Building on early gains in Dharavi

Pic: An image grab showing Dharavi, from a promo of the film 'Gully Boy' which was shot in the area

Mumbai and Delhi, followed by Chennai, have become hotspots of coronavirus infection and the complications related to the COVID-19 disease. These cities accommodate some of the most vulnerable sections of the population. In Mumbai, Dharavi — Asia’s largest slum and the most densely populated place in the world — saw its first COVID-19 patient in April. The panic that started since has not abated for several reasons that go well beyond medical diagnosis.

The three factors that check the spread of infection — hand washing, social distancing and wearing a mask — are all difficult to implement when a large section of the population lives in crowded conditions with poor and substandard housing, several family members holed up in a limited space, deficit water supply so access gets limited and availability of few public toilets with unsanitary conditions.

Dharavi is one such place. But despite all the negative publicity, the government has to a great extent been able to contain the spread there. Considered the largest slum settlement in Asia, it is estimated to have over a million inhabitants in an area confined to just 535 acres. Its population density is an incredible 8.5 lakh people per square mile.

Dharavi’s population density is 11 times higher than that of the city that encompasses it. In fact, the success in addressing COVID-19 has become a case study. It was achieved by roping in all the local support teams, including local area doctors. It was local teams that reportedly went house to house to look for patients with symptoms and offer them quarantine in a State facility. A similar approach is needed in Chennai and Delhi, which also have a large number of poor people living in densely populated areas.

Dharavi’s population density is 11 times higher than that of the city that encompasses it. In fact, the success in addressing COVID-19 has become a case study.

Measures at the micro and physical level are important but the impact of COVID-19 on the individual psyche should not be lost. The trauma experienced is severe and deep. Loss of livelihood and income, depletion of savings, death of loved ones, friends, neighbours, lack of proper documents to avail benefits and an uncertain future are making individuals vulnerable to anxiety, depression, panic attacks and other psychotic symptoms, hitherto latent. The risk of suicide is high.

COVID-19 aftermath

The aftermath of COVID-19 will be serious. Economic slowdown, loss of jobs, erosion of livelihoods, serious mental health issues will increase in the general population, which will need treatment and intense psychosocial care. Several studies have shown that poverty can precipitate mental illness.

Given the above scenario, the need for professional social workers/counsellors who have been in the forefront during disasters and pandemics, coordinating and delivering relief materials to the affected populations, mainly the vulnerable sections, cannot be disputed. The significance of servicing the affected with the much-needed psychosocial care that helps them to face life cannot be underestimated in the current circumstances.

A counsellor to reach out and to be reached becomes important in managing and overcoming this. It will increase well-being and decrease mental distress. Though the counsellor’s primary role is to counsel people in distress, given the grim situation, their intervention will extend to providing/linking/facilitating access to medical services and social entitlements of the government and civil society.

Yet, the nature of the lockdown has meant zero access or, at best, restricted access to vulnerable communities. Social workers and counsellors are often kept out of bounds, deemed as non-essential services in an atmosphere where physical contact is sought to be minimised.

The same is true in hospitals, where many of the elderly are dying without support form loved ones or the help and care that counsellors can provide. A mere presence, holding of a hand and listening in can make a huge difference to those living under lockdown, kept under quarantine or lying in hospitals.

Counsellors can also help mitigate mental health issues, communicate the importance of prevention of disease, guide people to the nearest facilities for testing and other care, work with the families to cope with the diagnosis and other life issues, facilitate appropriate referrals as and when the situation warrants, check and report malpractices and attend to issues of financial distress.

They also can help in the delivery of emergency food and other essential items hit due to physical distancing and loss of income, identify populations at risk, like the elderly, disabled, children, and women and provide essential services and liaise with the government to provide specific services to suit local population.

Pandemic management

Why then is it that three months into the lockdown and the pandemic, the fight against COVID-19 has not been able to rope in counsellors and other social sector support teams? The answer probably lies in management that continues to be drive from the top down, and is not always able to rope in voluntary teams to form a compact unit that can together fight COVID-19. India’s cities at least have had a tradition of active care providers who need to be activated fast and in fact called in to support the effort to fight the pandemic. Much of the support is coming from NGOs and civil society groups but then they are hampered by lack of access to persons needing support due to lockdown and resources.

If the early success of Dharavi is to be built upon and more of this achieved, we will need to rely on help from the army of social workers who stand ready in the given situation. A careful deployment can make all the difference between taking firm hold of the situation or losing the grip.

(S. Parasuraman was director of Tata Institute of Social Sciences from 2004-2018 and is now Principal Advisor, MIT World Peace University, Pune, India)

This article was published by The Hindu online here