Viral Pandemonium

Irshad, in happier times, demonstrating how we all feel about the virus.

On a good day in the community, there are dozens of sniffling, coughing, feverish children and adults. They live in tightly packed single room homes, built one on top of the other in narrow lanes with shallow gutters burbling with feces underfoot, where sunlight is all but absent except in pockets where the roofs don’t meet. On a regular day, people go about their business of child care, cooking, coming and going to daily wage jobs, often with handkerchiefs over their mouths and noses to block out dust and fetid smells from the gutters. And now the coronavirus is an issue.

A few months ago, when the virus was just taking hold in China and the world was put on notice, the children in the community who frequent Indu’s home to do their homework, were unaware of what lurked in another country, one that borders theirs. As they coughed and sniffled, sharing erasers, pencils, pinching each other’s faces and touching their own faces often, their bare feet having just traversed the slum, I sounded the coronavirus alarm in a bid to inform, not entertain. So it was a bit of a rant. My phone was put into service to google information, show photos, goad them into better hygiene standards and implore them to please cough and sneeze into a handkerchief or into their elbows. Washing hands here isn’t a priority at the best of times, but in the worst of times it’s a menace to more than just themselves. I shuddered to think just how fast a virus would spread in this community and the hundreds of slum communities in this teeming city.

A few weeks ago these children weren't aware of the coronavirus.

The next conversation we had about the virus a week or so later, as the news from China became more grim and we realized the world was involved, was whether they were getting any coronavirus updates from their school teachers or administrators in charge of the running of these small low-cost schools. Sitting cross-legged at Indu’s, a group of about fifteen children, all shook their heads and said, “No, we are not told anything about this virus.”

How was that possible? It was. Further discussion about how to prevent getting the virus led me to ask them how often they wash their hands at school. The reply was unnerving.

“We don’t have soap at school. When it’s time for lunch we are allowed to go to the tap and pass our hands under the water but there’s a long line and the teacher makes us hurry.”

No soap available in schools for use after the toilet or before eating lunch was unfathomable to me even in the best of times. The children sit four to a desk with up to seventy children in a classroom that should hold about half that amount. I imagined a spiky ball of coronavirus attacking them one by one.

The children said they are not allowed to bring their own soap, so when someone told us about paper soap packets available at medical stores, we stocked up and handed each child 2 packets, which, if each page of the packet is folded into four, they will each have about 80 hand washes. It was a small attempt to combat and delay what I assume will be the inevitable viral takeover.

Aagya holding her paper soap packet.

Indu asked the principal of the school if he would ask the teachers to discuss the virus so the children would be better informed, as would their parents, who are mostly illiterate. She got a shrug in return and watched as he walked away. With India now on lockdown, the school administration has finally received the message, although much too late. Schools were closed by the government about a week ago.

About one month ago we started seeing a few children wearing masks to school.

If the thought of a virus of any kind entering one of these schools weren’t frightening enough, taking a child to a doctor in the time of coronavirus was daunting. In the past weeks, we’ve taken three children to dentists, an ear/nose/throat specialist, and a skin doctor.

The dentist’s assistant is a woman dressed in a sari without a pink lab coat over top. She managed the very small treatment room, and I hoped, sanitized and laid out his dental tools. The large dental equipment (overhead light, magnifying glass etc) were covered in the original plastic packaging. This made it impossible to wipe clean. Every fold and crumple in the plastic was coated in dust and fingerprints. The dentist had numerous patients waiting in his outer office. Before one patient was finished, another patient was brought in to wait by the chair within in a metre of the each other. All payments are in cash and was handled by the dentist before he got to work on the next patient. I didn’t see him wash his hands but he did use gloves and a mask. We visited the dentist with Arpan, who had three root canals over the space of three weeks. The same dentist has a posh office in another area of the city where he treats wealthy clients. I suspect this office is bigger, cleaner, and more hygienic. To be clear, the dentist was kind to Arpan, thorough, and gave us a discount for Arpan's treatment, and for that we are grateful.

Ganesh at his skin doctor appointment.

