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Coronavirus in Dharavi | When a virus finds space in India’s largest slum

Private doctors in association with the BMC health department conduct door-to-door thermal screening in Mukund Nagar, Dharavi.

Private doctors in association with the BMC health department conduct door-to-door thermal screening in Mukund Nagar, Dharavi.   | Photo Credit: Prashant Nakwe

Packed settlements and common toilets make physical distancing an impossibility in Dharavi. Jyoti Shelar and Ajeet Mahale report on the efforts to stop COVID-19 from spreading in a 2.5-sq km area that has recorded more than 800 cases and 25 deaths

While the roads in India have remained largely empty since Prime Minister Narendra Modi imposed a nationwide lockdown on March 24 to contain the spread of the novel coronavirus, Dharavi in Mumbai stands in stark contrast. Dharavi is many things: Asia’s largest slum, one of the most densely populated areas in the world (with 3.6 lakh people per sq. km) and, now, also a containment zone. Driving through its narrow lanes, chock-a-block with settlements and thronging with people, it is evident that the one necessary norm to prevent the spread of COVID-19, physical distancing, is practically impossible here.

On March 18, a 68-year-old domestic help living in a congested slum pocket in Mumbai’s central suburb of Ghatkopar tested positive for COVID-19. The previous day, her U.S.-returned employer was found to be infected. At the time, there didn’t seem much to worry about. Mumbai had merely eight cases, all of them with a travel history abroad, barring this senior citizen.

Coronavirus | Dharavi emerges as COVID-19 hotspot

But things changed on April 1. It was on that day that Dharavi recorded its first positive case of COVID-19. The index patient was a 56-year-old garment unit owner. He had mild cough and fever. After consulting a local doctor, and when his symptoms worsened, he was admitted to the civic-run Sion Hospital. His throat swab was sent for testing and it returned COVID-19-positive. By the time the civic officials were informed and they could reach him to investigate his contact history, the garment unit owner succumbed to the disease on the evening of April 1. The resident of Dr Baliga Nagar Housing Society, one of the oldest clusters of buildings in Dharavi’s Jasmine Mill Road, had a simple routine. “Going by what his wife and two sons told us, he would go to his garment shop and to a nearby mosque to offer prayers everyday. So, we began our contact-tracing exercise as per that information,” said Kiran Dighavkar, assistant commissioner of G-North Ward, which includes Dharavi. Dighavkar said the entire housing society was sealed the same day the patient died.

It was during contact tracing that one of the locals passed on an important tip to the civic officials. He told them that the garment unit owner had another house nearby, where he had hosted some people a couple of weeks ago. “When we questioned the family about the other house, they got angry. We eventually had to take the help of the police. They investigated this further,” said Dighavkar. The police found that the garment unit owner had hosted five couples in his vacant house. All his visitors had attended the Tablighi Jamaat congregation in Delhi in March, India’s first big cluster of COVID-19 cases. “He took care of their food and other requirements. While the women slept in the house, the men would step out at night and sleep in the nearby mosque,” Dighavkar said.

The visitors had arrived on March 18 and stayed for five days before taking a flight back home to Kerala. But during their time at Dharavi, they had come in contact with 75 people, including the garment unit owner. Each one of them was isolated, in an attempt to break the chain of infection. But there was little reason to heave a sigh of relief. By this time, the number of cases in Mumbai had gone up to 181. The virus had quickly entered many other densely populated slums sprawled across the financial capital, making contact-tracing a nightmarish exercise.

Coronavirus in Dharavi | When a virus finds space in India’s largest slum

 

Alarm bells

A surgeon working in Wockhardt Hospital, which had reported many infections among its healthcare workers, was Dharavi’s second case. The doctor, who lived in Dharavi’s Vaibhav Apartment, got tested and admitted himself to the nearby SL Raheja Hospital after he suspected that he had contracted the virus. He then informed the civic officials that he had tested positive. The officials traced his contacts, isolated them and sealed his residential building. The doctor’s wife also tested positive later.

Meanwhile, a 30-year-old woman from Dr Baliga Nagar Housing Society also tested positive. “This case was again linked to the Tablighi Jamaat congregation. The visitors hosted by the Dharavi’s index patient had attended a birthday celebration in this woman’s house,” said Dighavkar.

