The plague today holds the same threshold of dread that it did in the 14th century. So when the Black Death struck India late last month, the administration and the country's health system collapsed under the power of both
A plague on this country
ONE of India's most outstanding economic jewels has lost its glitter. All that Surat could do is wait weak-kneed and groggy for a Pied Piper to slough off its gigantic army of rats and bandicoots, which recently sent the world's most dreaded disease rustling insidiously through India. One of the highest taxpaying cities in India, Surat should by rights have been squeaky clean and fortified against a genocidal killer like the plague.
Shaking off last month's flash floods in the Tapi river like a drenched rat, Surat, the somewhat grubby showcase of Gujarat's eco onomic upsurge, had just about missedAeath by drowning by a whisker. But by the end of last month, the only visitors - and reluctant at that - to the Diamond City were mediapersons and medics, who found a filthy ghost town reeking of plague and panic.
Confusion. pounded the streets as panic-stricken Surtis, faces half-covered behind masks, kerchiefs, bandannas and rags of utterly dubious utility, hurried in every direction but up, riding anything on wheels. The plague travels fast and quiet, and instead of clamping a pragmatic quarantine, the administration virtually abetted an exodus. Suddenly put under tremendous pressure, the local administration devoted more energy to sweeping its sins of criminal maladministration under the carpet than to plague control, and chaos turned the city into an unplanned, uncontrollable ecological mess. On trains, and state transport buses and private vehicles, the highly-infectious human-to-human pneumonic plague hitch-hiked to other parts of the country, some of which don't have a rat population large enough to feed a small platoon of cats.
K K Dutta, director at the National Institute of Communicable Diseases (NICD), Delhi, and also the head of the most eminent group of troubleshooters that was rushed to Surat, says, "It's true that the local administration panicked, Otherwise, perhaps a few more lives could have been saved."
On the night of September It. Suresh Tikwade Bokade, a 20-year-old millworker from Surat's Laxmi NaW (Ved Road) area, was declared dead ca arrival at the Surat Civil Hospital (SCH). He had been running a very high fcw was coughing and had blood in his turn. Doctors at the hospital beni suspected advanced pneumonia. all hell broke loose - within the e 12 hours, 8 people from slums on Road, and the Katargarn and Lim areas died of similar symptoms.
These were no sudden deaths, they caught the administration na Nayan Shah, a 35-year-old workeT kel one of the thousands of textile mills as give Surat its economic vitality, "People had been dying of what being called 'Surat fever' right September 13."
Running high fever Sushilaben, who runs a brothel on dingy Varialla Road, says that one od girls died on September 16. "She running a high fever since Septes 14. Two Aays later, she had blood is sputum and I took her to a local doc He gave her some injection and a d But she died that evening." Bhagm bhai J Za riwala, who runs a small d on Vaiialla Road, confesses, -N 10 days later, I am sure that it was ps monic plague."
Along with more cases came ing confusion among doctors and administration. Dinesh Shah, med superintendent at the SCH, says, "N*4 suspected that the disease was plague. Most doctors in the hospital I never seen a plague case in their lit Initially, they thought that it i advanced pneumonia. On Septesi 19, my own driver died of blood am lungs and we still had no clue."
But patients failed to resposW treatment for pneumonia. Sm Khandu, resident of the Shiv Nap colony in Katargam, complained fever and chest pain before dying September 17. His mother Latan recalls, "We took him to 4 differewd ics. Each of them administered 4W and gave him some injections. condition just kept worsenin him to the Civil Hospital." Rajeev Gupta, resident doctor at the 6 admits, "There was so much initial "ion that 7 doctors and a few nursoho unsuspectingly treated the early itnts without precautions were cted."
Finally, on the morning of member 22, Saifi Khadiya, head of the 6ology department at the SCH, "smelt a", as she puts it, and conducted an opsy on the body of Mahesh kraya, a 40-year-old man from the I Road area. The provisional judge- ot that Khadiya gave was that the used had had haemolytic pneu- nic plague, caused by the bacillus oinia pestis (see box: Of mice and men).
After anticipation, what?
NICD's Dutta commented later that a Woe outbreak had been anticipated in ed district, 500 km away in duraslitra, and in the adjoining states Karnataka and Andhra Pradesh. Kling to this, a senior epidemiologist & the Surat's Civil Hospital says, Ibat is the point in simply anticipatIan epidemic? The NICD should have mWed a nationwide alert and iKlned doctors, especially in governst hospitals. In this hospital alone, swWd have managed to save at least 40 lives.
The World Health Organization that on August 5, local health authorities in the Beed district began receiving complaints of a "flea nuisance" and "ratfall" (dead rats en masse) from 2 villages. Soon there were about 30 patients with suspected plague, but the Maharashtra government just sat on the emergency.
The Surat administration, following 10 deaths by September 20, on its part issued a coy notification in local dailies declaring the city a "mysterious disease affected area". City administrator Kundan Lal says, "We suspected that the floods had something to do with it. Thus we resorted to cleaning the city. The city's garbage backlog had built up to 5,000 tonnes while the removal capacity of the municipal corporation is just 500 tonnes a day."
