In the third week of May 2004 there was an outbreak of gastro-enteritis in the Bhind district of Madhya Pradesh, India. About 1700 people were found to have dehydration, vomiting and diarrhoea. More than 700 patients were admitted to the hospital. The majority of those affected were children, mostly under five years of age. Nigel Ede, UNICEF State Representative of Madhya Pradesh & Chhattisgarh, travelled through Madhya Pradesh on 20 May. Here’s his diary entry giving his personal view on what is happening there.
BHIND DISTRICT, Madhya Pradesh, India, 24 May 2004—It was a blistering hot summer day with the mercury shooting up to 43 degrees Celsius. Bhind, one of the 48 districts in northern Madhya Pradesh, is well known for its ravines, fertile land and dense forests. The population is approximately 1.5 million people, of which 17 per cent are children. The district also has the dubious distinction of having one of the lowest sex ratios in the country: 933 females per 1000 males.
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| © UNICEF India |
| A worried mother staring stoically at her sick infant. |
It was here that we met up with B.L. Pandey, our contact person in Bhind and Shivpuri. He is a retired civil servant and is helping to support UNICEF’s work. His experiences provide significant insight into the workings of the system within the district.
During the course of an informal chat with Mr. Pandey, he voiced his thoughts: “Initially, the district never realized that this infection would turn into an outbreak. It started on or around May 14, with the district administration thinking it was due to homemade ice creams being sold in the open market. Today, with seven deaths having been officially confirmed, they now feel it is the result of a viral infection.”
As per Mr. Pandey’s figures, 132 villages have been affected so far, 67 of which fall within Mehgaon block. Approximately 25 new patients are arriving every day. At any given moment, close to 150 patients are in OPD (the out-patient department). Almost all patients suffer from chronic diarrhoea, vomiting and/or dehydration.
To get the real picture, we then drove to a health centre housing the offices of the Block Medical Officer at Mehgaon, Dr. V.N. Kushwah. He confirmed that the seven deaths have been attributed to the outbreak. In his conversation with us, he added that the number of patients has steadily increased, forcing workers to transfer patients to a makeshift hospital set up in a school nearby. Luckily, it is summer vacation and the building is empty, thereby making it available to Dr. Kushwah and his staff.
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| © UNICEF India |
| Salmat Khan with his two children—a 13-year-old son and a five-year-old daughter, both of whom are suffering from diarrhoea, vomiting and high fever. |
We were now at the makeshift hospital. From outside, it looked like a desolate school building. Once inside, we could feel the dense, thick air. The moans of the 60 or so patients reverberated throughout. Some of the sick were lucky enough to find space on the classroom floor, while others were moved to the veranda out back. There was only one doctor. Anxious parents holding their children jostled with each other in their efforts to be examined first.
The additional skilled hands of another doctor arrived unexpectedly. Despite the medications, children were still vomiting. Anxiety amongst parents was obvious; they were unable to comprehend what was happening.
Salmat Khan was one of them. He was perplexed as to what was wrong with his two children—a thirteen-year-old son and a five-year-old daughter. They were suffering diarrhoea and had been vomiting for two days. Both had high fever. Standing with him, I sensed his anxious thoughts: “Will my children be okay?”
Afterwards, we had a round of official meetings with the Chief Medical and Health Officer (CMHO) for the district. The CMHO shared her thoughts: On a positive note, no patients had died at the hospital. All fatalities reported were amongst those infected who could not reach the hospital in a timely fashion. Meanwhile, UNICEF supplies are eagerly awaited and desperately needed.
Next we visited diarrhoea wards at district hospitals. So completely full was one ward, a young girl with acute dehydration was forced to lie outside and wait. One could see infants hooked up to IV drips while their worried mothers stared with blank expression. Four additional doctors were sent from Gwalior Medical College to assist. We received information from the CMHO that cases were now appearing in other areas in the district. The virus appeared to be spreading quickly.
The district administration is doing all it can. Yet much more needs to be done. UNICEF, as a partner, is supporting them to the best of its ability. There is a great need to educate the people through public campaigns. Cases must be monitored long after the infection has subsided. UNICEF is working closely alongside the State Health Department in order to assure a full recovery for the children seen lying helplessly on the classroom floor.
Darkness had set in by the time we finished our rounds of meetings with district officials. Our journey back to Gwalior seemed longer and the mood was sombre. Few words were exchanged between us. At one point Ramani exclaimed, “We must get more support—we must!”
Our next destination was Delhi. Upon returning to the UNICEF office, we faced anxious questions from our colleagues: “What is the news from Bhind? Is it getting better or worse?” We briefly shared what we had seen and headed for the supply and procurement (S & P) section. Caroline Bogren, who recently took over as Chief of S & P, vowed to do everything possible to rush supplies of drugs, syringes, needles and other necessities to Bhind. Our meeting with Caroline was brief, but our hearts were filled with hope when she assured us of her support to reinforce emergency supplies for Bhind. When we left Caroline’s office, Ramani and I felt better knowing that we had the support of 350 colleagues like Caroline, who will do everything within their power to ensure that all the children return home in perfect health. That is the true spirit of UNICEF.