A few weeks ago we took Ganesh to the skin doctor because he had a very itchy rash. We climbed a narrow stairway barely attached to the outside of the building and entered the small office. There was a sink in the corner and stacks of books and papers in disarray on his desk. The doctor's chair was covered in protective bubble wrap, coated in dust and shredded in long strips. He was pleasant enough and mildly concerned about Ganesh as he asked questions. My eyes looked to the sink wondering if he would wash his hands and then use gloves before he touched the child with the obvious rash. He didn’t perform hand washing or use gloves. I wasn’t astonished when he held the child’s arm with his bare hands to inspect the rash. This is normal procedure at every doctor's office we've taken patients to. He declared that the rash was scabies and told us how contagious it is. Without washing his hands after touching the contagious rash on Ganesh's arm, he grabbed his pen from his messy desk and wrote out a prescription, while telling the child to not sit near or touch other people until he was cured. (Ganesh lives with his blind mother and his grandmother, who also had the rash.) Then he pulled open a drawer with hundreds of loose pills scattered inside and picked through them with bare hands until he found a few pills he thought might help Ganesh. He found a piece of paper and wrapped the pills in it and passed them to the boy with instructions for taking the medicine. I mentioned he shouldn’t go to school and the doctor replied, “Yes, he can go to school, he just shouldn’t touch anyone.” When I mentioned how impossible that would be he just shrugged.

Sofian was our next patient. He had a severe ear infection that was leaking fluid. We sat with numerous other patients in the waiting room, a 6 feet wide by 8 feet long space, our knees almost touching the person sitting across from us, at an Ear/Nose/Throat specialist. The building where this office is located is crumbling. There are many doctor’s offices and surgeries located on the four floors, as well as a small hospital. The filthy stairwells leading to the many offices and hospital are stained with paan spit, debris, years of grime and layers of dust and grit. Patients and visitors are required to remove their shoes before entering the doctors’ offices. By this time the news about the coronavirus was everywhere and people were aware and talking about it. We’d hear the word ‘coronavirus’ in shops and from snippets of conversation as we navigated streets on foot. This now widespread knowledge didn’t stop the other patients from sneezing openly or coughing in the waiting area that should accommodate four people at best, but where a dozen people came and went, casually touching their faces, and brushing against those they squeezed by in an attempt to talk to the receptionist.

Sofian heading to the Ear/Nose/Throat doctor housed in this building.

After what felt like an eternity in the waiting area, the receptionist motioned for Sofian and me to go in to the doctor’s office. We opened the door to see the previous patient paying his fee in cash to the doctor who sat behind a desk covered with paperwork. He left the room and the doctor asked us to take a seat. After a few questions about Sofian's health and a sarcastic remark about how many siblings he must have, he opened his desk drawer, searched for a few seconds and pulled out an instrument with a probe on the end. He had just handled cash and examined the previous patient, but he didn’t wash or disinfect his hands or use gloves, or sanitize the probe, before he casually inserted it in Sofian's ear. When he was satisfied with his inspection of the ear, he searched for a cotton ball, and still without the protection of gloves, he mindlessly wiped off the tip of the probe and threw the cotton ball on the floor. The probe was put back in the drawer for the next patient. Next, he grabbed a metal tongue depressor from a plastic serving tray found in markets for serving chai, and asked Sofian to open his mouth so he could have a look. Was this sanitized? Probably not. A list of medicine for us to purchase from a medical shop was written on a pad of paper and handed to me with instructions to come back in a week. Sofian's ear was severely infected and it was possible that the child would require surgery if the medicine didn’t work. We left the office and Sofian managed to touch every dirty wall on the way back down the stairs.

A government hospital corridor where family members wait for news about loved ones.

