By Alasdair Pal

MUZAFFARPUR, India (Reuters) – Five-year-old Soni Khatun was playing in the midday sun last week when she began to vomit and lose feeling in her hands. Her mother, a poor laborer living in rural India, borrowed money to take her to hospital.

Five hours later, Soni was dead, one of more than 100 children to die this month from Acute Encephalitis Syndrome (AES), or ‘brain fever’, in one district of eastern Bihar state.

“I still see her in my dreams,” said Sahana Khatun, Soni’s mother. “I can’t accept she is gone.”

The deaths were preventable, doctors say, if poor families had access to good food, clean water and better medical care in Muzaffarpur district, 80 km (50 miles) from the state capital Patna.

The epidemic has sparked a debate over growing inequality in India and focused attention on a free healthcare scheme for the poor – known as “Modicare” after Prime Minister Narendra Modi – eight months after it was launched.

The precise causes of AES, which killed more than 350 in Bihar in 2014, are not known, though a majority of medical professionals say it is linked to a ferocious heat-wave that has gripped Bihar for the last month.

Some studies have blamed toxins in lychees, a fruit grown in abundance in orchards around Muzaffarpur, though many families told Reuters their children had not eaten them in recent weeks.

The victims come from poor families who often suffer from malnutrition and dehydration, doctors in Muzaffarpur said.

If caught quickly, AES patients can often recover with simple rehydration treatment, doctors said, but delayed care can lead to convulsions and eventual death.

“It is a preventable disease,” said Dr. Chaitanya Kumar at the district’s Kejriwal Maternity Hospital, one of two treating young AES patients. “Glucose and providing meals to some of the poorest districts – these are not expensive things.”


India has world-class hospitals in major cities like New Delhi and Mumbai, but rural facilities like those in Muzaffarpur are overstretched, doctors say.

The 600-bed Sri Krishna Medical College Hospital in Muzaffarpur has more than 900 patients, a third of them children with AES. Ninety-three AES patients have died at the facility since the outbreak began.

Stray goats roam over rubbish and rubble on the hospital grounds. The building has frequent power cuts and the stench of urine lingers in the hallways.

The hospital evicted a group of sick inmates from a ward to accommodate the surge in AES patients, but at times there are still two or three children assigned to one bed.

“It is incredibly difficult to be a doctor in a place like this,” said Ravikant Singh, a volunteer doctor from Mumbai who was giving rehydration solutions to patients at the hospital.

Other doctors said they felt powerless.

“I can’t do anything. It is the social conditions that have to change,” said Rajkumar Goenka, secretary of the trust that operates Kejriwal hospital. “The government – state and national – has to do something,” he added.


Nearly half of all children in Muzaffarpur are underweight, and a similar number are stunted, or too short for their age, according to government data.

In Marwan, a village of thatched huts where many residents belong to one of the lowest rungs in India’s caste system, some children have swollen stomachs – a common sign of malnutrition.

Residents interviewed by Reuters said they were unaware of Ayushman Bharat, the program known as ‘Modicare’ launched in 2018 to give India’s poorest free access to private healthcare.

Nand Lal Mandhji, 61, whose four-year-old granddaughter died from AES, said the family was given a flyer about the scheme during a hospital visit in May. The family is illiterate and the program was not explained to them, he said.

“They gave us something but we didn’t understand what it meant,” he said, clutching the flyer with Modi’s image.

Eight families in Marwan with sick relatives said they had never heard of Modicare, and did not receive warnings from authorities about the dangers of AES.

“No one comes here. Not politicians, health workers, no one,” said Sahana Khatun, Soni’s mother.

($1 = 69.6350 Indian rupees)

(Reporting by Alasdair Pal, additional reporting by Sandeep Kumar in MUZAFFARPUR; Editing by Sanjeev Miglani and Darren Schuettler)