A female student’s death in Punjabi University lifts the fog on respiratory pandemic in North India

Undiagnosed chronic respiratory illnesses were responsible for 1.8 lakh deaths in India in 2022, higher than Covid deaths in the same year.

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"I hate Patiala now. I want my son to go out and study like his sister. To Ludhiana, to Chandigarh, or to Moga, but not to Patiala," says Jurmeet, mother of a 20-year-old language student at Punjabi University, Patiala.

Her daughter, Jashandeep, passed away on the night of September 14 at 2.15 a.m. in their village Chauke (Bathinda), while Jurmeet was sleeping beside her. The family cremated the body the next morning.

Jashandeep's death was sudden for them. But her death followed a long history of prolonged respiratory difficulties, which she developed during the five-year languages course at Punjabi University, Patiala in 2021.

That year, she dropped out of college because of poor health. In 2023, she re-enrolled and maintained her attendance by sometimes wearing a mask to the classroom, taking regular multivitamins and relying on her village doctor.

Her hostel roommate, Prabjoot, told me that a night before Jashdeep died in her village, she coughed heavily in the hostel room. Recalling her first meeting with Jashan, her friend Meenakshi said that she struggled to bring her luggage from the university main gate to her hostel room on the second floor. She was wheezing, and was breathless on her first day of college.

In the absence of a post mortem report and any past medical record with Jashan's family, or with the university, it is impossible to detect the cause of her death on the night of September 14.

Her friends and family report 'prolonged wheezing and bad coughing' which was never diagnosed or treated.

Popularly characterised as 'asthma' inside campus, respiratory difficulties in children and young adults remain unattended.

In 2022, European Respiratory Journal analysed data from International Study of Asthma and Allergies in Childhood (ISAAC); Global Asthma Network (GAN); National Family Health Survey (NFHS), 2006; All India Institute of Medical Sciences (AIIMS), Delhi; and from many Indian cities like Chandigarh on the prevalence of undiagnosed 'wheezing'.

"Almost 82 percent of current wheezers and 70 percent of subjects with symptoms of severe asthma were not clinically diagnosed as having asthma by a doctor… Only 23 percent of asthmatic patients call their disease 'asthma' while the rest use terminology like swas, dama or cold and cough," the report concluded.

Lack of awareness, illiteracy, social stigma, inadequately equipped medical institutions, fear of inhaler addiction or ignorance are the usual causes for young patients to keep their respiratory illness undiagnosed or undertreated.

For students coming from rural areas, who are often unable to define their respiratory ailments, undiagnosed respiratory illnesses lead to school or college absenteeism.

This is often misunderstood as lack of interest in studies by peers and teachers. "For a young asthmatic girl, fear of problems in her marriage also makes families keep respiratory illnesses a secret," says Harpreet Kaur, senior warden of Amrita Shergill Hostel, where Jashan stayed.

The Global Burden of Disease Report (2019) by Lancet highlighted that while India accounts for only 12.9 percent of global asthma burden, it accounts for 42 percent of all global asthma deaths, the highest in any country.

This translates into roughly 24.3 million undiagnosed chronic respiratory patients and 1.8 lakh deaths in 2022. In the same year, respiratory disease death count surpassed even Covid death count (viz. 1.6 lakh).

"'Diseases of the respiratory system' is the second-most leading cause, responsible for 10 percent of medically certified deaths," the Medical Certificate of Cause of Death (MCCD) 2022 reports.

Students conceal respiratory illness from university authorities

When Jashan first enrolled in 2021, she could not avail the hostel and had to live as a paying guest outside the campus. In 2023 she rejoined college, and did not provide any information about her poor respiratory health.

Her admission form, asking for records of any chronic illness, and her hostel declaration form, asking for any neurological illnesses, were both devoid of any information on her ailment. The warden at Amrita Shergill Hostel, where Jashan stayed for one-and-a-half months, had no information about her respiratory difficulties.

Jashan is not the only student who hid her chronic respiratory illness. A female PhD student enrolled in the same languages department Jashan was part of, is in possession of medical records of her being asthmatic but has not disclosed it to the university.

