Public Health : Collapse in the Face of Emergencies

The epidemic unfolding in Siliguri and the way it is being handled is symptomatic not only of the disarray in the health management system in many states, but also of the critical state of medical research in India. Today, almost a month after the disease claimed its first victim and was spotted as more than a rare occurrence in the area, the government is yet to set in place any special system for handling the epidemic. Worse, between them the National Institute of Virology (NIV), the School of Tropical Medicine (STM) and the All India Institute of Hygiene and Public Health (AIIHPH), all premier research institutes funded by government, and a team from the World Health Organisation have not been able to identify the disease, or even to prescribe public health measures to be put in place on a tentative basis.

The epidemic began with the death of a patient in a private hospital in Siliguri from an infection of unknown origin. No diagnosis could be made and interestingly soon afterwards several others who had been with this patient also developed similar symptoms and subsequently died. Within two weeks the disease had claimed 20 victims, its peculiarity being its severity, non-compliance with known treatment and eventually death. By mid-February a team of doctors from Kolkata had written to the government that a team from the NIV, STM and AIIHPH be urgently despatched. A fortnight after the first death, the outbreak having been suspected to be some form of viral encephalitis, blood samples were sent to a private hospital in Kolkata over 700 km away. The hospital was not equipped to conduct such investigations and sent the sample on to the AIIHPH. By this time, that is the beginning of the third week of the month, the samples were unusable. As the director of AIIHPH pointed out to The Statesman,”There are certain conditions for collecting samples. If these are not fulfilled, the virus in the blood sample could get contaminated; then the tests will not reveal anything.” Samples sent to the STM were examined and tentatively falciparum malaria and Japanese encephalitis were eliminated. Further investigations required other pathological samples, such as brain tissue from a dead body preserved at sub-zero temperature, which was unavailable. Why the government had not, immediately after the first few deaths, put together an investigation team and why these institutions and the NIV, whose responsibility is epidemiological and infectious disease research, had themselves not initiated such a visit and why the state government dragged its feet on this are as much a mystery as the origins of the disease. The Siliguri municipality has attempted its best – mobilising over 300 workers to visit all homes to check on the ill and arrange ambulance services, etc. But handicapped by the lack of an epidemiologist and no clear direction about patient management, its efforts fell far too short. By the end of the third week of the outbreak, the local administration had decided to treat it as some form of encephalitis, possibly spread by a vector-borne virus, with pigs as the intermediate hosts and begin such measures as eliminating stagnant water pools to prevent mosquito larval spread and moving pigs away from habitations or destroying them. People in a panic reaction are dosing themselves, inevitably quite indiscriminately, with tetracycline that the hospitals have been prescribing for those infected and resorting to ‘local’ treatments and unscrupulous medical practitioners are in command.