Swathed in personal protection gear, a mask on the face and temperature gun in hand, Dr Deepali Patil had an unusually hostile reception when she visited a chawl in Dharavi. A pregnant lady displaying flu-like symptoms refused to be screened. She initially screamed at the doctor, asking her to go away, but later relented after some cajoling. Fortunately, she was found to be free of COVID-19 symptoms. Dr Patil, a private medical practitioner, is one of 10 teams, each led by a doctor, a nurse and two officials of the Brihanmumbai Municipal Corporation (BMC), dispatched by the municipal body to go door-to-door looking for coronavirus positive patients in Dharavi.
Asia’s largest slum is on the edge these days and health workers, especially, are viewed with fear and suspicion. Millions live here in 8 foot by 10 foot brick shanties which open into sewers and narrow lanes. Some 189 people have tested positive here for COVID-19 in the past 16 days. Twelve people have died. If Mumbai, with close to 3,500 cases, is the epicentre of COVID-19 in Maharashtra, then Dharavi is at the core of the problem. It has the highest number of infections in the city’s smallest geographical knot, a 2.1 sq. km. irregular pentagon in the heart of Mumbai.
Cleaning up: Disinfectant-spraying machines at work in Dharavi. Photo by Milind Shette
It is not clear how many more are infected because health workers like Dr Patil, who are checking residents for symptoms of fever and cough, find it difficult to enter its warrens. What is known is worrying enough, COVID-19-positive patients have been found in all 17 of its slum clusters or ‘pockets’. Dharavi is among the most densely populated places on earth. So dense that around 800,000 inhabitants, more than Jalandhar’s population, are packed into an area the size of Lakshadweep’s Kiltan Island. Mumbai’s population density is 228 people per hectare; in Dharavi, it’s a mind-boggling 3,846. Social distancing is doomed to fail here simply because residents live in such close proximity. More worrying is Dharavi’s location, and the potential for COVID-19 cases to explode across the city. The slum city is flanked by Mahim on the west, Matunga on the east. Maharashtra chief minister Uddhav Thackeray’s private residence ‘Matoshree’ in Bandra (East) and the city’s second business district, the Bandra-Kurla Complex, are just five km away.
This is also the reason why the slum is under siege now. Policemen conduct flag marches here on alternate days, appealing to people to not step out. Drones buzz over the shanties looking for violators even as policemen scan footage from CCTV cameras in a newly set up control room. The BMC has deployed over 200 doctors in half a dozen ‘fever clinics’ to scan residents for symptoms. A private laboratory has been roped in to swiftly collect samples if symptoms are detected. At an April 20 virtual panel discussion, one of Mumbai’s most distinguished residents agonised about Dharavi and the city’s failure to build affordable housing. “For the first time, the close proximity and low-value structures that we have built are the cause of new problems,” Tata Group chairman emeritus Ratan Tata said. “The past few months have taught us that we’re suffering from close proximity.” He called for a “re-examination of what we consider to be acceptable standards in terms of quality of life”.
Around 55 per cent of Mumbai’s 12 million population lives in slums like Dharavi which occupy just 0.5 per cent of the metropolis’ real estate. The sunless slum’s undying spirit and the dreams of its residents for a better life have been eulogised in films such as the 2008 Hollywood hit Slumdog Millionaire and, more recently, the Zoya Akhtar-directed Gully Boy. Rais Khan, a tailor who lives in a tiny one-room dwelling perched atop another shanty, epitomises this spirit. His five-member family can only access their house using a narrow, steep ladder. They share the space with a sewing machine, their source of livelihood which Khan uses to realise the family’s dreams for a better life. His son Kasim wants to be an engineer and daughter Nargis has ambitions of studying medicine. His wife Farida spends the day cooking and cleaning for the family and looking after daughter Iram. Khan worries about his survival during the lockdown. His earnings are locked away in large blue plastic bags that hold the clothes he tailors for clients. They are still to be delivered.
Dharavi’s chawls have always been a breeding ground for disease. Natural epidemics have swept through the slum since as far back as 1896 when the plague wiped out nearly half its residents. The place is a nightmare for healthcare providers. Dysentery, cholera and typhoid epidemics are common.
Ironically, the COVID-19 outbreak originated here not in the matchbox shanties but in a multi-storeyed housing complex in Dr Baliga Nagar, the slum’s poshest pocket. On April 2, a 56-year-old garment trader had hosted preachers of the Tablighi Jamaat in his flat, died of COVID-19. The Union health ministry blames a congregation at the Tablighi Jamaat headquarters in Delhi in March for 30 per cent of all cases in India. It is not known if the Jamaat members in Dharavi were part of that, but what has emerged is that the preachers had also attended a birthday function in the locality and met several people in the area before the trader died. The disease has now spiralled through the slum pockets, Mukund Nagar, Dhanwada Chawl, Social Nagar, Janata Society, Kalyan Wadi, PMGP Colony, Murugan Chawl, Rajiv Gandhi Chawl, Shastri Nagar, Nehru Chawl, Indira Chawl, Gulmohar Chawl. Not one has been spared.
