Of rainy cities and public health

This is an expanded version of an article published in Sunday Spotlight submission to Deccan Herald dated September 17, 2017

Recognition is famously a passage from ignorance to knowledge

The above line is from Amitav Ghosh’s The Great Derangement, his recent meditation on how literature has engaged with climate change and its effects. Ghosh laments the absence of substantive engagement by contemporary arts and literature on climate change. One does not have to look too far to see parallels of this neglect. Quick on the heels of the cheer brought about by the announcement of average to normal monsoon this year, was the news of heavy rains lashing Bangalore, Mumbai, Chennai and other cities. Very soon, the news stories of the drought-like conditions and receding groundwater in Bangalore were replaced with stories of waterlogging, overflowing waterbodies and mixing of sewerage water with rainwater. From smaller cities like Kalaburgi, there were stories of hospital wards knee-deep in sewerage-mixed rainwater.

The monsoon system of rains is an ancient one; they have been observed and celebrated for thousands of years in our traditional knowledge, songs and literature, much before modern science discovered tools to predict them. Despite that, year after year, our cities reel under the effects of rains and the impending infectious diseases, as if these are entirely unpredictable natural disasters. This begs the question if these are purely natural phenomena that we ought to cope with, or if mismanagement of the city health and sanitation systems makes it a human crisis.

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Rise of infectious diseases in cities

Predictably, the heavy downpours tested the limits of city drainage and solid waste management systems. It is now routine to see heavy rain flush our solid waste into the streets and around our homes. Overlapping with the monsoons is the spike in the incidence of various vector-borne diseases like malaria, dengue, chikungunya as well as diarrhoeal diseases especially in children. Dengue cases in cities are on the rise with over 3000 being reported within Bangalore this season. Diarrhoea is the third most common cause of death of children under five in India. According to an estimate by the Million Death Study group, up to 300,000 children, every year die of diarrhoeal disease, a largely treatable and preventable health problem, that most countries in our region have addressed better. In fact, a study assessing Global Disease Burden, published earlier this month in the international medical journal Lancet, ranked India 126 out of 188 countries in meeting the United Nations Sustainable Development Goals by 2030. Among the important drivers of India’s poor score is, unsurprisingly, our drinking water and sanitation system.

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Based on reports generated for the National Vector-bourne diseases Control Programme. Possibly heavily under-reported; actual numbers likely to be much higher.

According to a projection, India may achieve only 2 of over 10 SDG targets by 2030 with our water & sanitation being among major contributors to this

According to a projection, India may achieve only 2 of over 10 SDG targets by 2030 with our water & sanitation being among major contributors to this. Map by GBD 2016 collaborators published in The Lancet 12 Sep 2017 under OpenAccess licence. See http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32336-X/fulltext

Hygiene and safe drinking water as a panacea

The strong link between public health and access to safe water and sanitation is an old story in modern medical and public health literature. In a poll conducted by the British Medical Journal in 2007, the sanitary revolution was hailed as the biggest medical advance since the first publication of the reputed journal in 1840, bigger than the discovery of vaccines, antibiotics and new medical and surgical techniques. Even today, medical students about the English doctor John Snow who, in 1854 analysed Cholera deaths in London and rightly attributed it to polluted drinking water. In a society where bacterial cause of Cholera was not yet known, John Snow’s work built the foundation for public health (See London School’s celebration of his bicentenary here). Earlier still, evidence of a systematic use of sanitation several thousand years ago in cities of the Indus valley tells us how important the management of drinking water and sanitation is at the city level (see archaeologist, R S Bisht’s presentation on Harappan hydro-engineering and water management).

Urbanisation as an emerging humanitarian disaster

India’s push for a global centre-stage has produced cities with aspirations toward becoming economic and industrial hubs. However, in our zeal to jump onto the economic bandwagon, the foundational aspects of healthy cities have been forgotten. Cities are literally sweeping their dirt under themselves. Overflowing drains, lakes spewing out toxic froth and foam, free-ranging dogs and rats fighting over unsegregated wet and dry waste in plastic bags are a new normal in cities; most of us have learned to cope by looking away. Global health experts have called urbanisation as an emerging humanitarian disaster. Our cities are not able to manage basic amenities for their residents, thus pre-disposing many in the cities to various infectious diseases.