Coronavirus | Dharavi victim likely met Jamaat members

But the real alarm was set off on April 4 when a positive case was reported from Dharavi’s slum, Mukund Nagar. In the official books, this was the fourth case from Dharavi. The 48-year-old-man lived with 11 members of his family in a two-room house, each room barely 100 sq ft. “He complained of chest pain and breathlessness. So, we immediately rushed him to Sion Hospital where they found that he was positive for COVID-19. The next day, they shifted him to Kasturba Hospital,” said the patient’s son adding that they were all quarantined in a facility in Dharavi. “We don’t know what they treated him for. On April 13, we received a call saying he had passed away. We continued to be confined in the quarantine facility,” he said. His father’s burial was carried out by the civic staff in the presence of a family friend. When they returned home after completing the 14-day-long quarantine period, the family members were told to strictly remain at home and maintain distance from one another. “Can you imagine maintaining distance in such a small space,” the son asked. “Dharavi is a maze of tiny lanes and by-lanes. You cannot escape rubbing shoulders multiple times even when you step out to attend nature’s call.”

The problem of common toilets

India’s most famous slum was a mangrove swamp originally inhabited by fishermen. As small factories and units found a footing in the area, it gradually grew into a dense slum that today offers livelihood to lakhs of people. According to the 2011 Census, Dharavi, which is spread over 2.5 sq km, is home to a population of 6.53 lakh people. “But there are over 2.5 lakh migrant workers who are unaccounted for,” said Dighavkar.

The biggest issue in the area is common toilets, he said. “Most houses are merely 10x10 feet and you will find eight to 10 people living in such small rooms. How does one contain the virus in such a cramped space?” It is challenging to keep people confined to their homes, he said. “We are now providing 19,000 lunch packets and 19,000 dinner packets so that people don’t venture out for food. But even during food distribution, we have crowds.”

Also read | A problem we can’t flush away

As a result, Dighavkar has put all his energy into removing the possible contacts of patients, or those with symptoms, from the area and placing them in quarantine facilities. “This is the only way to deal with the problem in Dharavi,” he said. In Dharavi nearly 3,000 quarantine beds have been made available — across a large sports complex, schools, a nature park, marriage halls, hotels and guest houses. Dighavkar claimed that 66% of the cases that have been found positive in Dharavi were people who were already in quarantine facilities.

Activists in the area are not convinced that this will stop the virus from spreading. Only if all the common toilets are sanitised aggressively at hourly intervals and people are made conscious about hygiene will infection stop spreading, they said. Dharavi has 275 municipal toilet blocks and 125 Maharashtra Housing and Area Development Authority (MHADA) toilet blocks. Each block consists of an average of 10 toilet seats. While a few buildings in the area and some pockets like Dharavi-Koliwada have their own toilets, the majority of the population depends on these common toilets. “We have been urging the civic officials to make sanitisers available for people at the entrance of the toilets. But even this basic step has not been initiated so far,” said Raju Korde, president of the Dharavi Development Committee.

Closing a crucial link

The residents of Dharavi-Koliwada decided to take it upon themselves to safeguard their population. They have barricaded the area to keep out outsiders. Koliwada, neighbour to Mukund Nagar, Shastri Nagar, and 60 Feet Road, which are hotbeds of COVID-19 cases, has recorded about five cases so far. “We don’t want an explosion of cases in our area. Therefore, we have barricaded all the entry points,” said Digambar Koli, secretary of the Dharavi Koli Samaj Trust. Koliwada has plenty of shops and markets, including a fish market. “Barricading our entry points was the only way to stop the public from walking into the area,” he said. The lockdown is practically non-existent in most of the area, he said. “Within Koliwada, we are trying to maintain discipline as much as possible,” he said.

“Walk into Dharavi any time in the morning or evening, it is like a mela,” said Anjum Shaikh, 60, a resident of Diamond Apartment on Jasmine Mill Road. “People living in buildings follow some discipline. But for others, it is impossible to stay inside their homes. With the ongoing holy month of Ramadan, many people step out in the evening to buy fruits and other things. Given the population of the area, even a few people form a large crowd.”

Members of the Dharavi Medical Practitioners Association screen residents of Dharavi-Koliwada in Mumbai.

Members of the Dharavi Medical Practitioners Association screen residents of Dharavi-Koliwada in Mumbai.   | Photo Credit: Vijay Bate

 

A railway track separates the Transit Camp area at the eastern edge of Dharavi from the high-rise buildings in the suburb of Sion. Since the lockdown, a key bridge connecting the slum and the city has been shut. Locally known as Dhobi Ghat Bridge, it has long been a vital link for the residents of the area to access key medical facilities including the civic-run Sion Hospital. Dharavi residents now have to wait for an ambulance or a vehicle to take them to the other side, which was merely a five-minute walk from the bridge. “Many people have had a tough time reaching the hospital. We don’t even know how many have died because of the delay,” said Rahul Medhe, a resident of the area who has been organising food camps since the lockdown started.

Also read | Coronavirus triggers panic migration from Dharavi to Tirunelveli district

Residents say that the bridge was closed as Dharavi started recording more cases and the people on the other side became apprehensive of its residents crossing over. The local doctors have shut their clinics too, which has added to their hardships. “The Transit Camp area has only three doctors opening their clinics,” said Medhe. Chemists in the area are also regularly running out of their stock of drugs, he said. The queues and the struggles remind him of the demonetisation days, Medhe said.

