Coronavirus outbreak: In Mumbai, an uphill battle called Dharavi

Mumbai’s overworked public health officials face a new challenge this week: Dharavi. After a 56-year-old garment shop owner living in India’s largest, most-densely

Mumbai’s overworked public health officials face a new challenge this week: Dharavi. After a 56-year-old garment shop owner living in India’s largest, most-densely populated slum succumbed to Covid-19 on April 1, two teams of 50 officers and volunteers landed up in the area to spread awareness about Sars-Cov-2, the virus responsible for the global pandemic, and to quarantine 70 high-risk residents of an eight-building Slum Rehabilitation Authority complex in which the victim stayed. The locality also has 91 shops. All of them have been ordered shut, even those selling essential supplies. The next day, an additional 2,500 persons were home-quarantined, and will probably be tested for exposure to the virus.

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On Thursday morning, just as the two teams and an additional army of 800 community health volunteers were getting ready for another busy day at Dharavi, a second case emerged – a municipal conservancy worker from south Mumbai who was assigned the area, tested positive for Sars-Cov-2. Twenty of his friends and co-workers had to be quarantined.

Neither the garment shop owner nor the conservancy worker has a travel history, according to information released by the city’s health department. “It is going to be an uphill task identifying asymptomatic patients in an area that has more than 8.5 lakh people,” says Kiran Dighavkar, assistant commissioner, BMC, and the officer is in charge of the city’s G-North ward where Dharavi is situated.

It is not just about Dharavi’s population. Its inhabitants live in some of the most cramped spaces in the country. In an area measuring 2.1 sq km, the slum has over 57,000 shanties, huts and small flats, almost all of them illegal. Its estimated population density – 66,000 people per square kilometre – is more than double that of Mumbai (32,303 people per square kilometre), the fifth most-densely populated city in the world, according to a United Nations Population Prospects study released in July 2019. Mumbai is also the worst Covid-19-affected city in India, with 235 positive cases and at least 17 deaths on April 2. With private laboratories also testing for Covid-19, state health officials say this number will only rise.

Mumbai’s – and Dharavi’s – population numbers make social distancing – one of the key preventive measures recommended by the World Health Organisation (WHO) – almost impossible to sustain. “It is almost certain that the cases will spike in Dharavi due to overpopulation,” says Baburao Mane, a former state legislator from Dharavi. “There are, on average, 10-12 people living in thousands of 250 sq ft huts. As summer approaches and the temperature soars, it will be almost impossible to prevent home-quarantined people from coming out of their cramped spaces.”

For Dharavi, therefore, BMC has a special plan in place. It has created two teams of 25 people each that work round the clock in two shifts. These teams include a sanitary inspector, medical officers, police personnel and community volunteers. In addition, the ward officer has got on board 800 community health volunteers whose primary responsibility will be to trace vulnerable residents such as senior citizens, patients with respiratory ailments and pregnant women.

“I have sought permission to convert the Rajiv Gandhi District Sports club in a quarantine facility with 300 beds,” says Dighavkar. “Once approved, we will shift high-risk people.”

He says the primary concern for health officers is cooperation. “People in slums don’t cooperate. The statements given by the dead man’s wife and children have confused us. We are unable to trace his contacts. We don’t even know if he had visited his shop during the lockdown. Despite symptoms, has he roamed around the slum? The family can’t confirm this activity, and we don’t know how many people he may have infected.”

Sanitation and water supply are other issues here. In line with WHO recommendations, the Maharashtra state health department too has advocated regular hand-washing with water and soap to avoid any possible transmission of Sars-Cov-2. In Dharavi, this is a distant dream. Neena More, a local social activist, says the slum averages one toilet per 500 people (official figures peg the number at one toilet per 1440 people), and most residents use the nearby Mahim creek for urination and defecation. “Every morning, people stand in long queues to use the toilets making them susceptible to the infection,” she says.

And then, there is economic desperation. Almost every family in Dharavi faces the prospect of spending more than two months without wages on account of the nationwide lockdown and shutting of private business establishments. Shibani Salvi, a 26-year-old mother of two lost her last source of income in the third week of March. Prior to the lockdown, she earned Rs 20,000 a month working as a domestic help in five flats in the neighbourhood. “Now,” she says, “I cannot even go out of my house to collect my salary even though one of my employers called me. We have enough food to last only three more days. I don’t have money to buy even masks or sanitisers for my family.” One of Salvi’s employers is Divya Dhar, a 36-year-old designer who stays with her mother and two-year-old daughter at the affluent Shivaji Park. Even after the lockdown began, she would drive to Dharavi to fetch her domestic help and cook to help her concentrate on being a single working mother. From Wednesday – the day the news broke about the first Covid-19 fatality in Dharavi – Dhar has stopped the practice. “I can’t risk my daughter who is already an asthma patient. I will get tested. Until then, I have locked myself in a room,” Dhar says.

Drinking water is another of Dharavi’s challenges. Qamruddin Sheikh, who runs an NGO named Bal Vikas Shikshan Sanstha the area, says that in an area that has scant drinking water, it is impractical to think they will keep washing their hands. “People are using handkerchiefs and cotton masks, both of which are of no use to stop the virus transmission. BMC should provide quarantined people with proper masks and hand sanitisers,” he says.

Dighavkar says the primary challenge for health officers will be tracing the people who were in close contact with infected patients. One health officer HT spoke to said on the condition of anonymity, “Many of the shops in Dharavi are illegal, and people do not share information openly. Getting accurate information here is the work of a full-time detective.”

According to the ward officer, BMC has been providing rice, wheat and dal to those in home quarantine, but residents HT spoke to, said the ration does not include essentials such as oil and vegetables. Besides, he says, there is little awareness.

Sagar Kamble, a Dharavi resident, says, “Almost 80% of the slumdwellers here are uneducated and do not understand the gravity of the situation. Only a few gated colonies in the area have locked their premises; the rest of the population is roaming around freely.” Mane says this is the main reason he has been asking for compulsory screening of all of Dharavi’s residents. “BMC needs to screen all the locals and if needed, send them back to their respective villages using available public transport. There is no other way to enforce social distancing or to contain the virus.”

But this is not possible, says BMC. The city’s health officers have overruled the possibility of running universal tests in Dharavi. “There are just not enough test kits,” says a health officer. “There is a shortage of masks and sanitisers in the slum, so with the help of NGOs and philanthropists, we are trying to procure protective masks for quarantined people.” He adds, “There is also large-scale ignorance. When our volunteers counsel on the importance of sanitation and social distancing, many from the Muslim community respond by saying their immunity is high as they eat meat. It’s not going to be easy at all.”