Dharavi: How a slum city beat the virus

3 months ago 11

Frequently tagged as ‘Asia’s largest slum’, Dharavi is made up of 17 localities, each one named after either the profession of its resident community or their state. Thus a potter will most likely be living in Kumbharwada, and a fisherman in Koliwada. Over 800,000 people (which is nearly half the population of Goa) live here, in an area no more than 2.5 square kilometres. On an average, one small room in Dharavi, measuring 10x10 ft, houses eight people. Surrounded by Mahim, Matunga and Dadar, Dharavi is the beating heart of India’s commercial capital.

Which is why when Covid first arrived here on April 1, Dharavi threatened to become a tinderbox for the spread of the disease, a potential super-spreader for Mumbai’s 12.3 million-strong population. With its history as a breeding ground for dis­ease and epidemics in the past, the fear was that Covid would escalate into a crisis like the outbreak of bubonic plague, which killed half of Dharavi’s residents in 1896.

Yet, nine months later, Dharavi has emerged as a shining example of a community that defied both the odds and the virus. Till February 1, it had registered 3,930 cases, far fewer than its immediate neighbours, Dadar (4,924) and Mahim (4,791). On December 25, January 21 and February 2, Dharavi did not register a single positive case. It has also registered zero deaths since December 1. Its average daily cases have come down from 43 in May 2020 to six in December 2020, and the daily deaths from 10 to zero. On January 12, Dharavi’s rate of infection at 0.09 per cent was below 0.21 per cent for Mumbai and 5.7 per cent for India. Its death rate of 0.47 per cent is also much lower than Mumbai’s 1.5 per cent and India’s 1.4 per cent. Its doubling rate in the same period has gone up from 10 days to 1,211 days, far higher than Mumbai’s 565 days and India’s 363.

What explains Dharavi’s success? How did acongested settlement manage to turn around from being a Covid hotspot to showing others just how to defeat the virus?

When the going got tough...

...Dharavi’s residents got going. It was their attitude as much as the tireless efforts of health workers and several NGOs that contributed to the settlement’s success. “You will find a stock of hand sanitisers in every house today,” says Hilda Nadar, a primary school teacher who lives near 90 Feet Road.

Realising that large-scale screening was crucial for early detection and treatment, the Brihanmumbai Municipal Corporation (BMC) sprang into immediate action. The civic body roped in 24 private doctors, equipped with PPE kits, thermal scanners and pulse oxime­t­ers, to identify and isolate suspected cases through door-to-door screening in high-risk zones. Those with symptoms were moved to quarantine centres at the Bandra-Kurla Complex and Manohar Joshi College. Around 360,000 people have been tested so far.

Soon, several NGOs joined the BMC in the war against Covid. The Bharatiya Jain San­ghatana (BJS), the largest NGO to provide volunteers, involved 150 local doctors to screen the residents in 100 mobile dispensaries. Some 35 other NGOs reached Dharavi with medical help, food, masks, sanitisers and other essentials. “We had good coordination with the BMC,” says Nilendu Kumar, general manager (west zone), CRY (Child Relief & You). The volunteers at SNEHA, a partner NGO of CRY, camped in Dharavi, to track residents’ needs. “They not only provided masks and sanitisers but also made the residents realise it was a battle they needed to win themselves.”

Indeed, awareness played a big role in helping Dharavi’s residents battle Covid. It wasn’t easy. “The residents of Koliwada used to threaten us with dire consequences whenever we knocked on their doors for screening,” recalls Anagha Amburle, 54, a nurse with the BMC. “Today, they call me tai.” Bit by bit, Amburle and her team of 30 women health workers succeeded in convincing residents about the importance of washing hands and sanitising their homes.

Shantilal Mutha, president of BJS, also recounts how their volunteers worked towards minimising fear among residents. They insisted the virus could be defeated if they got themselves screened for symptoms and got early treatment if infected. “Once the residents realised we were there to help them out and had no ill will, they began queuing up for screening,” says Mutha.

In many instances, local ingenuity came to the rescue. Rajendra Bhoite, owner of a leather shop in Dharavi who is also a social worker atta­ched to the Tata Memorial Cancer Hospital in Bhoiwada, cites the example of Dharavi’s migrant workers, who come mostly from Uttar Pradesh, Bihar and Jharkhand, and make up a third of its population. Living either in overcrowded rooms, for which they pay Rs 3,000-5,000 as rent, or sleeping on the floors of factories where they work, they share 450 public toilets among them. Since close to 80 people use one public toilet, keeping them free of infection was a challenge. The locals, says Bhoite, devised a routine whereby the migrants would use the toilets in shifts. “Only a certain number of people would go in at one time, the next batch would be allowed only after the toilets had been sanitised thoroughly.”

The next challenge came when Mumbai began lifting its lockdown gradually and Dharavi’s five big industries, leather, garments, pottery and plastic recycling, opened up. The poorly-ventilated, cramped factories became potential Covid hazards. To avoid a crisis, local BMC ward officer Kiran Dighavkar made masks, face shields, gloves and sanitisers available to the workers free of cost. The 37-year-old civil engineer also managed to get positive patients isolated in three facilities within Dharavi. “Only critical patients were moved to hospitals for treatment,” he says.

The other factors

Some scientists believe that the secret of Dharavi’s success may be herd immunity. A serology survey by the Tata Institute of Fundamental Research in October found that almost 60 per cent of Dharavi’s population had been exposed to the virus and developed antibodies. The uninfected residents, therefore, were not at risk until they travelled outside Dharavi.

Dr Sanjay Oak, head of the Maharashtra task force on Covid-19, is among those who think that herd immunity helped Dharavi overcome the virus. “As Dharavi is a cramped place, the residents got infected rapidly. Fortunately, most of them were asymptomatic.” Some 150,000 migrant labourers had also left for their home towns when the lockdown was announced, reducing the burden on the administration. “As the residents became immune, our fight against the virus started yielding results,” says Dr Oak.

However, the return to ‘normalcy’ could rapidly undo Dharavi’s success story. Its streets are seeing pre-lockdown level crowds, and largely without masks. The cleanliness and strict discipline of the lockdown days is fast disappearing. The public toilets, once cleaned and sanitised regularly, are back to being dirty. “We try to convince them that the mask is mandatory till the virus is completely eradicated, but they don’t bother,” says Amburle. “Some of them,” says Nadar, “have even asked me whether the coronavirus really existed.”

What lies ahead

Meanwhile, residents have plenty of other worries to preoccupy them. Dharavi’s MSMEs (micro, small and medium enterprises) may be back in business, but those who run them are not entirely happy. Abdul Sattar, who runs a zari work factory, says his business has returned to only 5 per cent of what it used to be prior to the lockdown. “The big cloth makers used to keep a large stock before the lockdown. Now, they are not interested in investing money in the business,” says Sattar, who employs eight workers, all of them migrants from Bihar.

The future looks equally bleak for Balu Murugan, who had moved to Mumbai from his native Tamil Nadu in 2012, and used to make living selling idli. He and his family went back home when the lockdown was announced, but returned in December when they heard things had started getting better. However, while earlier he could make Rs 1,500 daily selling his home-made fare in Dadar, these days even 12 hours of selling yields only around Rs 700 a day. “I have not brought my children back to Mumbai. They are still in Madurai,” he says. Murugan is worried about paying his rent of Rs 3,000 and his landlord has refused to waive the amount for the nine months he was away. “I could pay only Rs 12,000, which I earned by working as a tree cutter in my village. I don’t know what the future holds.” It is a question many are asking.