Chhapra/Patna, July 17: Many lives could have been saved had the Chhapra Sadar Hospital been stocked with the antidote for organophosphorus, a chemical used as insecticide that laced the meal offered to children at a primary school in Saran yesterday.

As many as 22 children, aged between 5 and 10 years, are now confirmed dead. All the children were students of the Gandaman Primary School (Class I to V) in Saran district, 90km northwest of Patna.

It was not immediately clear how the insecticide ended up in the food. Local villagers, however, say that the container in which the edible oil had been kept contained the fatal compound and it led to the tragedy.

The school cook, Manju Devi, who has been preparing the meals for the past four months, is herself admitted at Patna Medical College and Hospital (PMCH).

Education minister P.K. Shahi said prima facie it appears that the mustard oil, which was used for cooking the food, was adulterated with organophosphorus. The minister said the mustard oil and other food items such as pulses and soyabeans supplied to the school came from the shop owned by the husband of principal Meena Kumari.

“Meena Kumari’s husband, Arjun Rai, owns the grocery shop at Dharamsati. He is a member of the Opposition party that has a strong presence in Chhapra,” Shahi said in a veiled attack on the RJD, whose chief Lalu Prasad said he did not know whose resignation to ask for, as “there was no government in the state”.

The principal, who went into hiding yesterday, has been dismissed from service, Shahi said.

The children fell ill after eating a lunch consisting of rice, pulses and a curry made of potato and soyabean provided for free at their school yesterday under the mid-day meal scheme, the world’s largest school feeding programme involving 120 million children across India.

The students had complained of a foul smell emanating from the curry and they suspected the cooking oil was spiked.

While two children died in the school itself, seven perished on their way to the Masrakh primary health centre, another seven when they were being taken from the centre to Chhapra Sadar Hospital, four on their way from the hospital to PMCH. Two children died during the course of treatment at PMCH.

Doctors at PMCH said they detected the presence of organophosphorous during clinical diagnosis of children. Even the doctors at the Chhapra hospital had guessed that organophosphorous was the cause for the mass ailment but they were helpless as the centre did not have the antidote pralidoxime, known as Pam, in its stock.

Sources said Chhapra Sadar Hospital did not have a single ampoule of Pam in its stock when the children started arriving for treatment. Sources said the hospital somehow managed 10 ampoules of the antidote around 7.30pm, a good two-and-a-half hours after the first child reported sick. By that time, eight students had died. Doctors lamented that had timely treatment been provided, the death toll would have not been this high.

“We did not have the Pam antidote in stock. In fact, we do not keep it in stock because rarely are cases of poisoning caused by organophosphor us reported,” said a senior official at the Chhapra Sadar Hospital who did not wish to be named.

“We somehow managed to get 10 ampoules of the Pam antidote after two-and-half hours of the first case being reported in our hospital. We sent officials to purchase the antidote from the market but they could not find it in the medical stores. Somehow they managed to get a few ampoules from the wholesaler,” said Dr Shaligram Vishwakarma, the medical officer at the Chhapra Sadar Hospital.

Doctors said timely intervention could have prevented the deaths.

J.P.N. Barnawal, a doctor at the paediatrics department of PMCH, said: “If a patient suffering from food poisoning caused by organophosphorous is given the Pam antidote, there is a great chance of his/her survival. In fact there is a hundred per cent chance of a patient’s survival if he/she is given the antidote on time. Organophosphorus is so toxic in nature that it can damage the entire nervous system and lead to death if treatment is not started early.”

Organophosphorus compounds are key ingredients of insecticides used to protect grains from infestation. They should not be present in food. Guidelines for the use of organophosphorus compounds demand that all food stuff and water supplies should be kept away from the area where these compounds are kept. Old containers of pesticides should be thrown away and not used after washing as they could still retain residues.

Organophosphorus poisoning can lead to nausea, vomiting, diarrhoea, abdominal pain, muscle weakness, abnormal heart rhythm, cardiovascular collapse.

Atropine, pralidoxime and benzodiazepine are standard antidotes for organophosphorus poisoning. “These antidotes should be present in most hospitals,” said B. Suresh Shetty, professor of forensic medicine at the Kasturba Medical College, Mangalore. Fatality depends on multiple factors, including the actual amount ingested by each individual. The Chhapra hospital had around 2000 atropine ampoules, but that would not have been enough to treat 50 patients.

The midday meal programme became universal in India following a Supreme Court order in 2001. In Bihar, this programme is being run through 73,000 government schools and on an average 1.6 crore students are served midday meal on a daily basis against the 2 crore children studying in government schools.

Dozens of residents took to the streets in Chhapra and Patna. Demonstrators pelted a police station with stones, set ablaze buses and other vehicles, chanted slogans denouncing the state government and burned effigies of chief minister Nitish Kumar.

Junior Union human resource development minister Jitin Prasada hinted at negligence and non-compliance of guidelines.

“It appears that guidelines have not been followed. The state governments are responsible for implementation,” Prasada said.