Dharavi’s thriving business hub, its informal economy and its vibrant businesses of leather, garment, pottery and plastic recycling that generate an estimated $1 billion (Rs 7,600 crore) worth of business each year, are shuttered. The shops lining the slum’s business district, the 90 Feet Road, are closed. Heaps of plastic pellets sit outside recycling units. “I am not sure whether business will get on track in the near future,” says a rueful Praful Shinde, a local leather goods retailer.
Health workers, meanwhile, have their own horror stories of how residents are defying social distancing. Residents of Mukund Nagar recently ritually bathed a COVID-19 patient’s body in the open before his burial. Since then, they affirm, the number of COVID-19 patients has shot up. Enforcing social distancing is proving to be a challenge for even the police. “They disappearand reappear a little while later,” says an exasperated police constable, Deepak Ahire, recounting his futile efforts to disperse people. Crowds still throng the grocery stores within the slum, pushing aside barricades installed by store owners to avoid direct contact. Dr Patil says she fears for her safety sometimes. “At some places, the crowds swell to watch us conduct screenings.”
Social worker Raju Korde explains why social distancing is a problem in a slum where the lanes are so narrow in places that two people can’t walk side by side. “The houses are like matchboxes with no proper ventilation. They need to step out to breathe fresh air.” Over 90 per cent of the residents use the 225 public bathroom complexes and 1,500 toilets daily. Fifty persons on an average use a toilet seat each day. “The possibility of infections spreading is very high,” admits local councillor Babbu Sheikh.
The BMC has been disinfecting all 225 public toilets in Dharavi daily. A special treatment and solution machine imported from New Zealand has been deployed for the purpose. Five teams of 150 sanitation workers are sweeping the roads, collecting and disposing of garbage. BMC workers also fumigate the area every alternate day.
Local MLA and school education minister Varsha Gaikwad from the Congress says the government has focused on sanitisation, containment and isolation in Dharavi. The 50-bed Sai Hospital has been taken over for treating COVID-19-positive cases. The corporation has created a 300-bed isolation facility at the Rajiv Gandhi Sports Complex, a two-storey structure with two big halls located at Kala Qila, close to the Mithi river that flows near Dharavi. A municipal school in the heart of the slum is also being equipped with a 700-bed isolation facility. Since the locals are shy of discussing their symptoms with officials, the BMC has approached 150 local medical practitioners to convince them to step forward if they have health problems.
Assistant municipal commissioner of G/ North ward Kiran Dighavkar says the BMC has for now divided Dharavi into five zones of 55,000 residents each for a focused approach. “All of them will be screened for fever and cough in a couple of weeks. We are working in mission mode.” The corporation’s chief health official, Dr Daksha Shah, says the drug hydroxychloroquine or HCQ, now being exported by India across the world, is not yet being used in Mumbai for treatment.
Who is to blame?
The outbreak has put the spotlight on Dharavi’s most prominent neighbour, Uddhav Thackeray. The chief minister continues to stay at ‘Matoshree’ and uses the official residence Varsha on Malabar Hill for his meetings. The BMC is responsible for the health facilities in Dharavi and Uddhav’s party, the Shiv Sena, has controlled it since 1997. The Sena won three of Dharavi’s seven municipal wards in the 2017 corporation elections.
Dharavi is rapidly emerging as a test of the chief minister’s leadership. He has been under continuous pressure from the opposition over his handling of the pandemic. Leader of the opposition Devendra Fadnavis emphasises the need for aggressive testing all over the city, especially in Dharavi. “The BMC has suddenly stopped testing asymptomatic patients so that the number of positive patients stays low,” he says. “But this is dangerous. They are playing with people’s lives.” BMC commissioner Praveen Pardeshi says they will test the asymptomatic patients after a quarantine period of at least five days.
Say aah: A doctor takes a swab sample of a young resident in Dharavi. Photo: AFP
The Union government, though, is not convinced the BMC can handle the crisis. On April 21, it dispatched a team of five experts under additional secretary Manoj Joshi to assess the situation. The team is empowered to issue orders to the civic body wherever required. On the first day of his visit, Joshi suggested that the state government focus on door-to-door services and the high-risk patients in the slums. He also recommended the shifting of suspected patients out of the slums.
But the issue that isn’t going away is the political apathy and vested interests that have stalled attempts to replace Dharavi’s shanties with multi-storeyed buildings. Since 1997, the Maharashtra government has floated multiple tenders to redevelop the slum but without success. In the most recent attempt this January, Dubai-based SecLink Technologies Corporation won a Rs 28,000 crore bid to redevelop the slum. For reasons unknown, the contract has still not been awarded, forcing the company to issue a threat of seeking Rs 2,299 crore in compensation. Today, the stalled project is coming back to haunt city authorities. It’s a stark reminder of how public health is sometimes held hostage to political whims.