Brain fever debate: Health minister takes firm stance, Opposition chickens out

The Opposition UDF on Wednesday ridiculed health minister Veena George, saying she was "groping in the dark" and insisted that she open her mouth and allay the concerns of the people on the alarming rise in the deadly brain-eating amoeba cases, amoebic meningoencephalitis. They wanted the Assembly proceedings of the day to be suspended to discuss the health scare. The health minister quickly conceded the demand.

But when the minister went step by step and explained how the Health Department has been tackling the rare form of brain fever, the UDF suddenly developed cold feet. Rather than listen, ask incisive questions and offer creative solutions, Opposition Leader V D Satheesan made use of a weak excuse to stage a walkout right in the middle of the minister's speech. His excuse for the sudden walkout: The minister refused to allow N Samshudheen to respond to a remark she had made against him.

The fact is, the minister was ready with the government's response to amoebic meningoencephalitis (AME), all that the UDF had asked for. The Opposition Leader had said that the minister was "reactive and not proactive", that she had never addressed the issue publicly.

"By now, 19 deaths have been recorded. In 2023, only eight cases have been reported. In 2024, it was 80. This year, till now, 68 cases have been reported," Satheesan set the context in his speech. "What is the reason for this surge in cases? What are the symptoms? What are the preventive measures taken? Have you evolved a protocol for the treatment of the disease. What have you done to create awareness," Satheesan's posers evoked the urgency of the issue.

The minister came armed with material good enough for the lead presentation in a health seminar. "Amoeba is a microscopic organism that is found in various water bodies and very rarely causes infection in humans," George said. 

She said the amoeba came in two forms. One, primary amoebic meningoencephalitis (PAM). This, she said is caused by 'naegleria fowleri', a microscopic amoeba commonly called the "brain-eating amoeba."  Globally, she said PAM's mortality rate is near absolute, above 98 per cent. The second is granulomatous amoebic encephalitis (GAE). This, she said, is caused by many kinds of amoeba. "Acanthamoeba is one. Sappinia and Balamuthia are others," she said. Its mortality rate is 60 per cent.

After introducing the amoeba-induced brain fever, the minister spoke of the Health Department's role in tracking down the amoeba. "The first case of amoebic meningoencephalitis (AME) was reported in 2016. Meaning, it was first detected in Kerala in 2016," she said. "In the subsequent years, cases were reported in a trickle, one or two a year," she said. 

A major decision on tracking AME was taken after the Nipah outbreak in Kozhikode in 2023. At that stage, the causes of only 45-50 per cent brain fever cases were known worldwide. Studies showed India to be far more in the dark. "The causes behind only 25-30 per cent brain fever cases were known in the country. Meaning, the origin of 70 per cent brain fever cases in the country remained a mystery," the minister said. Further, studies showed that 7 per cent brain fever cases in India could be AME. This again alerted the Health Department to the urgency of testing all brain fever cases.

It was this knowledge that led to the decision taken in the backdrop of the 2023 Nipah outbreak. "It was decided to strictly report all brain fever cases. It was also decided to find the cause of these fevers," George said.

Muslim League's Kondotty MLA T V Ibrahim had a doubt. "What if someone in Kasaragod had brain fever? By the time the person's sample is tested in the only lab in Thiruvananthapuram, the person would have already succumbed to the disease," Ibrahim said.

A triumphant glee animated the minister. "This is one of the many misleading notions peddled in Kerala," George said. "The presence of amoeba in a sample can be tested in all microbiology labs in Kerala. A sample in Kasaragod can be tested in Kasaragod itself," she said. The minister said the presence of amoeba in a sample was enough to begin treatment for AME. 

She also noted that it was this meticulous recording of brain fever cases and their prompt testing in microbiology labs that led to the increase in recent cases. Higher number of cases, more than a surge in numbers, meant that the Health Department was detecting AME cases that could have been lost to obscurity and certain death from seemingly unidentified causes.

Once the amoeba has been detected and the treatment has started, comes the next stage. "We have to identify the type of amoeba that has caused the fever," George said. For this, a PCR test is required. Earlier, such a test was available only in Chandigarh and Pondicherry.  "Now, the State Health Lab in Kerala has developed the technology to do the PCR test. The Institute of Virology (in Thiruvananthapuram) also has the technology. A PCR testing facility will soon come up in Kozhikode," she said. As a result of all of this, the minister said the mortality rate of AME in Kerala was pulled down to 24 per cent. 

The Opposition Leader had earlier, quite derisively, asked whether the Health Department had evolved a protocol for the treatment of AME. George had three documents with her. One, treatment guidelines for AME, brought out in 2024. The first state in the country to develop such guidelines, she said. 

Two, Technical Guidelines on Prevention, Diagnosis and Treatment of Amoebic Meningoencephalitis in Kerala, which was also published in 2024. Again, a first for India. She said this document, based on all available scientific literature on the disease, had identified various water bodies and activities as likely sources of AME infection: activities like swimming, bathing, nasal irrigation, splashing and water sources like swimming pools, tap water, canals, ditches, puddles and aquatic sports venues. 

It was the third document that enraged the UDF. It was a Haritha Kerala Mission document on the various preventive measures, drawn up on the basis of the above two documents, and conducted in cooperation with local bodies and people's representatives across the state. She specifically mentioned the activities in Palakkad, as N Shamsudheen, who moved the adjournment motion on the issue, was Mannarkad MLA. 

After stating the number of meetings and activities in Palakkad, the minister asked Shamsudheen: "Were you not in your constituency? How come you are unaware of activities?"

Shamsudheen got up to protest, but the minister continued speaking. Infuriated, the MLA walked towards the Speaker. Pandemonium ensued, and the Opposition Leader, who just a while ago challenged the minister to talk about the measures she had taken to stall AME, walked out in protest against the refusal of the minister to let Shamsudheen speak.