Epidemic Ward number 12 was breathing easy the day I visited last week. "Just six cases of AES," the head nurse said, showing me the register of entries.
Acute Encephalitis Syndrome brings on high fever and brain inflammation and leaves a trail of mind-numbing child deaths in eastern Uttar Pradesh every monsoon.
More than 550 deaths were recorded last year. If this sounds shockingly high, the record in 2005 was worse: 1,344 deaths.
There’s only one large government hospital in the entire region to take on the chronic killer of children: Baba Raghav Das Medical College's Nehru Hospital.
From villages far and near, families arrive here with their ailing children, sleeping kits and gas stoves. The children are deposited in Epidemic Ward 12 and the parents bunk down in the fly-infested corridors outside. The lucky ones find out that the malaise gripping their child is not encephalitis, but something more ordinary: typhoid, diarrhoea, viral fever. Others end up keeping anxious vigil for days on end over an immobile child plugged into machines that keep beeping.
Careful not to disturb those critically ill, I walked into section B of the ward, where I was told by the nurse that all the children were encephalitis-free.
Two-year-old Satyam was playing with his mother. “We’ve been here for 11 days,” his mother said. “But the doctor says we can leave in three-four days.”
“Where did you take him the day he fell ill?” I asked her.
“To the store of the doctor,” she said.
"Store" is a rather appropriate term for the clinics of private doctors who charge exorbitant fees, regardless of whether they are qualified to practice.
“Is there a government health centre in your village?” I asked Satyam’s mother.
“There is…but it is no good.”
India’s public health system is decrepit in most states but UP has arguably the worst. In 2007, a report of the National Family Health Survey said that 59% of sub-centres lacked a regular water supply and 75% lacked electricity. Of the 16,283 sanctioned posts of doctors in the state, the Hindustan Times reported last year, as many as 5,500 are lying vacant, 1,400 doctors are holding administrative posts and 600 doctors are simply missing.
Even the National Rural Health Mission, the United Progressive Alliance government’s flagship health scheme launched in 2005, failed to make a dent, getting mired in massive corruption. In 2011, the Comptroller and Auditor General reported that since the start of the NRHM, Rs. 5,754 crore of the scheme’s funds remained unaccounted for in UP. Sanctioned public health centres never came up and existing centres were used to store potatoes.
Like most scams in India, UP’s NRHM racket involved high-ranking politicians and bureaucrats. The day I arrived in Gorakhpur, the newspapers reported the seizure of the property of a former Bahujan Samaj Party legislator, Ram Prasad Jaiswal, one of the accused in the NRHM Scam.
Would this affect the elections in any way, I asked Satyam’s father.
“Not really,” he said. “Politics in Gorakhpur revolves entirely around the Hindu-Muslim question. Babaji has won three times. He will win this time as well.”
Babaji or Yogi Adityanath, the current MP of Gorakhpur, is the head of a local temple and a rabble-rousing Hindutva leader.
“He has done nothing in 15 years but people still vote for him because he has managed to create an impression that if he loses, it would be an insult to Hindus,” Satyam’s father said. “If Lok Sabha polling happens on Hindu vs Muslim lines, the state assembly elections are fought on caste lines.”
Almost 30, Satyam's father called himself a student although he isn’t actually enrolled for any course. “Student” is the preferred descriptor in UP for those applying for government jobs. The family had land, but Satyam’s father did not want to work the fields. Instead, he had set up a “net ki dukkan”. Not an internet café for idle people who wasted time over Facebook, he clarified: a store with two computers available for those who wanted to download and submit forms for government jobs. He had himself applied for a job when the state government had advertised 72,000-odd teacher vacancies. But the recruitment process got stuck in litigation. “Under Mayawati,’s government, the recruitment was to take place according to TET merit.” TET is the Teacher’s Eligibility Test. “But Akhilesh government came and changed it to board exam merit. Someone went to court to challenge that…”
“What do you prefer – TET or school exam merit?”
“TET,” he said.
“Why?”
“There is rampant cheating in UP school exams. But the time I went to high school, Kalyan Singh was the chief minister. Under him, the administration was very strict. Idhar udhar nahi dekh sakte the. Only a couple of students used to clear the exams. Under Mulayam Singh, it is the exact opposite. Those who have cheated in school exams would stand to gain in the merit list.”
He sounded critical of Mulayam Singh Yadav, the leader of the Samajwadi Party, but when I asked him who he would vote for, he took no time in stating, “SP, regardless of whether it wins or loses.”
The reason for his political preference was not far to seek. It lay in his name: Bipin Kumar Yadav.
