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By Anosh Malekar The last time Pune saw a public health crisis like the present swine flu outbreak was the plague epidemic in 1897. As the city virtually shuts down, Pune’s haphazard growth, precarious infrastructure and complete unpreparedness for a crisis are exposed
In normal circumstances, this time of the year, Pune in western Maharashtra would be gearing up for big-time religious festivities. The annual Ashadhi Ekadasi Wari, the unparalleled 21-day trek or pilgrimage by a few lakh devotees to the famous Lord Vithoba temple at Pandharpur, has passed through the city, and the popular Dahi Handi, a ceremonial human pyramid formed by youth to claim the prized curd from the pot (dahi is curd, and handi means pot) on the occasion of Janmashthami, the festival celebrating the birth of Lord Krishna, is round the corner. This year, the Wari started from the holy towns of Alandi and Dehu near Pune on June 15, and concluded at Pandharpur on July 3, setting the tone for the festive season ahead. In the interim, the delayed monsoon caused much concern with major cuts in drinking water supply to the entire city. But the monsoon recovered around mid-July filling up water reservoirs in the narrow fertile river valleys west of Pune, and bringing relief to citizens. Then, on August 3, Pune reported India’s first swine flu death when a 14-year-old schoolgirl, who tested positive for the H1N1 virus, died at a private hospital. Within the next 10 days, the city reported 10 deaths due to swine flu, raising concerns across the country where the toll of people succumbing to the viral infection has now climbed to 17. The number of swine flu cases crossed the 1,000 mark in India as the Centre and states intensified their battle against the infection. Scores of schools and public places across several cities were shut. The Centre dispatched central teams to all states and union territories after Health Minister Ghulam Nabi Azad chaired a meeting of 35 additional secretaries and joint secretaries drawn from various ministries who would fan out to the states. In Pune, panic-stricken citizens queued up at hospitals to be tested for swine flu. They gathered in their thousands outside the two government hospitals and 22 municipal health centres designated to look after swine flu cases in the city. Chemist shops began reporting a shortage of face masks. Patience wore thin outside the central facility in Naidu hospital as people complained: “We have been stranded outside the hospital since the wee hours. The doctors are not calling us in for the tests.” The concerns did not end here despite the Maharashtra government ordering the closure of all educational institutions, including private tuition centres, in the city for a week and shutting down theatres and multiplexes for three days. The Indian Council of Medical Research, as reported by The Indian Express, declared the Pune situation a pandemic with transmissibility at the highest level (Level 6) but virulence still at lowest (Level 1) -- a “community spread” to denote that the flu virus was circulating freely in the city. The city-based National Institute of Virology (NIV) said there was no point in flooding it with more samples for confirmation as “everybody is being treated for swine flu”. NIV also put up a ticker on its website refuting rumours circulating in the city via SMS that it had recommended the use of eucalyptus oil to prevent the spread of swine flu. “NIV has not recommended any indigenous formulations like Nilgiri oil as use against H1N1 (swine flu). Please refer to authentic public health information or call the helplines for queries.” A study in the current issue of The Lancet Infectious Diseases seems to provide a glimmer of hope: closing down schools can help control new cases if transmission from schools contributes to more than 50% of total cases. Maharashtra Water Resources Minister Ajit Pawar, who is guardian minister for Pune district, announced low-key Independence Day celebrations on August 15, urging school authorities to keep children away from ceremonial gatherings. He also requested parents to keep their wards at home during the week-long school break and avoid crowded places like malls, cinemas and picnic spots. One of the biggest malls in the city displayed a circular that read: “In view of the government advisory with regard to swine flu… the mall will remain closed with immediate effect for general public…” Gold and precious metal traders closed shop for two days -- August 12 and 13 -- Pune Saraf Association secretary Saurabh Gadgil saying the decision was taken keeping in mind the health safety of customers. Clearly, concerns in Pune stretch beyond schools and shops. Ravindra Malwadkar of Sakhlipeer Talim Rashtriya Maruti Mandir, one of the oldest youth associations in downtown Nana Peth, says the impact of the flu is being felt right across the city. “We have decided to have low-key celebrations for Dahi Handi on August 14. Similarly, the real crowd-puller, the annual Ganesh festival commencing on August 23, is going to be affected too.” Ganesh Chaturthi is the birthday of the elephant-headed son of Shiva and Parvati, the Vighnharta, who is believed to bestow his presence on earth for all his devotees starting this day. The festival lasts for 10 days and is most elaborate in Maharashtra, especially Pune, where it was transformed into a public event of national awakening over a century ago during the freedom struggle by Lokmanya Bal Gangadhar Tilak. Enthusiastic Puneites bring home idols of ‘Ganpati bappa’ while innumerable mandals, or public associations, hold celebrations