Lini Puthussery died of the Nipah virus on May 21st

WHEN the patient was admitted at the end of April, Lini Puthussery was starting her night shift. He was a young man of 26, bearded, and with his hair fashionably swept back from his forehead. His name was Mohamed Sadiq, from Changaroth panchayat. The symptoms were fever and difficulty breathing, which struck her as unusual, even then. But her job was to care for him, so she gave him fluids and paracetamol, changed his sweaty clothes and sheets, and sat up with him all night long.

She had been working seven months on contract at the Perambra Taluk hospital, in the countryside outside Kozhikode (once Calicut). The place had been upgraded from a community health centre a decade ago, but was still short of doctors and specialists. Difficult cases had to go to Kozhikode, 50km away. Not many people filled the beds, but every day 1,000 or so queued at the outpatient counter or at the pharmacy. The noisy crowd still milled there when she arrived for night shifts.

The journey from her home village of Chempanoda by bus was slow but beautiful, across fresh-flowing rivers, through groves of areca-nut and rubber trees and past wooded hills. The Western Ghats towered to the east and, in the evenings, took the light of the sun. The place was not quite paradise, because from time to time farmers gathered outside the village office to protest when their land was misclassified as protected forest and their claims to ownership were rebuffed. In 2017 a farmer hanged himself there. Yet apart from those things it was a quiet, green place, with her parents, aunts and cousins all close by.

As a daily-wage nurse, she worked flexible hours. That suited her, because she had her two small boys, five-year-old Rithul and two-year-old Sidharth, to look after. Her husband, Sajeesh, had been away for five years, working as an accountant for a small firm in Bahrain. He returned a few times a year, and they spoke every day on the phone. Many Keralans worked in the Gulf. It was more lucrative than staying at home, and meant in Lini’s case that they could afford their one-storey brick house, with a small terraced garden, looking over open pasture. They took proud pictures of themselves outside it.

The book of notes

Sajeesh had tried to get a family visa, but Lini hadn’t wanted to go unless she could get a nursing job there first. She loved her work too much. Nonetheless she kept dreaming of the Gulf as a magical place, telling Rithul all the time that if he studied well, he could go there like his father. And she would not have minded more money. In her spare time she was busy improving her knowledge, to be eligible for a permanent government nursing job. She had filled a large black hard-bound book with neatly underlined entries in English, rather than her native Malayalam, on diseases and their treatments. Her notes, however, did not seem to cover what Sadiq had.

She and her colleagues called it “the mystery disease”. In a few days he had died of it. She cried a lot, not out of fear, but because she had taken such complete care of him. The story came out slowly. Sadiq had gone to clean a disused well with his elder brother Saliah. Their parents had just bought a new house and the brothers, who also worked in the Gulf, had come back to help. The well was deep, and as they went down into it they disturbed so many bats that they gave up the job in horror.

Those bats were the clue. They had either infected the water, or had bitten and infected the mangoes that grew round it. On May 21st officials from the Health Department, the Forestry Department, the Regional Diagnostic Laboratory and the Animal Husbandry Department caught a bat for testing and sealed the well with nets. By then, Saliah and his aunt Mariumma were dead too: not of Japanese encephalitis or some strain of malaria, as the doctors kept guessing, but (it turned out) of Nipah virus, which had appeared only once before in India. It was fatal in 70% of cases.

For the virus to spread between humans, contact had to be intensive and direct. That was exactly what Lini, with her tireless nursing, had provided. On May 16th she felt feverish, but insisted to Sajeesh that she would go to work because “lots of patients are there”, as always. When she grew worse, she checked herself into a hospital in Kozhikode and asked to be quarantined. Sajeesh flew back from Bahrain to find her barely conscious. She left him a note, partly in Malayalam and partly in English, which he folded away inside the cover of his phone.

Sajeeshetta, am almost on the way. I don’t think I will be able to see you again. Sorry. Please take good care of our children. Poor Kunju [Sidharth], please take him to the Gulf with you. Don’t stay single like our father. Plz. With lots of love, Umma

By the end of May the outbreak was not yet contained. At the hospital in Perambra, Lini’s colleagues now wore protective coats, gloves and masks. Their patients, however, had fled from the waiting rooms and even from their beds. In Changaroth panchayat half the houses were left empty. On social media, rumours still swirled. Nipah had not spread from bats. It had come in with migrants. Perhaps—some said—it had even come in from Lini’s wonderland of possibility and opportunity, across the Arabian Sea.