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Encephalitis has claimed 152 lives in Bihar. It is extremely distressing that such a large number of children have ‘succumbed to the disease’. Equally worrying is the fact that the physicians themselves are reported to be equivocal in many cases about whether encephalitis is behind the mass mortality. Muzaffarpur district is the worst affected and it has been witness to such outbreaks since 1995. But this year the outbreak has been more severe than in the past. The government in power is definitely to be blamed for the situation, particularly as the said district was known to be prone to the disease. The government cannot deny that the deaths are being caused by encephalitis given that it has not initiated adequate measures to prevent occurrence of the disease in the area. The healthcare system in Bihar is in disarray and the rot showed even as the state was grappling with the outbreak. It has been reported that a portion of the roof outside the paediatric intensive care unit of Shri Krishna Medical College and Hospital of Muzaffarpur, one of the institutions providing care to children affected by the disease, collapsed, although it did not cause any harm to life. Infrastructure aside, it is also hazy whether the hospitals in the centre of crisis are even adequately equipped to offer care for the patients. In any case the mortality caused by encephalitis, the main suspect in this case, can be controlled more by preventive care rather than in hospitals. The fact that healthcare workers were unable to conduct an awareness drive of the scale carried out in previous years as they were assigned election duties in the same period is said to be one reason for a slack awareness campaign. India is yet to awaken to the vital role that preventive care can play in better health of its people. The focus of healthcare needs to shift from creating and developing institutions offering primary, secondary and tertiary healthcare to the grass roots level. Preventive care will have to be given a prominent role in ensuring health of people. Simple things such as ensuring cleanliness at the local level and preventing accumulation of garbage can do wonders to health of communities. No doubt the onus of such a state cannot be laid at the doors of the healthcare system alone. The system can reach localities only to a certain extent. It will take consistent efforts on the part of people themselves to prevent diseases. And for people to take care of cleanliness and hygiene in their surroundings, education and economy play a major role. Unless people are freed of poverty and have adequate means to worry about matters above and beyond three square meals a day, basic healthcare cannot be achieved. It would be illogical to expect a labourer living in, say, a thickly populated shantytown just to be close enough to work and workplace to worry about the environs s/he lives in. The pressure of earning a living draws people to urban centers and their temporary settlements lead to the creation of unhealthy spaces. Health cannot be achieved merely by developing hospitals and appointing physicians. It will take a comprehensive approach that takes care to avoid creation of unhealthy spaces in the first place. Synchronised action by multiple agencies, especially in matters such as birth control, in which ministries and departments will be required to participate is needed to make India healthy. Going by the rate of increase in population in the country today, it is the most daunting task for which no government seems to have the will or inclination to pursue with vigour.
