Editor's Note: A network of 60 reporters set off across India to test the idea of development as it is experienced on the ground. Their brief: Use your mobile phone to record the impact of 120 key policy decisions on everyday life; what works, what doesn't and why; what can be done better and what should be done differently. Their findings " straight and raw from the ground " will be combined in this series, Elections on the Go, over a course of 100 days.
Bareilly: "Many of my family members were sick when I read reports of people dying in the district hospital due to a mysterious fever; I was really very scared. Yet, I delayed taking them to the doctor and, later, got them admitted to Novoday Hospital, where I had to shell out Rs 40,000. Not only have I realised that nothing is more important than life, but I have also seen the state of our healthcare sector and will vote wisely now." " Pramod Srivastava, a resident ofBareilly district's Qilla area
"My father came down with the mystery fever, too, during the time the number of cases were rising. I admitted him to a private hospital, and he recuperated well. It's been three months since, but we are still scared that anyone in the family can get it." - Rahul Kumar, a resident of Bareilly's Kamarchari Nagar
These are just two stories among the many that surfaced in the six months after cases of a 'mystery fever' in Uttar Pradesh first broke last year, killing scores of people across four districts of Bareilly division. After sweeping through Bareilly, where 140 villages were affected, Badaun, where 160 villages were hit, and then afflicting Pilibhit and Shahjahanpur, strains of the 'mystery fever' were felt in Lucknow division, as well.
Health department authorities struggled to contain the outbreak and are still groping in the dark to find the exact cause of the disease. Opposition leaders, however, resorted to government-bashing while the cases emerged.
There is no realistic assessment of the toll even now, but media reports peg the figure anywhere between 100 and 700.
How it all started
The outbreak began in September 2018, as the monsoon was retreating. Back then, speculations were rife that the deaths were due to either typhoid, malaria or "some other" viral fever. Encephalitis was being debated, as well. That's what State Director-General of Health Services Padmakar Singh's "prima facie" evaluation was.
"Medicines are being provided and fogging operations are being carried out to control the mosquito population," he had said.
It took Chief Minister Yogi Adityanath ordering an audit on 20 September for officials to take serious note of the issue. However, the official report has yet to be released.
Soon after the outbreak, one of the teams formed to analyse it tested water samples from various areas and found the presence of plasmodium falciparum in some, including in the samples taken from Bareilly's Majhgawan block, where a large number of people died of the 'mystery fever'.
Plasmodium falciparum is one of the four protozoa that cause malaria. According to the World Health Organization, the symptoms include fever, chills, headache, muscular pain and weakness, vomiting, cough, diarrhoea and abdominal pain. These are usually followed by organ failure, which then leads to a coma and/or death.
It's a known fact that mosquitoes breed around accumulated trash and stagnated water after monsoon, but what needs to be investigated now is why this mystery fever gripped Bareilly and Badaun the hardest. Also intriguing is the fact that despite malaria and typhoid being curable, the outbreak hit epidemic proportions.
However, in the absence of an official audit report, coupled with the fact that many deaths went unreported and without autopsies, it remains an epidemic of a mystery fever, not malaria.
What did the health department do?
According to Bareilly Chief Medical Officer Dr Vineet Kumar Shukla, more than 100 teams were formed after the first outbreak of the mystery fever, and they were sent to all villages to diagnose the symptoms among patients and provide preliminary medication.
"Our teams of doctors did rapid active surveillance to check this fever in various villages in Bareilly division, which was the first to report the disease. Fortunately, this year, the health department has not heard of any such deaths," Dr Shukla said, adding that it was the media that had coined the term 'mystery fever'.
When asked why doctors were unable to diagnose the fever and contain its spread faster, he said people died of the disease in a very short time, giving doctors little time to get to the bottom of it. They worked in the emergency ward as per emergency medical protocol to contain the epidemic, he added.
Dr Shukla explained that lack of awareness compounded the problem, and hence, the health department is now taking the help of the education department.
"By taking simple precautions, one can easily protect oneself from diseases, but lack of awareness hinders that. Hence, we are taking the help of the education department to spread important information. Our first priority is to curb the spread of vector-borne diseases. Spreading awareness will play a crucial role in controlling them."
Dr Rajendra Kumar, who heads the Community Health Centre (CHC) in Aonla, Bareilly district, said they got a lot of cases of the mystery fever.
"The hospital was full of patients with a fever that came with symptoms similar to those of malaria. Several died, too. Surveillance teams were formed soon after the seriousness of the issue was realised and sent to every affected village," he said, adding that the health department's field staff was also asked to spread awareness about precautions, such as sleeping wearing full-sleeved clothing, using mosquito nets and drinking clean water.
"At the CHC and PHC (Public Health Centre) level, we formed separate teams to check this fever and set up different wards for it."
Reports show that several of those who took precautions for malaria, as instructed by the health department, succumbed to their illness nonetheless. Dr Kumar, however, asserts that authorities are now fully prepared to deal with any such situation should it recur.
Fear lingers as election draws nearer
To get a firsthand account of the situation, this correspondent visited Pathri village in Aonla.
According to Gram Pradhan Gurvir Singh, "Seven people died due to the mystery fever, and many villagers abandoned their homes and moved to urban areas, where they had access to proper medical care. Some villagers even had to sell their land to get their kin treated. Since then, residents have been living in constant fear that the outbreak will reappear."
Another villager Narottam Singh said, "Some had to sell their harvest at throwaway prices just to be able to afford treatment for their sick family members."
Village elder Hira Lal explained: "It all happened so fast that many lost several family members in quick succession, even before anyone could get the right medical attention. That's why we are all still scared."
He claimed that neither government officials nor local politicians came forward to help the affected families.
Meanwhile, members of Opposition parties began to take potshots at the government for neglecting the affected villagers. They demanded that proper compensation be paid to the families that lost their loved ones.
Highlighting the "bad state" of healthcare services in Uttar Pradesh, Congress spokesperson Onkar Nath Singh claimed: "Even after so many deaths, the government hasn't upgraded the healthcare services in the affected areas, nor has any effort been made to provide them financial assistance. Instead, all that the BJP government is doing is brazenly indulging in divisive politics in the name of caste and religion."
State unit head of the Rashtriya Lok Dal, Dr Masood, echoed Singh's views and said: "The government has failed to protect the lives of the people. By not providing timely healthcare services to the needy, the government aggravated the situation, as a result of which casualties mounted."
Dr Masood demanded that the government provide Rs 10 lakh compensation to every family that lost its members to the fever.
Amid these accusations of neglect and indifference, the health department has maintained that the situation is under control, but there is no denying that the Opposition now has a crucial point to target " the state's deteriorating healthcare system " ahead of the upcoming Lok Sabha election. This mystery fever in Uttar Pradesh is compelling and scathing poll ammunition, especially as it follows the deaths of several children last year at Gorakhpur's Baba Raghav Das Medical College allegedly due to an oxygen shortage.
The author is a Bareilly-based freelance writer and a member of 101Reporters