What to Do? Covid news from the source.

The slum community abuts a middle-class apartment building in Mumbai

Who could miss the daily, hourly, up-to-the minute news, coming from India. The horrific scenes unfolding in hospitals and the sight of drone footage of vacant lots being turned into ghostly cremation grounds is sobering. India is a nation united in mourning the dead while fearing for their own lives.

I speak to many families from the community every week, sometimes a few times a day. There’s some fear and anxiety, but also some complacence about the virus. I think that has more to do with a lack of information, coupled with misinformation in the form of gossip and rumours (about prevention of the virus and the availability of vaccines) seeping into the lanes of these very crowded communities, then with willful ignorance. Yet, without proper information that is easily understood for a population with low literacy rates, COVID-19 cases in slum communities are surprisingly low. They wear masks out on the street, but when we connect through a video call I see from ten to thirty children sitting side by side in Indu’s nine by twelve foot home, none of them are wearing masks. There’s a theory being discussed by the medical establishment that many residents of slum communities have had the virus, with few or no symptoms, having acquired antibodies from living in crowded conditions with poor standards of hygiene. Another reason might be that residents of slums are territorial and tend to remain in their own area, visiting neighbours, but only passing through other areas of the slum on their way to and from the community. They leave the community for work (recently curtailed by curfews and lockdowns), sometimes they ride in an auto rickshaw, but most walk to their job, or to the local market area. Their lives are measured by the few rupees in their pocket which doesn’t allow for dining in restaurants, shopping in enclosed mega malls, attending large weddings, or memberships to recreation facilities. Beside the uncertainty of COVID-19 impacting their their lives, they live with constant dread of contracting a host of other diseases such as dengue, malaria, typhoid, tetanus, and malnutrition, all of which are rampant in slum communities. COVID-19 has brought yet another monster to their door, one they are perhaps too tired to contemplate.

One of the entrances to the community. Hundreds of people pass through here every day.

What the poor do know, is that they are shut out of their jobs again during the current lockdown/curfew situation, which will cause an avalanche of problems for them for months to come. The worries I hear about are loss of their income, how they will manage to buy basic necessities for their families and pay their rent. They are resistant to go to government hospitals because they say no one who goes to a hospital returns. Harvesting organs from patients who are poor is a rumour running through slum communities. I’ve also heard about a mother from the community recently taking a child for an x-ray because of fever and cough symptoms. The doctor determined that the child had a “touch” of pneumonia and waved away any concerns about them travelling that week to their ancestral village, a two day journey on a crowded train. He did not check the child or the parents for COVID-19, but gave the okay for the family, possibly affected with the virus, to travel on a train heading for a remote rural village with few medical facilities. Upon arrival at the village, we took a video call from the family. I asked whether there were people sick with COVID-19 in the village. She said there were a few cases in a neighbouring village, but many more cases of typhoid and malaria. The nearest small hospital is 45 kilometres away.

The good news in all of this, is that no one I speak with has COVID-19, or claim to know of anyone in the slum community who’s been infected. There was one vague report a few weeks ago about a possible case, which if true, the person has yet to infect anyone else. There is a stigma attached to contracting the virus, so it is possible, that if someone is sick, they are managing the symptoms in their home. This is no small feat in communities where social distancing is impossible, where one-room homes are crowded and often windowless, where public toilets are shared among many, and where a labyrinth of narrow lanes lined with rooms one atop the other keep the sunlight from finding a way in.

The waiting area of a small private hospital in Mumbai. The water bottles are for sharing while waiting. The x-ray is drying.

They aren’t the only ones who have decided to ignore the wolf scratching at the door. In February 2020, we took a few children to a wonderful, kind dentist, who treated them well, and gave us a discount. His one room office, housed in a rundown building along dusty Pipeline road in Saki Naka, mostly deals with middle to lower income patients from the surrounding area. He has another larger, very posh office, as he described it to me, in another part of Mumbai, where he treats patients who make a fine living from the film industry, modelling, and big business. The news of “the corona” as it was referred to back then, was still about what was happening in China. The rest of the world, on nervous watch, hadn’t been affected yet. I asked him if he was worried about what would become of India if the virus jumped the border. His very assured reply to me was, “No, not at all. India has systems to deal with this kind of thing. The medical profession won’t allow it.” While I watched him write out my receipt, I pressed on with my questions and concerns. He waved his hand in the air as if swatting a kind, but annoying mosquito, indicating to me that this absurd conversation was over.