The status of Dharavi being Mumbai’s COVID-19 hotspot is doing the area more harm than good, said residents. “Hospitals are turning away patients coming from Dharavi. Even as grocery stores and other essential services remain open, many employees living in Dharavi have been asked to stay at home, which has affected livelihoods,” said a resident.

Also read | Turned away by 4 hospitals, constable dies | Woman dies after shuttling between hospitals

‘Pushed to the margins’

Aaj Dharavi lawaris ho gayi hai (Today Dharavi is orphaned),” said Babu Khan, president of the Dharavi Garment Association. Khan feels that it is unfair that the Brihanmumbai Municipal Corporation (BMC) has to deal with Dharavi alone. The State and Centre should have pitched in, he said, especially given that there are so many migrant workers in the area. “It is the migrant workers who have made Dharavi a manufacturing hub for garments and leather. Today, they have been pushed to the margins,” he said. Khan claimed that there are as many as 10 lakh migrant workers (higher than the BMC estimate) in the region, many of whom have had no choice but to subsist on handouts. “For how long can you survive on daal khichadi,” he asked. According to Khan, the only solution to the spread of infection in Dharavi is to allow the migrant workers to leave. This would decongest the area. “This should have been done much earlier, but it is not too late even now.”

“We want to go back home. Nobody wants to die here. If I have to die, I might as well die while I’m with my family back home,” said Triveni Yadav from Jharkhand, who was employed to carry out interior work in homes. Desperate to submit his application to get back home, Yadav stood in line for three hours from 6 a.m. only to be driven away by the police. In another corner of the Transit Camp, Haseena Shaikh, a widow raising four children, said she has been unable to buy milk for them for the last three weeks. “We got ration at the beginning of the lockdown, but after that there was nothing. We are dependent on the food distributed every night,” she said. Shaikh said going back home to Gulbarga in Karnataka was not an option for her. “My two brothers are rickshaw drivers and they don’t have any income now. How will they support me?”

Coronavirus | Non-COVID-19 patients find care out of reach at Mumbai hospitals

Akkubai, who has lived in Dharavi for the last 40 years, said she has never seen a situation as bad as this. “Every day we see long queues outside doctors’ clinics and outside police stations; hundreds standing in the hot sun. People may just die in this heat,” she said.

Many residents of Dharavi question the BMC’s statistics while some remain completely oblivious of the spurt in cases in their neighbouring lanes, which is only a stone’s throw away. “I don’t think the number of cases is so high,” said Jagan Nadar, a resident of Kannada Chawl, which is close to Mukund Nagar, where many cases have been reported. “I have not come across any person who knows of a positive case. If the threat is so big, why has there been no medical check-up in our area,” he asked.

The way forward

But Dighavkar has a different take. He said Dharavi’s popularity has played a crucial role in bringing focus to the area during the pandemic. “Every small development, every single positive case is reported by the media. The residents of Dharavi are constantly watching this, and it is helping spread awareness as well as caution,” he said, as he received a music video of a new Dharavi pandemic rap song on WhatsApp. Featuring Bollywood stars, the trilingual music video by rappers from the area has a simple message: stay home, stay safe. Dighavkar hopes that the music video will create further awareness.

Coronavirus | Sion Hospital turns away patient due to overcrowding

In an attempt to detect people with symptoms early, a door-to-door screening exercise in Dharavi has covered a population of 90,000 people till Friday. Health workers have also been tasked with checking the blood oxygen levels of senior citizens. Nearly 7,000 senior citizens have undergone this check-up and 250 were referred to hospitals for treatment after their oxygen levels were found low.

On Thursday, a Central government team, including the Joint Secretary of the Union Ministry of Health and Family Welfare, Lav Agarwal, visited Dharavi and suggested that all focus should be on institutional quarantine to break the chain of infection. Till date, Dharavi has quarantined 2,480 people in various institutions. Only 2,400 people from the slum have been tested for COVID-19 so far.

Also read | ‘Rising cases in Dharavi, Govandi due to contact tracing’

By Friday, Mumbai recorded 12,142 cases of which 808 were from Dharavi. Of the 462 deaths in the city, 26 patients were from Dharavi.

All eyes are on Dighavkar. Will he be able to stop an exponential jump in cases and deaths? Where will Dharavi stand by the end of this month? “As we screen more people and isolate them, we are likely to see a substantial decrease in the number of cases in the coming days. But I can’t give you a specific number,” he said.

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Printable version | Jun 6, 2020 10:24:15 PM | https://www.thehindu.com/news/cities/mumbai/when-a-virus-finds-space-in-indias-largest-slum/article31537623.ece

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