Surat was sprayed generously with gamaxene (benzene hexachloride), DDT and malathion. In fact, statutory discretions in the spraying of insecticides and pest control chemicals, formulated after the DDT-happy overspraying of the '60s and '70s, were ignored. As a result, rats started dying inside the houses in several colonies, complicating the problem.
Thakorebhai Naik, state minister for coopera- tion, was belatedly rushed in by Gujarat Chief Mini- ster Chhabildas Mehta to monitor the crisis. Isolation wards were set up at the Civil Hospital, guarded against curious onlookers and desperate relatives by the blue-camouflaged and incongruously heavily-armed Rapid Action Force. The state managed to divert popular attention towaras the garbage pile-up, which actually had little to do with the epidemic in the city. (State minister for health, S Sehlat, still argues that the plague was n'o't homegrown and had come from-Maharashtra.). Small groups of people took on themselves the task of garbage clearing and incineration, the administration's reneged responsibility.
Argues Dinesh Shah, "The epidemic in Surat was identified as the highly- infectious pneumonic plague. The only nexus between this strain and squalor is that in unhygienic conditions, lots of viruses tend to thrive. These viruses weaken resistance to diseases of those living in predominantly poor areas. Coupled with nutrient diets of low value, this creates ideal conditions for the plague baccilli to make a killing. In reality, the clean-up operations ought to be directed to checking plague of the contagious bubonic variety."
By the time it creaked into operation, the spraying was invested with desperate haphazardness. Anand Park Society saw residents pouring edible salt over heaps of garbage and open drains in an effort to sterilise them. A game of mad musical chairs had garbage being allegedly lifted from one area and offloaded in another. And another. Buses and other inter-city transport pit-stopping at Surat were let off unfurnigated.
In the first few days, medicines were in short supply and blackmarketing started. Medical vans were looted. Enraged residents in the focal Katargarn area set alight the clinics of 2 private practitioners who had ded the city. (A quarter of the city's 4,000 private doctors were among the first to pack and leave. They face possible prosecution). The distribution of tetracycline was restricted to certain areas, notwithstanding the fact that there was enough of the drug for every citizen - by September 28, medicine worth Rs 1.5 crore had been distributed. Although chief health officer K Sinha claimed that 260 teams toured the city on a door-to- door search for patients and disbursing medication, the worst-affected areas depended almost exclusively on local chemists.
The exodus of 5 lakh-odd Surtis began in right earnest on the afters of September 22, a full week after first known fatalities. Plague a began popping up in neighboud districts and villages in Surat dis" Eight other cities were declared piq threatened.
The flood of people started froon epicentral, Ved Road and Ka" areas in the north of the city. Dom businessmen, leaders of industrv. I ernment officials and workers joined panicky migration. But the worst cm all was the flight of doctors who rm I vate clinics. Thakorebhai confesses i it never occurred to the adminis" to invoke the emergency Essensial Senices Maintenance Act and order the &Ltors to stay.
Chandrika Prasad, a worker in the fwlav Textile Mill in Mota Binsara, waiting for a train to Delhi at the railway wation says, " The owner of the factory Ckosed his unit and fled the city. With no Job and little chance of being paid in the wimt 15 days, I decided to leave."
Says Gupta, "Not one death was worded among the middle or upper dmses in Surat. The epidemic preyed on mWant labour. Their resistance to any jokction is low. Many plague patients 06mitted to the hospital already had Pobtrculosis or asthma, making them Pwe vulnerable to the plague."
anti-plague operations. The ruling Congress party, which faces elections next year, not wanting the administration to be Held responsible for the epidemic, organised a major cover-up. The NICD'S team, which reached Surat on September 23, cut short its study trip, ostensibly because the Surat administration refused to declare the city "plagueaffected". Only after the Union minister for health, B Shankaranand, visited the city on September 25 was Surat declared plague-threatened".
The anti-plague operations were, in fact, absurd; a majority of those who fled the city were non-Gujarati migrants from other states, while public notifications and campaign posters were in English and Gujarati.
The city administration hesitantly asked for assistance from paramilitary forces and the Central government rushed in a battalion of the Rapid Action Force. This anti-riot battalion, unused to playing guard, failed to prevent over 150 patients - including 23 who had tested positive - from escaping.
To keep the death record low, the administration juggled the figures. For instance, on September 28 at 10.30 am, health minister Naik said that the toll till 5 am had been 44. An hour later at the Civil Hospital, briefing the visiting Union deputy minister for health C Silvera, doctors said that the toll stood at 48. In fact, only those who had died in the hospitals were being included in the list of fatalities.
The Civil Hospital had deputed just one micrc,biologist working overtime: when Rashmiben Patel fainted of exhaustion on September 29, the administration refused to depute another one, leading to inordinate delay in the confirmation of cases.
Violating the provisions of the Epidemic Control Act, some who died of pneumonic plague were not cremated but buried hastily at the Haripura and Ranadeva burial grounds. Experts feel this unnecessarily ripens conditions for an outbreak of bubonic plague.