The irony is that the ill-effects of urbanisation are not equal. There is an unfairness about who bears the brunt of the city’s mismanagement. People living in our urban poor neighbourhoods, the migrant workers from drought-prone areas coming in as cheap labour to build our metros and schools, and various other communities facing disadvantage either due to homelessness, disability, caste or gender are the most vulnerable to the effects of adverse weather and its resulting public health effects. With limited safeguards either in our health system or in our social security cover, the effects of dengue or chikungunya over migrant labourer family are very different from its effects on a software engineer or a doctor. Living in a health system where treatment for these illnesses are based on payments at the point of service delivery (in the private sector) or faced with poorer quality care in an under-resourced government health service, the poor are at a disadvantage. What is merely a bad traffic hour for one family is a house under water or a child faced with financially catastrophic hospital admission for another.

Protecting public health as a city’s responsibility

Public health in cities cannot be wished away to doctors or health workers. Protecting public health involves an active engagement of the city municipal administration in disease surveillance, preventing disease and promoting health. And in doing so, we ought to strive for systems that work for all, not for some. Posh neighbourhoods have regular cleaning and municipal workers in clean uniforms, whereas urban poor neighbourhoods are themselves dumping grounds for unsegregated garbage, further disadvantaging such neighbourhoods. Striving for reforms in municipal workforce so that sanitation workers have access to health, safety and a dignified working environment is still a far cry. Parks and public spaces are spick and span for evening walkers and yoga enthusiasts in some areas, as if these are merely middle-class pre-occupations.

We need city administrations and corporators to recognise the public health disaster on which cities are sitting upon. We need to recognise the problem at various levels. Firstly, at the level of city governance, wherein urban planning ought to incorporate the principle of equity in allocating resources and executing projects. Rather than pet projects in some neighbourhoods, city municipal corporations have to urgently fix our broken sewerage systems and invest in building up a capable municipal workforce. Secondly, greater consultation and participation of residents through ward-level engagement and partnering with residents in tackling the garbage problem locally, and thirdly, a strengthening of urban health through greater engagement of public health professionals in urban planning, disease surveillance and strengthening urban primary health care systems is the need of the hour.

History of natural disasters and their devastation has shown that individual people and even societies have enormous resilience. Collective human history has often coped with disasters of global proportions. If we do not recognise and accept the mismanagement of our cities as an important underlying cause driving poor public health and merely choose to deal with these as an act of nature, then our blindness is one that we have chosen.

 

Additional facts and figures compiled by the DH team can be seen on the e-paper version of the article

Additional facts and figures compiled by the DH team can be seen on the e-paper version of the article

Goodbye Jadeswamy

“Sir, pls confirm if yellow-throated bulbul is seen near forest IB”

This was his last message to me a few days back. Jadeswamy was checking with me if the bird he saw was indeed the bird Profile Jadeswamy e1492661564160 considered globally threatened and seen only in stony parts of several south Indian hills. He was watching it near his house in BR Hills. Of the identity there was no doubt; on asking the description of the bird, his message clearly showed his keen observation skills, and his eye for detail. He said “sir, the throat and full head is yellow and when it’s flying around end of tail prominent white spots”. Although first reported (from BR Hills) in literature in 1995, the bird was missed during the survey of the region by Salim Ali. Later records are few and far between.

Jadeswamy's last checklist, a day before he died (September 2, 2017)

Jadeswamy’s last checklist, a day before he died (September 2, 2017)

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Jadeswamy Madaiah was a keen naturalist and a wonderful human being. I met him as one of the Soliga people, Kalyan had selected to train as a naturalist for Gorukana. Kalyan had rightly found in him a deep sense of awe about wildlife and natural-history, as well as an attention to detail. His ability to spot large mammals like Elephants at a distance, or tiny and beautiful birds and his enthusiasm to interpret these to the visitors to the hills was unmatched. His entrepreneurial skills too were exemplary. His keenly followed social media posts show a deep interest in wildlife and environmental issues. Jadeswamy also cared a lot for his community, often lamenting about the difficulties that his fellow Soliga people face in overcoming various disadvantages. His investment in learning English was a part of his drive to overcome these generational disadvantages and “stand up on his own feet” (as he used to say). Be it a nesting bird, or the time when mothers have delivered in his car on the way to hospitals, his social media updates were a snapshot of what life is in and around BR Hills. Over the years, his interest in birds had blossomed into a great interest in eBird, possibly the first Soliga birder to come onto an online birding platform. In a recent interview to Birdcount India, Jadeswamy set a birding goal for the coming months to “take a photo of the Yellow-throated Bulbul, which is seen in BR Hills.” He also aspired to be a “good/top birder from Chamarajanagar district”.