in the city’s nooks and corners. While some hold cultural events and exhibitions, most erect decorated pandals on street corners that feature impressive Ganesh idols. The big-ticket events are the Pune Festival that attracts hordes of tourists, both domestic and foreign, for week-long cultural and social events, and the immersion processions during which the city comes to a virtual standstill. Over the years, myriad social themes like the importance of solar energy, windmills, yoga and pranayam have been showcased in exhibitions held by the Sakhlipeer Talim Rashtriya Maruti Mandir. This season they are not sure. “We have always made it a point to spread social awareness through our displays during the festival,” says Malwadkar, who is the Mandal’s president. “This year we may have to gather and display authentic information about swine flu to dispel unnecessary fears in the public mind.” But that’s easier said than done with government authorities dissuading people from crowding public places. Pune’s prominent mandals are meeting soon to take a decision. Some like Natu Baug and Hatti Ganpati Mandal have sought to set a precedent by cancelling public celebrations. Malwadkar says: “We will hold a token Dahi Handi and will instead distribute milk and packets of nutritious food to over 1,000 patients at the government-run Sassoon General Hospital.” Shyam Mankar of Hatti Ganpati Mandal says the swine flu has served as a wake-up call. “It’s time we curtail wasteful expenditure during festivities and instead contribute to social causes.” Mandals like his have cancelled their grand plans and are instead planning to engage social activists to explore ways of highlighting issues related to individual and public hygiene, besides garbage disposal, that may serve an important purpose in the time of swine flu. Usman Hiroli, a prominent Muslim social activist from Camp area, says Ramzan Eid, the festival that marks the end of Ramadan, a month when Muslims fast throughout the day and eat only at night after communal prayers, will remain what it is -- recurring happiness or festivity. But the organisers are taking all precautions in consultation with health authorities. “A very important aspect of Eid is charity, which all Muslims are expected to extend to the needy. Curtailed festivities will be hitting the poor, daily-wage-earning citizenry. Hence we will be giving a thought to helping them this year.” In the meantime, Pune’s district collector Chandrakant Dalvi finds himself loaded with the difficult task of persuading people not to panic. “Please don’t leave Pune,” he urges citizens. “Leaving the city could spread the infection further though few states are screening people arriving from Pune.” Clearly, swine flu has brought back memories of the bubonic plague of late-1896 which still live on in the minds of many Puneites. Historical sources reveal that by January 1897, the plague had reached epidemic proportions in Pune. Colonial government sources report that, when the governor of the presidency inspected the city on February 8, 1897, he was told that the people would rather have plague than go to a government hospital. In 26 days of February, 657 deaths (0.6% of the city’s population) were attributed to the plague and half the population had deserted the city. In order to suppress the epidemic and prevent its spread, it was decided that drastic action would have to be taken. A Special Plague Committee was appointed under W C Rand, an Indian Civil Services officer, and troops -- 893 officers and men, both British and native -- were placed on plague duty. The work of the committee began on March 13 and ended on May 19. The total estimated plague mortality was 2,091. A state government-published school textbook describes the Pune plague as follows: “In 1897, there was an epidemic of plague in Poona. In order to control the epidemic, an officer named Mr Rand was appointed. He used tyrannical methods and harassed the people. On 22 June 1897, the Diamond Jubilee of the coronation of Queen Victoria, Rand and his military escort Lt Ayerst were shot at, while returning from the celebrations at Government House. Both died, Ayerst on the spot and Rand of his wounds on 23 June, 1897.” The Chapekar brothers and two accomplices were charged with the murder, as also the shooting of two informants and an attempt to shoot a police officer. All three brothers were found guilty and hanged; an accomplice was dealt with similarly, another, a schoolboy, was sentenced to ten years rigorous imprisonment. The Chapekar brothers are hailed to this day as freedom fighters, although the colonial powers considered their actions the worst violence against political authority seen anywhere in the world during the third plague pandemic. The Medical History of British India, that displays nearly 50 disease and public health reports from the India Papers collection held at the National Library of Scotland, says: “…although the cost in human lives of the plague in India was great, historians have argued that the significance of the plague epidemic lies more in its political impact and what it tells us about the organisation and priorities of public health in British India. The colonial state’s efforts to prevent the spread of plague within India should be seen within the broader context of international efforts to impose quarantine to prevent the spread of epidemic diseases such as cholera and plague along international trade routes.” “The response of the British Indian state to the late-19th century plague epidemic was marked by the exceptionally intrusive measures enforced using colonial state power and starkly revealed the