By Aniruddha Ghosal
When her 4-year-old son fell ill, racked by fever, Shampa Das immediately thought of the time when she had nearly died of malaria. Back then, nearly four decades ago, no one in her village had heard of it. While she survived, the experience made her acutely aware of the dangers that mosquitoes pose and Shampa always took precautions, ensuring her son never slept outside a mosquito net.
So she was surprised when the doctors told her that he was bitten during the day and that it wasn’t malaria he had contracted but dengue. “I had never even heard of the disease,” she said while peering to see if the queue ahead of her at the Sriram Chandra Bhanja (SCB) Medical College and Hospital had budged. It hadn’t.
Shampa is not alone. Back in 1780, the year that India had its first recorded incidence of a dengue epidemic in modern-day Chennai, the SCB medical college had existed as a small dispensary that looked to treat pilgrims suffering from, among other diseases, malaria. Since then, and before, the focus for the state has been malaria. From 2001 to 2017, a total of 3,320 people died of malaria, as per state records. That is, on average, 195 people every year — or a malaria death every two days. Sustained efforts, though, focused at specific districts and areas earlier left untouched, resulted in an 87 per cent decline in malarial deaths from 2017-18.
But increasingly that incredible success, on which India’s plans to eliminate malaria by 2027 rests, is being compounded by concerns over an overburdened health system and economic inequality in a changing climate.
Concerns about the inadequacy of Odisha’s health infrastructure is writ large upon the hospital’s sprawling campus. Crowded corridors are filled sick patients who lie in a daze, on the floor.
In 2006 a mysterious fever that was accompanied by severe headaches, unbearable muscle and joint pain and a debilitating fatigue broke out across the country, leaving doctors baffled. By the time, the National Vector Borne Disease Control Program (NVBDCP) in Odisha identified the disease as dengue in 2011, 38 people had died. Another vector-borne disease (VBD), Japanese encephalitis (JE) was recorded for the first time, and in 2013, with four positive cases, chikungunya too left its mark on the state. Today, the prevalence of chikungunya and JE is minuscule, with the latter being impacted by other factors including toxins present in fruits. But dengue is another matter, with an average of 4,200 cases each year and is fast becoming the most prominent emerging challenge for the state.
VBDs are directly impacted by myriad factors, ranging from migration to urbanisation, from trade to temperature. But increasingly, the state and its public health system are zeroing in on the link with climate change. Perhaps unsurprisingly. Knowledge of climate change in Odisha is as ubiquitous as shops selling mosquito nets. Odisha has been declared disaster-affected for 95 of the past 105 years by the Indian government. In 1998, a heat wave killed an estimated 2,200 people. From 1891-1970, the state saw 952 cyclones and 451 tornadoes. From 1963-99, the state faced 13 major disasters that killed 22,228 people.
In the midst of these ravages, however, the government is only now realizing the risks of the more ‘gradual’ changes of climate change. The challenge for Odisha, like the rest of India and in fact, the world, is to not just try and predict these impacts of climate change and design health policies accordingly but to also account for the ways in which lives are impacted, and often, lost. With dengue outbreaks in Himalayan states like Uttarakhand and Kashmir and malaria finding new ground, Odisha’s experiences are vital for the country.
In this series, News18 will focus on the state’s efforts to combat vector-borne diseases, interrogate the varying, and often surprising ways, in which climate change is impacting this fight and also look at what this means for the country, and consequently the world.
In 1953, British entomologist Michael Thomas Gillies, while researching malaria in modern-day Tanzania published a paper confirming how in warmer climates, “adult female mosquitoes digest blood faster and feed more frequently, thus increasing transmission intensity”. Sixty-four years later and 6,260 kilometers away, his research continued to inform and influence two researchers who asked the same question, albeit in a different context. What exactly does this mean for Odisha, a state with hills and dense forests, along with coastal cities?
Mithun Karmakar of the National Health Mission (NHM) in Odisha and Madan Mohan Pradhan, who at the time was with NVBDCP-Odisha, decided to look at heat waves as an indicator of climate change in a study. On analyzing the data they found that until 2002, the month of May was “characterized by a higher number of heatwave days”. But consequent years have “experienced a higher or equal number of heatwave days in ...June” — a period usually associated with the onset of the South West Monsoon. This, they argued, could be “an indicator of gradual shift of monsoon season in Odisha.” Other experts echoed this. KJ Ramesh, former director-general of the Indian Meteorological Department (IMD), who was the senior advisor to the Ministry of Earth Sciences for atmospheric sciences and climate since 2007, explained that scientists have been observing a delay in the withdrawal of monsoons since 2010. "From 2010, one sees that the length of the monsoon has become longer," he told News18.
What these studies show is that weather conditions favorable for mosquitoes to breed, bite and infect have extended to nearly half the year.