In the last week of July, 150 people streamed into the district hospital at Churachandpur in Manipur. They had come from four remote villages in Henglep block about 80 km away and the journey had taken them more than a day. They had walked, waded through water and covered the last stretch in Shaktimaan trucks.

Henglep has a population of about 31,000. Since the beginning of July, more than 300 of these residents suffered symptoms of fever, diarrhoea, headache, nausea, vomiting and muscle pain. In non-hilly areas of Churachandpur district itself, 67 people had tested positive for dengue and 42 for Japanese encephalitis. Some people tested positive for both infections. District authorities say that despite the large number of people who have fallen ill, there have been no deaths in Henglep. Only on fatality was recorded in Churachandpur district in July.

Henglep has only one primary health centre. There are a few sub-centres run by auxiliary nurse and midwives whose primary role is to administer vaccinations and help in uncomplicated childbirth. The only doctor, an Ayurveda practitioner running the primary health centre, was transferred to Imphal on June 2. There has been no doctor there since.

Medical teams from the district administration went to this block three times in July, often with great difficulty since the villages cannot be reached by road.

A jeep with doctors and health workers gets stuck on the road to Henglep. (Photo: John Baite)

To reach these villages from Churachandpur, the doctors had to travel 47 km up the National Highway 2 in cars or trucks, then 35 km up the Henglep Road and then walk long distances after the motorable road ends. All year, the soil is moist here. But no ordinary vehicles dares to venture out on the Henglep Road during the monsoon as unabated rain this year has made the road slick with mud and overgrown with vegetation. The Leimata river that flows in the area and between the affected villages is in full spate during the rains.

Doctors and health workers make their way to villages in Henglep block on foot. (Photo: John Baite)

Feverish July

By mid-June, the block coordinator first informed the district health department about a fever outbreak in Hingkom village. On June 22, a medical team including an epidemiologist, doctors and nurses went to the village. Thirty one patients who complained of upper respiratory tract infections, fever, indigestion and diarrhoea were examined.

On July 2, there was a similar outbreak affecting 61 people was reported in Pansang village. Two tested positive for dengue, and two for Japanese encephalitis. On July 10, 131 patients complaining of acute gastroenteritis, loose motions, nausea, fever, cough and headache were examined in Santing L village. Eight cases were positive for dengue and five for Japanese encephalitis.

On July 11, two remote villages Najang and Dungmol, nearly 110 kms away reported fever outbreaks. Doctors, nurses, paramedical staff, and an epidemiologist was sent on a jeep and a Bolero. The car could drive only about 30-40 kms. The road then had to be cleared by bulldozers. “We walked for more than four-five hours to reach the villages,” said John Baite, the district epidemiologist.

The team examined 164 patients. They tested some residents for dengue and they were all negative. They also conducted a rapid blood test for malaria, of which all the samples were negative.

A doctor examines children with fever. (Photo: John Baite)

No further testing could be done to check the causes of infection in those who did not test positive for any specific disease simply because the villages are so remote. To have blood samples tested, the team would have to get the samples back to a laboratory on the same day and that was not possible. Samples cannot be kept sterile on ice packs for longer.

The medical teams treated the patients assuming that they might have dengue or Japanese encephalitis.

“If there are some positive [Japanese encephalitis or dengue] cases and there are others with similar symptoms, there is a probability that the others were also infected with the disease,” said Dr PK Sen, director of National Vector Borne Disease Control Programme.

There is no specific cure for either disease and treatment consists of managing symptoms until a patient recovers. Patients in the Henglep villages were given basic treatment with paracetamol, oral rehydration solution packets and basic antibiotics.

The patients’ journey

Despite the treatment, the outbreak did not abate and patients from Najang and Dungmol villages needed to be transported to the district hospital. The only vehicle that can navigate roads in the area are modified versions of Shaktimaan trucks used by the Indian Army. Some older trucks were auctioned by the Army to civilians in the area, who lent them to district’s health authorities during the outbreak.

On the evening of July 27, the first Shaktimaan truck with 40 people reached the hospital. On July 29, 85 more people came to the hospital and 25 more on the following day. Most of them were from Najang village, some from Hengleng subdivision, F Khonomnun and Thingijang.

Many of the patients were children, who had to be carried for the first eight kilometres on foot. Many patients arrived dehydrated from the long journey.

“We have no choice but to take the journey to be able to receive our treatment” said Lunkhojang, the chief of Najang village, who had come to the hospital with fever and other symptoms. “Adults who could walk joined us but the weaker ones had to be left behind as we could not carry them like the children.”

“The same people we have examined 10 days ago came back to the district hospital,” said Baite.

Patients getting out of trucks at the Churachandpur district hospital. (Photo: Sianthuam Guite)

The 150-bed Churachandpur district hospital had space for only 29 patients from Henglep. The district administration moved the rest to the nearby youth hostel.

Meanwhile, on August 1, the state government sent another medical team of three doctors and 10 health workers to the Henglep subdivisional headquarters. Another team of specialists and paramedics from Imphal were sent for a medical camp at Churachandpur town.

In Santing, state epidemiologist Sasheekumar Mangang found that some patients tested positive for dengue as well as Japanese encephalitis. One woman had dengue, Japanese encephalitis and malaria.

Mangang said that poor living conditions and poverty had made residents more vulnerable to the disease. Most sleep without mosquito nets in villages where lack of sanitation allows water to accumulate forming mosquito breeding sites. Most residents do not take precautions against mosquito bites during the day either.

Patients from Henglep at the Churachandpur district hospital. (Photo: Sianthuam Guite)

In the beginning of August, the district administration finally sent teams to spray mosquito repellants in the villages where residents tested positive for dengue and Japanese encephalitis.

Even as the district administration struggled to get the fever outbreak under control, state authorities started distributing the homoeopathy medicines to affected patients. The Imphal division of the Central Council of Homeopathy, which is the country’s scientific body for homeopathy, have givem 74,600 people in Churachandpur Belladonna 200 and 64,520 people were given Eupatorium perfoliatum. About 2.31 lakh people in the state have been given these homoeopathy formulas as prevention even though homoeopathy has never been tested and proven effective against Japanese encephalitis.

Sianthuam Guite is a journalist with the Sangai Express.