Mumbai’s Dharavi Exercise - The Road Map Towards Hope
Flattening the curve
Common sense, compassion, coordination and critical care have become the core around which Mumbai’s Dharavi area has been able to bring the rising numbers of coronavirus cases under control.
Although not yet out of the woods, the triumvirate of testing, tracing and quarantining as part of the three-pronged approach adopted by the Maharashtra government in conjunction with the Brihanmumbai Municipal Corporation (BMC) have shown that there is a way to buck the trend, if not flatten the curve altogether.
In one of the most affected cities in the country – Mumbai, where the coronavirus case count stands at over 55,000, Mumbai’s Dharavi area, also infamously dubbed as Asia’s largest slum, has provided a ray of hope and a story of what can be done even in a seemingly impossible situation when many helping hands are joined in unity towards collective effort.
Although Dharavi had its first coronavirus related death on the 1st of April, that of a fifty-six year old man, and the cases rising steadily, as the migrant crisis was becoming the lead story, Maharashtra government led by Shiv Sena’s Uddhav Thackeray joined in collusion with the BMC to launch what has been described by both, Thackeray and Kiran Dighavkar, assistant municipal commissioner of G-North ward that includes Dharavi, as a policy to “chase the virus” rather than wait for the virus to knock on the door and then have a domino effect by chalking up numbers rapidly.
Identifying Dharavi’s million strong population as the most vulnerable and most in need of proactive action, the largest unorganized underbelly of the city’s commercial activity became arguably the world’s greatest experiment and exercise in stemming the spread of the pandemic at an alarming rate. If the Dharavi narrative has emerged as a heartrending story, it is not only because of the bucking trend as far as numbers go towards flattening the curve but also, of the manner in which the systematic dismantling of the pandemic was undertaken in a coordinated effort.
While the city’s growth rate currently stands at 3 per cent per day and in some parts of the city at 5 percent, Dharavi has shown a remarkable 1.57 percent. Furthermore, the per day cases on average has dropped from nearly fifty in April to less than 30 at the end of May. (In Mumbai the government has reportedly been testing a steady 4,000 samples per day from May 1 to June 9.) With over fifty percent recovery rate, Dharavi is suddenly now far from April’s picture of dismaying, decayed hope despite the high propensity of numbers rising rapidly in the high density area.
The largest unorganized workforce boasting of a turnover of nearly one billion dollars and housing at least 5,000 small scale industries and over 15,000 in house one-room businesses, Dharavi is emerging as a victory story in a case where as Kiran Dighavkar, admitted, social distancing and lockdown have no existing value. As he reiterated to the media several times, Dighavkar stated, “Our aggressive testing and screening of people through fever clinics helped in tackling the challenge.” Calling it an experiment that many thought would fail, surprise is the word he used to describe this welcome outcome.
Huddled together in a high density area, with as many as ten people occupying a 100 sq. foot space, Dharavi is home to India’s large tannery business and one of the leading exporters of leather products including handbags and jackets, wholesale shops lining the haphazard makeshift streets.
Simultaneously it is home to the lakhs of migrant workers travelling from places as far as Uttar Pradesh and neighbouring Gujarat and dabbling in the lanes of kumbharwadi – selling pottery and gardening and kitchen earthenware – and waste and plastic waste management which account for as much as sixty percent of the city waste.
Social distancing norms in a lockdown are hard to maintain in such a transfixed, underprivileged, impoverished slum zone where the basic necessities of life including clean drinking water, proper sanitation facilities (as many as seventy to eighty people are known to use a single toilet), inexpensive medical aid, proper drainage and adequate sewage facilities (witnessing chronic flooding during the monsoons when the nearby Mithi river overflows) are hard to come by.
Yet, once the area was identified as a possible hotspot since it is also home to domestic help, drivers and other workers as part of the large labourer force, the BMC sprung into action in this G North ward area of Mumbai through preemptive, preliminary door-to-door testing, contact tracing and also, isolation facilities. Prone to high mortality rates stemming from the fast spread of virulent diseases such as dysentery, cholera and influenza, Dharavi was able to beat the curve and stem the rot to a great extent largely because of these measures.
But the Maharashtra government and the BMC had to rope in additional help in order to undertake this mammoth assignment whose outcome is yet to be fully assessed as the ICMR has revised the possible peak of the pandemic in the country from mid-July to November recently.
Several hundred volunteers were brought together with the local medical practitioners numbering more than 300, setting up over 100 fever clinics where the people were asked to voluntarily get themselves checked after the preliminary door to door check.
Simultaneously while the initial close contact isolation was limited to less than five members, the increase to about fifteen and the quarantine and isolation wards in the converted Rajiv Gandhi sports complex and Mahim nature Park have allowed the organizers to identify, isolate and treat patients in the early stages of the disease and therefore, negate the death rate.
The massive screening and testing – over 50,000 people were tested on a door-to-door basis initially and nearly five lakh overall in this 8.5 lakh area alone - was not without its challenges. Doctors of the Indian Medical Association and the Mahim Dharavi Medical Practitioners’ Association adopted tests such as fever testing and oximeter usage and testing in the absence of enough equipment to check oxygen saturation levels, which is one of the key indicators in detecting the virus.
Traditionally built on what was a swamp in 1896, Dharavi’s propensity to suffer an epidemic has been always a high risk, whether it was the plague in 1897 or an outbreak of cholera in 1986. Therefore, roping in doctors on a voluntary basis, providing them with free PPE kits and arming the volunteers to undertake the critical but dangerous job about educating and orienting the people while also, providing them basic essentials of grains and common vegetables of tomatoes, onions and potatoes, the scale has dramatically been brought down.
Furthermore, the undertaking of repeated disinfection of homes, shops, workshops and factories in the area and sanitation work to the point of cleaning the public toilets up to three or four times a day has helped maintain a level of civilized living not previously seen as the Maharashtra government has contemplated an estimated 26,000 crore rupee makeover of the slum community. Where these measures have been the need of the hour for over a decade but not implemented on a war footing, the tactics adopted to ensure that the most marginalized and vulnerable section of the population do not buckle under the pandemic are now being considered as action finally being taken to ensure a reasonably decent quality of life as possible for the many lakhs of people who make up the financial currency of the city and the nation.
Although Dharavi enjoyed a rare coronavirus-related casualty-free week between the 30th of May and 8th of June, the sobering moment came as the deaths were being registered once more. As grim as the reality may be, the heartrending numbers and the collaborative efforts have provided a heartwarming story and also, a possible road map of first steps for other cities in the country and around the world with vulnerable populations towards their social and economic upliftment and wellbeing.
That it took a pandemic for such a gargantuan pulling together of forces might seem unfortunate. As Dighavkar pointed out, the pandemic is yet to be pushed out of the city and the country.
Indeed, the job is far from over. But the silver lining is in the pragmatic, proactive and practical lessons to take away as the doctors and the sanitization workers put on their masks and go back to work once again tomorrow in one of the densest, challenging, and most susceptible areas of the nation’s financial capital.