Village markets are changing in Bihar — as they are in the other states #ETTG reported from. This piece looks at some of those changes — and advances hypotheses to explain these changes.
In Bhagalpur, the historic Bihar city on the southern banks of the river Ganga, doctors disagree about the threat of dengue in the area. Vijay Kumar, the civil surgeon for Bhagalpur, says dengue is under control. His statement has been flatly contradicted by doctors at Bhagalpur’s Jawaharlal Nehru Medical College and Hospital. The hospital identified its first dengue case about four or five years ago. Since then, said an administrator, the number of cases has grown. “We had 441 confirmed cases last year – almost double from the previous year.”
Bihar’s exposure to dengue is relatively recent but the state needs to start fighting the disease. Fighting dengue can be easy because there are clear measures that need to be taken. Since there is no cure and no vaccines for the disease, doctors can only treat symptoms – pain, chills, fever, nausea and vomiting, rashes and bleeding. In most cases the disease subsides but a few cases may be so severe that without hospitalisation and treatment it can lead to death. If a patient has excessive bleeding or a very low platelet count he might be given a platelet infusion.
But fighting dengue is also difficult because it requires meticulous and consistent control of the Aedes aegypti mosquitoes – the main species of mosquitoes that carry and spread the dengue virus. This can be done using anti-mosquito sprays to kill the mosquitoes that are normally active during the day. Dengue control also involves thwarting the mosquitoes from breeding, which can be done by reducing places – any stagnant water – where they can lay eggs. To ensure this, regular water supply is essential so that people stock less water. Also important is good garbage disposal.
Given the meticulous work needed to combat diseases like Dengue, how is Bihar doing? And what does its response tell us about the state?
In 2016, dengue hammered Krah. As many as 100 people living in this densely-packed, predominantly Muslim ghetto of about 1,000 families near Biharsharif contracted the disease, say residents. The scale of the outbreak was unprecedented. As Mohammad Ilyas, a young tailor who works and lives in Krah, said: “We never had such an outbreak earlier.”
The disease itself is a newcomer to the region. Krah and surrounding areas have been battered by many diseases. But many of the old diseases are in decline now, according to Dr Lakshmi Chaudhary who runs a clinic in adjacent Silao. “There were only two-three cases of jaundice last year,” he said. “Hepatitis B is even lower. We now almost never see cases of diarrhoea.”
This is the story across Bihar. Doctors, epidemiologists and people living across the state say that in the last ten years the state’s disease burden has seen three large changes. First, some infectious diseases like kala azar, measles, diphtheria, pertussis and polio that used to wreak havoc earlier are far less common now. Second, people are falling to new diseases like drug-resistant tuberculosis, dengue, chikungunya, Japanese encephalitis and arsenic poisoning. Third, some of the old infectious diseases – hepatitis A and E, malaria, pneumococcal meningitis and typhoid – are claiming more patients than before.
This, as the article says, is very different from the epidemiological transitions in other states. And gets into the reasons why. Part two, out tomorrow, will look at the state’s response to these causal factors.
One of the vehicles was still recognisable as a cycle rickshaw, despite its reinforced axle, thickened frame and motorcycle wheels. The rest were cycle carts – the kind vegetable vendors pull around in India’s streets – with motorcycle engines welded onto the frame. The open cart had been replaced by a large metal box with faded posters of the Sai Baba of Shirdi, a Muslim spiritual leader who became immensely popular with Hindus in the 19th century and is still revered today.
Each of the carts housed a shrine of Sai Baba. And yet the group, camping along the road to Pichavaram, a fishing village in coastal Tamil Nadu, were not devotees travelling around the country spreading his gospel.
A small railway station with shanties on either side. A main street running the length of the town, selling everything from household provisions to construction materials. A semi-finished temple, a few lodges and bars, and as the town ends, a series of truck-repair shops.
But come November and it whirrs to life as people arrive from the nearby countryside after harvesting the year’s sole rainfed crop. With no work in the villages for the next few months, they come to the town with their meagre belongings to catch trains to Andhra Pradesh and Tamil Nadu, where they would spend the next five or six months working in brick-kilns.
During those weeks in November, the town becomes the largest migrant labour market in western Odisha. Its guesthouses and hotels fill up as brick kiln owners called “seths” come to recruit workers, with the help of local labour contractors called “sardars”. Two trains heading to Visakhapatnam – the Korba-VSKP Link Express and the Durg-VSKP Passenger – extend their halts to make sure all the workers enter (or are loaded into) the unreserved compartments.
the persistence of this trade, despite the migrants knowing the harsh conditions which await them at the kilns, is perplexing. in this story, Scroll’s #eartotheground series tries to find answers.