ANM) who lives in a room behind the facility with her family.

She told me that she had been an employee at the hospital ever since it was first opened back in 1985. In a truly astounding revelation, she further said that no doctor had ever visited the facility since then. All patient care happens at the hands of pharmacists.

On stepping out, we ran into Chanchal, a resident of the adjoining Indarpatti. He told me that they might at first get admitted into a government hospital but they are cured properly only in a private one.

Even the Sweeper Dispenses Medicines

After that, we made our way to the village of Prithvipur which borders the state of Bihar. While this place does have a PHC, it is falling apart. A broken main gate as well as overgrown grounds tell us all we need to know. Here, I met Lakshman Singh. Singh, a ward boy in the homeopathy wing of this Centre, tells me that he has never seen any doctors in this place.

Puzzled, I ask him about the information I received from the villagers – that a doctor is present here from 8 in the morning to 2 in the afternoon. He tells me that the villagers mistake any personnel within the hospital premises for a doctor. Apparently, the sweeper dispenses medicine too.

While Singh’s claim may seem fantastic, I can vouch for its accuracy. Throughout this ground report, I was puzzled by the disconnect between villagers who claim that doctors serve their local government hospitals and the widespread reports of medical mismanagement.

(Photo: Vikrant Dubey)

If doctors do indeed service these PHCs, why do patients travel to private hospitals or far-flung places like Gorakhpur for treatment? Singh’s answer accounts for this discrepancy. Is it any wonder that residents of these rural spaces seem to have lost all faith in government hospitals?

On our way back, I wondered if the dismal healthcare conditions I had witnessed were because these were located in rural outposts, far from towns and cities. To test this hypothesis, I travelled to Davarpar Primary Healthcare Centre in Gorakhpur’s Belipar area.

Also Read: Gorakhpur Horror: We Pumped Oxygen For Our Children, Say Families

The conditions here, unfortunately, were much the same. The only difference seemed to be superficial, like brand new notice boards for an ambulance area. I met the village pradhan, who told me that this Centre was woefully ill-equipped to serve the patients that came here. The lack of proper infrastructure, combined with a pervasive smell of cow dung indicative of livestock nearby, lent weight to his words.

With things in such dire straits at the local level, it is no surprise that the number of Encephalitis patients at BRD Medical College increases every day. While the previous government did commission 10-bed ICUs for Encephalitis patients in every district hospital of Gorakhpur, it is still not enough to meet the needs of the current number of patients.

When I raised the issue with Dr Satish Kumar at a hospital in Kushinagar, he told me that if patients were admitted to the hospital in the initial stages of the disease and given adequate primary care, the mortality rate would significantly decrease.