The state's onus

As the death toll due to the AES epidemic rises, news of Bihar's social misfortune echoes across the country with discussions ranging from causes of encephalitis to remedial mechanisms. Experts from the medical community have the onus of narrowing the source of encephalitis that has gravely aggravated the situation in Bihar. Ground zero–Muzaffarpur–of this outbreak remains to be analysed and studied in order to derive that. While the medical team attends to the affected seeking answers to origins of this misery, it is the administration's task to control the ruckus caused at the local level. The death toll was hovering around 80 when Central and state health ministers paid a combined visit to the state-run Sri Krishna Medical College and Hospital on June 16 to take stock of the situation. As they announced a slew of measures, it was expected that the situation, now under complete government scanner, will be expeditiously tackled and mortality could be curbed. But just as the Union Health Minister had once proposed to build a virology laboratory in Muzaffarpur in 2014, he did the same that day. Between 2014 and 2019, there was no materialisation of that proposal. In fact, encephalitis is not an unknown disease in the region. AES outbreak has claimed more than 400 lives in the last decade. A decade is sufficient time to arrive at the cause, develop relevant medicines, take necessary precautions and basically bring an entire framework to prevent AES' fallout in effect. And here, we are nowhere near it even after a decade. Even if the medical fraternity takes home the benefit of the doubt of not having made any breakthrough in finding out the cause for this condition, the administration gets no leverage. Disaster management is an entirely different sector made solely to cater to efficient management during disasters. It cannot be so that a decade was not enough for the state government to become proficient in handling AES outbreaks despite no luck from the medical team over the cause. Kerala displayed par-effort in quarantining Nipah and preventing an epidemic this year after it had learned its lesson last year–not that it had grown into the magnitude of the current AES outbreak but still the lesson was there for taking, and Kerala took it. In fact, Kerala prevented any casualty and that remains commendable. In a span of one year, Kerala developed a mechanism to cater to Nipah virus, should it threaten to become an epidemic again in future. Current AES adversity outlines the fact that Bihar could not do a similar task in ten years, if not more. Now Nipah and encephalitis may not be the same thing but the bone of contention is not the virus that caused the epidemic but how effective was the administration in preparing for either of them by utilising state machinery to that one job it has amongst others. Ten days after the health ministers' visit, the death toll hovers somewhere near 140. The wide scanner under which this outbreak lies has not attracted the government's prime attention to the cause yet and the increasing death toll validates that. It also explains the PIL filed which alleged that there was a complete failure of the state machinery in dealing with the outbreak of the disease. Inadequate steps to prevent the outbreak, coupled with negligence have resulted in several deaths. Seeking immediate steps to combat the rising death toll, the Supreme Court issued notices to Central and Bihar government but the larger perspective narrates negligence on the face of an outbreak. But entering the root of the situation, it can be also be said that the surrounding is also not supporting Bihar as it struggles to combat AES. Blaming litchi and cooking up potential causes was convenient and while Indira Gandhi Institute of Medical Sciences, Patna conducts its research on the cause, analysing the local surrounding is also imperative. Local surrounding includes all kinds of man-made causes, viz. lack of hygiene, malnutrition, poverty, misgovernance, grievance redressal mechanisms et al. As Muzaffarpur MP Ajay Nishad called it a result of '4G': gaon (village), gandagi (uncleanliness), gareebi (poverty), and garmi (heat), it becomes necessary to question the state administration of efforts been put in managing areas such as cleanliness and poverty considering temperature remains out of our hands. An example of Odisha is relevant having dealt with a similar crisis of AES where they handled the outbreak by initiating state-mechanisms to ensure prevention at all costs. If Kerala can manage and Odisha can guide, all Bihar needs to do is learn. It is an equal state of India and there will not be any shortage of resources from the Central government to support its initiative to handle this outbreak. While short-term measures need to be expeditiously implemented, there is a need for dynamism in the policy structure to tend to the local surroundings and realise that Bihar's AES-affected segment is poor and malnourished and in need of the state's heightened attention in ensuring prevention of outbreaks like AES, dengue or even floods or drought since the poor will find itself unable to sustain. Bihar has to step up.