In UP, the Samajwadi Party is seen as a natural repository for Yadav votes, while the Bahujan Samaj Party, led by Mayawati, a dalit leader, is viewed as the catchment for dalit votes.
“You are young and educated. Why do you vote along caste lines?” I asked Bipin.
“Ab aapko kaise samajhaye,” he said. "Ab maan lijeye ki BSP ka log Mulayam Singh ko vote de dega to koi nahi manega diya. If BSP’s people vote for Mulayam’s party, no one would believe they did. If I vote for the BJP, the BJP won’t believe that I did.”
***
Three-year-old Sunil had virulent pneumonia. The phlegm had to be drained by a surgical cut on the right side of his chest. He was on blood transfusions and was being tended by his old grandparents. The family was from Ramnagar village in the neighbouring district of Deoria.
A fortnight ago, when Sunil had come down with high fever, they had taken him first to the public health centre, but when the doctor did not show up, they moved him to a private hospital, where within four days, they had expended Rs 10,000, to no effect.
“Rs 800 on one injection, and injections twice a day,” said Sunil’s grandmother, a frail woman who looked exhausted with the effort of taking care of a sick child.
The expenses had come down in the government hospital but they still needed to buy medicines, bandage rolls and syringes from outside.
“It's fine as long as our child recovers,” the old woman said, revealing why Sunil was so valued in the family: he was born after three daughters. The oldest is now 13 years old.
“Would you be marrying her off soon?”
“No, no,” she said. “Not for another three-four years.”
UP has the highest infant and maternal mortality rates in India. As long as girls are married young, it will be hard to bring it down.
“Who do you vote for?” I asked the old couple.
“Jisko ichcha kiya…Whoever catches one’s fancy,” said Sunil’s grandfather, Paramhans. “Although there is nothing to be gained by voting.”
“Then why do you vote?”
“Yahin to adhikaar hai public ka. Aur to koi adhikaar nahi. This is the only right available to the public. Nothing else.”
On the mention of 'adhikar', his wife got very agitated. “Jab aayi mile saamaan chal gayi. Something was sent for us, but it was passed on to other people,” she said.
Sunil had been hospitalised for the first time when he was six months old, along with a few other children of the village suspected to have encephalitis. At that time, officials had visited Sunil's neighbourhood and promised to provide a source for clean drinking water supply, since contaminated water is key to the spread of encephalitis. But the tap never materialised. Paramhans suspects the money was used by the village head, the pradhan, to sink handpumps in his compound. “He is Brahmin, you know,” he said, while they were Yadavs.
***
On the bed opposite Sunil's, a tiny six month-old baby was suckling her mother's breast. Her name was Divya. She had been admitted to the hospital with high fever, but it had turned out to be a routine viral infection.
Like others in the room, Divya's family had spent money and wasted time at the private clinics near their village before they came to the city. They were dalits and they owned no farm land. Divya’s father lived and worked in Chennai. “Paint polish karat hai,” her mother said. She had visited him once, taking a three-day train journey. Her memories of the visit revolved around the heat and the strange language.
“Do you vote for Behenji?” I asked Divya’s mother. Behenji is how Mayawati is addressed by her followers. The young woman smiled, as did her mother-in-law.
“Behenji had come to Gorakhpur some years ago," said the old woman. "I came to see her, spending my own money.”
“Your own money?”
“To phir motor bhejeli reh li. You expect her to send a motor car for us.”
“When Behenji was in the government, did you get any benefits?"
“No, nothing.”
"Rations?"
"We have a white card but we get only oil,” she said.
Meant for below-the-poverty line families, the white-coloured ration cards entitle families to subsidised wheat, rice and sugar.
“Then why do you vote for her?
Her daughter-in-law said, “Hum aap pe vishwaas karenge to sab kuch ba aur nahi vishwas karnge to kuch nahi ba. Everything rests on faith.”
***
The fourth bed in the ward was taken by a child who belonged to a more prosperous family.
“We came here yesterday as soon as Ansh fell ill. We didn’t want to waste any time,” said the child’s father, Kameshwar, who said he was a jeweller.
“Does that mean you are from the Bania community?”
“No, we are Nishads, the caste to which Jamuna Nishad belongs.”
Jamuna Nishad was a former legislator who contested and lost elections for BJP and SP, before he won on a BSP ticket, becoming a minister in the Mayawati government. In 2008, he was booked for murder, which led to his expulsion from BSP. He died in 2010. His wife was given a ticket by the SP. She is currently the MLA from a constituency in Gorakhpur district and has been fielded against Adityanath by the SP. For many of her voters she still remains “Jamuna Nishad ki aurat”.