political constraints on medical intervention in India. As such, they are considered by historians to be a formative moment in the development of public health in India,” adds the Medical History of British India. Pune has come a long way since the late-19th century plague epidemic. But a cursory look at the medical response of the authorities and random interactions with citizens reveals that the official measures have fallen short of expectations, especially when it comes to infrastructure facilities and information dissemination. It clearly belies the city “corporation’s corporate strategy” tom-tommed in the new City Development Plan (CDP) drafted by CRISIL under the Jawaharlal Nehru National Urban Renewal Mission (JNNURM). This single document is expected to have a far-reaching impact on Pune’s development in the next two decades or so. But, except for being posted on the Pune Municipal Corporation’s (PMC) website, since February 2006, it has hardly made any impact on the ground. The CDP begins with a cursory reference to the year 1818 when the development of Pune as a city commenced on an area of 5 sq km. Fast-forward to 1987 -- when the last development plan was prepared -- Pune had expanded to 138.38 sq km. With the addition of adjacent villages in 1997, the area under the PMC’s jurisdiction is now 243.96 sq km. In the last 50 years, the city’s population has grown by more than five times; in excess of 3 million (2001), the city’s population is expected to cross 5 million by 2021. Pune’s student population exceeds 5 lakh, which includes some 8,000 foreign students from over 62 countries. From a traditional city with an agro-based economy, Pune has steadily metamorphosed into an industrial and educational centre, crowned with labels like ‘Oxford of the East’ and ‘Detroit of India’. The first software technology park in India was set up in Pune. In the last eight years, the IT business in Pune has grown from Rs 250 crore to over Rs 6,500 crore. A major cause for concern is the haphazard and uncontrolled development that’s now spilling over into the peripheral villages. Pune’s slum population has been increasing at a tremendous rate, from 15% in 1961 to 40% in 2001. There are 564 slums in the city. The density in slums (person/sq km) is about six times that of the overall density prevailing in the rest of the city. Such a high density also indicates spiralling health and social costs. Most slums are located along the riverbed, on hilltops and other environmentally sensitive areas. One of the most crucial issues for Pune city today is the pollution of the Mula-Mutha rivers. Almost one-third of the total sewage generated in the city remains untreated and is disposed of in the rivers. Pune’s drainage system comprises rivers, large lakes, natural channels and roadside drains. Except during the rainy season, these rivers receive untreated sewage and other waste from the city. The Central Pollution Control Board (CPCB) has repeatedly highlighted high levels of pollution due to the release of industrial foam, alkaline and other detergents into the river, as also disposal of untreated domestic sewage and activities like the washing of clothes, animals and vehicles, especially in Khadakwasla lake, the source of the city’s drinking water supply. Citizens of Pune also suffer high levels of air pollution due mainly to large vehicle ownership. The daily emission of carbon monoxide into the city’s atmosphere amounts to 103 tonnes, of which the growing two-wheeler population contributes 34%. Pune generates 182 tonnes of harmful emissions every day. The total quantity of solid waste generated per day is around 1,000 tonnes (approximate generation per capita per day is 360 grams). The PMC is responsible for collection, transportation and disposal of all solid waste generated in the city, except untreated bio-medical waste which is assigned to a private operator appointed by the PMC for hospitals on a pay-and-use basis. In addition to PMC staff, 4,208 ragpickers have been authorised to segregate waste at five of its 18 centres. Because of this, waste generation is reduced to about 800 tonnes; the ragpickers take away around 150 tonnes of waste for recycling. Thus, the PMC has to collect and dispose of only about 650 tonnes. With the outbreak of swine flu, the civic authorities are now bracing themselves to deal with an additional waste item -- thousands of used face masks strewn all over the city by careless citizens. On a single day, August 10, a single organisation, the Bharatiya Janata Yuva Morcha, claimed to have provided 18,000 disposable masks to activists of 130 Ganesh mandals for distribution among residents of a single locality, Parvati. The organisation distributed another 2,000 masks to schools in the area, that same day. Pune’s district collector is now asking schools to desist from distributing masks -- except the three-layered N95 masks -- that are not 100% H1N1-proof. Meanwhile, the State Food and Drugs Administration has ordered a crackdown on illegal hoarding and black marketing of masks after media reports that some 2.5 lakh masks were sold at a premium in the city on a single day, Sunday, August 9. Used masks need to be disposed of properly by burning them. Hardly anybody in Pune knows that. Dalvi, who, as district collector, is the sole authority to deal with the flu situation, appeals to citizens: “Use a handkerchief instead of a mask as the latter’s disposal may lead to a bigger health hazard.” Such a response, in the middle of a pandemic in the early-21st century, exposes serious shortcomings in the development of public health in India.
Infochange News & Features, August 2009 |
