DHANGADI - August and September are encephalitis months along the Nepal-India border, and it proved no different this year. According to an official count, more than 100 people have died so far this year. Thousands more are in poorly-equipped, understaffed hospitals all along the tarai. Many more are silently suffering and dying far away from hospitals, undiagnosed and untreated.

The only thing remarkable about this year's toll of 103 deaths so far is that it is four times less than last year, though the monsoon is not over yet. We have seen from past years that the intensity of an encephalitis epidemic tends to be
determined by the intensity of the monsoon and its timing because of the ponds and puddles where the virus-carrying mosquitoes breed.

As usual, Radio Nepal and Nepal Television are repeating public health announcements through the air waves: drain puddles, stay indoors, use mosquito nets. But for many the announcements came too late. Although everyone knows that encephalitis is an annual phenomenon, the announcements only started after the epidemic had already spread.
The worst affected this year are the mid-and-far west tarai where hospitals and health posts are bursting at the seams under the pressure of patient numbers. Doctors are overworked, one hospital here had to pull a clothesline across the corridors to hang intravenous drips administered to patients scattered on the floor.

Because the disease needs close monitoring, almost an equal number of people accompanying the sick have flocked to the hospital making disease management a nightmare. "Most of the sick are very poor and weak," a doctor in Dhangadi told us. "These are the ones that die first." Older, weaker people are the most vulnerable. Children usually survive the first onslaught, but could develop neuropsychiatric complications if the infection is not treated properly
and in time. Open sewers, water logging and stagnant water on paddy fields allow mosquitoes to breed, which then transmit the disease from pigs and ducks to human beings.

Protection against mosquito bites is the most effective preventive measure. Japanese encephalitis usually starts as a flu-like illness, with fever, chills, tiredness, headache, nausea, and vomiting. Confusion and agitation can also occur in the early stage. Symptoms usually appear a week after the bite of an infected mosquito. Then there is the danger of being wrongly diagnosed because the early symptoms are common for many tropical diseases and people tend to ignore the ailment until it is too late.

It is around Dhangadi that the epidemic has hit hardest this year, and it is here where the newly freed kamaiyas (bonded labourers) are camped out in the rain after being evicted by landlords. Public health officials criticise the government for its public service announcements on radio and television that came too late and also for being unprepared to tackle an epidemic they knew would happen. Last year, the government received a donation of live SA14-14-2 vaccine from South Korea and vaccinated about 170,000 children in the tarai districts.

In Nepal, doctors say about one in ten infected patients die. But half of them suffer long-term neurological disorders because the virus invades the central nervous system, sincluding the brain and spinal cord.