4Ts of Dharavi’s successful pandemic management: Tracing, Tracking, Testing, Treating

The daunting responsibility of managing the outbreak in Dharavi, spread over 2.5 square kilometres packed with 60,000 families. How it was done

An interview with Kiran Dighavkar, Assistant Municipal Commissioner of G-North Ward. He received acclaim from the WHO which cited Dharavi as an example in how to manage the fight against the virus.

By the end of March, three positive COVID-19 cases were reported in a two day period in Dharavi, one of the largest slum clusters in Mumbai. Soon after, on April 1, the first death from the virus was reported when a 56-year-old resident of Baliga Nagar in Dharavi died. The person had no travel  history.

Within eight days of the first death, as the city reported 320 positive cases, 161 were from Dharavi and the daily count kept rising.

The responsibility for managing the outbreak in Dharavi, spread over 2.5 square kilometres and 60,000 families packed into it, fell on Assistant Municipal Commissioner of G-North Ward Dharavi, Kiran Dighavkar.

Dighavkar was faced with the task of ensuring the virus did not spread like wildfire within the colony and surrounding areas.

Given that the only way to contain the spread was Tracing, Tracking, Testing and Treating, Dharavi posed a particular challenge.

Social distancing, for instance, was practically impossible in a place where large numbers of people lived in cramped living spaces, with poor sanitation and drinking water facilities. They were dependent on community toilets for which they had to venture out. Many cook food outside their homes as they live in cramped rooms.

In such a situation, ‘social distancing’ was not a possibility. Neither was home quarantine.

Dighavkar, a civil engineer by training, was posted to Dharavi a little over a year ago. His learning from an earlier experience in a slum area in the city’s eastern suburb of Govandi, came in handy.

Dighavkar parked himself in the war-room of Dharavi’s slum, assessing the situation and planning and implementing counter measures. He used 4Ts method of – Tracing, Tracking, Testing, Treating – to deal with the crisis.

WHO Director General Tedros Adhanom Ghebreyesus, cited the example of Dharavi as an example in how to manage the fight against the virus.

In a telephone interview with Citizen Matters, Kiran Dighavkar spoke about how he managed this seemingly impossible task. Edited excerpts:

CM: Given your meagre staff, how did you manage the fight?

Dighavkar: Dharavi comprises largely migrant and stranded labourers whose food needs were met purely by their daily work. They do not have a kitchen in their place of work or stay.

The first step was to arrange community kitchens. Free-food and grocery was distributed by the local representatives and non-profit organizations. The BMC too distributed 25,000 grocery kits and 21,000 food packets for lunch and dinner separately within the containment zones for these labourers.

Support for community kitchens came from local corporators, MLAs, MP and even ministers who got involved in ensuring smooth running of community kitchens. Subsequently, several NGOs, like Action Aid Association, reached out to around 15,500 individuals with dry ration and direct cash transfer to over 200 individuals bank accounts. All were roped in as an integral part of the Dharavi community kitchen facility.

The second important step was pro-active screening by setting up a team of nurses and doctors. The door to door screening was a challenging job but we found that one identified COVID-19 patient was in touch with 72 persons minimum. So instead of waiting for a person to approach the hospital or civic body, we reached them through this door door screening, which proved effective in tracing the tracking positive patients.

We got local doctors from Dharavi involved in this as people have more trust on doctors in their vicinity. These doctors readily joined hands with BMC to contain the virus and did not charge a single rupee. They took it up as a mission and as more tests were conducted, more COVID-19 patients were detected.

As home quarantine was not possible here, we decided to set up institutional quarantine centers for asymptomatic patients. BMC schools, marriage halls and even open parking places reserved by the government were turned into quarantine centers .

The institutional quarantine centers received good response from residents as they realised that social distancing was impractical in the slum.

CM: With just two government hospitals, how did BMC manage the daily surge in COVID-19 patients?

Dighavkar: We realized in April that it would be difficult to completely rely on government hospitals. So we took over three private nursing homes in the vicinity for treating COVID patients. It helped in decongesting government hospitals. This arrangement worked out well.

As the nearest hospitals, LT Municipal hospital and KEM hospital were more than 7 kilometres from Dharavi, we needed treatment centers nearer the slum for treating positive patients. We insisted that private doctors open up clinics in the area.

Sanitation work was done on a weekly basis.

CM: How did you manage to disseminate information on the virus among the people of Dharavi?

Dighavkar: We held talks with the residents and started telling them about the virus and how it behaves.

It was not easy. People began to understand that it is a contagious disease and can spread to anyone if physical distance is not maintained. As our teams were doing proactive screening, there was direct communication with people of all castes and religions.

When we checked on how one positive person was in touch with 72 others, we found that many Dharavi residents were part of essential services, like delivery of grocery and food, and had been working during the lookdown.

Also, Dharavi being too much in the media helped in many ways. The people’s representatives were on the field with the staff and any rumours and false information was quashed well before reaching the people.

CM: What pressure did continuous media attention on Dharavi create on you?

Dighavkar: Dharavi received too much media attention locally, state-wide,  nationally and even Internationally. I took only two days off but could not resist myself and got back to Dharavi. Frustration was gripping the staff as well after one of the staff tested positive and died. It had brought negativity to all when 21 BMC staff tested positive.

I had to run the show so I kept motivating all of them.

CM: It was alleged the BMC suppressed figures on the number of COVID-19 related deaths. Do you concur?

Dighavkar: Pandemic is new to everyone and we were dealing with war like situation. Thus most of the BMC staff right from top was and is still on the field to deal with pandemic.

Data management was not our priority.  Usually the assistant municipal commissioner of the ward is sitting in the cabin to do data analysis. We were on the field right from the additional municipal commissioner to the grass root staff.

The data managed by the people could have been possibly misquoted and in the situation like this there are possibilities of misquoting the data.  For example if a building is collapsed the efforts are made to rescue people and not to make a record of that how many died than saved lives

Similarly delay in records of data analysis or data reporting is because most of the top people were on the field and it was never intentional. Eventually, everything was put out in the public domain.

CM: Did the return of migrants to their home states help in reduction of positive cases?

Dighavkar: It really impacted the ongoing drive as according to the government data approximately 89,000 migrant labourers left Mumbai by Shramik Special trains.

Many also left by arranging their own vehicles or even walking. Migrants from states like Tamil Nadu, Rajasthan, Bihar, Jharkhand and Uttar Pradesh are very active in the small units in Dharavi.

Today, I think out of the one million migrant labourers, maybe 2 lakhs or more left Dharavi, so the burden on the system definitely eased.

CM: Did you ignore anti-malarial and dengue drive in Dharavi due to covid-19 pressure, as residents have alleged?

Dighavkar: Maybe the focus was not that strong in the areas it used to be before this crisis, but it is also not that they were completely ignored. Separate staff are engaged in our regular health drive before the monsoon. So a separate department is tasked for other health-issues.

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