Two young people have died very recently at 12/1 Meher Ali Lane bustee in ward 57.
Mustari Khatoon, daughter of Mhd Rashid, aged about 15 years, was taken to the ID Hospital with fever on the morning of 18.11.09. Mustari was refused admission by the hospital authorities then, but was eventually admitted there at 3.25 pm, in the late afternoon hours with the symptoms of fever, headache, convulsions and vomiting. Mustari expired on the same date at 9.30 pm and the cause of death was recorded in the death certificate as meningoencephalitis.
Sarique Mohammad, son of Shah Mohammad, also a promising young boy of 16 years of age, was admitted to ID Hospital on 5.11.09 at 10.10 am with similar symptoms but he expired on 6.1109 at 10.20 am. The cause of death mentioned in his death certficate was cardiorespiratory failure in a case of encephalitis.
A state hospital of repute has given the cause of deaths as encephalitis/meningoencephalitis in these two cases. This no doubt has to be a clinical diagnosis as Mustari was admitted to the hospital for only 6 hours and Sarique for about 24 hours. I have spoken with representative doctors from ID Hospital about corroborative investigations regarding such claims and have been informed about the absence of crucial investigations of CT / MRI scan of brain or lumbar puncture, required to diagnose such cases. Still talks about a brain fever affecting a sizable section of the local populace has been circulated, leading to an atmosphere of fear, apprehension and anger among them!
Again as the most common cause of encephalitis is viral in origin, there may be the natural inquisitiveness, whether these deaths are at all linked to the dreaded Japanese Encephalitis. We also have information that besides being an area of great uncleanliness, a good proportion of the population are involved in rearing pigs and culling cows and buffaloes. So the rumour may try and attribute these two deaths as caused by the japanese encephalitis virus. As far as my knowledge of public health goes, JE is a zoonotic disease, infecting mainly animals and only incidental in man who is a dead-end host, the disease being primarily limited to the cycle of pigs, cattle, buffaloes - mosquito - pigs, cattle, buffaloes or certain birds/poultry - mosquito - birds/poultry of which pigs are the most important amplifiers, and the culex vishnui complex of mosquitoes responsible for the propagation of the disease is absent in the city of kolkata ( as informed by Dr Debasish Biswas, vector control officer KMC).
Both these deaths have been greatly highlighted by the media as "AJANA JAR" that has affected about 100-150 people and is also on the rise on a daily basis. It has also been reported that the civic services particularly of solid waste disposal being almost absent in the area, is an important responsible factor in such untimely deaths of two young people. True the whole bustee at 12/1 Meher Ali Lane has not been serviced by the solid waste disposal department for a considerable span of time, thereby leading to the accumulation of garbage and plastic materials and containers in huge quantities, leading to a situation hazardous to health. There is truly an urgent necessity to remove these at the earliest, but the question remains whether someone is listening !
Regarding the concept of "ajana jar", all I would like to say, that at any point of time, there may be about 10% of the population who will be suffering from fever and that may be viral in origin or malaria or related to other obvious bacterial causes. Our findings after a house to house survey has corroborated this concept and is not supportive of either the rising trend of fever in a large section of the local populace nor the diagnosis of "encephalitis" or "ajana jar" as tagged by ID health authorities or the visual media.
LESSON OF THE DAY : Though we trust the clinical eye of physicians, hospital authority should have given the cause of death as cardiorespiratory failure in a patient suffering from pyrexia of unknown origin or cardiorespiratory failure in a patient suffering from suspected viral fever. Specific cause should only be given if there are supportive investigations.
Excellent informative post from Munmun. At first, I had difficulty identifying the location, but the ID hopital and the Bengali names gave it away. I wonder why a simple lumbar tap and bedside tests (Wellcogen) and/or culture for common bacterial pathogens cannot be done in ID hospital. The ICMR lab at NICED or School of Trop Med besides ID hospital can surely test for JE IgM ELISA.
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