“Who are you voting for?”
“Jamuna Nishad ki aurat. We have voted for Nishadji regardless of the party. Now we vote for his wife.”
Kamleshwar's father, Ram Daman Nishad, explained why they were so loyal: "It is best to stick with one's own family. Gaali dega, dulaar bhi karega. You get both love and abuse."
“But if Babaji is so strong here, why is she wasting her money fighting a losing battle?"
“This is not a business. It is a career. And elections are unpredictable. Don’t write off the SP. After all, the government has done so much work.”
“What work?”
“They have distributed laptops and cycles. One hundred and fifty cycles have been distributed in our village alone. Would the beneficiaries forget the favour? Pappu Jaiswal used to win votes by distributing saris."
"Jaiswal – as in in the one involved in NRHM ghotala?"
"No, no, Jitendra Jaiswal, the liquor mafia."
A former BJP legislator and minister, Jitendra (alias Pappu Jaiswal) was a liquor baron.
“Does that mean he also distributed liquor along with sari?” I asked Ram Daman. Visibly annoyed at the question, the old man said, “Yeh koi poochne ki baat hai.”
***
“Eastern Uttar Pradesh has three prime ministers in making: Narendra Modi, Mulayam Singh and Arvind Kejriwal, but none of them has uttered a single word on encephalitis,” said Dr RN Singh, a Gorakhpur-based doctor who had been campaigning for years for a National Encephalitis Eradication programme on the lines of the anti-polio drive.
As part of his campaign, a few years ago, Singh met Rahul Gandhi who responded with great sensitivity, he claims. "The Centre sanctioned Rs 4,000 crore but then the 2012 UP elections took place. The Congress did badly in eastern UP and since then Rahul seems to have lost interest.”
In the run up to the 2012 elections, Singh took out a yatra through eastern UP, getting people to write letters to political leaders on the issue of encephalitis deaths. "I myself wrote letters in blood," Singh said. "I will write again this time."
What a waste of blood, if the people of eastern UP are voting in the way of those I met in the Epidemic Ward.
Click here to read all the stories Supriya Sharma has filed about her 2,500-km rail journey from Guwahati to Jammu to listen to India's conversations about the elections – and life.
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letters@scroll.in.
Acute Encephalitis Syndrome brings on high fever and brain inflammation and leaves a trail of mind-numbing child deaths in eastern Uttar Pradesh every monsoon.
More than 550 deaths were recorded last year. If this sounds shockingly high, the record in 2005 was worse: 1,344 deaths.
There’s only one large government hospital in the entire region to take on the chronic killer of children: Baba Raghav Das Medical College's Nehru Hospital.
From villages far and near, families arrive here with their ailing children, sleeping kits and gas stoves. The children are deposited in Epidemic Ward 12 and the parents bunk down in the fly-infested corridors outside. The lucky ones find out that the malaise gripping their child is not encephalitis, but something more ordinary: typhoid, diarrhoea, viral fever. Others end up keeping anxious vigil for days on end over an immobile child plugged into machines that keep beeping.
Careful not to disturb those critically ill, I walked into section B of the ward, where I was told by the nurse that all the children were encephalitis-free.
Two-year-old Satyam was playing with his mother. “We’ve been here for 11 days,” his mother said. “But the doctor says we can leave in three-four days.”
“Where did you take him the day he fell ill?” I asked her.
“To the store of the doctor,” she said.
"Store" is a rather appropriate term for the clinics of private doctors who charge exorbitant fees, regardless of whether they are qualified to practice.
“Is there a government health centre in your village?” I asked Satyam’s mother.
“There is…but it is no good.”
India’s public health system is decrepit in most states but UP has arguably the worst. In 2007, a report of the National Family Health Survey said that 59% of sub-centres lacked a regular water supply and 75% lacked electricity. Of the 16,283 sanctioned posts of doctors in the state, the Hindustan Times reported last year, as many as 5,500 are lying vacant, 1,400 doctors are holding administrative posts and 600 doctors are simply missing.
Even the National Rural Health Mission, the United Progressive Alliance government’s flagship health scheme launched in 2005, failed to make a dent, getting mired in massive corruption. In 2011, the Comptroller and Auditor General reported that since the start of the NRHM, Rs. 5,754 crore of the scheme’s funds remained unaccounted for in UP. Sanctioned public health centres never came up and existing centres were used to store potatoes.