A government hospital

As we now know, the kind dentist was wrong. Mumbai, and the rest of India is wrestling with the unimaginable magnitude of the second wave of the COVID-19 crisis closing down their cities and killing their relatives. My mind goes to the state of the hospitals that we’ve spent many, many hours inside of while taking children, or their parents, for medical care. There are magnificent, palatial, private hospitals in Mumbai for those with the means to access that kind of environment and care. However, most people in need of medical care must choose between small private hospitals owned and operated by a family or a corporation where there will be fees attached to treatment. Or, in the case of slum communities, line up at a government hospital where the care is free, but medicine must be purchased. The small private hospitals, usually located on one floor of a building housing industry, business offices, and other medical offices, are businesses first, but when we show up with patients, they have received reasonable, attentive, care at most of them. The standard of cleanliness, and the state of repair and availability of equipment varies greatly in this sector, but doesn’t begin to compare to the decrepit, filthy conditions of a government hospital, where medical staff work in desperate conditions in wards where patients rest on rusting beds in crowded rooms with not enough bedpans let alone medical equipment. What can these hospitals be like in the midst of the pandemic?

A middle class housing society in Mumbai. We lived in the Sunglow building society in 2018.

I also spoke this week to acquaintances and friends who represent the other Mumbai, the solidly middle class propelled by white collar jobs, living in Mumbai, as well as those who live abroad but have family in the city. They report COVID-19 infections with minor symptoms not requiring hospital stays among their friends and family. However, they know of entire apartment buildings that have been sealed when there are 5 COVID-19 cases in the building. The middle class and the wealthy, assuming the worst of the pandemic was over, allowed themselves the privilege to go to movies, shopping malls, and attend large functions, contributing to a rise in cases. They now fear becoming one of the patients desperately needing oxygen.

There is disbelief in India and abroad, that the Kumbh Mela, a Hindu festival where millions make the pilgrimage, culminating in the largest religious gathering in the world held over many weeks, was allowed to take place. In February 2019, we traveled to the city of Prayagraj in Uttar Pradesh, to put ourselves in the middle of the Kumbh Mela, excited to witness one of India’s most spectacular religious events. There was a constant flow of millions of people shuffling to the bank of the Ganges river, waiting for their turn to bathe, to pray, and to be blessed by the ash covered Sadhus sitting cross legged in tents along the river. The site was a massive tent city within a city, housing the pilgrims, along with food stalls and small shops, set up for the devotees. We were lucky to find a room at a hotel in Prayagraj, a few miles from the main site. Over three days we joined the thousands of others who weren’t staying on site in the tent city, to make our way to the festival joining the mass of people who were already there. If brushing up against strangers isn't for you, this isn't the place to be. It is an incredible sight to behold and observe, the experience, no doubt magnified if you are a Hindu. I understand the pull of the event, especially if you are a devout Hindu, but I can’t fathom being a part of that kind of event during a pandemic.

Crowds at the Kumbh Mela/February 2019

The government finally intervened and ended the current festival one month early, but there have been reports of 1700 people, as well as 65 healthcare workers, who attended the festival testing positive for the virus. They will no doubt bring the virus back to their villages and cities to infect thousands more. Add to that the political rallies, and up to 15,000 fans allowed to watch major league cricket games in stadiums, the surge in cases starts to make sense. Life lived in a crowd is commonplace in India, especially its major cities. To stay six feet apart seems an impossible task while going about daily life.

The families living in most slum communities or on the street under tarps, are generally not the faces in news, waiting for vaccines, waiting to be admitted to hospital, or waiting to be counted. So far, they are not the people putting COVID-19 numbers in the nightly news. Their cases, and the suffering, could be silent and ignored, which if counted could greatly increase the COVID-19 numbers in Mumbai.

Proof of vaccination from a government hospital (April 22, 2021) (photo courtesy of family)

While talking with the woman in the rural village yesterday, I wondered how they would access the vaccine. The information she gave was vague. "Maybe they will come to each village to give the vaccine, but no one will take it. They have heard when you get the vaccine you will die." She said she would get the vaccine but didn't want to question the fear that others in the village have. She is staying with extended family in a rural setting with patriarchal rules that governs daily life. Her voice there is weakened to a subservient level.

A father of three children (who lives in a slum rehabilitation building in another area of the city) recently received his first vaccine shot. The vaccine is given free at government hospitals, but can be booked at a private hospital for a fee of 250 - 400 rupees ($5 - $8), a prohibitive price for most slum families. With nothing to do but wait for information about when and where they can receive the vaccine, and when they can resume their daily wage jobs, they obey the curfew, and hunker down in their cramped rooms, hoping for the best. “What to do?”, is a saying I hear often in Mumbai when there is a troubling situation with no solution. Poor communities are resilient and fortify each other when trouble arrives at their door, but, they would rather be safe, counted, and considered.

We are providing rations, once again, for any family who requires them. Most families are without jobs, or can only work half a day because of the noon curfew. Indu has set up an account with a ration shop, providing 3000 rupees ($50) to each family who contacts her. A member of the family visits the shop, gives their name provided to the shop owner by Indu, and chooses what the family needs for a month. This way there is some dignity about what they consider their needs to be. This month 8 families have received donations. More families have come forward. Indu is busy processing their ration needs to the shopkeeper.