Finally, the Gujarat government had to depute S Bhanujan, secretary to the government, and Gandhinagar's health commissioner Sudhaben Anchalia. Three areas were identified as At the interstate bus terminus, Surat., plagued by panic and cover-ups high-risk sectors. Armed with panchnamas (legal statement of intent), teams broke open the houses of those who had fled and fumigated them. Under the provisions of the Nuisance Act (Bombay Police Act, section 181 (A)), the administration was given the right to haul plague-affected people to the hospitals, 'by force if necessary.
By then, supplies of textiles, potatoes and milk to other parts of the country had become suspect. A businessman observed, "This damage is going to be irrecoverable and will have a telling effect in a month's time."
There are explanations galore for the Beed epidemic. But how the more virulent pneumonic form of the plague popped up in Surat is still a matter of bitter contention. Argument is divided: while people like Shah feel that it piggybacked on the transient pop-a from Beed, there are others who 21 that it was homegrown.
Says NICD's Dutta, "It is possz some of the Beed victims migran Surat. It is difficult to chart out the of the disease because it is just ncv. I ble to divine human migration '51 we have not been able to conc ' link the outbreak of the disease Lt with that in Surat."
Naresh Thambe, a residen- Yed Road area, who is original. Jalgaon district in Maharashtra, "Two days before Ganesh visarum. of my relatives from Sholapur as came to Surat and left after a 4-das My cousin Baburam had been runm high fever right since his arriva after returning to his village, he died. Soon after he left, my brother developed similar symptoms and died 3 days later."
Two other.families hailing from south Maharashtra had had relatives stricken with bubonic plague. One of them, Shivajirao Mule, recalls that his father returned from his native village with a strange fever and cough. He died on September 18.
Surat has a large Marathi popultion, some of it floating. Ganesh visarjan is one Of their most important festivals. Thousands from Maharashtra came to Surat in early September to celebrate with their richer cousins. Doctors suspect that when lakhs of people mingled -go freely, several Surtis contracted the baccilli.
kgain, during the same period, many urtis may have visited their relatives in Ilague-affected areas, or many fleeing need may have reached Surat. Pointing this direction is the fact that the first people who died on September 19-20 Jiled from different regions of Maharashtra.
Minister Naik, however, maintains "iat "the recent floods choked the sew and inundiated large areas. During -his, lots of rats might have died. This .0uld have led to the outbreak."
But this would presuppose the pres- cne of bubonic plague in Surat, not the ALready established pneumonic variety. Ihah counters, "No case of bubonic d in Surat. Even sus gue was reporte ted cases tested negative. There is no .cason to believe that changes in the rat k,pulation during or after the floods led the outbreak."
It is another matter that Surat has always held out a standing invitation to Ac epidemic. Naik says, "On September in a meeting of the senior health, municipal and administration officials, 2rs of an epidemic outbreak were oox;nded. An action plan was in the off ox but those who thought that cholera, 93s.roenteritis or typhoid could break OU! never even imagined that the plague vw_--uld hit the city."
Balwant Singh, Surat's municipal sarnmissioner, says, "The floods ,ught municipal activities to a stand The river entered large areas ,ugh the sewers and flood windows. ,djuthorised colonies like Katargam imbayat were under 10 feet of water 5 days running. Because of the rains, lifting the garbage was a problem, and the following floods stopped our operations for about 10 days."
Surat has been prospering since the late '60s; riding its prosperity were the thousands of immigrants and businessmen who poured in from the poorer quarters of the country. Ghettos housing lakhs of job-seekers from Saurashtra, Bihar, Orissa, Maharashtra, Karnataka and Andhra Pradesh burgeoned - with no civic amenities at all. Silk and diamonds kept the cash registers ringing.
The administration, happy with the "growth", ignored the squalid jhuggijhonpri clusters. With the skyrocketing demand for land, tree-felling became rampant, pollution soared, sewers got choked, and invariably, drains were clogged with rotting animal carcasses. The city could go to hell as long as the money to keep the interiors of houses glittering came in.
It is jarringly anachronistic that the 2 Indian states of Maharashtra and Gujarat, with a joint investment to the tune of Rs 8,000 crore in the past year have failed miserably to fend off a civic disaster like an epidemic. By the end of the first week of October, the killer epidemic had bloated to take in the country.
States sharing borders with Gujarat set up screening posts at all entry points immediately after the alarurn was sounded. Patients showing symptoms of pneumonic plague were either hauled off without ceremony or explanation to hospitals or were simply turned back.
Soon, the number of patients admitted in isolation wards of hospitals in cities like Bombay, Baroda, Delhi, Patna, Calcutta and Ahemedabad started going up and deaths began to be officially registered.
But 45 days after the epidemic broke, a medical and bureaucratic search is still on for "the most plausible explanation". Shah, unimpressed by the return to " near- normalcy", is not willing to let his guard down. He says, "It is a period to watch out for those who fled the city and never took any precautionary medicine. We are ready for a repeat of what happened after September 20."
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