Like most scams in India, UP’s NRHM racket involved high-ranking politicians and bureaucrats. The day I arrived in Gorakhpur, the newspapers reported the seizure of the property of a former Bahujan Samaj Party legislator, Ram Prasad Jaiswal, one of the accused in the NRHM Scam.
Would this affect the elections in any way, I asked Satyam’s father.
“Not really,” he said. “Politics in Gorakhpur revolves entirely around the Hindu-Muslim question. Babaji has won three times. He will win this time as well.”
Babaji or Yogi Adityanath, the current MP of Gorakhpur, is the head of a local temple and a rabble-rousing Hindutva leader.
“He has done nothing in 15 years but people still vote for him because he has managed to create an impression that if he loses, it would be an insult to Hindus,” Satyam’s father said. “If Lok Sabha polling happens on Hindu vs Muslim lines, the state assembly elections are fought on caste lines.”
Almost 30, Satyam's father called himself a student although he isn’t actually enrolled for any course. “Student” is the preferred descriptor in UP for those applying for government jobs. The family had land, but Satyam’s father did not want to work the fields. Instead, he had set up a “net ki dukkan”. Not an internet café for idle people who wasted time over Facebook, he clarified: a store with two computers available for those who wanted to download and submit forms for government jobs. He had himself applied for a job when the state government had advertised 72,000-odd teacher vacancies. But the recruitment process got stuck in litigation. “Under Mayawati,’s government, the recruitment was to take place according to TET merit.” TET is the Teacher’s Eligibility Test. “But Akhilesh government came and changed it to board exam merit. Someone went to court to challenge that…”
“What do you prefer – TET or school exam merit?”
“TET,” he said.
“Why?”
“There is rampant cheating in UP school exams. But the time I went to high school, Kalyan Singh was the chief minister. Under him, the administration was very strict. Idhar udhar nahi dekh sakte the. Only a couple of students used to clear the exams. Under Mulayam Singh, it is the exact opposite. Those who have cheated in school exams would stand to gain in the merit list.”
He sounded critical of Mulayam Singh Yadav, the leader of the Samajwadi Party, but when I asked him who he would vote for, he took no time in stating, “SP, regardless of whether it wins or loses.”
The reason for his political preference was not far to seek. It lay in his name: Bipin Kumar Yadav.
In UP, the Samajwadi Party is seen as a natural repository for Yadav votes, while the Bahujan Samaj Party, led by Mayawati, a dalit leader, is viewed as the catchment for dalit votes.
“You are young and educated. Why do you vote along caste lines?” I asked Bipin.
“Ab aapko kaise samajhaye,” he said. "Ab maan lijeye ki BSP ka log Mulayam Singh ko vote de dega to koi nahi manega diya. If BSP’s people vote for Mulayam’s party, no one would believe they did. If I vote for the BJP, the BJP won’t believe that I did.”
***
Three-year-old Sunil had virulent pneumonia. The phlegm had to be drained by a surgical cut on the right side of his chest. He was on blood transfusions and was being tended by his old grandparents. The family was from Ramnagar village in the neighbouring district of Deoria.
A fortnight ago, when Sunil had come down with high fever, they had taken him first to the public health centre, but when the doctor did not show up, they moved him to a private hospital, where within four days, they had expended Rs 10,000, to no effect.
“Rs 800 on one injection, and injections twice a day,” said Sunil’s grandmother, a frail woman who looked exhausted with the effort of taking care of a sick child.
The expenses had come down in the government hospital but they still needed to buy medicines, bandage rolls and syringes from outside.
“It's fine as long as our child recovers,” the old woman said, revealing why Sunil was so valued in the family: he was born after three daughters. The oldest is now 13 years old.
“Would you be marrying her off soon?”
“No, no,” she said. “Not for another three-four years.”
UP has the highest infant and maternal mortality rates in India. As long as girls are married young, it will be hard to bring it down.
“Who do you vote for?” I asked the old couple.
“Jisko ichcha kiya…Whoever catches one’s fancy,” said Sunil’s grandfather, Paramhans. “Although there is nothing to be gained by voting.”
“Then why do you vote?”
“Yahin to adhikaar hai public ka. Aur to koi adhikaar nahi. This is the only right available to the public. Nothing else.”
On the mention of 'adhikar', his wife got very agitated. “Jab aayi mile saamaan chal gayi. Something was sent for us, but it was passed on to other people,” she said.