One of several Elephants that Jadeswamy photographed in BR Hills few months back

One of the several Elephants that Jadeswamy photographed in BR Hills a few months back (Photo obtained from his Facebook feed)

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Earlier today, Jadeswamy, breathed his last, leaving behind two wonderful daughters, whom he loved more than anything and his wife, whose work as a nurse, he was proud of. Hundreds of well-wishers and friends of his gathered around VGKK hospital in the hills on hearing the news of his demise. I heard that most of the people from near and far had gathered, ranging from Soliga Sangha leaders, to naturalist friends and various other residents of the hills. His untimely demise leaves a void in many lives beyond his loving family. All I can say at this time is “may his tribe flourish”.

Painting with a broad brush: Stereotyping “tribal” identity

Yet another “tribal” story in a national newspaper. Based on my reading, the story is based on the seizure of a consignment of ghee packets at a forest checkpost by the department. Clearly this indicates that some of the ghee packets under a government scheme are finding ways into private markets for sale. Several reports abound about such “hand-outs” entering private markets. Often, these instances are cited as reasons for not giving subsidies or hand-outs. Without going into that larger policy argument, there’s a finer point to be made here on how the “tribal” identity gets typecast in news coverage.

From my letter to the Editor of NIE,

But, is it fair from this information to come to an all-encompassing title that paints all tribals in BR Hills with the same brush? In my opinion, journalists should put more effort into stories. For example, what kind of intermediaries are involved in organising such elaborate siphoning away of these food products? Often various intermediaries siphon away such hand-outs. Even, if ALL tribals were doing this, is it not the responsibility of the reporter to go a bit beyond this story and find out why? Is it not fair to at least interview/ask some tribal leaders/individuals for their opinion and reflect in a story? If a few members of a community/caste of people X residing in (say for example) Mandya were to do the same, would you write a story saying “People of Caste X from Mandya selling ghee for booze”. I would think not. Then why would you sanction such a story on “tribals”.

For a reputed national newspaper of NIE’s credibility, I would have expected higher journalistic and editorial standards.

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What is it like to be a bird?

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Cover of Tim Birkhead’s book Bird Sense

Can we ever know what it is like to be a bird? As poetic as the question may appear to be, it’s fascinating how the question has captured the attention of a bunch of  scientists, artists and other professionals ranging from neurosurgeons, ecologists, physiologists to bird illustrators and medieval travellers. The fascination with bird flight is possibly as old as language itself. Birds are among the early cave paintings, be it in the subterranean caves discovered by teenage boys at Lascaux, or the paintings of Genyornis in cave paintings in Northern Australia that could be 40,000 years old, dating to the time when man set foot on that continent. In Bird Sense, Tim Birkhead who has written fascinating stuff on history of science, birds and birdwatching and has edited the Cambridge Encyclopaedia of Ornithology, makes a narrative synthesis of the historical and contemporary knowledge on what it is like to be a bird. An extremely intriguing question throwing up questions such as “Is this know-able?”. Such philosophical meanderings have clearly not deterred several scientists from designing simple and elegent experiments to try and understand this. Continue reading

Of absurd letters and misplaced priorities

It is not too rare to see very bizarre letters. In fact, there have been letters unearthed from over 2000 years ago from the dawn of writing itself often written by people who wanted to complain about services or to authorities. More recent funny letter compilations abound on the Internet, many of them quite lame leave letters supposedly written by staff of  IT companies around Bangalore. But, this letter I chanced upon at one of Karnataka’s tiger reserves (BR Hills) definitely takes the cake on absurdity and ad-hocism, let alone other  more serious issues with the letter like making a mockery of people’s rights for starters. Continue reading