None of the medical professionals I talked to only a few weeks ago were concerned with my questions regarding the coronavirus. Their comments were bold in their assertion that the medical community in India was well informed and that the virus wouldn’t be an issue in India. I was astounded with the lack of awareness or concern within the medical community that I had access to on behalf of the patients I took for treatment. The cavalier attitude to cleanliness and hygiene is preposterous in medical offices and hospitals even in times without a rampant virus on the loose. The medical offices I've described are used by the working class. Low fees and no appointments make them a popular choice for thousands of sick families. At the time of these appointments, India had only a few reported cases of coronavirus. Given our daily experiences in a slum community and at doctors and dentists’ offices, I suspected these numbers were far from accurate. At best, people in slums are not treated with kindness and concern at a doctor's office, but more often with derision. Their symptoms and concerns are never taken seriously, but often mocked, with blame placed on the patient for their crowded, unhygienic living conditions, and often their religion, as the only reason for their illness. The hospitals available to the poor are government funded and most, if not all of these hospitals, are in a grim state of disrepair and filthy without adequate equipment. The doctors and nurses working in government hospitals are overwhelmed and overworked. The working poor also rely heavily on street doctors with shady credentials with drawers full of colourful pills. How will hospitals and clinics that are already in disrepair, without equipment, and with overworked staff handle the coming onslaught of thousands of coronavirus patients?

This small shop, one of three in the community, is now closed.

This week, India has finally awoken to the reality of the coronavirus and shut down the country to prevent the spread. Everyone must stay in their homes for 21 days. That’s not easy to do when you have resources, money, and a ready supply of food, medicine and cleaning supplies stocked in cupboards. For those who live in slum communities and who barely survive on daily wages and no savings, this will not just be difficult, it will be impossible to sustain.

Their food resources are street markets, vegetable carts, and ration shops. Online shopping, supermarkets, and the option for home delivery are not viable for them. If they have savings, they are meagre at best, and would be used up within a week. Socially isolating is not possible in homes that measure 8 feet by 10 feet and house numerous family members. In many homes, reusable containers are used for water, filled from a common hose lying on the ground in the lanes. For those who don’t have a toilet in their home, filthy public toilets shared by hundreds are their only choice. The police have been beating anyone who dares to go out to find a source of food, as well as entering the community to shut down small shops with little left to sell but sweet biscuits and a few packs of noodles. The shops selling a few vegetables have nothing left to offer.

On March 25, 2020, the government announced a plan to offer rations at discounted prices to the families who have the requisite paperwork. This is a relief (for those with paperwork) and a needed solution to hunger and nutrition, but if they can’t leave their homes, how will the families access the bags of grains offered to them? Many families in slum communities don’t have ration cards and won’t be able to access the government rations. How the government plans to roll out this initiative to serve the millions who live in poverty is yet to be seen and may well be impossible.

Self-isolating in these lanes, in small one room homes housing up to ten people, will be impossible.

The families in the community are scared and confused. They lack information, and any information they do receive becomes confusing as everyone weighs in without proper knowledge. Superstitions and fear are rampant and profiteers are everywhere. The rumour that the Hanta virus is also spreading from China is the newest piece of bad information that’s spreading among the community causing more distress. They tend to believe every new fake cure, they listen to uninformed people, they believe what their neighbours tell them, and they rely heavily on home remedies and the wisdom of older relatives from villages instead of experts on the news or the internet.

The good news is that Sofian, Ganesh and Arpan, (mentioned above) are healthy again despite the lack of hygiene at the doctors' offices. There are miracles in India. The coronavirus is another war to fight. The families in the community live with the scourge of bacteria, coupled with grim living conditions. Many people have diabetes and lung conditions. They endure misinformation and caste prejudice in normal times. This will be a test of wills, of solidarity, and of the unprecedented, possible failed attempt at understanding what is required of them to help stop the virus, while they search for food, medicine, and soap, and try to manage an epidemic ill suited for crowded living conditions. #not blessed

Costs:

Soap packets: 80 packets @ 4 rupees per packet: 320 rupees ($6.40 CAD)

Ganesh's doctor visit/medicine for scabies: 1062 rupees ($21.24 CAD)

Arpan's dental work (3 root canals): 7500 rupees ($150 CAD) The dentist gave us a hefty discount for Arpan's dental work.

Sofian's doctor visit/medicine for ear infection: 1960 rupees ($39.20 CAD)

Note: We arrived back to Canada a week ago. I continue to communicate daily with numerous families in the slum community as well as middle class families we know living in Mumbai. I get daily updates via WhatsApp conversations.