Sunil had been hospitalised for the first time when he was six months old, along with a few other children of the village suspected to have encephalitis. At that time, officials had visited Sunil's neighbourhood and promised to provide a source for clean drinking water supply, since contaminated water is key to the spread of encephalitis. But the tap never materialised. Paramhans suspects the money was used by the village head, the pradhan, to sink handpumps in his compound. “He is Brahmin, you know,” he said, while they were Yadavs.
***
On the bed opposite Sunil's, a tiny six month-old baby was suckling her mother's breast. Her name was Divya. She had been admitted to the hospital with high fever, but it had turned out to be a routine viral infection.
Like others in the room, Divya's family had spent money and wasted time at the private clinics near their village before they came to the city. They were dalits and they owned no farm land. Divya’s father lived and worked in Chennai. “Paint polish karat hai,” her mother said. She had visited him once, taking a three-day train journey. Her memories of the visit revolved around the heat and the strange language.
“Do you vote for Behenji?” I asked Divya’s mother. Behenji is how Mayawati is addressed by her followers. The young woman smiled, as did her mother-in-law.
“Behenji had come to Gorakhpur some years ago," said the old woman. "I came to see her, spending my own money.”
“Your own money?”
“To phir motor bhejeli reh li. You expect her to send a motor car for us.”
“When Behenji was in the government, did you get any benefits?"
“No, nothing.”
"Rations?"
"We have a white card but we get only oil,” she said.
Meant for below-the-poverty line families, the white-coloured ration cards entitle families to subsidised wheat, rice and sugar.
“Then why do you vote for her?
Her daughter-in-law said, “Hum aap pe vishwaas karenge to sab kuch ba aur nahi vishwas karnge to kuch nahi ba. Everything rests on faith.”
***
The fourth bed in the ward was taken by a child who belonged to a more prosperous family.
“We came here yesterday as soon as Ansh fell ill. We didn’t want to waste any time,” said the child’s father, Kameshwar, who said he was a jeweller.
“Does that mean you are from the Bania community?”
“No, we are Nishads, the caste to which Jamuna Nishad belongs.”
Jamuna Nishad was a former legislator who contested and lost elections for BJP and SP, before he won on a BSP ticket, becoming a minister in the Mayawati government. In 2008, he was booked for murder, which led to his expulsion from BSP. He died in 2010. His wife was given a ticket by the SP. She is currently the MLA from a constituency in Gorakhpur district and has been fielded against Adityanath by the SP. For many of her voters she still remains “Jamuna Nishad ki aurat”.
“Who are you voting for?”
“Jamuna Nishad ki aurat. We have voted for Nishadji regardless of the party. Now we vote for his wife.”
Kamleshwar's father, Ram Daman Nishad, explained why they were so loyal: "It is best to stick with one's own family. Gaali dega, dulaar bhi karega. You get both love and abuse."
“But if Babaji is so strong here, why is she wasting her money fighting a losing battle?"
“This is not a business. It is a career. And elections are unpredictable. Don’t write off the SP. After all, the government has done so much work.”
“What work?”
“They have distributed laptops and cycles. One hundred and fifty cycles have been distributed in our village alone. Would the beneficiaries forget the favour? Pappu Jaiswal used to win votes by distributing saris."
"Jaiswal – as in in the one involved in NRHM ghotala?"
"No, no, Jitendra Jaiswal, the liquor mafia."
A former BJP legislator and minister, Jitendra (alias Pappu Jaiswal) was a liquor baron.
“Does that mean he also distributed liquor along with sari?” I asked Ram Daman. Visibly annoyed at the question, the old man said, “Yeh koi poochne ki baat hai.”
***
“Eastern Uttar Pradesh has three prime ministers in making: Narendra Modi, Mulayam Singh and Arvind Kejriwal, but none of them has uttered a single word on encephalitis,” said Dr RN Singh, a Gorakhpur-based doctor who had been campaigning for years for a National Encephalitis Eradication programme on the lines of the anti-polio drive.
As part of his campaign, a few years ago, Singh met Rahul Gandhi who responded with great sensitivity, he claims. "The Centre sanctioned Rs 4,000 crore but then the 2012 UP elections took place. The Congress did badly in eastern UP and since then Rahul seems to have lost interest.”
In the run up to the 2012 elections, Singh took out a yatra through eastern UP, getting people to write letters to political leaders on the issue of encephalitis deaths. "I myself wrote letters in blood," Singh said. "I will write again this time."
What a waste of blood, if the people of eastern UP are voting in the way of those I met in the Epidemic Ward.
Click here to read all the stories Supriya Sharma has filed about her 2,500-km rail journey from Guwahati to Jammu to listen to India's conversations about the elections – and life.