Dalbeer (name changed) has been a long-time student of the university and has kept her medical records hidden to avail hostel facilities like her peers. Many hosteliers, like Dalbeer, fear losing their hostel if they report about their chronic illnesses.

She says, "We should mobilise against the dampness and peeling off paints of the hostel walls. Some people like me have episodes of aggressive respiratory irritation after shifting inside the hostel. While other colleagues have developed such difficulties afresh."

Dr Aparjot a pulmonologist at Park Hospital, Patiala spoke of the increasing bronchial asthma in school going children and young adults.

"Bronchial asthma in children usually occurs because of genetics. However, now, young patients are developing the disease because of environmental allergens like algae, suspended matter in the atmosphere and pollution. Patient count usually aggravates during November."

Dr Charanjit, who runs a small clinic at Chauke, also notes an increase in patient count with difficulty in breathing during November.

But he says that what most patients face is "only seasonal coughing that is cured by cough syrups". This is one of the clinics frequented by almost the entire family of Jashandeep.

The parali season

Chauke is a village in Bathinda district and is surrounded by paddy and cotton farms. Jashan's father, Harcharan Singh, owns two small plots on which he grows rice.

Paddy requires four months to grow. Before the 1980s, farmers in Punjab used to sow seeds in mid-May and would harvest it in mid-September. They used to have two months to clear the paddy stubble and sow for the next cycle in mid-November.

Much changed with the Punjab Prevention of Subsoil Water Act, 2006. The Act only allowed farmers to sow seeds in mid-June to match the seasonal rains and conserve Punjab's depleting groundwater.

The paddy season that used to be between mid-May to mid-September has now changed to mid-June to mid-October. Farmers are left with only 15 days to quickly get rid of stubble and sow paddy again in mid-November.

In spite of stubble burning being banned by Punjab Pollution Control Board, it is still widely used as a hassle-free, cost-effective and quick method to deal with leftover stubble, often informally encouraged by farmers as the only option.

Thick smoke from farms blankets Punjab and areas around it in November, increasing chances of respiratory problems even more.

Who bore the cost of Jashan's undiagnosed death?

Soon after Jashan's cremation on September 14, her uncle, Sukhwinder, informed the family that local media and YouTube influencers have started to report Jashandeep's death.

The news spoke of students of Punjabi University gathering in front of the vice-chancellor's office to protest against the behaviour of a Punjabi language professor, Dr Surjeet Singh.

According to the students, the professor's intemperate and harsh behaviour caused Jashandeep's death. The students were mobilised by student groups like Secular Youth Federation of India (SYFI) and Shiromani Akali Dal's Student Organisation of India (SOI) and were informed of Jashan's undiagnosed death via fake Whatsapp messages that alleged, among other things, her 'suicide'.

The protesting student crowd turned violent and physically assaulted professor Surjeet till he started to bleed from the head. The assault went on for 30 minutes. Some of the professor's students pulled him out of the agitated crowd and he was immediately rushed to Park Hospital in Patiala.

The cost of not holding any substantial medical record of an evident chronic respiratory disorder for Jashan's family is to rely on information from students.

A month later, an enquiry committee consisting of retired session's judge Jaswinder Singh and Dr Harshinder Kaur announced no actual connection between Jashan's death and Prof. Surjeet's behaviour. That being said, he is yet to walk back to his classes without fear and hesitation.

Battle against undiagnosed and undertreated asthma 

"I think Jashandeep's health would have been taken for granted by the university and her parents and fellow students because she was a female student. In Punjab, women's health is secondary to the health of a male student, who is supposed to support the family in future," said Jagtar, whose PhD flat is next to the university dispensary.

On being asked about the ways to increase diagnosis and enhance medical aid to university students with chronic respiratory difficulties, Dr Aparjot said, "Asthma, or any respiratory disease, can be best treated during the early stages. Regular medical camps in universities and basic spirometry tests in dispensaries can reduce the losses suffered because of lack of awareness amongst patients substantially."