The Covid-19 Miracle of Dharavi

How Asia’s largest slum conquered the coronavirus

By: Neeta Lal

Could the teeming Mumbai slum of Dharavi contain the answers in controlling the Covid-19 pandemic? It didn’t appear so when the first Covid-19 case was detected on April 1. But according to experts, a multi-pronged, proactive strategy involving city officials, epidemiologists, health workers, and the city residents working in close coordination did the trick.

Dharavi is Asia’s largest slum, 2,400 km of misery located in India’s financial capital. Epidemiologists feared the worst. A 56-year-old garment shop owner who died the same day he was infected, sending shockwaves through the city of 21 million, already reeling under skyrocketing coronavirus cases.

The sum, crammed with one-room shacks, narrow lanes and thronging with people, is best known as the setting for Danny Boyle's Oscar-winning film Slumdog Millionaire.

Social distancing seems to be a joke in the area, which hosts nearly 1 million people, many of whom survive on daily wages. There is an average of one toilet per 500 people and the low-lying area with poor sewage greatly amplifies dangers of death and disease, especially during the ongoing southwest monsoons that have shattered a 45-year-old record.

Yet the slum has not only contained the virus, even as the national tally surges to over two million (third highest in the world after US and Brazil), but seems to have pulled off what is being called a miracle. From being declared a hotbed of the virus – with nearly 1,000 people testing positive for the infection as of May 12 and at least 31 deaths – the situation seems well under control.

According to Brihanmumbai Municipal Corporation as of August 6, Dharavi has only 72 active Covid-19 cases, while 2,235 patients have recovered and discharged from Covid-19 facilities. More than 85 percent of patients in Dharavi have recovered so far.

How did Dharavi do it? Especially in a city notorious for its undercapitalized health infrastructure that manifests itself in shuttered private hospitals, paucity of PPE, lack of doctors, and hardly any Covid care hospitals during the crisis.

It began in April with health workers going door to door advising the residents to follow strict social distancing and hygiene protocols. The state-run Brihanmumbai Municipal Corporation swung into action to screen, contact-trace, and isolate infected patients. “Early intervention, screening and isolation measures helped turn around the situation,” BMC Assistant Municipal Commissioner of Greater North Ward, Kiran Dighavkar told the media.

“We started screening as many people in the area and simultaneously started building health infrastructure like quarantine centers. We started acquiring schools to have a quarantine center over there. We acquired Dharavi municipal school…we acquired a sports complex and various things. Also, in the second week of April when cases were hardly some 16 or 20 in number, we acquired a hospital as well.”

Roping in private practitioners, isolating vulnerable populations, and acquiring large quarantine facilities yielded desirable results. City officials zeroed in on five zones that they deemed high risk due to initial infections and patients’ histories.

“We assigned nearly 3,000 health workers to Dharavi. Schools, marriage halls, and community centers were all converted into quarantine facilities with food, regular checkups, and free healthcare and testing. Thousands were placed under quarantine to stem the spread,” a BMC official told Asia Sentinel.

Private doctors were deputized to attend to emergencies. They are the area’s main healthcare providers familiar in any case with medical histories of patients that include migrant workers, laborers, and shopkeepers.

“In the initial weeks, as we went door-to-door to screen the citizens, they were uncooperative, wary of sharing details about their medical conditions, the number of people staying in one shanty, etc,” said a community health volunteer working in Dharavi. “But gradually, when they saw we were there to help, at great risk to our own lives, they warmed up to us.”

There were round-the-clock doctors, nurses, and medical staff for immediate treatments. The availability of medicines, multivitamins, masks, sanitizers, and essential medical equipment helped keep the virus in check.

What also helped Dharavi’s case, according to BMC officials, is the mass exodus of migrant workers – about 150,000 – who had returned to their native homes in different states. This helped contain the spread.

Yoga and pranayam sessions were organized to help the asymptomatic recover at home without requiring hospitalization, “Most of the patients in the centers had no symptoms, but the stress of being diagnosed with Covid-19 triggered mental strain impacting their health,” said Ambrish Maheshwari, a private practitioner who was appointed as a facilitator at a Covid-19 hospital.

With rampant job losses and work coming to a standstill since the lockdown began, many residents counted on the authorities and NGOs for ration. As state-run ration shops were only giving out rice and wheat, volunteer groups came forth to provide dry ration kits and thousands of cooked meals. Community kitchens provided breakfast, lunch, and dinner.

Media coverage on Dharavi further helped mobilize funds and ensure a steady stream of donations. Crowdfunding was also done by some good Samaritans.

Rations were distributed at night to adhere to norms of social distancing. Activist Gulzar Waqar Khan, Chairperson, Hum Sab Ek Hain Foundation, a local non-profit says his team makes its way through Dharavi’s labyrinthine lanes at night to distribute ration and essential supplies to those worst affected by the COVID-19 lockdown.

“We’re working with other local NGOs to raise funds to source supplies and then coordinate with the police to distribute these supplies to the residents. All of this takes place late at night to avoid violation of social distancing,” elaborates Khan.

Experts say the slum offers a stellar example of managing the coronavirus for other poor, densely packed communities around the world. In July, Dharavi was lauded by the World Health Organization for its “aggressive action” in containing the pandemic.

“There are many examples from around the world that have shown that even if the outbreak is very intense, it can still be brought back under control,” WHO Director-General Tedros Adhanom Ghebreyesus said at a news conference July 10, citing Dharavi’s success.

But there’s no time for complacency. The challenge of a possible second wave is all too real as migrants slowly return to the slum and monsoons hamper the task of health givers.

But volunteers and health workers are cautiously optimistic that they are now better equipped to handle such emergencies. For Dharavi to turn a corner in the midst of a national public health crisis – when India is battling over two million cases of Covid-19 and 40,000 deaths, with Maharashtra leading the national tally with 458,000 cases and 16,142 fatalities – is nothing short of remarkable. It is surely reason enough for reassurance, if not rejoicing.

Neeta Lal is a Delhi-based editor and journalist and a longtime contributor to Asia Sentinel. She tweets at @neeta_com

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